Suicide among physicians and health-care workers: A systematic review and meta-analysis

Frédéric Dutheil (1, 2, 3, 4) , Claire Aubert (5) , Bruno Pereira (6) , Michael Dambrun (1) , Fares Moustafa (7) , Martial Mermillod (8, 9) , Julien Baker (10) , Marion Trousselard (11) , François-Xavier Lesage (12, 13) , Valentin Navel (14)

1 LAPSCO - Laboratoire de Psychologie Sociale et Cognitive
2 Service Santé Travail Environnement [CHU Clermont-Ferrand]
3 WittyFit
4 ACU - Australian Catholic University
5 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
6 Unité de Biostatistiques [CHU Clermont-Ferrand]
7 Pôle Urgences [CHU Clermont-Ferrand]
8 LPNC - Laboratoire de Psychologie et NeuroCognition
9 IUF - Institut universitaire de France
10 Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
11 IRBA - Institut de Recherche Biomédicale des Armées, Département Neurosciences et Contraintes Opérationnelles, Unité de Neurophysiologie du Stress, 92123 Brétignysur- Orge cedex, France
12 EPSYLON - Dynamique des capacités humaines et des conduites de santé
13 CHU Montpellier
14 Service d'Ophtalmologie [CHU Clermont-Ferrand]

Background : Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among healthcare workers. Method : The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect metaanalysis. Differences by study-level characteristics were estimated using stratified metaanalysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). Results : The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. Conclusion : Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

Domaines: Médecine humaine et pathologie; Psychologie

Frédéric Dutheil, Claire Aubert, Bruno Pereira, Michael Dambrun, Fares Moustafa, et al.. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS ONE, 2019, 14 (12), pp.e0226361. ⟨10.1371/journal.pone.0226361⟩. ⟨hal-02971858⟩