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As the medical community braces for the mental health crisis emerging from COVID-19, a new study identified several risk factors for suicide among healthcare professionals.

Compared with the general population, an increased risk of suicide was observed among surgeons, nonsurgeon physicians, and dentists who had job problems like conflicts with superiors (odds ratio 1.79, 95% CI 1.49-2.17, P<0.001), legal problems (OR 1.61, 95% CI 1.15-2.26, P=0.006), or physical health problems (OR 1.40, 95% CI 1.19-1.64, P<0.001), reported Yisi D. Ji, DMD, of Harvard Medical School in Boston, and colleagues.

Healthcare workers who died by suicide were also substantially older than those who died by suicide in the general population, and this was identified as a risk factor across all specialties as well (59.6 vs 46.8 years), the researchers wrote in their study online in .

However, 767 suicide deaths occurred among healthcare professionals in the study, which was just 0.5% of the total number of suicides recorded in the used in this study.

"The prevailing belief is that medical residents have a greater risk of suicide owing to difficulty associated with the high number of training hours required," Ji and co-authors wrote. "Our results suggest that, in addition to reports describing trainee burnout, another population comprising older surgeons and nonsurgeon physicians may also be at risk of suicide."

Physicians have been shown to than the general population, and mental health issues are on the rise among healthcare professionals on the frontlines of the COVID-19 pandemic.

The association between age and suicide risk is "worrisome," as surgeons have been known to report being satisfied with their careers and feeling respected in their communities, commented Julie Ann Freischlag, MD, of Wake Forest Baptist Health in Salem, North Carolina, and colleagues, in an .

This "may be associated with working longer before retirement," Freischlag and co-authors noted. "Loss of connection with colleagues during retirement and a perceived loss of relevance after a satisfying career could be factors in surgeons' high levels of distress."

The editorial pointed to the importance of building resilience in the medical community and moving towards a culture of empathy and support in the midst of professional and personal stressors. Freischlag and co-authors recommended increasing access to on-site mental health services, implementing systemic changes that reduce burnout, and promoting programs that offer a sense of community to healthcare workers.

"Through such approaches, which are focused on resilience and relevance, we can better recognize warning signs of distress, and even prevent them from occurring, as we encourage all health care professionals to care for their patients and themselves," the editorialists wrote.

For the study, Ji and colleagues retrospectively looked at death records from 2003-2016 from 32 states. During that time period, 170,030 individuals who died by suicide were reported in the database.

The majority of the 767 healthcare professionals to die across the study period were male (88%) and white (89.7%). About two-thirds (63.2%) were nonsurgeon physicians, 23.3% were dentists, and 13.4% were surgeons.

Compared with the general population, healthcare professionals were also at an increased risk of suicide if they had mental illness (OR 1.45, 95% CI 1.24-1.69, P<0.001) or were of Asian or Pacific Islander descent (OR 2.80, 95% CI 1.96-3.99, P<0.001), the researchers reported.

Asian individuals make up 6% of the U.S. population while accounting for 17.7% of surgical faculty, however, and this may not be proportionately reflected in the NVDRS database, Freischlag and co-authors noted. "Conclusions drawn by the authors regarding the need for targeted interventions could therefore be misinterpreted by individuals in a racial group that may not be at increased risk."

Compared with the general population, healthcare workers were at a lower risk of suicide if they had intimate partner problems, alcohol use issues, were black, female, or unmarried.

Compared with other specialties, surgeons had a higher risk of suicide if they were older (OR 1.003 per year, 95% CI 1.002-1.004, P<0.001) or had mental illness (OR 1.32, 95% CI 1.09-1.61, P=0.005).

An increased risk was also observed among surgeons compared with other specialties for doctors with civil legal problems (OR 1.80. 95% CI 1.19-2.71, P=0.006), job problems (OR 1.72, 95% CI 1.35-2.20, P<0.001), or physical health problems (OR 1.53, 95%CI 1.25-1.87, P<0.001).

Searching for surgeons by occupation may not be precise because they may also be listed as physicians, which is a limitation, the researchers noted, adding that they were also unable to assess suicide rates over time due to the nature of the database.

If you or someone you know is considering suicide, call the at 1-800-273-8255.

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