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Research

Suicide rates among physicians compared with the general population in studies from 20 countries: gender stratified systematic review and meta-analysis

BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2023-078964 (Published 21 August 2024) Cite this as: BMJ 2024;386:e078964

Linked Editorial

Doctors and suicide
  1. Claudia Zimmermann, doctoral student1,
  2. Susanne Strohmaier, ap professor1,
  3. Harald Herkner, associate professor2,
  4. Thomas Niederkrotenthaler, professor3,
  5. Eva Schernhammer, professor and adjunct professor14
  1. 1Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
  2. 2Department of Emergency Medicine, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
  3. 3Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
  4. 4Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
  1. Correspondence to: E Schernhammer eva.schernhammer{at}muv.ac.at (@EvaSchernhammer on X)
  • Accepted 10 June 2024

Abstract

Objectives To estimate age standardised suicide rate ratios in male and female physicians compared with the general population, and to examine heterogeneity across study results.

Design Systematic review and meta-analysis.

Data sources Studies published between 1960 and 31 March 2024 were retrieved from Embase, Medline, and PsycINFO. There were no language restrictions. Forward and backwards reference screening was performed for selected studies using Google Scholar.

Eligibility criteria for selecting studies Observational studies with directly or indirectly age standardised mortality ratios for physician deaths by suicide, or suicide rates per 100 000 person years of physicians and a reference group similar to the general population, or extractable data on physician deaths by suicide suitable for the calculation of ratios. Two independent reviewers extracted data and assessed the risk of bias using an adapted version of the Joanna Briggs Institute checklist for prevalence studies. Mean effect estimates for male and female physicians were calculated based on random effects models, with subgroup analyses for geographical region and a secondary analysis of deaths by suicide in physicians compared with other professions.

Results Among 39 included studies, 38 studies for male physicians and 26 for female physicians were eligible for analyses, with a total of 3303 suicides in male physicians and 587 in female physicians (observation periods 1935-2020 and 1960-2020, respectively). Across all studies, the suicide rate ratio for male physicians was 1.05 (95% confidence interval 0.90 to 1.22). For female physicians, the rate ratio was significantly higher at 1.76 (1.40 to 2.21). Heterogeneity was high for both analyses. Meta-regression revealed a significant effect of the midpoint of study observation period, indicating decreasing effect sizes over time. The suicide rate ratio for male physicians compared with other professions was 1.81 (1.55 to 2.12).

Conclusion Standardised suicide rate ratios for male and female physicians decreased over time. However, the rates remained increased for female physicians. The findings of this meta-analysis are limited by a scarcity of studies from regions outside of Europe, the United States, and Australasia. These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at risk subgroups.

Systematic review registration PROSPERO CRD42019118956.

Footnotes

  • Contributors: CZ, SS, and ES conceived and designed the study, HH and TN contributed and advised on methodological aspects. CZ performed the literature search and was the first reviewer for article screening, data extraction, and risk of bias assessment. SS was the second reviewer for article screening, data extraction, and risk of bias assessment. CZ performed the statistical analyses and SS accessed and verified the underlying study data. CZ, SS, and ES interpreted the data. CZ drafted the manuscript and prepared tables and figures. All authors critically revised the manuscript for intellectual content and approved the final version. ES supervised the study. CZ is the study guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This study was partially supported by the Vienna Anniversary Foundation for Higher Education (grant number H-303766/2019). The funder had no role in the study design, data collection, analysis, or interpretation, or in writing or submitting the report. The researchers were independent from the funder and all authors had full access to all of the data (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: CZ received partial funding from the Vienna Anniversary Foundation for Higher Education for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: The authors plan to disseminate the study findings through conference presentations, talks, press releases, social media, and in mandatory courses on mental wellbeing for medical students. The results will also be forwarded to national and international organisations that the authors have had contact with, to be disseminated both within these organisations and through their communication channels. This includes organisations in the field of mental health, public health, suicide prevention, and professional associations (for physicians and medical students); examples include the American Foundation for Suicide Prevention, the International Association for Suicide Prevention and particularly its Special Interest Group on Suicide and the Workplace, the Canadian Medical Association, the Austrian Public Health Association, and the Austrian Medical Chamber. Discussions on how these findings might be used in local and national suicide prevention efforts in Austria will involve physicians, hospital administrators, mental and occupational health professionals, and interested members of the public who are affected by suicidality among physicians.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Additional data are available from the corresponding author at eva.schernhammer@muv.ac.at upon request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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