|
ScienceWeek
PSYCHIATRY: ON THE HIGH RATE OF PHYSICIAN SUICIDE
The following points are made by Eva Schernhammer (New Engl. J. Med. 2005 352:2473):
1) Although physicians tend to have healthier lifestyles than those of the general public and thus to live longer, it has been known for some time that suicide rates among doctors are higher than those in the general population[1]. And when these tragic events make it into the headlines, as did the recent suicide of gifted heart surgeon Jonathan Drummond-Webb, we begin to wonder why these healers apparently cannot heal the hurt in their own lives.
2) The gap in suicide rates evidently begins as early as medical school, where overall suicide rates are higher than in the age-matched population. This increased rate of suicide is driven largely by higher rates among women: female medical students commit suicide at the same rate as male medical students,[2] whereas in the United States in general, suicide rates are much higher among men. Evidence from a large study of physician suicide indicates that female doctors, in particular, are much more likely than other women to take their own lives. The combined results of 25 studies suggest that the suicide rate among male doctors is 40 percent higher than that among men in general, whereas the rate among female doctors is 130 percent higher than that among women in general.[1]
3) Several factors that may contribute to the suicide of physicians, especially female physicians, deserve closer examination. Physicians may have a higher prevalence of depression than nonphysicians, and depression is clearly an important risk factor for suicide; among female physicians, the risk may be exacerbated by sexual harassment; and when they become suicidal, physicians generally choose effective suicide methods.
4) A prevalent view is that both biologic and psychosocial factors play a role -- and interact -- in the decision to commit suicide. There is a higher prevalence of psychiatric disorders among physicians than in the general population. Some 30 to 70 percent of all persons who attempt suicide apparently have an affective disorder (generally depression), a substance-use-related disorder, or schizophrenia.[3] Evidence further suggests that drug abuse and alcoholism, possibly under circumstances of heightened stress or depression, are often associated with the suicides of physicians. Female physicians, in particular, have been shown to have a higher frequency of alcoholism than women in the general population. Drug abuse is also related to specialty, being particularly prevalent among psychiatrists, anesthesiologists, and emergency physicians. Recent reports emphasize that the exposure that anesthesiologists have to drugs as they work represents a risk factor for drug addiction and possibly suicide, indicating that access to drugs may support higher suicide rates among physicians by a variety of pathways. In the general population, according to autopsy studies and other evidence, as many as 25 percent of all persons who commit suicide are drunk at the time of their deaths.[4,5]
References:
1. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-2302
2. Pepitone-Arreola-Rockwell F, Rockwell D, Core N. Fifty-two medical student suicides. Am J Psychiatry 1981;138:198-201
3. Litman RE. Mental disorders and suicidal intention. Suicide Life Threat Behav 1987;17:85-92
4. Kirsling RA, Kochar MS. Suicide and the stress of residency training: a case report and review of the literature. Psychol Rep 1989;64:951-959. [ISI][Medline]
5. Frank E, Brogan D, Schiffman M. Prevalence and correlates of harassment among US women physicians. Arch Intern Med 1998;158:352-358
Science http://www.sciencemag.org
--------------------------------
Related Material:
PUBLIC HEALTH: TRENDS IN THOUGHTS OF SUICIDE IN THE US
The following points are made by R.C. Kessler et al (J. Am. Med. Assoc. 2005 293:2487):
1) Suicide is one of the leading causes of death worldwide. As a result, the World Health Organization[1] and the US surgeon general[2] have highlighted the need for more comprehensive data on the occurrence of suicidal thoughts and attempts, according to the assumption that such data would be useful for planning national health care policy, as well as for evaluating efforts to reduce suicide and suicide-related behaviors. The latter are among the official national health objectives in the United States.[3] The assumption that information on suicide-related behaviors, including thoughts, plans, gestures, and nonfatal attempts, is important for understanding completed suicides can be called into question because only a small fraction of suicide attempters eventually complete suicide.[4] However, suicide attempts are significant predictors of subsequent completed suicide, as well as important in their own right as indicators of extreme psychological distress.
2) Little is known about trends in suicidal ideation, plans, gestures, or attempts or about their treatment. Such data are needed to guide and evaluate policies to reduce suicide-related behaviors. The objective of this study was to analyze nationally representative trend data on suicidal ideation, plans, gestures, attempts, and their treatment. Data came from the 1990-1992 National Comorbidity Survey and the 2001-2003 National Comorbidity Survey Replication. These surveys asked identical questions to 9708 people aged 18 to 54 years about the past year's occurrence of suicidal ideation, plans, gestures, attempts, and treatment. Trends were evaluated by using pooled logistic regression analysis. Face-to-face interviews were administered in the homes of respondents, who were nationally representative samples of US English-speaking residents.
3) Results of the study: No significant changes occurred between 1990-1992 and 2001-2003 in suicidal ideation, plans, gestures, or attempts, whereas conditional prevalence of plans among ideators increased significantly, and conditional prevalence of gestures among planners decreased significantly. Treatment increased dramatically among ideators who made a suicidal gesture and among ideators who made an attempt.
