March 09, 2020
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Female physicians have higher suicide mortality rate than male physicians, women in general

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Since 1980, suicide standardized mortality ratios have been high among female physicians and low among male physicians, according to findings of a systematic review and meta-analysis published in JAMA Psychiatry. However, these ratios decreased over time in both groups.

“From 1980 to 2015, the proportion of female U.S. medical school graduates increased from 23% to 47.6%, but female participants in the U.S. civilian labor force rose only from 42.5% to 46.8%,” Dante Duarte, MD, PhD, of the department of physical medicine and rehabilitation at Harvard Medical School in Boston, and colleagues wrote. “This implies that gender dynamics in medicine changed much more rapidly than in the general population during this period, which may have affected female and male physicians’ SMRs [standardized mortality ratios]. However, many additional cultural, socioeconomic and political changes influenced health care during this period, reinforcing the need for action regarding physician suicides.”

Duarte and colleagues hypothesized a higher risk for male and female physician suicide than the general population from the 1980s to date, as well as that the suicide rate for both groups of physicians would be reduced from before to after 1980. To evaluate these risks, they retrieved studies using the search terms “suicide,” “self-harm” or “suicidality” and “physicians” or “doctors” and included those that assessed male and/or female physician suicide. For the meta-analysis, they included only cohorts from 1980 to the present. The main outcomes and measures were suicide SMRs for male and female physicians from 1980 to the present and changes over time before and after 1980.

Duarte and colleagues included 32 articles in the systematic review out of 7,877 search results, and nine articles and data sets in the meta-analysis. Meta-analysis revealed a significantly higher suicide SMR for female physicians than women in general (SMR = 1.46; 95% CI, 1.02-1.91). The SMR for male physicians was significantly lower than for men in general (SMR = 0.67; 95% CI, 0.55-0.79). SMRs for both female and male physicians significantly decreased after 1980 compared with before 1980 (male physicians, SMR = 0.84; 95% CI, 1.26 to 0.42; female physicians, SMR = 1.96; 95% CI, 3.09 to 0.84). The researchers reported no evidence of publication bias.

“Suicide [proportionate mortality ratios] highlight the importance of suicide relative to other causes of mortality in physicians,” they wrote. “This qualitative and quantitative work illustrates physician suicide patterns and characteristics for future studies and policies.”

In a related editorial, Katherine J. Gold, MD, MSW, MS, and Thomas L. Schwenk, MD, outlined a path forward for addressing physician suicides.

“Accurate estimates of the true rate of physician suicides may still be lacking, but the risk is not zero and the consequences loom large,” they wrote. “The medical profession must address the root causes of physician distress. The profession must adopt, as a core professional value, a more sustainable approach to managing the burdens of medical practice. Educational and work environments are needed that support rather than stigmatize physicians who seek help. Barriers to accessing mental health care must be removed.” – by Joe Gramigna

Disclosures: The study authors and editorial authors report no relevant financial disclosures.