Medicine: a profession with a high risk of suicide

When it comes to correctly identifying the factors that may increase or decrease the level of risk of the suicidal causeIt has always been of great interest to attend to the close relationship they have with such conduct. It must be taken into account that this level increases proportionally to the number of manifest factors and that some have a higher specific weight than others. Knowing them and studying their relevance can be decisive when it comes to understanding the problems that surround each group.

Unfortunately for interns, their profession constitutes a significant added risk to suffer a death by suicide. According to the American Foundation for Suicide Prevention (AFSP), an average of 400 commit suicide each year physicians of both sexes in the United States, which is equivalent in absolute numbers to an entire medicine. Similar dynamics also occur among medical students in which, after accidents, suicide is the most common cause of death.

• Related article: "What needs to be done to lower the suicide rate?"

The relationship between medicine and suicide

Studies carried out by the AFSP in 2002 confirm that doctors died by suicide more often than other people of the same age, gender of the general population and of other professions. On average, death by suicide is 70% more common among male physicians than other professionals, and 250-400% higher among female physicians. Unlike other populations, in which men commit suicide four times more often than women, doctors have a suicide rate that is very similar between men and women.

Subsequently, Schernhammer and Colditz conducted in 2004 a meta-analysis of 25 quality studies on medical suicide and concluded that the rate The aggregate suicide rate for male physicians compared to males in the general population is 1.41: 1, with 95% and a confidence interval of 1.21 to 1,65. For female physicians, the ratio was 2.27: 1 (95% CI = 1.90-2.73) compared to women in the general population; which constitutes a worryingly high rate.

However, the singularities with respect to the rest of professional groups do not end here. Several epidemiological studies have found that members of some specific occupations have a higher risk of suicide than others and that the Most of this considerable variation in risk is explained by socioeconomic factors, in all cases, except those belonging to the doctors.

A case-control study with 3,195 suicides and 63,900 matched controls in Denmark (Agerbo et al. 2007) corroborated that the risk of suicide decreases in all occupations if the variables of psychiatric income, employment status, marital status and gross income are controlled. But, again, doctors and nurses were the exception, in which, in fact, the suicide rate increased.

Also, between people who have received inpatient psychiatric treatment There are modest associations between suicide and occupation, but not for physicians, who are at much higher risk, up to four times higher.

Finally, the combination of situations with high stress together with the access of lethal means of Suicide such as firearms or medicines is also an indicator of certain groups occupational. Among all physicians, an even higher risk for anesthetists has been assessed for having easy access to anesthetic drugs. These studies are reflected with the results obtained from other high-risk groups such as dentists, pharmacists, veterinarians and farmers (Hawton, K. 2009).

A very sacrificed profession

After preparing a consensus document among experts to assess the state of knowledge of depression and deaths by suicide among physicians, it was concluded that the traditional culture of medicine places the mental health of the doctor as a low priority Despite the evidence that they have a high prevalence of mood disorders not properly treated. Barriers to clinicians seeking help are usually fear of social stigma and compromising their professional career, so they postpone it until the mental disorder has become chronic and complicated with other pathologies.

The etiopathogenic factors that can explain the increased risk of suicide consist of poor coping, or lack of resources for due to coping with the psychosocial risks inherent to clinical activity such as the stress of the clinical activity itself, harassment and the professional wear (burnout), as well as institutional pressures (cuts, forced hours and shifts, lack of support, malpractice litigation).

It has been recommended to change professional attitudes and change institutional policies to encourage Doctors to ask for help when they need it and to help their colleagues to recognize and treat themselves when they need it. The doctors are as vulnerable to depression as the general populationBut they seek help to a lesser extent and rates of completed suicide are higher (Center et al., 2003).

Bibliographic references:

• Medicine and Occupational Safety. Printed version ISSN 0465-546X Med. sure. work vol.59 no.231 Madrid Apr.-Jun. 2013
• Suicide and Psychiatry. Preventive and management recommendations for suicidal behavior. Bobes García J, Giner Ubago J, Saiz Ruiz J, editors. Madrid: Triacastela; 2011
• http://afsp.org/
• http://www.doctorswithdepression.org/