May 8, 2018 -- One doctor commits suicide in the U.S. every day -- the highest suicide rate of any profession. And the number of doctor suicides -- 28 to 40 per 100,000 -- is more than twice that of the general population, new research shows. The rate in the general population is 12.3 per 100,000.
Doctors who die by suicide often have untreated or undertreated depression or other mental illnesses, a fact that underscores the need for early diagnosis and treatment, says study researcher Deepika Tanwar, MD, of the psychiatric program at Harlem Hospital Center in New York.
"It's very surprising" that the suicide rate among physicians is higher than among those in the military, which is considered a very stressful occupation, Tanwar says.
The findings were presented at the American Psychiatric Association (APA) 2018 annual meeting.
Stigma, Access to Lethal Means
Using MEDLINE and PubMed, the researchers looked at studies of doctor suicide that included articles published in peer-reviewed journals during the past 10 years.
The results also showed that although female doctors attempt suicide far less often than women in the general population, their completion rate exceeds that of the general population by 2.5 to 4 times. It also equals the completion rate of male doctors.
Experts are trying to understand why the rates are so high, Tanwar says. The study shows that some of the most common diagnoses are mood disorders, alcoholism, and substance abuse.
One study showed that depression affects an estimated 12% of male doctors and up to 19.5% of female doctors, a rate similar to the general population. Depression is more common in medical students and residents. About 15% to 30% have symptoms of depression.
The researchers note that mood disorders among health care professionals are not restricted to North America. Studies from Finland, Norway, Australia, Singapore, China, and elsewhere have shown an increase in anxiety, depression, and suicidal thoughts among medical students and health care professionals.
Tanwar says stigma is a major obstacle to seeking medical treatment. One 2016 study found 50% of female doctors who completed a Facebook questionnaire reported meeting criteria for a mental disorder but were reluctant to seek professional help because of the fear of stigma.
The new study showed that poisoning and hanging are among the most common means of doctor suicide. The findings also suggest that having knowledge and access to potentially lethal substances account for the higher rate of suicide completion in doctors.
The review also showed that of all medical specialties, psychiatry is near the top in terms of suicide rates.
There is growing awareness of doctor suicide, and programs to prevent it are increasing.
Tanwar says that several sessions at this year's APA meeting address doctor wellness and burnout, which may help reduce suicide rates.
Beth Brodsky, PhD, associate clinical professor of medical psychology in psychiatry at Columbia University and the Irving Medical Center, New York, calls the high rate of doctor suicide "alarming."
But she says it is not surprising, given the stress doctors face.
The stress starts in medical school and continues in residency with the high demands, competitiveness, long hours, and lack of sleep. This may contribute to substance abuse, another risk factor for suicide, Brodsky says.
This high stress is made worse by dwindling healthcare resources and residency positions, she says. When medical students graduate and enter the profession, they face different but equally challenging stressors.
As more women enter the medical profession, they are becoming increasingly vulnerable to the fallout from work stressors. As a result, their rate of suicide is also increasing, Brodsky says.
Brodsky is among the experts advocating for better ways of addressing these problems, which may start with simple changes. People do not "commit" suicide but "die by suicide," she says. She notes that suicide is an "illness and not a crime."
Openly discussing suicide as an illness helps to "bring it out of the darkness" and shed the stigma shadowing this problem, she says.