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

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

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.

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.

Why Do We Agree to Disagree? Agreement and Reasons for Disagreement in Judgements of Intentional Self-Harm from Coroners and a Suicide Register in Queensland, Australia, from 2001 to 2015

Suicides are likely to be underreported. In Australia, the National Coronial Information System (NCIS) provides information about suicide deaths reported to coroners. The NCIS represents the findings on the intent of the deceased as determined by coroners. We used the Queensland Suicide Register (QSR) to assess the direction, magnitude, and predictors of any differences in the reporting of suicide in Queensland. Therefore, we conducted a consecutive case series study to assess agreement and variation between linked data from the NCIS and QSR determinations of suicide for all suicide deaths (N = 9520) in the QSR from 2001 to 2015 recorded from routinely collected coronial data. The rate of concordance between the QSR and NCIS for cases of intentional self-harm was 92.7%. There was disagreement between the findings in the data, since 6.3% (n = 597) were considered as intentional self-harm in the QSR but not in the NCIS, and, less commonly, 0.9% (n = 87) were considered intentional self-harm in the NCIS but not in the QSR. Overall, the QSR reported 510 more suicides than the NCIS in 15 years. These findings indicate that using suicide mortality data from suicide registers may not underreport suicide as often.