Suicide Risk Significantly Higher for Nurses Compared to US Population

Matthew A. Davis, MPH, PhD (University of Michigan)

A new study suggests nurses are at a significantly greater risk of suicide than physicians when compared to rates of suicide among the general population.

Investigators, led by Matthew A. Davis, MPH, PhD of the University of Michigan, used data from 2007 - 2018 to estimate the trend of both instance and characteristics of suicide rates among nurses and physicians. The data was compared to the risk of suicide for a general adult population. 

An analysis of studies found few data sets focus on suicide rates among US nurses, the largest health profession in the US at 3.3 million nurses. Prior research shows that an individual’s occupation may result in stressors that place them at a high risk of suicide.

Investigators gathered data from the CDC and the Prevention National Violent Death Reporting System (NVDRS) to analyze the incidence trends of US suicides. Workforce data from the US Bureau of Labor Statistics and the Association of American Medical Colleges State Physician Workforce Data was used to examine characteristics of suicide among nurses and physicians, as well as the general population.

The data from NVDRS included death certificates, medical examiner reports, law enforcement reports and toxicology examination, which provided information for the team on occupation, suicide method and results of toxicology estimates at time of death.

Investigators collected workforce data from 2007 - 2018, including physician and nurse workforce data and sex of each profession. They also used data from the NVDRS to collect basic sociodemographic characteristics, including race and ethnicity. The team used t tests, χ2 tests, and 1-way analysis of variance to compare the different groups within the study.

The team categorized the method of suicide in the data collected as suicide by firearm, suffocation or poisoning vs. other causes.

The observed population of suicide decedents included 2374 nurses and 857 physicians, as well as 156,141 individuals making up the general population. All included decedents were ≥30 years old.

In sex-adjusted incidence, nurses had rates of 23.8 per 100,000 versus 20.1 per 100,000 for the general population. Female nurse suicide rates were an additional 8.5 suicides per 100,000, compared with the general population of women.

Per gender, the suicide incidence rate for women per 100,000 in 2017 - 2018 was 17.1 for nurses, 10.1 for physicians, and 8.6 for the general population. 

Among men, suicide incidence rates per 100,000 in 2017 - 2018 were 31.1 for nurses, 31.5 for physicians and 32.6 for the general population.

Both nurses and physicians who died by suicide were more likely to use poisoning and less likely to use a firearm, compared to the general population.

Data showed 24.9% of nurse suicides involved poisoning and 16.8% of suicides in the general population used poisoning. Nurses who died by suicide were less likely to use hanging or suffocation (19.4%) compared to physician rates of the same method (24.1%). 

Investigators found the data in toxicology reports reported evidence of higher substance use in nurses and physicians who die by suicide, compared to the general population. The data also showed nurses who died by suicide had higher rate of substances such antidepressants, opiates, and amphetamines appear in the toxicology examination.

The study found that suicide rates among nurses is much greater than the general population, but the incidence rates did not increase for physicians over the observed time period.

The team concluded that a focus on knowledge and suicide preventative measures to increase the welfare of nurses may do well to help decrease rates of suicide, but further research is necessary.

“Initiatives to promote clinician well-being should include a particular focus on nurses,” investigators concluded. “Our findings contribute to a growing body of literature suggesting that health care institutions should routinely assess clinician well-being and intervene if necessary, the benefits of which may extend well beyond the clinicians themselves.”

The study “Association of US Nurse and Physician Occupation With Risk of Suicide,” was published online in JAMA Psychiatry.