Male and Female Physician Suicidality: A Systematic Review and Meta-analysis | Health Care Workforce | JAMA Psychiatry | JAMA Network
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    2 Comments for this article
    Counter intuitive to whom?
    Cheryl Winchell, M.D. | Retired primary care M.D.
    It has long been known that women physicians have a suicide risk significantly higher than male physicians. The data in the 80's supported a 7 fold higher risk of suicide for women physicians compared to men. We lost one of the 7 women in my class to suicide a few years after graduation and one female attending during my medical school years. Suicide rates among physicians are much higher than reported. Death certificates are filled out by fellow physicians. I know of at least two physician suicides that were reported out as accidental deaths.
    Cheryl Winchell, M.D.
    Male and female physician suicidality
    Tomoyuki Kawada, MD | Nippon Medical School
    Duarte et al. conducted a meta-analysis to evaluate male and female physician suicide risk (1). Standardized mortality ratio (SMR) (95% confidence interval [CI]) of female physicians against women in general for suicide was 1.46 (1.02 to 1.91) since 1980. In contrast, SMR (95% CI) of male physicians against men in general for suicide was 0.67 (0.55 to 0.79). Furthermore, difference in SMRs (95% CIs) of male and female physician after 1980 vs before 1980 for suicide were -0.84 (-1.26 to -0.42) and -1.96 (-3.09 to -0.84), respectively. There was a sex difference in suicidality, although recent decreasing trend was observed in both males and female physicians. I want to present information on sex difference and time trend of suicidality in physicians.

    Dutheil et al. conducted a meta-analysis on suicide among physicians (2). SMR (95% CI) of female physicians for suicide was 1.9 (1.4 to 2.58), which was predominant than male physician. Risk of suicide was observed especially in US physicians, and it decreased over time in Europe. They also recognized the high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation, and early screening of suicide risk should be conducted at medical workplace. Education program for the job management in physician should be prepared by considering sex difference in their lifestyle.

    1. Duarte D, El-Hagrassy MM, Couto TCE, et al. Male and female physician suicidality: A systematic review and meta-analysis. JAMA Psychiatry. 2020 Mar 4. doi:10.1001/jamapsychiatry.2020.0011
    2. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One. 2019;14(12):e0226361. doi:10.1371/journal.pone.0226361
    Original Investigation
    March 4, 2020

    Male and Female Physician Suicidality: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
    • 2Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
    • 3University of São Paulo, São Paulo, São Paulo, Brazil
    • 4School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
    JAMA Psychiatry. 2020;77(6):587-597. doi:10.1001/jamapsychiatry.2020.0011
    Key Points

    Question  Are age-standardized suicide mortality ratios (SMRs) for male and female physicians high worldwide after 1980, and did they decrease from before to after 1980?

    Findings  In a meta-analysis of 9 studies and databases, female physicians’ SMRs were high, while male physicians’ SMRs were significantly lower since 1980, and both SMRs decreased over time. A systematic review showed increased risk associated with male sex, relationship difficulties, youthful or elderly age ranges, and especially career difficulties; suicide methods were by poisoning, firearms, and asphyxiation.

    Meaning  More research is critical to address modifiable risks of physician suicide and understand what causes vulnerability in physician subpopulations.


    Importance  Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

    Objective  To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

    Data Sources  This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term “(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors))).” Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

    Study Selection  Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

    Data Extraction and Synthesis  The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

    Main Outcomes and Measures  Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

    Results  Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, −0.84 [95% CI, −1.26 to −0.42]; P < .001; female physicians: SMR, −1.96 [95% CI, −3.09 to −0.84]; P = .002). No evidence of publication bias was found.

    Conclusions and Relevance  In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.