Suicide among emergency service workers: a retrospective mortality study of national coronial data, 2001-2017

Work-related suicide: Evolving understandings of etiology & intervention

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

A Comparison of Suicides in Public Safety Personnel With Suicides in the General Population in Ontario, 2014 to 2018

Background: There is conflicting evidence on the suicide rates of different public safety personnel (PSP). There have been few studies that compare suicides in PSP with the general population and none that have used a detailed comparison of coroner records. Aims: The current study estimates suicide rates among different PSP and compares PSP suicides with the general population. Method: We identified coroner records of PSP suicides from January 2014 to December 2018 and compared each one to two matched general population controls. Results: We identified 36 PSP suicides and 72 general population controls. Police had a higher suicide rate than other PSP groups. PSP were more likely to die by firearm, be separated/divorced or married, die in a motor vehicle, have problems at work, and have a PTSD diagnosis. PSP were less likely to die by jumping. Limitations: The study may have not identified all PSP suicides. Apart from the cause of death, data in coroner records are not systematically collected, so information may be incomplete. Conclusion: PSP suicides appear different than the general population. Death records need to have an occupation identifier to enable monitoring of trends in occupational groups, such as PSP.

Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades

OBJECTIVE

To examine the relative risk of suicide among healthcare professionals compared to other occupations and examine changes in suicide rates over time.

METHODS

Suicide cases were identified using the National Coronial Information System and were included if they were recorded as a death by intentional self-harm between 2001 and 2017 and were by an employed adult aged 20-69 with a known occupation at the time of death. Suicide methods were reported descriptively. Workforce data at the population level was extracted from the Australian Bureau of Statistics 2011 Census. Age-standardised suicide rates per 100,000 person-years for each of the four occupational groups were calculated using direct standardisation and using the Australian Bureau of Statistics population-level data from the 2011 Census. Negative binomial regression was used to estimate suicide risk by healthcare employment status and profession, to investigate differences by sex and to examine trends in suicide rates over time, using rate ratios and 95% confidence intervals.

RESULTS

Healthcare professionals were at increased risk of suicide compared to other occupations (rate ratio = 1.30, 95% confidence interval = [1.19, 1.42], p < 0.001), controlling for age, sex and year of death. Nurses and midwives were identified as being at significantly increased risk of suicide (rate ratio = 1.95, 95% confidence interval = [1.73, 2.19], p < 0.001). Suicide rates among female medical practitioners increased substantially over time (p = 0.01).

CONCLUSION

Health professionals are at significantly increased risk of suicide, though the relative risk of different groups is changing over time. There has been a substantial increase in the risk of suicide among female medical practitioners with rates of suicide in this group more than doubling over the last two decades. Findings highlight the need for targeted suicide prevention initiatives for healthcare professionals.