US health workers had an increased risk for suicide compared with employees in other sectors, with the risk being greater among women than men. The study noted that statistics may be under-reported.
The nationally representative US cohort study, which used data from 2008 to 2019, found the risk of suicide was 32% higher among the 176 000 healthcare workers in the study (adjusted hazard ratio [aHR] 1.32, 95% CI 1.13-1.54), and highest among support staff, followed by registered nurses and health technicians:
• Support workers: aHR 1.81 (95% CI 1.35-2.42)
• Nurses: aHR 1.64 (95% CI 1.21-2.23)
• Technicians: aHR 1.39 (95% CI 1.02-1.89)
No increased suicide risk was seen among physicians or other healthcare workers included in the study, reported the researchers, led by Mark Olfson, MD, MPH, of the New York State Psychiatric Institute.
Writing in JAMA, they noted that most prior studies examining suicide risk in healthcare have focused on physicians, who represent only about 5% of the workforce.
“These data make the case that we need to improve the detection and treatment of healthcare workers experiencing mental health problems [and] crises,” Olfson told MedPage Today.
Support workers, whose work is often low-paid and repetitive, rarely see opportunity for advancement, he noted. “We need to look at their working conditions and try to make reforms to provide them greater support, flexibility in their work routines, and timely access to mental healthcare.”
Healthcare support workers also have an “exceptionally high risk for work-related injuries”, he said.
In a previous study, the team had found a higher risk for overdose deaths among certain healthcare workers, including support staff, and workplace injuries, often preceded such problems.
In the current study, an exploratory analysis revealed that the association between the increased risk for suicide among the health workers was greater for women compared with men (P=0.03 for interaction).
“That’s a new finding,” he said. “We don’t know what’s driving that.”
Various factors could be at play, he speculated, including that female clinicians tend to spend more time in direct clinical care and are more frequently mistreated, more likely to develop insomnia, more likely to report lower job satisfaction, and more prone to burnout.
These psychological risk factors may “hit women harder than men”, he said, and might contribute to this finding.
Olfson stressed, however, that even among healthcare workers, the absolute risk of suicide was still far higher among men than women (20.3 vs 7.0 per 100 000 person-years, respectively, compared with 19.5 vs 4.7 per 100 000 person-years among non-healthcare workers).
Altogether, the study underscored the importance of training healthcare workers to identify warning signs of depression, suicidality, and other mental health problems, Olfson said, as well as the importance of making treatment options readily accessible and confidential.
If healthcare workers’ only option for receiving mental health counselling or care lies within their own organisation, that also can be a barrier to access, he added.
For the study, the team used the Mortality Disparities in American Communities data set, linking participants aged 26 and older from the 2008 American Community Survey to National Death Index records until the end of 2019.
The study population consisted of 1.84m adults, including 176 000 health workers and 1.66m non-healthcare workers (median age 44; 43.4% women). During follow-up, suicides occurred in 200 healthcare workers and 2 500 non-healthcare workers.
Registered nurses comprised the largest share (n=42 000; 91.1% women) of the six healthcare worker groups, followed by healthcare support staff (n=39 000; 89.6% women), health technicians (n=32 500; 78.3% women), social/behavioural health workers (n=27 000; 72.5% women), other healthcare-diagnosing or treating practitioners (n=22 500; 60.9% women), and physicians (n=13 000; 32.4% women).
Annual standardised suicide rates per 100 000 person-years were 21.4 for healthcare support workers, 16.0 for registered nurses, 15.6 for health technicians, 13.1 for physicians, 10.1 for social/behavioural health workers, and 7.6 for other healthcare-diagnosing or treating practitioners, compared with 12.6 for non-healthcare workers.
Adjusted hazards showed no significant increase in suicide risk for physicians (aHR 1.11, 95% CI 0.71-1.72), social/behavioural health workers (aHR 1.14, 95% CI 0.75-1.72), or other healthcare-diagnosing or treating practitioners (aHR 0.61, 95% CI 0.36-1.03).
