Editorial

Physician suicide—why?

Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway.

Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively.

Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3–52.4), physicians (25.7, 21.3–30.2) and nurses (22.2, 16.6–27.7) had higher suicide rates compared others with higher education (11.7, 10.7–12.7). For females, this was the case for psychologists (15.0, 8.2–21.7) and nurses (9.3, 8.3–10.3), vs. others with higher education (5.1, 4.2–6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education.

The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for.

Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not.

Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n=2) or completed (n=5) suicide versus the remainder of the sample.

Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P<.05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher’s Exact Test, P<.05).

Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.

Los médicos tienen mayores tasas de suicidio en comparación con la población general. Este riesgo tiende a incrementarse incluso a partir del inicio de la formación de pregrado en medicina. Existen pocos estudios que evalúen la frecuencia de conductas suicidas en estudiantes de pregrado de medicina, especialmente en Latinoamérica.

Determinar la prevalencia de vida y factores asociados con la ideación suicida e intentos suicidas en una muestra de estudiantes de medicina de Bucaramanga, Colombia.

Se condujo un estudio observacional analítico de corte transversal, para determinar la prevalencia de vida de ideación suicida e intentos suicidas, en una muestra no probabilística de estudiantes de medicina matriculados en las 3 facultades de medicina de Bucaramanga. El cuestionario autoaplicado fue respondido de forma voluntaria y anónima por los participantes. Las versiones validadas de las escalas CES-D y CAGE fueron utilizadas para evaluar síntomas depresivos y uso problemático de alcohol, respectivamente. Se generó un modelo multivariado de regresión logística, con el fin de ajustar los estimadores de las variables asociadas con el desenlace «ideación suicida alguna vez en la vida».

La muestra de estudio estuvo formada por 963 estudiantes. El 57% (n = 549) de los participantes fueron mujeres. El promedio de edad fue de 20,3 años (DE = 2,3 años). En relación con la prevalencia de ideación suicida, el 15,7% (n = 149) de los estudiantes informó haber tenido por lo menos un episodio de ideación suicida serio a lo largo de la vida. El 5% (n = 47) señaló haber realizado por lo menos un intento suicida. El 13,9% (n = 131) de los estudiantes informó haber ingerido antidepresivos durante su entrenamiento médico. Las variables asociadas con la ideación suicida en el modelo de regresión logística fueron: síntomas depresivos clínicamente significativos (OR: 6,9; IC 95%: 4,54-10,4), historia de consumo de sustancias psicoactivas ilícitas (OR: 2,8; IC 95%: 1,6-4,8) y percepción del regular o mal rendimiento académico durante el último año (OR: 2,2; IC 95%: 1,38-3,63). El modelo de regresión logística clasificó correctamente al 85% de los sujetos con antecedente de ideación suicida.

La ideación suicida es un fenómeno de frecuente ocurrencia en estudiantes de medicina. Es necesario que las facultades de medicina establezcan programas de detección e intervención temprana que permitan disminuir la probabilidad de ocurrencia de desenlaces negativos.

It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America.

To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia.

An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a non-random sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life».

The study sample consisted of 963 medical students, of which 57% (n = 549) of the participants were women. The average age was 20.3 years (SD = 2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n = 149) of the students, with 5% (n = 47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n = 131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified 85% of the subjects with a history of suicidal ideation.

Suicidal ideation is a frequently occurring phenomenon in medical students. Medical schools need to establish screening procedures for early detection and intervention of students with emotional distress and suicide risk.