Abstract
The purpose of this study was to identify individual and residency program factors associated with increased suicide risk, as measured by suicidal ideation. We utilized a prospective, longitudinal cohort study design to assess the prevalence and predictors of suicidal ideation in 6,691 (2012-2014 cohorts, training data set) and 4,904 (2015 cohort, test data set) first-year training physicians (interns) at hospital systems across the United States. We assessed suicidal ideation two months before internship and then quarterly through intern year. The prevalence of reported suicidal ideation in the study population increased from 3.0% at baseline to a mean of 6.9% during internship. 16.4% of interns reported suicidal ideation at least once during their internship. In the training dataset, a series of baseline demographic (male gender) and psychological factors (high neuroticism, depressive symptoms and suicidal ideation) were associated with increased risk of suicidal ideation during internship. Further, prior quarter psychiatric symptoms (depressive symptoms and suicidal ideation) and concurrent work-related factors (increase in self-reported work hours and medical errors) were associated with increased risk of suicidal ideation. A model derived from the training dataset had a predicted area under the Receiver Operating Characteristic curve (AUC) of 0.83 in the test dataset. The suicidal ideation risk predictors analyzed in this study can help programs and interns identify those at risk for suicidal ideation before the onset of training. Further, increases in self-reported work hours and environments associated with increased medical errors are potentially modifiable factors for residency programs to target to reduce suicide risk.
Highlights
Physicians may be at elevated risk for suicide compared to the general population [1,2]
We found that prior quarter suicidal ideation (Odds Ratio (OR) = 7.84, p = 4.4 x 10−32, baseline suicidal ideation (OR = 5.41, p = 2.5 x 10−11), increase in self-reported work hours from the previous quarter (OR = 1.34, p = 4.0 x 10−6), current quarter self-reported medical errors (OR = 1.80, p = 1.1 x 10−5), prior quarter depressive symptoms score (OR = 1.36, p = 1.8 x 10−4), baseline neuroticism score (OR = 1.33, p = 3.4 x 10−4), and baseline personal history of depression (OR = 1.45, p = 4.7 x 10−3) were significant predictors of current quarter suicidal ideation under a threshold of p < .01, holding all other model covariates constant
As with any observational study, we do not know if the factors we identified as being associated with increased risk of suicidal ideation are causal for suicidal ideation, or if they are the result of other unmeasured causal factors; we do know that they help predict suicidal ideation risk in these cohorts of interns
Summary
Physicians may be at elevated risk for suicide compared to the general population [1,2]. Recent suicides have raised concerns that training physicians may be at high risk [3,4].
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