Research reportRisk of suicide in medical and related occupational groups: A national study based on Danish case population-based registers
Introduction
There is accumulating evidence that risk of suicide is increased in certain occupational groups, especially those involved in medically-related professions. Studies in different countries have indicated that suicide risk is elevated in physicians (Agerbo et al., 2007, Hem et al., 2005a, Kelly and Bunting, 1998, Meltzer et al., 2008, Schernhammer and Colditz, 2004), especially in females (Hawton et al., 2001, Lindeman et al., 1997a, Petersen and Burnett, 2008, Schernhammer and Colditz, 2004). However, in other investigations this has not been confirmed, or the reverse found in male physicians (Petersen and Burnett, 2008), especially in recent studies (Meltzer et al., 2008). Suicide risk has also been found to be elevated in nurses in some, but not all studies (Hawton and Vislisel, 1999, Meltzer et al., 2008). Other medically-related occupational groups in which risk of suicide has been reported as increased include dentists and pharmacists, although findings of studies differ, especially for dentists (Alexander, 2001, Boxer et al., 1995, Meltzer et al., 2008, Stefansson and Wicks, 1991). Also, an elevated risk of suicide has been reported in veterinary surgeons in several countries (Platt et al., 2010), including the UK (Charlton, 1995, Kelly and Bunting, 1998, Mellanby, 2005, Stark et al., 2006), USA (Blair and Hayes, 1982), Australia (Jones-Fairnie et al., 2008) and Norway (Hem et al., 2005b). However, some studies of risk of suicide in veterinary surgeons have been based on local data and/or relatively small numbers of deaths.
Suicide is strongly associated with psychiatric disorder (Cavanagh et al., 2003, Hawton and Van Heeringen, 2009). Therefore, one explanation for the increased risk of suicide in medical occupational groups could be an increased rate of psychiatric disorder compared with other occupations. Whilst prevalence of psychiatric disorders has been investigated in psychological autopsy studies of suicides in nurses (Hawton et al., 2002) and doctors (Hawton et al., 2004), rarely has this been examined in case–control studies within occupational groups (Hawton et al., 2002), and in comparisons with other occupational groups.
Greater access to means for suicide in medical and medically-related occupational groups has been proposed as another explanation for their increased suicide risk (Aasland et al., 2001, Hawton et al., 2000, Kelly and Bunting, 1998). All medically-related occupational groups have greater access to medicinal drugs than the general population. There have been few studies, however, in which the methods used for suicide in specific medically-related occupational groups have been compared to those used in the general population (Hawton et al., 2000).
We have used data from the national registers for Denmark to examine the relative risk of suicide in nurses, physicians, dentists, pharmacists and veterinary surgeons compared to the risk in teachers and the rest of the general population using a case–control design. We have also investigated whether any elevated risk in these occupational groups is related to prevalence of psychiatric disorder as indicated by contact with psychiatric services. Finally, we have examined the use of specific methods of suicide in these professional groups compared with their use for suicide in other occupational groups.
Section snippets
Source of data and population-based registers
Data were obtained by linking four Danish population-based registers using the unique personal identification number, assigned to all persons living in Denmark and used across all registration systems (Pedersen et al., 2006). The Danish Cause of Death Register has been fully computerised since 1970 (Juel and Helweg-Larsen, 1999). Suicide was defined by ICD8 (World Health Organisation, 1967) codes E950-E959 and ICD10 (World Health Organisation, 1992) codes X60-X84. The Integrated Database for
Results
In total, 20,826 suicides (6666 females) and 488,020 controls (150,528 females) were identified. The number of controls assigned to each suicide ranged from 6 to 51 with a median of 23 controls. The distribution of cases and controls across the risk factor categories is shown in the tables.
Discussion
Using Danish national data for a 26-year time period we have shown that risk of suicide is elevated in most medically-related occupations, namely nurses, physicians, dentists and pharmacists compared to teachers, but not in veterinary surgeons. A similar result was found in comparisons with the general population (except in pharmacists, in whom the risk was no longer elevated). This pattern was largely replicated in both genders, except that risk in female dentists was not elevated. Adjustment
Role of the funding source
Keith Hawton was supported by University of Aarhus and Oxford Health NHS Foundation Trust. He is a National Institute for Health Research (NIHR) Senior Investigator. Belinda Platt was supported by Hill's Pet Nutrition; the Royal College of Veterinary Surgeons Trust Fund; and the Veterinary Benevolent Fund. Sue Simkin was supported by NIHR through the Programme Grants for Applied Research scheme (RP-PG-0606-1247). The views and opinions expressed in this paper are those of the authors and do not
Conflict of interest
None.
Acknowledgements
This work was carried out whilst Keith Hawton was Visiting Professor at Aarhus University. The study did not need approval from the ethics committee according to Danish laws, but the project was approved by the Danish Data Protection Agency.
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2023, Medical Clinics of North AmericaCitation Excerpt :Potentially, this combination of factors often leads HPs to experiencing both a substance use and a nonaddictive mental disorder thus complicating their evolution and prognosis. Suicide risk among HPs is elevated compared with the general population32,38,39 and suicide incidence data may understate the problem, in part because of difficulties related to reporting reliability.39Besides other specific psychosocial factors, delaying help seeking together with easier access and knowledge of potential lethal methods may account for this phenomenon.40,41 Risk of suicide is higher among nurses, veterinarians, physicians, dentists and pharmacists compared with other HPs and other occupational groups [REF].40,42