is based in the USA. In Alexander's review, Steven Stack's paper (1996) Suicide among dentists: A national study, also USA based-which concluded that, even after controls for associated covariates, dentists are 6.64 times more likely than the general populace to commit suicide-is questioned and dismissed as flawed. In my view there is plenty of evidence to suggest that dentists in the UK have a higher than average risk of suicide. For instance: 'Several occupational groups in the United Kingdom appear to have considerably elevated risk of suicide. These include, for example, farmers, doctors (especially females), dentists, pharmacists, veterinary surgeons, and female nurses. ' 1 Proportional mortality ratios (PMRs) compare the proportion of deaths in an occupation from a specific cause to the proportion of deaths from that cause in all occupational groups. A PMR of 100 for a particular occupation indicates no difference in the proportion of deaths from that particular cause. A PMR of 50 indicates only half the proportion of deaths. 'From 1982-1987, male vets showed the highest PMR from suicide having more than three times the average male suicide risk. However, this figure comes from a total of 17 suicides over the six years. From 1991-1996 the number of suicides dropped to nine, resulting in the second highest PMR (349) of those analysed. Dental practitioners are now seen as a higher risk group as the figure is based on a larger number of suicides and is therefore more reliable. 'Male dental practitioners have become the group with the highest significant suicide risk in the time period 1991-1996 (2.49 times the average), during which there were 25 suicides in this group. 2 'PMRs for dentists, pharmacists and veterinarians have been increased in several previous studies. Differences in these occupations in Scotland were not statistically significant. In 16 to 45year-old men, dentists had ratios with confidence intervals for men aged a PMR of 128 (95% CI 26-374), pharmacists a PMR of 43 (95% CI 1-238) 16-45 years, 1981-1999 and veterinarians a PMR of 293 (95% CI 80-749). In 46 to 64-year-old men, the PMR for dentists was 235 (95% CI 76-548), 118 for pharmacists (95% CI 14-242) and 301 for veterinarians (95% CI 36-1,088). ' 3 On the bright side, dentists' death rates from other causes are lower, and on average they live several years longer than the general population. 4 M. Preston Essex LETTERS
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