What you need to know
The thirteenth leading cause of death worldwide is suicide, with previous research, often pre-2000, suggesting physicians may be at a higher risk compared to non-physicians. However, little contemporary information exists on suicide among Canadian physicians. Researchers in this study evaluated the risk of suicide and self-harm among physicians compared to non-physicians in Ontario, Canada.
What is this research about?
Previous studies from the United States, Europe and Australia, reported higher country-level rates of suicide in physicians compared to non-physicians. Several risk factors have been identified to be associated with suicide among physicians in Canada such as high levels of psychosocial stress, burnout, mental health, substance disorders, and recently the COVID epidemic. A single previous study from Quebec identified 36 physician suicides between 1992 to 2009. Whether the suicide risk and self-harm, a behaviour that is strongly predictive of suicide, is higher among physicians compared to non-physicians in a contemporary Canadian cohort remains unknown.
In this study, researchers evaluated the risk of suicide and self-harm among physicians compared to non-physicians in Ontario, Canada.
What did the researchers do?
The researchers conducted a population-based, retrospective cohort study using registration data from the College of Physicians and Surgeons of Ontario linked to administrative health data at ICES. Physicians 25 or older registered to practice from 1990 to 2015 with follow-up in 2016 were included. The study cohort included all newly registered physicians and non-physicians aged 25 or older from January 1990 to December 2015. The researchers then analyzed data from 35,989 physicians and 6,585,197 non-physicians.
The data obtained from each participant included:
- location of residence
- income quintile
- coexisting medical illnesses
- specialty (family medicine, psychiatry, anesthesia, internal medicine, surgery, radiology)
- medical school location (Canada vs. international)
- previous healthcare use
- previous mental health disorders
The primary study outcomes were a measure of physician death by suicide and physician episodes of self-harm resulting in an admittance to the emergency room or requiring hospitalization as defined by the International Statistical Classification of Diseases Codes. The secondary outcome was the composite of suicide or self-harm events across the population.
What did the researchers find?
Overall, a higher proportion of physicians were male and younger compared to non-physicians. They were also less likely to live in a rural setting and more likely to live in higher-income neighbourhoods. Physicians also had fewer medical disorders and fewer health care visits. About one in 1,300 (0.08%) physicians died by suicide between 1990 and 2016 and about 1 in 400 died by suicide or had an episode of self-harm between April 2002 and 2016. The crude rate of physician suicide was 9.44 vs. 11.55 in on-physicians per 100,000 person-years.
When examining risk factors at the time of death, a lower risk of suicide or suicide/self-harm was associated with age over 45 years whereas a higher risk was associated with a history of a mood or anxiety disorder, an outpatient mental health visit in the past year, and any psychiatry visit in the past year.
Limitations of the research
The researchers note that their study had several limitations. The study cohort included newly registered physicians from 1990 onwards, therefore limiting the number of individuals over 60 years of age. This limitation could have led to an underestimate of the total risk of death from suicide and self-harm. Another limitation was that the self-harm outcome only captured more severe presentations and did not capture ambulatory visits. Misclassification or underreporting also might have occurred resulting in an underestimation of the rate of self-harm episodes in physicians.
Other limitations included underreporting of specialty information, not including medical students in the study cohort and using only one-time point, which may not reflect the changes over time. Researchers were also unable to examine time-based trends.
How can you use this research?
The researchers suggest that by examining self-harms and the combination of suicide or self-harms, interventions and awareness programs can be developed with the goal to prevent the loss of life. Furthermore, introducing wellness programs, screening and individualized tests early on in the careers of residents, physicians and those in other subspecialty training could prove to be beneficial.
About the researchers
Manish M. Sood1,4, Emily Rhodes3, Robert Talarico2,3, Caroline Gérin-Lajoie5, Christopher Simon5, Edward Spilg1,3,Taylor McFadden5, Kwadwo Kyeeremanteng1,3, Daniel T. Myran2,3,7, Nicholas Grubic2,3, and Peter Tanuseputro1,3
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, the Ottawa Hospital, Ottawa, Ontario, Canada
- Canadian Medical Association, Physician Wellness and Medical Culture Team, Ottawa, Ontario, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada