Physician burnout and suicide are a growing public health concern, with one in 15 physicians experiencing suicidal ideation. Studies consistently show that they are more likely than non-physicians to experience work-related stressors before suicide. Still, the exact nature of these stressors was unknown.
To better understand and characterise these job stressors, researchers at the University of California – San Diego Health reviewed the death investigation narratives from 200 physician suicides collected by a national database between 2003 and 2018.
Using natural language processing and thematic analysis – tools for extracting and interpreting data from the reports – the team was able to identify the main issues contributing to physician job stress and suicide.
The study, published in Suicide and Life-Threatening Behaviour, found six overarching themes in the reports. These included an incapacity to work due to deterioration of physical health, substance use that was jeopardising employment, the interaction between mental health and work-related issues, and relationship conflicts affecting work.
“We often overlook the physical well-being of our healthcare workers, but poor health can lead to difficulty performing tasks at work, which then leads to job stress and mental health issues," said corresponding author Dr Kristen Kim, a resident physician in psychiatry at UC San Diego Health.
The authors outlined several short- and long-term solutions for healthcare systems to consider.
In the short-term, they stressed the need to improve physicians’ access to primary care services, minimise their scheduling challenges, and address their concerns about confidentiality. Kim encouraged them to use resources like the UC San Diego Healer Education Assessment and Referral (HEAR) programme, which provides access to confidential mental health counselling and was recently endorsed by the US Surgeon-General’s Advisory on Health Worker Burnout.
In the long-term, the authors called for broader structural and cultural changes to tackle workplace stress and poor physician self-care.
“The unspoken culture of medicine encourages self-sacrifice, deferred needs and delayed rewards,” said Kim. “We always want to put our patients first, but healers cannot optimally heal unless they themselves are first whole.”
The authors highlighted the importance of cultivating a sense of safety and community among physicians. They also suggested that healthcare systems and medical schools provide additional personal finance education and legal support.
“There is a lot of work to be done,” said Kim, “but identifying and acknowledging the problem is always the first step towards a solution, and that’s exactly what we’re doing.”
Co-authors include: Gordon Y Ye, Nicholas Kos, Sidney Zisook and Judy E Davidson at UC San Diego, as well as Angela Maria Haddad at Universidad Autónoma de Guadalajara.
Study details
Thematic analysis and natural language processing of job‐related problems prior to physician suicide in 2003–2018
Kristen Kim, Gordon Y. Ye, Angela Maria Haddad, Nicholas Kos, Sidney Zisook, Judy E. Davidson.
Published in Suicide and Life-Threatening Behavior on 29 June 2022
Abstract
Introduction
Although previous studies have consistently demonstrated that physicians are more likely than non-physicians to experience work-related stressors prior to suicide, the specific nature of these stressors remains unknown. The current study aimed to better characterise job-related problems prior to physician suicide.
Methods
The study utilised a mixed methods approach combining thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018.
Results
Through thematic analysis, six overarching themes were identified: incapacity to work due to deterioration of physical health, substance use jeopardising employment, interaction between mental health and work-related issues, relationship conflict affecting work, legal problems leading to work-related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes.
Conclusions
This is the first known study that integrated thematic analysis and natural language processing to characterise work-related stressors preceding physician suicide. The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.
Suicide & Life-Threatening Behaviour article (Open access)
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