Despite not finding an increased risk of suicide among physicians, Olfson cautioned against ignoring the “substantial” stressors faced by physicians face – from longer hours and greater dissatisfaction with their work-life balance to elevated levels of burnout.
And he pointed out that the study sample was too small to tease apart the risk of suicide among female doctors, noting that previous research has shown differences between male and female physicians when it comes to suicide risk.
A study limitation included that suicide deaths of healthcare workers may be more likely to be under-reported than those of other professionals, due to stigma. In some cases, a colleague of the deceased may complete the death certificate, Olfson said, and “with the family in mind … may not count it as a suicide”.
Study details
Suicide Risks of Health Care Workers in the US
Mark Olfson, Candace Cosgrove, Melanie Wall, P; et al.
Published in JAMA Network on 26 September 2023
Key Points
Question Are US health care workers at greater risk of suicide than non–health care workers?
Findings From a nationally representative cohort of approximately 1.84m employed adults observed from 2008 to 2019 and controlling for potentially confounding socio-demographic characteristics, the risk of suicide was higher for healthcare workers compared with non–healthcare workers, including specifically registered nurses, healthcare support workers, and health technicians.
Meaning Heightened suicide risk for registered nurses, health care support workers, and health technicians highlights the need for concerted efforts to support their mental health.
Abstract
Importance
Historically elevated risks of suicide among physicians may have declined in recent decades. Yet there remains a paucity of information concerning suicide risks among other health careworkers.
Objective
To estimate risks of death by suicide among US health care workers.
Design, Setting, and Participants
Cohort study of a nationally representative sample of workers from the 2008 American Community Survey (N = 1 842 000) linked to National Death Index records through December 31, 2019.
Main Outcomes and Measures
Age- and sex-standardised suicide rates were estimated for 6 health care worker groups (physicians, registered nurses, other health care–diagnosing or treating practitioners, health technicians, healthcare support workers, social/behavioural health workers) and non–health care workers. Cox models estimated hazard ratios (HRs) of suicide for health care workers compared with non–health care workers using adjusted HRs for age, sex, race and ethnicity, marital status, education, and urban or rural residence.
Results
Annual standardised suicide rates per 100 000 persons (median age, 44 [IQR, 35-53] years; 32.4% female [among physicians] to 91.1% [among registered nurses]) were 21.4 (95% CI, 15.4-27.4) for health care support workers, 16.0 (95% CI, 9.4-22.6) for registered nurses, 15.6 (95% CI, 10.9-20.4) for health technicians, 13.1 (95% CI, 7.9-18.2) for physicians, 10.1 (95% CI, 6.0-14.3) for social/behavioural health workers, 7.6 (95% CI, 3.7-11.5) for other health care–diagnosing or treating practitioners, and 12.6 (95% CI, 12.1-13.1) for non–healthcare workers. The adjusted hazards of suicide were increased for healthcare workers overall (adjusted HR, 1.32 [95% CI, 1.13-1.54]), health care support workers (adjusted HR, 1.81 [95% CI, 1.35-2.42]), registered nurses (adjusted HR, 1.64 [95% CI, 1.21-2.23]), and health technicians (adjusted HR, 1.39 [95% CI, 1.02-1.89]), but adjusted hazards of suicide were not increased for physicians (adjusted HR, 1.11 [95% CI, 0.71-1.72]), social/behavioural health workers (adjusted HR, 1.14 [95% CI, 0.75-1.72]), or other health care–diagnosing or treating practitioners (adjusted HR, 0.61 [95% CI, 0.36-1.03) compared with non–healthcare workers (reference).
Conclusions
Relative to non–health careworkers, registered nurses, health technicians, and healthcare support workers in the US were at increased risk of suicide. New programmatic efforts are needed to protect the mental health of these US workers.
JAMA Network article – Suicide Risks of Health Care Workers in the US (Creative Commons Licence)
JAMA Psychiatry article – Male and Female Physician Suicidality (Creative Commons Licence)
MedPage Today article – Higher Suicide Risk in Nurses, Other Health Workers (Open access)
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