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Duarte D, El-Hagrassy MM, Couto TCE, Gurgel W, Fregni F, Correa H. Male and Female Physician Suicidality: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020;77(6):587–597. doi:10.1001/jamapsychiatry.2020.0011
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?
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.
More research is critical to address modifiable risks of physician suicide and understand what causes vulnerability in physician subpopulations.
Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.
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.
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.
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).
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.
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