Even within the health care community itself, female nurses were found to be roughly 70% more likely to die by suicide than female doctors.
Why? Study author Matthew Davis said that for now, "We don't know for certain what forces are directly responsible for the higher risk of suicide among nurses. It could be related to high job demands, lower autonomy compared to physicians, avoidance of mental health services for fear of stigma, [and] greater access to the means to complete suicide," meaning prescription drugs.
Not only that, but the pandemic "has added enormous strain to health care workers, particularly nurses who provide the vast majority of bedside care," said Davis, an associate professor in the Department of Systems, Population and Leadership at the University of Michigan.
In the study, Davis and his team pored over suicide risk information -- for adults 30 and older -- drawn from the National Violent Death Reporting System.
More than 159,000 suicides occurred during the study time frame -- 2007 to 2018. Of those, nearly 2,400 involved nurses, roughly 8 in 10 of whom were women. (That correlates with estimates indicating that 80% to 85% of nurses are women, the study authors noted.
Just over 850 suicides were cited among doctors, of which about 85% were men. The remainder (156,000 suicides) were among the general public; three-quarters of those cases involved men.
Drilling down, Davis and his team determined that the suicide incidence among nurses was 17.1 per 100,000, compared to 8.6 per 100,000 among women in the general public, a doubling of risk.
The picture is murkier with respect to male nurses, said Davis, due to the study's small sample of male nurses. But suicide risk among doctors was not found to be significantly higher than the risk seen among the general public.
The team also observed that when nurses or doctors take their lives, drugs are often involved. In fact, while 17% of the general public died by suicide via poisoning, that figure jumped to nearly 25% among doctors and nurses. Specifically, clinician suicides were more likely than general public suicides to entail the use of antidepressants, barbiturates, opioids and/or benzodiazepine medications.
Davis and his colleagues published their findings online April 14 in the journal JAMA Psychiatry.
Dr. Constance Guille is director of the women's reproductive behavioral health division in the department of psychiatry and behavioral sciences at the Medical University of South Carolina. She wrote an accompanying editorial and wasn't surprised by the findings.
"First of all, we know that women are twice as likely as men to have depression," Guille explained. "And among nurses in particular, we know two things really increase suicide risk: prior mental health problems and depression and stressful events. And health care is a really stressful environment to work in, and has only gotten increasingly stressful over the years."
The overriding issue, Guille noted, is the enormous weight of responsibility placed on nurses' shoulders. "Nurses are by the patient's side throughout their care, and really are doing a lot of the heavy lifting, implementing treatment plans and taking care of the patient," she said.
"And the health care system and industry has changed over time to increase efficiency and workload," Guille added. "That means nurses now carry additional workload along with a reduction in staff. So the patient-nurse ratios have changed."
The upshot: "It's an already difficult job that's become even more challenging, as they try to do a lot more with less resources and time."
Regardless, said Guille, nurses still tend to feel like it's on them to make sure patients do well. "So, if there's a bad outcome they're often blaming themselves, which further compounds their risk for depression and suicide," she said.
What can be done? "Well, burning out our health care workforce is really self-defeating," Guille said. "So, I think it really starts with awareness. For people to really see this as a problem. And to destigmatize this a bit. That at least helps people speak out and get needed treatment. And it helps everyone be more vocal about how we are going to prevent this."
As to the impact of the coronavirus pandemic, Guille said it likely hasn't helped matters.
"I would anticipate the stressors -- personally and professionally -- are even higher than normal. It's speculative to say so at this point," she said. "But I can't imagine it's gotten any better. If anything, it's potentially gotten much worse."
There's more on suicide at the U.S. Centers for Disease Control and Prevention.
SOURCES: Matthew Davis, PhD, MPH, associate professor, Department of Systems, Population and Leadership, University of Michigan, Ann Arbor; Constance Guille, MD, professor and director, women's reproductive behavioral health division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; JAMA Psychiatry, April 14, 2021, online