BUDAPEST, HUNGARY — Data on physician suicide are not readily available in many countries, and there are few educational and preventive programs to help tackle the problem, an international study of national healthcare systems showed.
Here at the European Psychiatric Association Congress (EPA) 2024, investigators led by Kata Kostyál, PhD, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, in Szeged, Hungary, examined access to national suicide databases, prevention strategies, and interventions.
Kostyál told Medscape Medical News that at her hospital, nurses are screened for burnout and depression but not physicians.
“It’s a very big problem,” Kostyál said. Physicians learn how to help their patients, but they do not learn how to seek help, or use prevention strategies, themselves, she added.
US data indicated that suicide rates among doctors are higher than those among the general population. Kostyál and colleagues reported that among different medical specialties, general practitioners have the highest risk, followed by internal medicine and then psychiatry.
Aside from Anglo-Saxon countries, data on physician suicide in other countries are limited, and in some countries, the topic is taboo. For the pilot study, the researchers developed a short nine-item questionnaire, which was completed by psychiatrists in Croatia, Czech Republic, Ethiopia, France, Germany, Hungary, Kazakhstan, Mexico, Qatar, Serbia, Sweden, and the United Kingdom (n=25). Of the 25 psychiatrists from 20 participating countries, 12 psychiatrists from 12 countries returned the questionnaire.
Results showed none of the responding countries has publicly available data on the number of physicians who died by suicide in the last 3 years. Further, suicide risk and substance abuse were not systematically assessed or published in any of the participating countries.
Two countries had free toolkits to help identify and support at-risk populations. One country had self-help groups for physicians, and two had an annual suicide prevention day that had a special focus on physician suicide.
None of the countries had any events, either online or in person, dedicated to the issue of physician suicide.
With the exception of Ethiopia, general suicide hotlines were available in every country. However, a hotline specifically for physicians and healthcare workers in crisis was available in three countries: Mexico, Qatar, and Kazakhstan. Kazakhstan was the only country where doctors are regularly assessed for burnout, depression, and anxiety.
“We are at an early stage of our study, and we want to map physician burnout, depression, anxiety, substance abuse, and impulsivity in a representative sample of Hungarian doctors” and explore the risk factors for suicidal behavior.
Older Age a Risk Factor
A separate analysis recently published in the Journal of Affective Disorders showed that in Norway, where dedicated initiatives to reduce the stigma around physician suicide and prevention initiatives have been available for several decades, physical suicide rates are declining.
Helene Seljenes Dalum, PhD, Institute for Studies of the Medical Profession, Oslo, Norway, and colleagues examined suicide rates across a range of healthcare professions in Norway and compared them with those among other graduates of other professions, as well as the general population.
They linked data from the Norwegian Cause of Death Registry to information on educational attainment from the National Educational Database of Statistics Norway, as well as to demographic information from the Norwegian Population Registry, for the years 1980-2021.
The total number of suicides during the study period was 21,298. Men without higher education had a suicide rate of 26.6 per 100,000, whereas the rate in women was 9.6 per 100,000 person-years.
Graduates of both sexes tended to have lower suicide rates than those without higher education. However, male physicians (25.7), nurses (22.2), and veterinarians (35.9) had a higher rate of suicide than other, nonhealthcare graduates (11.7). Moreover, female nurses (9.3) and psychologists (15.0) had higher suicide rates than other, nonhealthcare graduates (5.1; all per 100,000 person-years).
Over the study period, suicide rates declined among male physicians, from 46.4 per 100,000 person-years in 1980-1999 to 17.0 per 100,000 person-years in 2010-2021 and approached those of other people with higher education.
Conversely, the suicide rate among nurses increased during the study period, from 21.1 per 100,000 person-years in 1990-1999 to 22.6 per 100,000 person-years in 2010-2021 among male nurses, and from 8.8 per 100,000 person-years to 9.6 per 100,000 person-years over the same period among female nurses.
“From 2010 to 2021, nurses of both genders were the only group with higher suicide rates compared to other graduates,” the team noted, adding that the suicide rate in nurses should be further monitored.
Interestingly, the physician suicide rate increased with age. Physicians aged 60 years and older were more than twice as likely to die by suicide than other, nonhealthcare graduates and were nearly four times more likely to take their own lives than physicians younger than 40 years.
However, coauthor Erlend Hem, MD, also from the Institute for Studies of the Medical Profession, told Medscape Medical News that because the study’s findings are based on registry data, it is difficult to draw definitive conclusions.
Nevertheless, he believes that efforts to reduce the stigma and negative attitudes around physician mental health problems and suicide in Norway over the past 30 years are likely to be “reflected in the reduced suicide rates.”
Battling Stigma
Dalum noted that for physicians in Norway, “there has been increasing attention to both the stigma connected to having mental health issues and in trying to provide low-threshold counselling or advice for doctors who are struggling.”
There has also been a major increase in the number of applications to a counselling service for Norwegian physicians, “which might reflect that the stigma and the barriers for help-seeking are lower now than they were 20 years ago,” she added.
Moreover, physician organizations have been working “strategically and systematically for some time on suicide prevention measures and preventive mental healthcare,” she said.
Interestingly, the researchers showed in a previous paper that self-reported suicide attempts among physicians were “quite low.” Hem said this is likely because when physicians decide to take their own lives, “they know how to do it,” an indication that suicide prevention efforts need to be targeted before mental issues become a major problem, making it more difficult “to reverse the negative spiral for the doctors.”
Hem said his team hopes to publish a follow-up study further exploring suicidal ideation, plans, and attempts in physicians.
No funding and relevant financial relationships were declared.
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