Association of US Nurse and Physician Occupation With Risk of Suicide

Abstract

Importance: Nurses are the largest component of the US health care workforce. Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist.

Objectives: To estimate the national incidence of suicide among nurses and examine characteristics of nurse suicides compared with physicians and the general population.

Design, setting, and participants: This retrospective cohort study used US data from 159 372 suicides reported in the National Violent Death Reporting System from 2007 to 2018. With the use of workforce denominators, sex-specific suicide incidence estimates were generated among nurses, physicians, and the general population (age, ≥30 years). Associations between clinician type and method of suicide and results of toxicology examination at death were calculated, adjusted for sociodemographic characteristics. Statistical analysis was performed from October 16, 2020, to January 10, 2021.

Exposure: Occupation as a nurse or physician.

Main outcome and measures: Suicide incidence and characteristics associated with suicides.

Results: A total of 2374 suicides among nurses (1912 women [80.5%]; mean [SD] age, 52.8 [11.8] years), 857 suicides among physicians (723 men [84.4%]; mean [SD] age, 59.8 [15.3] years), and 156 141 suicides in the general population (121 483 men [77.8%]; mean [SD] age, 53.1 [14.7] years) were identified. Overall, suicide was more common among nurses compared with the general population (sex-adjusted incidence in 2017-2018, 23.8 per 100 000 vs 20.1 per 100 000; relative risk, 1.18 [95% CI, 1.03-1.36]). Among women in 2017-2018, the suicide incidence among nurses was 17.1 per 100 000 (506 among 2 966 048) vs 8.6 per 100 000 (8879 among 103 731 387) in the general female population (relative risk, 1.99 [95% CI, 1.82-2.18]). In absolute terms, being a female nurse was associated with an additional 8.5 suicides per 100 000 (95% CI, 7.0-10.0 per 100 000) compared with the general population of women. By sex, physician suicide rates were not statistically different from the general population other than among female physicians in 2011-2012 (11.7 per 100 000 [95% CI, 6.6-16.8 per 100 000] female physicians vs 7.5 per 100 000 [95% CI, 7.2-7.7 per 100 000] general population; P = .04). In terms of the characteristics of suicides, clinicians were more likely to use poisoning than the general population; for example, 24.9% (95% CI, 23.5%-26.4%) of nurses used poisoning compared with 16.8% (95% CI, 16.6%-17.0%) of the general suicide population. The presence of antidepressants, benzodiazepines, barbiturates, and opiates was more common among clinician suicides than suicides in the general population.

Conclusion and relevance: This study suggests that, in the US, the risk of suicide compared with the general population was significantly greater for nurses but not for physicians. Further research is needed to assess whether interventions would be associated with benefit in reducing suicide risk among nurses.

Figure 1.. Unadjusted Trends in Suicide Incidence Among Nurses, Physicians, and the General Adult Population for Women and Men

The numbers of suicides do not sum to total for each group in Table 1 because analyses are restricted to states with 2 years of data for each time point. Suicide incidence estimates can be found in eTable 4 in the Supplement. General population refers to adults (age, ≥30 years) who are not nurses or physicians.

Figure 2.. Adjusted Method of Suicide Among Nurses, Physicians, and the General Adult Population (n = 155 919)

Percentages are adjusted for age, sex, race/ethnicity, and marital status. Error bars indicate 95% CIs. General population refers to adults (age, ≥30 years) who are not nurses or physicians.

Figure 3.. Adjusted Substances Identified in Toxicology Examination at Time of Suicide Death Among Nurses, Physicians, and the General Adult Population

A decedent can use more than 1 substance; therefore, totals do not sum to 100%. Percentages are adjusted for age, sex, race/ethnicity, and marital status. Error bars indicate 95% CIs. General population refers to adults (age, ≥30 years) who are not nurses or physicians.