Physician suicide demographics and the COVID-19 pandemic

Abstract

Objective: To identify suicide rates and how they relate to demographic factors (sex, race and ethnicity, age, location) among physicians compared to the general population when aggravated by the coronavirus disease 2019 (COVID-19) pandemic. Methods: We searched U.S. databases to report global suicide rates and proportionate mortality ratios (PMRs) among U.S. physicians (and non-physicians in health occupations) using National Occupational Mortality Surveillance (NOMS) data and using Wide-ranging Online Data for Epidemiologic Research (WONDER) in the general population. We also reviewed the effects of age, suicide methods and locations, COVID-19 considerations, and potential solutions to current challenges. Results: Between NOMS1 (1985( -1998( ) and NOMS2 (1999( -2013, the PMRs for suicide increased in White male physicians (1.77 to 2.03) and Black male physicians (2.50 to 4.24) but decreased in White female physicians (2.66 to 2.42). Conclusions: The interaction of non-modifiable risk factors, such as sex, race and ethnicity, age, education level/healthcare career, and location, require further investigation. Addressing systemic and organizational problems and personal resilience training are highly recommended, particularly during the additional strain from the COVID-19 pandemic.

Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout

“…Moreover, the COVID-19 pandemic ravaging the world has had harmful effects on the mental health of physicians, especially frontline physicians. 4 For instance, China was the first country hit by the pandemic and we found that rates of depression and anxiety symptoms were as high as 50% in 1,257 physicians and healthcare workers in China, while 70% were in distress. 5 A similar trend was observed in Italy, which was one of the most affected countries in Europe, where nearly 50% of 1,379 healthcare workers reported posttraumatic stress symptoms and almost 30% reported symptoms of depression and anxiety.…”

“…Suicide reports vary by country and location for various reasons; 3,4,77 one reason is that suicide data is collated from multiple incomplete and even overlapping sources. 3,4 Different locations and organizations may have challenges in reporting or identifying suicides, may lack the resources to collect information or the data are not collected systematically and reliably. 78 These data may be incorrectly codified, whether this is due to lack of information availability (e.g., death of unclear intent), negligence, or intentional misrepresentation (e.g., physicians not reporting the death of a colleague as suicide to spare the feelings of the family and for life insurance) or omission (e.g., organizations not reporting suicides to avoid bad publicity).…”

“…Suicide reports vary by country and location for various reasons. 3 , 4 , 77 One reason is that suicide data is collated from multiple incomplete and even overlapping sources. 3 , 4 Different locations and organizations may face challenges in reporting or identifying suicides, may lack the resources to collect information, or data may not be collected systematically and reliably.…”

“…3 Psychiatric comorbidities, one of the physician suicide risk factors outlined in our systematic review 3 need further consideration, as do factors that were not addressed: medicine judicialization and organization oversight, and "burnout". Moreover, the COVID-19 pandemic ravaging the world has harmful effects on physicians' mental health, especially frontline physicians 4 . For instance, we found that in China, the first country hit by the pandemic, depression and anxiety symptoms were as high as 50% in 1.257 physicians and healthcare workers; moreover, 70% had distress 5 .…”

Walk the line: a systemic perspective on stress experienced by emergency medical personnel by comparing military and civilian prehospital settings

“…A PTSD diagnosis (as defined by the DSM-V) requires a direct or repeated indirect exposure to trauma that results in the development of symptoms, for at least 1 month, from each of the following criterion domains, i.e., intrusive memories, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. According to several recent studies [e.g., ( 12 , 20 – 23 )], PTSSs, depression, anxiety, and PTSD prevalences are dramatically increasing among EM personnel, leading to an alarming rise in personnel loss due to burnout, drop-out, or suicide [e.g., ( 24 – 29 )].…”