US health care workers are at greater risk of suicide than non–health care workers

By Neha MathurSep 28 2023Reviewed by Lily Ramsey, LLM

In a recent article published in Jama, researchers estimated the risks of death by suicide for six healthcare worker (HCW) groups and non–healthcare workers in the United States of America (USA).

Study: Suicide Risks of Health Care Workers in the US. Image Credit: Ground Picture/Shutterstock.com

Background

All HCWs, including physicians, manage heavy workloads while caring for severely ill patients and have little control over patient outcomes, which makes their occupation stressful and emotionally demanding.

Thus, even though some of them might live longer and healthier lives than the general population, the risk of suicide for HCWs might be higher, too.

Studies have investigated standardized mortality ratios (SMRs) due to suicide for physicians but not 95% of other HCWs. A recent meta-analysis of small-scale methodologically crude studies published during 1969-2018 found that suicide SMRs for female and male physicians were 1.94 and 1.24, respectively.

In past decades, risks of suicide among physicians might have declined, but information concerning suicide risks among other HCWs is scarce.

About the study

In the present cohort study, researchers used a USA-wide representative sample of 1,842,000 HCWs from the 2008 American Community Survey (ACS) linked to National Death Index records to determine their cause of death. 

All ACS participants were aged ≥26 years and comprised six types of HCWs, registered nurses, physicians, healthcare–diagnosticians/treating practitioners (e.g., dentists), healthcare technicians, healthcare support workers (e.g., home health aides), and behavioral/social health workers (e.g., psychologists, counsellors).

The main study outcome was death due to suicide among all HCWs per International Classification of Diseases (ICD) codes- X60-X84, Y87, and U03, stratified by age and sex.

The team computed suicide rates per 100,000 person-years with 95% confidence intervals (CIs), wherein all ACS participants aged ≥26 comprised the reference group. 

Further, the team used Cox proportional hazard regression models to estimate suicide hazard ratios (HRs) for all HCW groups versus non-healthcare workers while accounting for their baseline sociodemographic characteristics, including age, gender, race/ethnicity, marital and educational statuses, personal annual income, and region of residence (rural/urban), also adding personal income in secondary analyses as a potential mediator. 

The team measured event (suicide) time from the ACS survey to suicide or death from other causes till December 31, 2019.

They also explored the interaction of an HCW gender with suicide hazard, however, without adjusting for multiple comparisons; thus, researchers cautioned judicious interpretation of CIs.

Results

Regarding baseline characteristics of all six HCW groups, the researchers noted that the highest percentage of physicians were men, while most registered nurses and healthcare support workers were women.

The proportion of non–Hispanic Black and Hispanic people in the healthcare support worker group was the highest.

As expected, the income of healthcare support workers was the lowest, while that of physicians, registered nurses, and other healthcare–diagnosticians/treating practitioners was highest.

Compared to non–HCWs, registered nurses, healthcare support workers, and health technicians had markedly higher gender- and age-standardized suicide rates, while healthcare–diagnosticians/treating practitioners had lower standardized suicide rates than non–HCWs. 

Even though suicide risk was not higher for physicians compared to non–HCWs, the CIs for this group were wide, and the sample size was constrained when gender-stratified. 

The secondary analyses controlling for personal income or ceasing follow-up at age 65 did not change these findings substantially. Likewise, the adjusted suicide hazards for these three HCW groups remained significantly higher even after controlling for potential confounders.

Suicides among HCWs grew from 3.8 million to 6.6 million between 2008 and 2021 in the USA. Thus, these results are broadly consistent with studies showing that increased risks for mental health problems in HCWs, such as mood disorders, might affect their work, contributing to increased suicide risk. 

Intriguingly, adjusted Cox regression analyses suggested a stronger association between suicide risk and occupation among all female HCWs than among male workers (χ2 = 4.83; P = .03).

Thus, future research might explore reasons for gender-related variations in occupational roles, stress, and job satisfaction. 

Studies might also explore specific healthcare work-related occupational exposures, e.g., the effect of burnout, that are associated with suicidal ideation and might contribute to suicide risk. 

Conclusions

The current study analyzed risks of death by suicide in HCWs in a period before the coronavirus disease 2019 (COVID-19) pandemic. During the pandemic, efforts to improve the mental health of HCWs received higher attention, which might lose momentum now as the pandemic has receded.

However, it will remain crucial to identify and enhance specific work-related factors that contribute to mental health occupational risks of HCWs, especially registered nurses, health technicians, and support workers.

Alongside, there is a need for workplace mental health interventions that make mental health services affordable and easy to access. Moreover, it would be important to ensure that HCWs do not have to face disciplinary action for seeking mental health treatment.