Study finds older physicians and those of asian ancestry are at highest risk of suicide

June 10, 2020

Health care professionals who die by suicide are more likely to be older and nearing the end of their careers, or be of Asian or Pacific Islander ancestry, or confronting physical, mental health or medical malpractice issues, according to a new study from Massachusetts General Hospital.

In a study published in JAMA Surgery, researchers identified modifiable and behavioral risk factors that can lead to burnout and suicide among three groups of health care providers (surgeons, nonsurgeon physicians and dentists) as a way of informing hospitals and residency training programs of potential areas for intervention through increased screening and treatment.

"Our study highlights the fact we have to be concerned about a larger physician population than we originally thought, including individuals facing civil legal, marital and cultural risk factors, as well as those receiving treatment for mental illness," says Yisi Daisy Ji, DMD, with the Department of Oral and Maxillofacial Surgery and lead author of the study.

"Providers are comfortable advising patients when to seek help but are often reluctant to do so themselves. Part of that is the perceived stigma of being a health care professional with a mental health problem, as well as concern it could adversely affect their medical licensure."

The ongoing COVID-19 pandemic raises the importance of physician mental health and suicide prevention. "With physicians across the country facing uncharted challenges in working conditions, redeployment and physical and emotional stress, we must be more vigilant than ever," emphasizes Faith Robertson, MD, with the Department of Neurosurgery, and co-author of the study. "We are calling on all physicians to recognize the signs of mental health difficulties in their colleagues, as well as in themselves, and take early action."

To determine which physicians are most at risk, researchers examined data from the National Violent Death Reporting System from 2003 though 2016. Of the more than 170,000 individuals who died of suicide, 767 were health care professionals.

The Mass General study is the first national evaluation of suicide risk factors and outcomes in the health care provider sub-groups of surgeons, nonsurgeon physicians and dentists.

Some Unexpected Findings

Among the surprising findings of the retrospective study was that physicians who died of suicide were substantially older (mean age, 59.6 years) compared to the general population of suicide victims (mean age, 46.8) years. "This is a previously unrecognized demographic to be at risk," notes Ji.

"Our hypothesis is that the transition into a senior career position or retirement introduces new and often unsettling challenges of purpose, finances and restructuring of routine and family dynamics."

Another unexpected finding by the team was that physicians of Asian and Pacific Islander ancestry were at higher risk of suicide than those of white ancestry. Researchers theorized that the cultural stigma of experiencing mental health problems among this health care population may contribute to low rates of diagnosis and treatment.

Civil legal problems were also found to be a significant risk factor for suicide in physicians compared to the general population, and more so in the nonsurgeon than the surgeon cohort.

The reason, the study suggested, is that physicians in specialties where malpractice litigation is less common (such as nonsurgical) may experience more emotional distress when claims occur, compounded by the duration and uncertainty of each case.

The researchers propose that hospitals would benefit from offering additional psychological as well as legal and human resource support to physicians during times of litigation-induced stress.

With reported cases of physician burnout on the rise nationwide, the study emphases the need for more intense screening and support of health care professionals across all high risk groups.

The paper cited a model educational program at the University of California, San Diego focused on destigmatizing mental health issues and promoting help-seeking behavior and treatment, including an anonymous, interactive online screening program for all medical students and faculty.

Harvard Medical School, too, maintains a robust program that allows physicians under stress to confidentially seek and receive treatment.

"Our study underscores the need for more targeted intervention and support to fit the risk factors of health care professionals," says Ji. "And that support, including mental health screenings and more open conversations among colleagues about warning signs, needs to continue throughout the physician's career if we're going to mitigate burnout and decrease the rate of suicides in the field of medicine."
Lead author Ji is a resident in oral maxillofacial surgery at Massachusetts General Hospital and MD candidate at Harvard Medical School. Senior author Cory Resnick, MD, DMD, is assistant professor, Department of Oral and Maxillofacial Surgery, Mass General. Co-authors include Robertson, a resident in neurosurgery at Mass General, Zachary Peacock DMD, MD, assistant professor, Department of Oral and Maxillofacial Surgery, Mass General, and Nisarg Patel, DMD, research affiliate, Department of Biomedical Informatics, Harvard Medical School.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1B and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2019 Mass General was once again named #2 in the nation by U.S. News & World Report in its list of "America's Best Hospitals.

Massachusetts General Hospital

Related Mental Health Articles from Brightsurf:

Mental health strained by disaster
A new study found that suicide rates increase during all types of disasters -- including severe storms, floods, hurricanes and ice storms -- with the largest overall increase occurring two years after a disaster.

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

World Mental Health Day -- CACTUS releases report of largest researcher mental health survey
On the occasion of 'World Mental Health Day' 2020, CACTUS, a global scientific communications company, has released a global survey on mental health, wellbeing and fulfilment in academia.

Mental illness, mental health care use among police officers
A survey study of Texas police officers examines how common mental illness and mental health care use are in a large urban department.

COVID-19 outbreak and mental health
The use of online platforms to guide effective consumption of information, facilitate social support and continue mental health care delivery during the COVID-19 pandemic is discussed in this Viewpoint.

COVID-19 may have consequences for mental health
The COVID-19 pandemic appears to be adversely affecting mental health among hospitalised patients, the healthcare professionals treating them and the general population.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental ill health 'substantial health concern' among police, finds international study
Mental health issues among police officers are a 'substantial health concern,' with around 1 in 4 potentially drinking at hazardous levels and around 1 in 7 meeting the criteria for post traumatic stress disorder and depression, finds a pooled data analysis of the available international evidence, published online in Occupational & Environmental Medicine.

Examining health insurance nondiscrimination policies with mental health among gender minority individuals
A large private health insurance database was used to examine the association between between health insurance nondiscrimination policies and mental health outcomes for gender minority individuals.

Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.

Read More: Mental Health News and Mental Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to