In a recent article published in JAMA, researchers estimated the risks of death by suicide for six healthcare worker (HCW) groups compared to non-healthcare workers in the United States.
All HCWs, including physicians, manage heavy workloads while caring for severely ill patients and have little control over patient outcomes, making their occupation stressful and emotionally demanding.
This stress can contribute to a higher risk of suicide among HCWs, despite some of them potentially living longer and healthier lives than the general population.
Previous studies have investigated standardized mortality ratios (SMRs) due to suicide for physicians but not for 95% of other HCWs.
A recent meta-analysis of small-scale studies published from 1969-2018 found that suicide SMRs for female and male physicians were 1.94 and 1.24, respectively.
While the risks of suicide among physicians might have declined in past decades, information concerning suicide risks among other HCWs remains scarce.
In the present cohort study, researchers used a nationwide representative sample of 1,842,000 HCWs from the 2008 American Community Survey (ACS), linked to National Death Index records, to determine their cause of death.
The study included six types of HCWs: registered nurses, physicians, healthcare diagnosticians/treating practitioners (e.g., dentists), healthcare technicians, healthcare support workers (e.g., home health aides), and behavioral/social health workers (e.g., psychologists, counselors). All ACS participants were aged ≥26 years.
The main study outcome was death due to suicide among all HCWs, identified by International Classification of Diseases (ICD) codes X60-X84, Y87, and U03, stratified by age and sex.
The team computed suicide rates per 100,000 person-years with 95% confidence intervals (CIs), using all ACS participants aged ≥26 as the reference group.
Additionally, the team used Cox proportional hazard regression models to estimate suicide hazard ratios (HRs) for all HCW groups versus non-healthcare workers while accounting for baseline sociodemographic characteristics, including age, gender, race/ethnicity, marital and educational statuses, personal annual income, and region of residence (rural/urban).
They also included personal income in secondary analyses as a potential mediator. The event (suicide) time was measured from the ACS survey to suicide or death from other causes until December 31, 2019.
The researchers also explored the interaction of an HCW’s gender with suicide hazard but cautioned against overinterpreting the CIs due to not adjusting for multiple comparisons.
Regarding the baseline characteristics of all six HCW groups, the researchers noted that the highest percentage of physicians were men, while most registered nurses and healthcare support workers were women.
The proportion of non-Hispanic Black and Hispanic people in the healthcare support worker group was the highest.
The income of healthcare support workers was the lowest, whereas physicians, registered nurses, and other healthcare diagnosticians/treating practitioners had the highest incomes.
Compared to non-HCWs, registered nurses, healthcare support workers, and healthcare technicians had markedly higher gender- and age-standardized suicide rates.
In contrast, healthcare diagnosticians/treating practitioners had lower standardized suicide rates than non-HCWs. Although suicide risk was not higher for physicians compared to non-HCWs, the CIs for this group were wide, and the sample size was constrained when gender-stratified.
Secondary analyses controlling for personal income or ceasing follow-up at age 65 did not substantially change these findings.
Adjusted suicide hazards for the three HCW groups remained significantly higher even after controlling for potential confounders.
Suicides among HCWs increased from 3.8 million to 6.6 million between 2008 and 2021 in the USA.
These results align with studies showing that increased risks for mental health problems in HCWs, such as mood disorders, might affect their work, contributing to increased suicide risk.
Adjusted Cox regression analyses suggested a stronger association between suicide risk and occupation among all female HCWs than male workers (χ2 = 4.83; P = .03).
Future research might look for reasons for gender-related variations in occupational roles, stress, and job satisfaction.
Additionally, studies could investigate specific healthcare work-related occupational exposures, such as burnout, that are associated with suicidal ideation and might contribute to suicide risk.
The current study analyzed risks of death by suicide in HCWs before the COVID-19 pandemic.
During the pandemic, efforts to improve the mental health of HCWs received higher attention, which might diminish as the pandemic recedes.
However, it remains crucial to identify and enhance specific work-related factors that contribute to mental health occupational risks of HCWs, especially registered nurses, health technicians, and support workers.
There is also a need for workplace mental health interventions that make mental health services affordable and easy to access. Moreover, it is important to ensure that HCWs do not face disciplinary action for seeking mental health treatment.
