Suicide among physicians and health-care workers : A systematic review and meta-analysis

Journal article

Dutheil, Frédéric, Aubert, Claire, Pereira, Bruno, Dambrun, Michael, Moustafa, Fares, Mermillod, Martial, Baker, Julien S., Trousselard, Marion, Lesage, François-Xavier and Navel, Valentin. (2019). Suicide among physicians and health-care workers : A systematic review and meta-analysis. PLoS ONE. 14(12), p. e0226361. https://doi.org/10.1371/journal.pone.0226361
AuthorsDutheil, Frédéric, Aubert, Claire, Pereira, Bruno, Dambrun, Michael, Moustafa, Fares, Mermillod, Martial, Baker, Julien S., Trousselard, Marion, Lesage, François-Xavier and Navel, Valentin
Abstract

Background
Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers.

Method
The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet).

Results
The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers.

Conclusion
Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

Year2019
JournalPLoS ONE
Journal citation14 (12), p. e0226361
PublisherPublic Library of Science
ISSN1932-6203
Digital Object Identifier (DOI)https://doi.org/10.1371/journal.pone.0226361
Scopus EID2-s2.0-85076395552
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-28
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online12 Dec 2019
Publication process dates
Accepted24 Nov 2019
Deposited15 Jun 2021
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Crendal, Edward, Walther, Guillaume, Dutheil, Frederic, Courteix, Daniel, Lesourd, Bruno, Chapier, Robert, Naughton, Geraldine A., Vinet, Agnes and Obert, Phillippe. (2014). Left ventricular myocardial dyssynchrony is already present in nondiabetic patients with metabolic syndrome. Canadian Journal of Cardiology. 30(3), pp. 320 - 324. https://doi.org/10.1016/j.cjca.2013.10.019
Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males
Crendal, Edward, Dutheil, Fred, Naughton, Geraldine, McDonald, Tracey and Obert, Philippe. (2014). Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovascular Disorders. 14(95), pp. 1 - 10. https://doi.org/10.1186/1471-2261-14-95
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial
Dutheil, Frederic, Walther, Guillame, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent, Duclos, Martine, Vinet, Agnes, Obert, Philippe, Courteix, Daniel and Lac, Gerard. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial. Lipids in Health and Disease. 13(1). https://doi.org/10.1186/1476-511X-13-112
Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study
Tekath, Marielle, Dutheil, Frederic, Bellini, Romain, Roche, Antoine, Pereira, Bruno, Naughton, Geraldine, Chamoux, Alain and Michel, Jean-Luc. (2014). Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study. BMJ Open. 4(5), pp. 1 - 8. https://doi.org/10.1136/bmjopen-2014-004980
Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program
Serrano-Ferrer, Juan, Walther, Guillaume, Crendal, Edward, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine A., Lesourd, Bruno, Chapier, Robert, Courteix, Daniel and Obert, Philippe. (2014). Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program. Cardiovascular Diabetology. 13(1), pp. 1 - 11. https://doi.org/10.1186/s12933-014-0116-9
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial
Dutheil, Frederic, Walther, Guillaume, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent and Duclose, Martine. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial. Lipids in Health and Disease. 13(112), pp. 1 - 9. https://doi.org/10.1186/1476-511X-13-112
Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden
Crendal, Edward, Walther, Guillaume, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine, Lesourd, Bruno, Chapier, Robert, Rupp, Thomas, Courteix, Daniel and Obert, Philippe. (2013). Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden. Obesity: a resourch journal. https://doi.org/10.1002/oby.20537
Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial
Dutheil, Frederic, Trousselard, Marion, Perrier, Christophe, Lac, Gerard, Chamoux, Alain, Duclos, Martine, Naughton, Geraldine, Mnatzaganian, George and Schmidt, Jeannot. (2013). Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial. PLoS ONE. 8(8), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0071658
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial
Dutheil, Frederic, Lac, Gerard, Lesourd, Bruno, Chapier, Robert, Walther, Guillaume, Vinet, Agnes, Sapin, Vincent, Verney, Julien, Ouchchane, Lemlih and Duclos, Martine. (2013). Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2013.05.012
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement
Lopez, Vincent, Chamoux, Alain, Tempier, Marion, Thiel, Helene, Ughetto, Sylvie, Trousselard, Marion, Naughton, Geraldine and Dutheil, Frederic. (2013). The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002785
Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial
Dutheil, Frederic, Lac, Gerard, Courteix, Daniel, Dore, Eric, Chapier, Robert, Roszyk, Laurence, Sapin, Vincent and Lesourd, Bruno. (2012). Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial. Nutrition Journal. 11(1). https://doi.org/10.1186/1475-2891-11-72