By Carolyn Crist

Suicide is the only cause of death that is higher among doctors than the general population, according to two Canadian physicians who coauthored an information sheet about physician suicide.

In particular, male doctors are 40 percent more likely than members of the general public to die by suicide, and the risk to female doctors is more than doubled, they wrote in CMAJ.

“In residency training, my interest in this was personal and became professional after I talked to others and realized I wasn’t the only one dealing with (depression),” Dr. Sarah Tulk of McMaster University in Hamilton, Ontario told Reuters Health by phone. “It was such a relief to find out that I wasn’t the only one struggling.”

Tulk and co-author Dr. Joy Albuquerque of the Ontario Medical Association’s Physician Health Program wrote the information sheet to highlight five facts about physician suicide.

First, they note, suicide is an occupational hazard for doctors. Depression, suicide and suicidal ideation are elevated in doctors, which has been the case for several decades.

“Doctors see themselves on the physician side of mental health, not the patient side, so they learn to be strong and stoic,” Tulk said. “(They) learn to provide help and not receive it.”

Second, the co-authors note, as in the general public, the most common means of suicide among physicians is firearms. Doctors, however, are more likely than the average person to use poison, possibly because they have easier access. Doctors who completed a suicide were more likely to have benzodiazepines, barbiturates or antipsychotics detectable in their blood.

Third, they point out, an increased risk of suicidal ideation begins in medical school. According to a 2016 meta-analysis, the prevalence of suicidal ideation in the past year among medical students was 24 percent.

“The vast majority of people who have ideation don’t die by suicide, and most people would agree that having ideation at some point in our long lives is not abnormal, but it becomes a problem when ideation is elevated or pervasive,” said Dr. Douglas Mata of Brigham and Women’s Hospital in Boston, Massachusetts. Mata, who wasn’t involved with this informational page, has researched depression and suicide among physicians.

Fourth, regulatory complaints are also associated with increased rates of suicidal ideation among physicians, the two authors point out. In a survey of 8,000 doctors in the United Kingdom, for instance, those with a past or current regulatory complaint were more likely to report suicidal ideation. Those without complaints had an ideation rate around 2.5 percent, but this increased to 9.3 percent for those with a current or recent complaint and 13.4 percent for those with a past complaint.

Fifth, suicidal physicians face unique barriers to care. As do most people, doctors struggling with mental health issues face stigma, as well as lack of time to seek care and lack of access to care – but doctors have added burdens around confidentiality and fear of discrimination when it comes to licensing and applications for hospital privileges.

“There’s always been stigma surrounding mental health issues, but the more we talk about it, the more we can normalize it,” Mata said. “In the past 10 years, we’re paying more attention to it and writing more editorials about it, and medical schools are instituting lectures and small group learning around it.”

Importantly, Mata added, patients shouldn’t be worried about the increased risk as it relates to their personal health. Recent studies have shown that although doctors are at a greater risk for depression and suicide, it hasn’t been linked to negative patient outcomes.

“The increased risk is endemic and has been present for the past three decades,” he said. “It’s positive that we are seeing increased attention, both on a personal and public health level.”