Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).

OBJECTIVE Physicians' suicide rates have repeatedly been reported to be higher than those of the general population or other academics, but uncertainty remains. In this study, physicians' suicide rate ratios were estimated with a meta-analysis and systematic quality assessment of recent studies. METHOD Studies of physicians' suicide rates were located in MEDLINE, PsycINFO, AARP Ageline, and the EBM Reviews: Cochrane Database of Systematic Reviews with the terms "physicians," "doctors," "suicide," and "mortality." Studies were included if they were published in or after 1960 and gave estimates of age-standardized suicide rates of physicians and their reference population or reported extractable data on physicians' suicide; 25 studies met the criteria. Reviewers extracted data and scored each study for quality. The studies were tested for heterogeneity and publication bias and were stratified by publication year, follow-up, and study quality. Effect sizes were pooled by using fixed-effects (women) and random-effects (men) models. RESULTS The aggregate suicide rate ratio for male physicians, compared to the general population, was 1.41, with a 95% confidence interval (CI) of 1.21-1.65. For female physicians the ratio was 2.27 (95% CI=1.90-2.73). Visual inspection of funnel plots from tests of publication bias revealed randomness for men but some indication of bias for women, with a relative, nonsignificant lack of studies in the lower right quadrant. CONCLUSIONS Studies on physicians' suicide collectively show modestly (men) to highly (women) elevated suicide rate ratios. Larger studies should help clarify whether female physicians' suicide rate is truly elevated or can be explained by publication bias.

[1]  W. D. Johnson Predisposition to emotional distress and psychiatric illness amongst doctors: the role of unconscious and experiential factors. , 1991, The British journal of medical psychology.

[2]  M. A. Davis,et al.  Psychiatric disorders among professional women. , 1979, Archives of general psychiatry.

[3]  K. Hoffman,et al.  Medical student attitude toward seeking professional psychological help. , 1979, Journal of Medical Education.

[4]  G. Vaillant,et al.  Some psychologic vulnerabilities of physicians. , 1972, The New England journal of medicine.

[5]  M. Nordentoft [Suicide among physicians]. , 1988, Ugeskrift for laeger.

[6]  M. A'brook,et al.  Psychiatric Illness in the Medical Profession , 1967, British Journal of Psychiatry.

[7]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[8]  Pitts Fn,et al.  Suicide by male physicians during a five-year period. , 1979 .

[9]  K. Juel,et al.  Mortality and causes of death among Danish medical doctors 1973-1992. , 1999, International journal of epidemiology.

[10]  C. Stefansson,et al.  Health care occupations and suicide in Sweden 1961–1985 , 1991, Social Psychiatry and Psychiatric Epidemiology.

[11]  S Duval,et al.  Trim and Fill: A Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis , 2000, Biometrics.

[12]  W. Feuerlein [Suicide and attempted suicide. Trends, statistics, prevention, help]. , 1973, Medizinische Klinik.

[13]  E. Lew Mortality Experience among Anesthesiologists, 1954–1976 , 1979, Anesthesiology.

[14]  C. Rich,et al.  Suicide by male physicians during a five-year period. , 1979, The American journal of psychiatry.

[15]  A. Swerdlow,et al.  Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants. , 1997, Occupational and environmental medicine.

[16]  I. Rosow,et al.  Physicians who kill themselves. , 1973, Archives of general psychiatry.

[17]  Y. Steinert,et al.  Helping physicians in distress. Developing a physician assessment and referral service. , 1995, Canadian family physician Medecin de famille canadien.

[18]  J. Deeks,et al.  Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995 , 2001, Journal of epidemiology and community health.

[19]  E. Frank,et al.  Mortality rates and causes among U.S. physicians. , 2000, American journal of preventive medicine.

[20]  F. Pitts,et al.  Suicide among U.S. women physicians, 1967-1972. , 1979, The American journal of psychiatry.

[21]  A. Rimpelä,et al.  MORTALITY OF DOCTORS: DO DOCTORS BENEFIT FROM THEIR MEDICAL KNOWLEDGE? , 1987, The Lancet.

[22]  J. Sterne,et al.  Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. , 2001, Journal of clinical epidemiology.

[23]  G. Dean The causes of death of South African doctors and dentists. , 1969, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[24]  W. L. Beeson,et al.  Cause-specific mortality among physicians with differing life-styles. , 1991, JAMA.

[25]  H. W. Linde,et al.  Causes of Death among Anesthesiologists: 1930–1946 , 1981, Anesthesia and analgesia.

[26]  Ian Richard Gordon,et al.  Suicide and related deaths in Victorian doctors , 1990, The Medical journal of Australia.

[27]  J. Mausner,et al.  Suicide in male and female physicians. , 1974, JAMA.

[28]  L. Hankoff Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients , 1991 .

[29]  W. Simon Suicide among physicians: prevention and postvention. , 1986, Crisis.

[30]  P. Sainsbury,et al.  The accuracy of officially reported suicide statistics for purposes of epidemiological research. , 1982, Journal of epidemiology and community health.

[31]  B. Bressler,et al.  Suicide and drug abuse in the medical community. , 1976, Suicide & life-threatening behavior.

[32]  C. Rich,et al.  Suicide by psychiatrists: a study of medical specialists among 18,730 consecutive physician deaths during a five-year period, 1967-72. , 1980, The Journal of clinical psychiatry.

[33]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[34]  C. Nadelson,et al.  Medicine: a career conflict for women. , 1973, The American journal of psychiatry.

[35]  J. L. Tang,et al.  Misleading funnel plot for detection of bias in meta-analysis. , 2000, Journal of clinical epidemiology.

[36]  J. Bruce,et al.  An epidemic of suicide among physicians on probation. , 1980, JAMA.

[37]  G. Arana The impaired physician: a medical and social dilemma. , 1982, General hospital psychiatry.

[38]  J. Lönnqvist,et al.  BRIEF COMMUNICATION Suicide mortality among medical doctors in Finland: are females more prone to suicide than their male colleagues? , 1997, Psychological Medicine.

[39]  Results and implications of the AMA-APA Physician Mortality Project. Stage II. Council on Scientific Affairs. , 1987, JAMA.

[40]  J. Lönnqvist,et al.  A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors , 1996, British Journal of Psychiatry.

[41]  B. Arnetz,et al.  Suicide patterns among physicians related to other academics as well as to the general population , 1987, Acta psychiatrica Scandinavica.

[42]  V. Seagroatt,et al.  Suicide in doctors. , 1993, BMJ.

[43]  D. Revicki,et al.  Physician suicide in North Carolina. , 1985, Southern medical journal.

[44]  Y. Collan,et al.  Mortality among Finnish Doctors, 1953–1972 , 1979, Scandinavian journal of social medicine.

[45]  Pitts Fn,et al.  Suicide among U.S. women physicians, 1967-1972. , 1979 .

[46]  Pitts Fn,et al.  Suicide by psychiatrists: a study of medical specialists among 18,730 consecutive physician deaths during a five-year period, 1967-72 , 1980 .

[47]  K. Innos,et al.  Cancer incidence and cause-specifi c mortality in male and female physicians: a cohort study in Estonia , 2002, Scandinavian journal of public health.

[48]  C. Johnston Suicide totals for MDs sad reminder of stresses facing medicine, conference told. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[49]  H. Gunnarsdóttir,et al.  [Causes of death and incidence of cancer in physicians and lawyers in Iceland]. , 1998, Nordisk medicin.