You may be surprised that male physicians have a suicide rate 1.4 times higher than the general male population and female physicians have a suicide rate about 2.2 times higher than the general female population. Two common psychiatric disorders are highly associated with completed suicides in both populations: depression and alcohol use disorders.
An article by Katherine Gold and colleagues in the journal General Hospital Psychiatry provides information about predisposing factors associated with physician and non-physician suicides. These researchers used a large database known as the National Violent Death Reporting System and compared information on 203 physicians who died by suicide from 2003 to 2008 with 31,636 suicides in the general population during the same time period. This database involves 16 states and combines information from law enforcement, coroners’ reports, medical examiners’ reports, crime labs, and vital statistics reports. It is organized by the Centers for Disease Control and Prevention.
The most common method of suicide in both groups involved firearms (48% of physician suicides and 54% of non-physician suicides). However, the second most common method among physicians was overdosing on medications (23.5%) followed by asphyxiation/blunt trauma (14.5%). In the general population, asphyxiation was more common (22%) than medication overdose (18%).
Different psychosocial stressors were associated with suicide in the general population than in physicians. The occurrence of a recent death or interpersonal crisis was more common in the general population. Alcohol use or substance use disorders were also more common.
On the other hand, physicians had reported more job stress. In addition, more physicians than non-physicians who took their own lives were on medications that suggested the presence of a psychiatric disorder. Interestingly, antidepressant use was not found to be higher among physicians. Rather, use of antipsychotics, benzodiazepines (drugs such as diazepam, alprazolam, and lorazepam), and barbiturates was higher. Barbiturates are not commonly used in clinical practice these days other than for epilepsy and anesthesia, and thus these agents might have been used to overdose.
What do these data mean? First, suicides are common in the general population and even more common among physicians. (About 30,000 Americans are thought to die by suicide each year.) Although some may think that being a physician would protect against suicide, the opposite seems to be true. While it is difficult to ascertain actual causes of suicide from survey data, doctors who completed suicide reported feeling significant work-related stress. Also, doctors may be aware that they are suffering symptoms suggestive of psychiatric disorders such as depression, anxiety disorders, or bipolar disorder, but they may be hesitant to seek care, fearing a negative impact on their careers. It is interesting that more physicians who took their own lives were taking antipsychotic medications than non-physicians who committed suicide. The reasons for this are unclear.
For the general population, it may be unsettling to consider the fact that doctors can suffer from mental and physical disorders just like everyone else. Doctors are not immune to heart disease, diabetes, or other medical disorders. Similarly, they are not protected from psychiatric disorders or stressors that increase the risk of psychiatric disorders and suicide.
Suicide is always a tragic event. The sobering data in this report strongly suggest the need for better recognition and treatment of depression, alcohol abuse, and anxiety as well as the stressors that can result in and compound these disorders. Perhaps then, the rates of suicide in both physicians and non-physicians can be substantially reduced.
This column was co-written by Eugene Rubin MD, PhD and Charles Zorumski MD