Suicide Risks of Health Care Workers in the US

Abstract

Importance: Historically elevated risks of suicide among physicians may have declined in recent decades. Yet there remains a paucity of information concerning suicide risks among other health care workers.

Objective: To estimate risks of death by suicide among US health care workers.

Design, setting, and participants: Cohort study of a nationally representative sample of workers from the 2008 American Community Survey (N = 1 842 000) linked to National Death Index records through December 31, 2019.

Main outcomes and measures: Age- and sex-standardized suicide rates were estimated for 6 health care worker groups (physicians, registered nurses, other health care-diagnosing or treating practitioners, health technicians, health care support workers, social/behavioral health workers) and non-health care workers. Cox models estimated hazard ratios (HRs) of suicide for health care workers compared with non-health care workers using adjusted HRs for age, sex, race and ethnicity, marital status, education, and urban or rural residence.

Results: Annual standardized suicide rates per 100 000 persons (median age, 44 [IQR, 35-53] years; 32.4% female [among physicians] to 91.1% [among registered nurses]) were 21.4 (95% CI, 15.4-27.4) for health care support workers, 16.0 (95% CI, 9.4-22.6) for registered nurses, 15.6 (95% CI, 10.9-20.4) for health technicians, 13.1 (95% CI, 7.9-18.2) for physicians, 10.1 (95% CI, 6.0-14.3) for social/behavioral health workers, 7.6 (95% CI, 3.7-11.5) for other health care-diagnosing or treating practitioners, and 12.6 (95% CI, 12.1-13.1) for non-health care workers. The adjusted hazards of suicide were increased for health care workers overall (adjusted HR, 1.32 [95% CI, 1.13-1.54]), health care support workers (adjusted HR, 1.81 [95% CI, 1.35-2.42]), registered nurses (adjusted HR, 1.64 [95% CI, 1.21-2.23]), and health technicians (adjusted HR, 1.39 [95% CI, 1.02-1.89]), but adjusted hazards of suicide were not increased for physicians (adjusted HR, 1.11 [95% CI, 0.71-1.72]), social/behavioral health workers (adjusted HR, 1.14 [95% CI, 0.75-1.72]), or other health care-diagnosing or treating practitioners (adjusted HR, 0.61 [95% CI, 0.36-1.03) compared with non-health care workers (reference).

Conclusions: Relative to non-health care workers, registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide. New programmatic efforts are needed to protect the mental health of these US health care workers.

Figure 1.. Suicide Risks of Health Care Workers Compared With Non–Health Care Workers^a

^aData are from the Mortality Disparities in American Communities data set, which is limited to adults aged 26 years and older who were employed at the time of the American Community Survey administration. Respondent follow-up duration was through 2019. US Census Bureau disclosure review board approval number: CBDRB-FY23-CES004-029. ^bValues for the number of participants, suicide deaths, and years observed are based on unweighted numbers and rounded following US Census Bureau rules. ^cP values indicate comparisons with non–health care workers. ^dModel 1 is adjusted for age, sex, race and ethnicity, marital status, education, and residence. ^eModel 2 is adjusted for age, sex, race and ethnicity, marital status, education, residence, and income. ^fInteraction of sex by worker status (health care vs non–health care), χ² = 4.83; P = .03. ^gInteraction of sex by worker status (health care vs non–health care), χ² = 4.98; P = .03.

Figure 2.. Suicide Rates per 100 000 Person-Years of Female and Male Health Care Workers and Non–Health Care Workers

Data are from the Mortality Disparities in American Communities data set, which is limited to adults aged 26 years and older who were employed at time of the American Community Survey administration. Numbers of participants are unweighted and rounded to the nearest 500 according to US Census rules. US Census Bureau disclosure review board approval number: CBDRD-FY23-CES004-029. ^aThe suicide rates of male registered nurses and female physicians are suppressed to protect participant reidentification. Error bars indicate 95% CIs.