Female physicians at elevated risk for suicide

In a new analysis of data from the Centers for Disease Control and Prevention, researchers at University of California San Diego School of Medicine found that female physicians in the U.S. had a 53% higher suicide risk compared to females in the general population. Physicians were also more likely to experience various risk factors for suicide, such as mental health struggles or legal issues. The findings, published in JAMA Psychiatry, underpin the need for more comprehensive suicide prevention strategies in a population that experiences unique and significant workplace stressors.

“We're seeing slow but steady progress in promoting wellness in the medical profession, but there’s clearly still a long way to go,” said senior study author Sidney Zisook, M.D., a professor of psychiatry at UC San Diego School of Medicine and a psychiatrist at UC San Diego Health. “Many suicides could be prevented if we destigmatize mental health treatment and make it more accessible and feasible for physicians.”

For physicians, mental health struggles like burnout and depression are all-too-common due to the high-stress nature of their profession. Physicians are regularly required to work long hours within complex health systems and are also responsible for making life-or-death decisions. While older research has suggested that physicians may be at higher risk for suicide than the general population, more recent studies have been inconclusive. Recent research is also ambiguous about the role of gender in suicide risk among physicians.

“Our study helps confirm the fact that physicians are at high risk for suicide, and it tells us that we need to be even more vigilant about this when it comes to female physicians,” said first author Hirsh Makhija, M.S., a postgraduate volunteerresearcher in the Department of Psychiatry at UC San Diego School of Medicine. “Existing suicide prevention programs may not be enough.”

The new study, which analyzed data from the National Violent Death Reporting System from 2017 to 2021, helps fill this gap in knowledge. By investigating more than 137,000 suicides across the U.S., the researchers found:

• While males accounted for 80% of physicians who died by suicide, female physicians had a 53% higher rate of suicide compared to females in the general population.
• Compared to the general population, physicians of either sex who died by suicide were 35% more likely to experience depressed mood, 66% more likely to experience other mental health issues, more than twice as likely to experience job problems, and 40% more likely to experience legal problems.
• Physicians were 85% more likely to use poisoning for suicide, and more than four times as likely to use sharp instruments.
• Physicians were 75% more likely to test positive for benzodiazepines, 32% more likely to test positive for opiates or opioids, 53% more likely to test positive for cardiovascular agents, and almost three times as likely to test positive for drugs not prescribed for home use.

While the study did not seek to determine why female physicians are at higher risk of suicide, the researchers hypothesize that it is due to factors such as under-recognition for their work, inequitable pay and opportunities for promotion, sexual harassment on the job, and often greater domestic responsibilities leading to work-life imbalance.

The findings highlight the need for comprehensive and multimodal strategies for enhancing suicide prevention. Specifically, the study authors recommend limiting access to lethal means, such as medications and sharp instruments and improving mental health resources and support for physicians. They also emphasize the need to continue investigating the root causes of mental health struggles in the health care field as a whole in order to develop new and better approaches to suicide prevention.

“Our work underpins the need for continued efforts to destigmatize mental health care and shift the culture of medicine from one of self-reliance and silent suffering to one of sharing, caring, and connecting,” added Zisook, “Self-care and self-compassion should be part of what it means to be a consummate medical professional.”

Link to full study.

Additional coauthors of the study include Judy E. Davidson at UC San Diego School of Medicine, Kelly C. Lee at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, Arianna Barnes at Barnes Jewish Hospital and Amanda Choflet at Northeastern University.

The study received no external funding.

# # #