Medicine: a profession with high suicide risk

People in nursing and medicine are at particular risk of suicide.

When it comes to correctly identifying the factors that can increase or decrease the level of risk of the suicidal cause, it has always been of great interest to pay attention to the close relationship between them.It has always been of great interest to pay attention to the close relationship they have with such behavior. It should be borne in mind that this level increases proportionally to the number of manifest factors and that some have a greater specific weight than others. Knowing them and studying their relevance can be decisive in understanding the problems surrounding each group.

Unfortunately for internal medicine physicians, their profession constitutes a major added risk to death by suicide. According to the American Foundation for Suicide Prevention (AFSP), an average of 400 physicians of both sexes commit suicide each year in the United States, which is equivalent in absolute numbers to an entire medical school. Similar dynamics also occur among medical students where, after accidents, suicide is the most common cause of death.

• Related article, "What needs to be done to decrease the suicide rate?"

The relationship between medicine and suicide

Studies carried out by the AFSP in 2002 confirmed that physicians died by suicide more frequently than other people of the same age, gender, age group of the same age, gender in the general population and in other professions. On average, death by suicide is 70% more frequent among male physicians than in other professionals, and 250% to 400% higher among female physicians. Unlike other populations, in which men commit suicide four times more often than women, physicians have a suicide rate that is very similar between men and women.

Subsequently, Schernhammer and Colditz conducted a 2004 meta-analysis of 25 quality studies on physician suicide and concluded that the aggregate suicide rate for male physicians compared with that for males in the general population is 1.41: 1, with a 95% and confidence interval of 1.21 to 1.65. For female physicians, the ratio was 2.27: 1 (95% CI=1.90-2.73) compared to females in the general population; which is a disturbingly high rate.

However, the singularities with respect to the rest of the professional groups do not end here.. Several epidemiological studies have found that members of some occupations in particular have a higher suicide risk than others and that most of this considerable variation in risk is explained by socioeconomic factors, in all but those belonging to physicians.

A case-control study of 3,195 suicides and 63,900 matched controls in Denmark (Agerbo et al. 2007) corroborated that suicide risk decreases in all occupations if the variables psychiatric income, employment status, marital status, and gross income are controlled for. But, again, physicians and nurses were the exception, where, in fact, the suicide rate increased.

In addition, among people who have received inpatient psychiatric treatment modest associations between suicide and occupation, but not for physicians, who have a much higher risk, up to four times higher.

Finally, the combination of high-stress situations with access to lethal means of suicide such as firearms or drugs is also an indicator of certain occupational groups. Among all physicians, an even higher risk has been assessed for anesthesiologists because of their easy access to anesthetic drugs. These studies are mirrored by the results obtained for other high-risk groups such as dentists, pharmacists, veterinarians and farmers (Hawton, K. 2009).

A very demanding profession

Following an expert consensus document to assess the state of knowledge of depression and suicide deaths among physicians, it was concluded that the traditional culture of medicine places the mental health of the physician as a low priority despite evidence that they have a high prevalence of inadequately treated mood disorders. Barriers to physicians seeking help are usually fear of social stigma and of compromising their careers, so they postpone seeking help until the mental disorder has become chronic and complicated by other pathologies.

The etiopathogenic factors that may explain the increased risk of suicide consist of poor coping, or lack of resources for proper coping, of the psychosocial risks inherent to clinical activity, such as the stress inherent to clinical activity itself, harassment and professional burnout, as well as institutional pressures (cutbacks, forced schedules and shifts, lack of support, malpractice litigation).

Changing professional attitudes and changing institutional policies have been recommended to encourage physicians to ask for help when they need it and to help their peers recognize and treat themselves when they need it. Physicians are as vulnerable to depression as the general population, but they seek help less often and seek help less often.but seek help less, and rates of completed suicide are higher (Center et al., 2003).

Bibliographic references:

• Occupational Medicine and Safety. Printed version ISSN 0465-546X Med. segur. trab. vol.59 no.231 Madrid Apr.-Jun. 2013
• Suicide and Psychiatry. Preventive recommendations and management of suicidal behavior. Bobes García J, Giner Ubago J, Saiz Ruiz J, editors. Madrid: Triacastela; 2011
• http://afsp.org/
• http://www.doctorswithdepression.org/