Older docs, Asian or Pacific Island ancestry, job and health issues among risk factors

Health care professionals in the United States who are older, receiving treatment for mental illness, and have health- or job-related problems have an increased risk of suicide compared with the general population, according to researchers.

Yisi D. Ji, DMD, Harvard Medical School, Boston, Massachusetts, and colleagues, whose study was published in JAMA Surgery, also found that health care professionals of Asian or Pacific Islander ancestry are at an increased risk of suicide.

According to Ji and colleagues, burnout continues to be a major job-related problem among health care professionals in the United States. While a recent survey showed that physician burnout rates have declined, the percentage of respondents who reported they exhibited at least one symptom of burnout in 2017 was still high at 43.9%. Studies also show that physicians experiencing burnout have poorer patient safety outcomes, lower patient satisfaction scores, and are more likely to behave unprofessionally.

Ji and colleagues pointed out that the risk factors for physician burnout also overlap with the risk factors for physician suicide. Thus, they suggested that examining these could help reduce the risk of suicide among health care professionals.

In this study, the authors used data from the National Violent Death Reporting System to assess risk factors for suicide among three groups of health care professionals — surgeons, nonsurgeon physicians, and dentists — compared to non-health care professionals (general population).

Of 170,030 individuals who died by suicide between 2003 and 2016, 767 (0.5%) were health care professionals (mean age 59.6 years 88.0% male, and 89.7% white). Of these health care professionals, 63.2% were nonsurgeon physicians, 23.3% were dentists, and 13.4% were surgeons.

Compared to the general population, health care professionals who committed suicide were more likely to:

  • Be older (mean age, 59.6 years) compared with the general population (mean age, 46.8).
  • Have Asian or Pacific Islander ancestry (odds ratio [OR], 2.80; 95% CI, 1.96-3.99).
  • Have job problems (OR, 1.79; 95% CI, 1.49-2.17).
  • Have civil legal problems (OR, 1.61; 95% CI, 1.15-2.26).
  • Have physical health problems (OR, 1.40; 95% CI, 1.19-1.64).
  • Be currently receiving treatment for mental illness (OR, 1.45; 95% CI, 1.24-1.69).

Conversely, health care professionals had a lower risk of suicide compared with the general population if they had black ancestry, were female, or were unmarried. They were also less likely to have problems with intimate partners, or alcohol use.

As for the comparison between surgeons and nonsurgeon physicians, surgeons had a higher suicide risk if they were older, male, married, or under treatment for mental illness.

Ji and colleagues noted that their study suggests health care professionals are at increasing risk for suicide as they approach the end of their careers. “One hypothesis is that the transition into a senior career position or retirement introduces new challenges regarding sense of purpose, finances, changes in routine, and restructuring of family dynamics,” they observed.

They also noted that Asian and Pacific Islander ancestry compared with white ancestry was a risk factor among health care professionals.

“Thus, screening for self-harm risks in health care professionals may be improved by age-informed and culturally sensitive assessments and interventions,” wrote Ji and colleagues.

In a commentary accompanying the study, Suzanne C. Danhauer, PhD, Wake Forest Baptist Health, Winston-Salem, North Carolina, and colleagues called the association between older age and suicide risk “worrisome.”

“Loss of connection with colleagues during retirement and a perceived loss of relevance after a satisfying career could be factors in surgeons’ high levels of distress,” they wrote. “To alleviate this issue, older surgeons should be actively engaged with meaningful ways in which they can continue to contribute to the field.”

Danhauer and colleagues also emphasized that strategies that mitigate burnout should be targeted at all physicians, and that approaches that focus on “resilience and relevance” will help in the recognition of the warning signs of distress, and even keep them from occurring.

  1. Health care professionals at an advanced age and near retirement are at increased risk for suicide compared to the general population, this study suggests.

  2. Health- and job-related problems, mental illness, and Asian or Pacific Islander ancestry are also risk factors.

Michael Bassett, Contributing Writer, BreakingMED™

None of the authors quoted in this article disclosed relevant relationships.

Cat ID: 150

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