Suicide is top cause of early death in physicians

OB/GYN News, March 1, 2003 by Doug Brunk

HENDERSON, NEV. -- Suicide ranks as the leading cause of premature death among physicians, Dr. Peter Mansky said at the annual meeting of the American Academy of Addiction Psychiatry.

"Physicians probably start out with better health than the regular population, but we take less care of ourselves as our careers go on," said Dr. Mansky, medical director of the Committee for Physicians' Health, a division of the Medical Society of the State of New York in Albany. "We're working long hours, and we put great stress on ourselves. Long hours isolate us from our support system."

According to various studies in the medical literature from 1963 to 1991, the relative risk for suicide among male physicians increased from 1.1 to 3.4, while the risk among female physicians jumped from 2.5 to 5.7.

At the same time, deaths among physicians from cancer, heart disease, and other ailments dropped 40%-60%.

However, in an interview, Dr. Mansky was quick to point out that many studies of suicide among physicians are "20 years old and fraught with methodological defects."

In his informal study Dr. Mansky asked the medical directors of six state physician health programs to tabulate the number of physician suicides between 1992 and 2002. Out of 2,500 participants enrolled in the six programs during that time--mostly for drug and alcohol dependence--13 committed suicide, a number that translates into a relatively low rate.

That finding runs counter to the results from one of the most recent studies aimed at tracking the cause of death among physicians in 28 states between 1984 and 1995 as reported by the National Occupational Mortality Surveillance database.

The database indicates that white male and white female physicians aged 90 or under were significantly more likely to die from suicide, compared with their counterparts in other professions, while black physicians did not differ in this respect (Am. J. Prey. Med. 19[3]:155-59, 2000). Specifically, 2.9% of white male physicians and 3.6% of white female physicians committed suicide, compared with 2.3% of black physicians and 0% of black female physicians.

In October 2002, as part of an effort to better understand the prevalence of suicide among physicians, the American Foundation for Suicide Prevention sponsored a workshop on the topic. Dr. Mansky, one of workshop participants, said the main goal of the gathering was to develop a consensus statement that will recommend concrete strategies for preventing physician suicide.

The statement will be targeted for use at hospitals, medical schools, group practices, and by physicians themselves.

According to the best available data, he said, male physicians have a relative risk of suicide of up to three times that of the general population, while females have a risk of up to six times that of the general population.

Among physicians, there are no gender differences in the number of those who attempt suicide, but male physicians tend to complete suicide more often than their female counterparts. No good data exist on possible differences in suicide prevalence among medical specialties.

"All of us are at the point where we need to do more research in physicians' health," Dr. Mansky said.

Physicians have a higher rate of suicide, compared with the general population not only because many are overworked and generally stressed, but also because of their increased knowledge of toxicology and access to legal drugs, he added. Physicians most commonly use firearms and drug overdoses to commit the act.