Abstract
Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.
Highlights
Suicide risk was increased in certain occupational groups, especially in medical-related professions [1]
Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons
The rate of suicide in physicians decreased over time, especially in Europe
Summary
Suicide risk was increased in certain occupational groups, especially in medical-related professions [1]. Physicians, and other health-care workers such as nurses [2,3], were considered like high risk group of suicide in different countries [4,5,6], especially for women [6,7,8]. We hypothesized that 1) physicians are more at risk to commit suicide than the general population, 2) women physicians are more at risk to commit suicide than their male counterparts, 3) some countries would have higher rates of suicide in physicians, 4) with an improvement over time, 5) some medical or surgical specialties would be at higher risk of suicide, 6) physicians would exhibit higher rates of suicide attempts and suicidal ideation, and 7) other health care workers would be at risk of suicide. We conducted a systematic review and meta-analysis on suicide risk among healthcare workers
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