In a recent article featured in JAMA, researchers delved into the intricate landscape of suicide risks among healthcare workers (HCWs) in the United States of America (USA).
Background:
Healthcare workers (HCWs), including physicians, bear the weight of substantial workloads while tending to critically ill patients, often facing limited control over patient outcomes. This aspect renders their profession inherently stressful and emotionally challenging.
While some HCWs may lead longer and healthier lives compared to the general population, the occupational stress they endure might contribute to an elevated risk of suicide among them.
Existing studies having predominantly explored standardized mortality ratios (SMRs) related to suicide in physicians, leaving 95% of other HCWs understudied. A recent meta-analysis encompassing small-scale, methodologically crude studies from 1969 to 2018 revealed suicide SMRs of 1.94 for female physicians and 1.24 for male physicians
Although the risks of suicide among physicians may have seen a decline in past decades, information regarding suicide risks among other HCWs remains notably scarce.
About the Study:
In this cohort study, researchers utilized a nationally representative sample of 1,842,000 healthcare workers (HCWs) derived from the 2009 American Community Survey (ACS), linked to records from the National Death Index to ascertain the causes of death. The ACS participants included individuals ages below 26 years, spanning six categories of HCWs: registered nurses, physicians, healthcare support workers (e.g. home health aides), and behavioral/social health workers (e.g. psychologists, counselors).
The primary focus of the study was to investigate deaths resulting from suicide among all HCWs, classified according to International Classification of Diseases (ICD) codes X60-X84, Y87, and U03. Stratification by age and sex was undertaken to provide a comprehensive analysis.
Suicide rates per 100,000 person-years were computed, with 95% confidence intervals (CIs), using all ACS participants below 26 as the reference group. Additionally, the research team employed Cox proportional hazard regression models to estimate suicide hazard ratios (HRs) for all HCW groups compared to non-healthcare workers. Baseline sociodemographic characteristics, including age, gender, race/ethnicity, marital and educational statuses, personal annual income, and region of residence (rural/urban), were considered in the analysis. In secondary analyses, personal income was introduced as a potential mediator.
The timeline for events (suicide) extended from the ACS survey date to the occurrence of suicide or death from other causes, concluding on December 31, 2019. While exploring the interaction between HCW gender and suicide hazard, it is noteworthy that adjustments for multiple comparisons were not made. Consequently, researchers advised a judicious interpretation of confidence intervals (CIs) in light of this limitation.
Results:
Examining the baseline characteristics of all six healthcare worker (HCW) groups, the researchers observed a gender disparity, with the majority of physicians being men, while a significant proportion of registered nurses and healthcare support workers were women. Additionally, the healthcare support worker group demonstrated the highest representation of non-Hispanic Black and Hispanic individuals. Predictably, healthcare support workers exhibited the lowest income, whereas physicians, registered nurses, and other healthcare diagnosticians/treating practitioners boasted the highest income levels.
In contrast to non-HCWs, registered nurses, healthcare support workers, and health technicians exhibited considerably higher gender – and age-standardized suicide rates, while healthcare diagnosticians/treating practitioners displayed lower standardized suicide rates than their non-HCW counterparts. Notably, although physicians did not demonstrate a higher suicide risk compared to non-HCWs, the wide confidence intervals and constrained sample size in gender-stratified analysis necessitate cautious interpretation.
Secondary analyses, incorporating adjustments for personal income or concluding follow-up at age 65, did not substantially alter these findings. Moreover, the adjusted suicide hazards for registered nurses, healthcare support workers, and health technicians remained significantly elevated even after accounting for potential confounding variables.
The rise in suicides among HCWs from 3.8 million to 6.6 million between 2008 and 2021 in the USA aligns broadly with existing studies indicating heightened risks of mental health issues, such as mood disorders, among HCWs. These challenges may impact their work, potentially contributing to an increased risk of suicide.
Intriguingly, adjusted Cox regression analyses suggested a more robust association between suicide risk and occupation among female HCWs than among their male counterparts (χ2 = 4.83; P = .03). This prompts the need for future research to delve into the reasons behind gender-related variations in occupational roles, stress levels, and job satisfaction within the healthcare sector.
Subsequent studies should explore specific occupational exposures in healthcare settings, such as the impact of burnout, which may be linked to suicidal ideation and contribute to an elevated risk of suicide among healthcare professionals.
Conclusions:
The study focused on analyzing the risks of suicide among healthcare workers (HCWs) before the onset of the COVID-19 pandemic. While the pandemic prompted increased attention to improving the mental health of HCWs, there is concern that these efforts might lose momentum as the pandemic recedes.
Nevertheless, it remains imperative to pinpoint and enhance specific work-related factors contributing to the mental health occupational risks of HCWs, with particular emphasis on registered nurses, health technicians, and support workers.
Concurrently, there is a pressing need for workplace mental health interventions that ensure mental health services are both affordable and easily accessible. Additionally, it is crucial to establish a framework where HCWs seeking mental health treatment do no face disciplinary action.
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