When correctly identifying the factors that may increase or decrease the level of risk of the suicidal cause , it has always been of great interest to pay attention to the close relationship they have with such behaviour. It must be taken into account that this level increases proportionally to the number of manifest factors and that some have a greater specific weight than others. Knowing them and studying their relevance can be a determining factor in understanding the problems surrounding each group.

Unfortunately for medical interns, their profession constitutes an important added risk to a death by suicide. According to the American Foundation for Suicide Prevention (AFSP), an average of 400 physicians of both sexes in the United States commit suicide each year, which is equivalent in absolute numbers to an entire medical school. Similar dynamics also occur among medical students where, after accidents, suicide is the most common cause of death.

The relationship between medicine and suicide

Studies conducted by AFSP in 2002 confirm that doctors died by suicide more frequently than other people of the same age, gender of the general population and other professions. On average, death by suicide is 70% more frequent among male physicians than among other professionals, and 250% to 400% higher among female physicians. Unlike other populations, where men commit suicide four times more often than women, physicians have a suicide rate that is very similar for men and women.

Subsequently, Schernhammer and Colditz conducted a meta-analysis of 25 quality studies on medical suicide in 2004 and concluded that the aggregate suicide rate for male physicians compared to males in the general population is 1.41:1, with a 95% confidence interval of 1.21 to 1.65. For female physicians, the ratio was 2.27:1 (95% CI=1.90-2.73) compared to females in the general population; this is a disturbingly high rate.

However, the singularities with respect to the rest of professional groups do not end here . Several epidemiological studies have ascertained that the members of some specific occupations have a higher risk of suicide than others, and that most of this considerable variation in risk is explained by socioeconomic factors, in all cases, except those belonging to physicians.

A case-control study with 3,195 suicides and 63,900 paired controls in Denmark (Agerbo et al. 2007) found that the risk of suicide decreased in all occupations if the variables of psychiatric admission, employment status, marital status, and gross earnings were controlled for. But, again, doctors and nurses were the exception, where the suicide rate actually increased.

Moreover, among people who have received hospital psychiatric treatment modest associations between suicide and occupation can be seen, but not for doctors, who are at much greater risk, up to four times more.

Finally, the combination of high-stress situations with access to lethal means of suicide such as firearms or medicines is also an indicator for certain occupational groups. Of all physicians, an even greater risk has been assessed for anesthesiologists because of easy access to anesthetic drugs. These studies are reflected in the results obtained from other high-risk groups such as dentists, pharmacists, veterinarians and farmers (Hawton, K. 2009).

A very sacrificial profession

Following an expert consensus document to assess the state of knowledge of depression and suicide deaths among physicians, it was concluded that the traditional culture of medicine places the mental health of the physician as a low priority despite evidence of a high prevalence of inadequately treated mood disorders. The barriers for physicians to seek help are usually the fear of social stigma and of compromising their professional careers, so they postpone it until the mental disorder has become chronic and complicated with other pathologies.

The etiopathogenic factors that may explain the increased risk of suicide include poor coping, or lack of resources for proper coping, with the psychosocial risks inherent in clinical activity such as the stress of clinical activity itself, harassment and burnout, as well as institutional pressures (cutbacks, forced schedules and shifts, lack of support, malpractice litigation).

Changing professional attitudes and institutional policies have been recommended to encourage physicians to ask for help when needed and to help their colleagues to recognize and treat themselves when needed. Physicians are as vulnerable to depression as the general population , but they seek help to a lesser extent and the rates of completed suicide are higher (Center et al., 2003).

Bibliographic references:

  • Medicine and Safety at Work. Print version ISSN 0465-546X Occupational Safety Med. vol.59 no.231 Madrid Apr.-Jun. 2013
  • Suicide and Psychiatry. Preventive recommendations and management of suicidal behavior. Bobes García J, Giner Ubago J, Saiz Ruiz J, editors. Madrid: Triacastela; 2011
  • http://afsp.org/
  • http://www.doctorswithdepression.org/