4) The authors conclude: Despite a dramatic increase in treatment, no significant decrease occurred in suicidal thoughts, plans, gestures, or attempts in the United States during the 1990s. Continued efforts are needed to increase outreach to untreated individuals with suicidal ideation before the occurrence of attempts and to improve treatment effectiveness for such cases.[5]
References (abridged):
1. World Health Organization. Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies. Geneva, Switzerland: World Health Organization; 1996
2. The Surgeon General's Call to Action to Prevent Suicide. Washington, DC: US Public Health Service; 1999
3. US Department of Health and Human Services. Healthy People 2010, 2nd ed: With Understanding and Improving Health and Objectives for Improving Health. Washington, DC: US Government Printing Office; 2000
4. Kuo WH, Gallo JJ. Completed suicide after a suicide attempt. Am J Psychiatry. 2005;162:633
5. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Centers for Disease Control and Prevention Web site]. Available at: http://www.cdc.gov/ncipc/wisqars/default.htm. Accessed March 21, 2005
J. Am. Med. Assoc. http://www.jama.com
--------------------------------
Related Material:
PUBLIC HEALTH: METHODS OF SUICIDE AMONG ADOLESCENTS
The following points are made by Centers for Disease Control (MMWR 2004 53:471):
1) In 2001, suicide was the third leading cause of death among persons aged 10-19 years.(1) The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%).(1) During 1992-2001, although the overall suicide rate among persons aged 10-19 years declined from 6.2 to 4.6 per 100,000 population,(1) methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the US during 1992-2001.
2) The results of that analysis indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10-14 and 15-19 years. Beginning in 1997, among persons aged 10-14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.
3) Among persons aged 10-14 years, the rate of firearm suicide decreased from 0.9 per 100,000 population in 1992 to 0.4 in 2001, whereas the rate of suffocation suicide increased from 0.5 in 1992 to 0.8 in 2001. Rate regression analyses indicated that, during the study period, firearm suicide rates decreased an average of approximately 8.8% annually, and suffocation suicide rates increased approximately 5.1% annually. Among persons aged 15-19 years, the firearm suicide rate declined from 7.3 in 1992 to 4.1 in 2001; the suffocation suicide rate increased from 1.9 to 2.7. Rate regression analyses indicated that, during the study period, the average annual decrease in firearm suicide rates for this age group was approximately 6.8%, and the average annual increase in suffocation suicide rates was approximately 3.7%. Poisoning suicide rates also decreased in both age groups, at an average annual rate of 13.4% among persons aged 10-14 years and 8.0% among persons aged 15-19 years. Because of the small number of suicides by poisoning, these decreases have had minimal impact on changes in the overall profile of suicide methods of youths.
4) Among persons aged 10-14 years, suffocation suicides began occurring with increasing frequency relative to firearm suicides in the early- to mid-1990s, eclipsing firearm suicides by the late 1990s. In 2001, a total of 1.8 suffocation suicides occurred for every firearm suicide among youths aged 10-14 years. Among youths aged 15-19 years, an increase in the frequency of suffocation suicides relative to firearm suicides began in the mid-1990s; however, in 2001, firearms remained the most common method of suicide in this age group, with a ratio of 0.7 suffocation suicides for every firearm suicide.
5) The findings in this report indicate that the overall suicide rate for persons aged 10-19 years in the US declined during 1992-2001 and that substantial changes occurred in the types of suicide methods used among those persons aged 10-14 and 15-19 years. Rates of suicide using firearms and poisoning decreased, whereas suicides by suffocation increased. By the end of the period, suffocation had surpassed firearms to become the most common method of suicide death among persons aged 10-14 years.
6) The reasons for the changes in suicide methods are not fully understood. Increases in suffocation suicides and concomitant decreases in firearm suicides suggest that persons aged 10-19 years are choosing different kinds of suicide methods than in the past. Data regarding how persons choose among various methods of suicide suggest that some persons without ready access to highly lethal methods might choose not to engage in a suicidal act or, if they do engage in suicidal behavior, are more likely to survive their injuries.(4) However, certain subsets of suicidal persons might substitute other methods.(5) Substitution of methods depends on both the availability of alternatives and their acceptability. Because the means for suffocation (e.g., hanging) are widely available, the escalating use of suffocation as a method of suicide among persons aged 10-19 years implies that the acceptability of suicide by suffocation has increased substantially in this age group.
References (abridged):
1. CDC. Web-based Injury Statistics Query and Reporting System (WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 2004.
2. National Center for Health Statistics. Multiple cause-of-death public-use data files, 1992 through 2001. Hyattsville, Maryland: U.S. Department of Health and Human Services, CDC, 2003
3. Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA. Deaths: injuries, 2001. Natl Vital Stat Rep. 2004;52:1-5
4. Cook PJ. The technology of personal violence. In: Tonry M, ed. Crime and Justice: An Annual Review of Research, vol. 14. Chicago, Illinois: University of Chicago Press, 1991:1-71
5. Gunnell D, Nowers M. Suicide by jumping. Acta Psychiatrica Scandinavica. 1997;96:1-6
Centers for Disease Control and Prevention http://www.cdc.gov
ScienceWeek http://scienceweek.com
|