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Jagdip Sidhu, a consultant cardiologist, passed away in 2018, tragically taking his own life. The weight of work-related pressures became unbearable, leading him to this unfortunate end. Reflecting on his brother’s death, Amandip Sidhu shared that Jagdip may have felt being signed off sick was a form of punishment (McGuinness, 2023). Regrettably, Jagdip’s story is not unique in the medical profession. It has been reported that in the United States, a doctor dies by suicide every day (Center et al., 2003), and in the United Kingdom, the frequency is estimated to be once every two weeks or so.
Research has delved into the prevalence of suicide among doctors, examining whether the medical profession poses unique risks. In light of World Mental Health Day, this blog scrutinizes the findings of a recent meta-analysis encompassing studies dating back to 1960.
In the US, a doctor dies by suicide every day.
Methods
The most recent meta-analysis on physician suicide rates was conducted by Austrian researchers in 2024 (Zimmermann et al., 2024). They combed through studies from 1960 to March 2024 in databases such as Medline, PsycINFO, and Embase, focusing on research that compared physician suicide mortality rates to a reference population. Only studies with rate-based outcomes were included, while those examining non-fatal suicidal behavior, specific methods, mental health, and other criteria were excluded. The study assessed risk of bias using the JBI checklist for prevalence studies (Munn et al., 2017) and compared suicide rates among male and female doctors with those of the general population and other non-medical professions.
Results
The meta-analysis encompassed 38 studies on male doctors and 26 on females, representing 20 countries primarily from the US, Australasia, and Europe. The collective data, spanning back to 1935, revealed a suicide rate ratio of 1.05 (95% CI 0.90 to 1.22) for male doctors and a significantly higher ratio of 1.76 (1.40 to 2.21) for female doctors.
Furthermore, a comparison of male doctors with other non-medical professionals showed a pooled effect estimate of 1.81 (95% CI 1.55 to 2.12). Although fewer studies on female doctors limited detailed analysis, their results mirrored those of male doctors. Recent studies indicated a decline in suicide rates for both genders, yet female doctors still exhibited a 24% increased risk compared to the general population.
Geographical analysis revealed varied suicide rates among doctors, with lower rates observed for male doctors in the Western Pacific Region. Female doctor rates did not exhibit the same pattern, though the suicide rate ratio for this region was comparably minimal.
Female doctors have a 24% increased risk of suicide compared to the general population.
Conclusions
Gender, location, and specialty contribute to the complexities of suicide risks among doctors, with female doctors facing additional challenges that impact their mental health and well-being. Factors such as career barriers, household roles, and workplace discrimination may exacerbate these risks.
Variability exists in the gender, location, and specialty of doctors affected by suicide.
Strengths and Limitations
The rigorous methodology of the meta-analysis lends credibility to its findings, yet inherent biases, such as underreporting of suicide deaths, may skew the results. Stigma surrounding mental health and suicide classification may particularly affect doctors, potentially inflating their suicide rates. Generational recording practices also impact data consistency over time.
Underreporting and stigma may underestimate suicide rates among doctors.
Implications for Practice
To address the elevated suicide risk among doctors, efforts must target causal factors like mental illness, substance abuse, and work-related stress. Physicians face unique stressors like heavy workloads and exposure to trauma, necessitating comprehensive mental health support. Overcoming stigma around seeking help is crucial, especially for female doctors facing compounded challenges.
Disciplinary investigations can significantly impact doctors’ mental health, leading to elevated risks of depression and suicide. Improving complaint handling processes and providing adequate support can mitigate these effects and prevent tragic outcomes.
Cultivating a supportive work environment, promoting work-life balance, and prioritizing staff well-being are key steps in safeguarding doctors’ mental health and reducing suicide rates in the profession.
Systemic changes are needed to address doctor unhappiness and prevent suicide.
Statement of Interests
CG is a Patron of the Charity Doctors in Distress.
CG was the medical lead for NHS Practitioner Health.
Primary Paper
Zimmermann, C., Strohmaier, S., Herkner, H., Niederkrotenthaler, T., & Schernhammer, E. (2024). Suicide rates among physicians compared with the general population in studies from 20 countries: Gender-stratified systematic review and meta-analysis. BMJ, 386, e078964. https://doi.org/10.1136/bmj-2023-078964
Other References
Additional references cited in the article include:
– Beghi, M., Rosenbaum, J. F., Cerri, C., & Cornaggia, C. M. (2013). Risk factors for fatal and nonfatal repetition of suicide attempts: A literature review. Neuropsychiatric Disease and Treatment, 9, 1725–1736.
– Bourne, T., Vanderhaegen, J., Vranken, R., Wynants, L., De Cock, B., Peters, M., Timmerman, D., Van Calster, B., Jalmbrant, M., & Van Audenhove, C. (2016). Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: An analysis of qualitative survey data. BMJ Open, 6(7), e011711.
– Brådvik, L. (2018). Suicide Risk and Mental Disorders. International Journal of Environmental Research and Public Health, 15(9), 2028.
– Center, C. et al. (2003). Confronting depression and suicide in physicians: A consensus statement. JAMA, 289(23), 3161–3166.
– Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 13(2), 153–160.
– Gerada, C., Jones, R., & Wessely, A. (2014). Young female doctors, mental health, and the NHS working environment. BMJ, 348, g1.
– Imo, U.O. (2017). Burnout and psychiatric morbidity among doctors in the UK: A systematic literature review of prevalence and associated factors. BJPsych Bulletin, 41(4), 197–204.
– Pitts, F.N., Schuller, A.B., Rich, C.L., & Pitts, A.F. (1979). Suicide among U.S. women physicians, 1967-1972. The American Journal of Psychiatry, 136(5), 694–696.
– Rátiva Hernández, N.K. et al. (2023). Factors associated with suicide in physicians: A silent stigma and public health problem that has not been studied in depth. Frontiers in Psychiatry, 14, 1222972.
– Rimmer, A. (2021). Nine in 10 female doctors in UK have experienced sexism at work, says BMA. BMJ, 374, n2123.
