Similarly, why do they think that rates by profession will improve overtime? In those 47 articles on deaths by suicide among physicians, 25 described SMR for suicide [7,8,41,46,52,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,82], eight reported percentages of suicide by specialty [15,16,40,43,45,47,51,83], 12 reported the number of physicians died by suicide among all deaths in physicians [16,39,41,42,44,46,48,49,50,51,52,53], and nine reported the number of physicians died by suicide among all the deaths by suicide in the general population [1,5,15,34,35,36,37,38,82]. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the Comments to the Author section, enter your conflict of interest statement in the Confidential to Editor section, and submit your "Accept" recommendation. [REPLY] Thank you for your relevant comment. NPR News MAY 17, 2019. PLOS authors have the option to publish the peer review history of their article (what does this mean?). Among the 25 included studies, 17 studies reported both male and female physicians [7,8,41,46,52,54,55,56,57,58,59,61,62,68,70,71,82], six reported only male physicians [60,64,65,66,67,72], and one only reported female physicians [63]. The majority of the healthcare professionals to die across the study period were men (88%) and white (89.7%). US physicians might also be particularly stress [113] because of medical errors that are the third leading cause of death in US [114,115] in a context of economic pressure and relationships with pharmaceutic companies [116,117], religious beliefs [118], access care difficulties for some patients [119], and legal procedure intended against physicians [120] leading them to practice a more defensive medicine [121] misleading patients in overdiagnosis [122]. Oncologist 24: 632-639. [3] [ citation needed ] Female physicians are at higher risk of attempting suicide than men, [2] [4] showing rates over 250% higher among women and about 70% higher among men versus the general population. 99. 1. Orthopaedic surgeons have the highest prevalence of death by suicide among all surgical subspecialties, comprising 28.2% of surgeon suicides from 2003 to 2017. Thank you for the opportunity to review the revised manuscript, Suicide among physicians and health-care workers: A systematic review and meta-analysis. I thank the authors for their thoughtful and thorough response to reviewers. Reviewer #1: All comments have been addressed. July 14, 2014. During the past decade, a confluence of forces has changed the practice of medicine in unprecedented ways. However, robust statistics on health-care workers were desperately lacking for suicides, suicide attempts and suicidal ideation. It is not clear why the authors are hypothesizing many of the points that they are. US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). - Greater discussion of the implications of these findings in the Conclusion section is needed. Psychosocial work environment has been shown in the literature as an important risk factor, doctors being confronted to conflicts with colleagues, lack of cohesive teamwork and social support, leading them individually [88]. Statistical heterogeneity between results was assessed by examining forest plots, confidence intervals (CI) and using formal tests for homogeneity based on I2 statistic, which is the most common metric for measuring the magnitude of heterogeneity between studies and is easily interpretable. 3. Between 2000 and 2018, the suicide rate jumped 35 percent. ED visits that involve suicide attempts, suicidal That is, were studies that did not information on the general population excluded from the review? Physicians suffering burnout are significantly more likely to leave healthcare. The impact of work-family life history. Just for clarification to you and our reviewer, I just noted below. (2008) [, Relation between the level of knowledge and the rate of vaccination against the flu virus among the staff of the Clermont-Ferrand University hospital, Kelly C, Dutheil F, Haniez P, Boudet G, Rouffiac K, Traore O, et al. We included 12 studies [16,39,41,42,44,46,48,49,50,51,52,53], and we demonstrated a prevalence of 4% (95CI 3, 5) with an important heterogeneity (I2 = 88.7%) (Fig 10). Multiple factors fuel this tragic situation. The conclusion now reads: Preventive strategies on the risk of suicides in physicians are strongly needed. Death by suicide is rare for children under 8 years old. In addition, the number of physician suicides is more Eight studies were included [15,16,40,43,45,47,51,83]. (2012), JOBSTRESS study: comparison of heart rate variability in emergency physicians working a 24-hour shift or a 14-hour night shifta randomized trial, Dutheil F, Marhar F, Boudet G, Perrier C, Naughton G, Chamoux A, et al. While suicide accounts for roughly 2% of all deaths amongst the general population in the United States, 4% of all physician deaths are by suicide. - In the discussion it would be useful if authors discussed in more depth the gender finding. According to her GP, she had put in a formal grievance against her Are they expected to have responsibilities that do not reflect traditional students? 1. Mata, D. A. To use PACE, you must first register as a user. Physicians are an at-risk profession of suicide, with a global SMR of 1.44 (95CI 1.16, 1.72), and an important heterogeneity between studies. 2 a, b, respectively) and in the later period 20012005 (Fig. 7 th leading cause of death among people 45 to 54 years of age. Universit Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France, 6 Public attention often focuses on teens and college students, but the highest numbers and rates are in middle-aged adults. When possible, we stratified results by gender, countries, time, and specialties. - Greater information on how the different time periods were handled in analyses would be useful (i.e., some time periods included 30+ years where others were shorter, some were partially overlapping, etc.). Two percent had attempted suicide and suicidal ideation and attempts were higher in doctors who were divorced and those who did not have children. Smith SJ (1990) Income, Housing Wealth and Gender Inequality. WebPhysicians have the highest rate of suicide of any profession, including the military and law enforcement, and female doctors rival their male counterparts in this regard. There are few data on the evolution of the rate of suicide over time and we were the first to demonstrate that, in some countries such as in Europe the suicide rate among physicians decreased significantly with time but not in the USA. The general literature demonstrates that men are more likely to die by suicide. Suicide of physicians in the special wards of Tokyo Metropolitan area, Suicide by psychiatrists: a study of medical specialists among 18,730 consecutive physician deaths during a five-year period, 196772, Patterson PD, Weaver MD, Frank RC, Warner CW, Martin-Gill C, Guyette FX, et al. Moreover, further detailed information and clearer descriptions, especially on methodology, must be required in order to convince our readers on why the authors approach was relevant and valid scientifically. Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Dickman SL, Himmelstein DU, Woolhandler S (2017) Inequality and the health-care system in the USA. and transmitted securely. - The authors detail 4 different meta-analyses in the statistical considerations questions, but present information on 8 different models. Moreover, insufficient data did not permit other meta-regression. Percentage of respondents within those studies may seem low, from 45% [74] to 76% [77], however the response rate was higher than usual [142,143,144,145,146]. We totally agree with you and deleted in the general population. 24, 2021). Please address all comments by our reviewer. The .gov means its official. That is according to a review of 10 years [REPLY] Thank you for your positive comment. 4. WebIt is important to note that NIOSH sample size: For Black men, the most suicidal jobs with a large sample size were police & detectives (2.55 times higher than average); furnace Suicide is already the second most common cause of death for young people, but in 2020, emergency room visits for suspected suicide attempts increased 31% for adolescents ages 12 to 17, according to the CDC (Morbidity and Mortality Weekly Report, Vol. [REPLY] Thank you for your relevant comment. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). Physicians are an at-risk profession of suicide, with a global SMR of 1.44 (95CI 1.16, 1.72), and an important heterogeneity between studies. Twenty-five states experienced a rise in suicides by more than 30%, the government report finds. For psychiatrists, the high risk of suicides has been linked by stressful and traumatic experiences such as, paradoxically, dealing with suicides of patient [16]. Results The provisional number of suicides in 2020 (45,855) was 3% lower than in 2019 (47,511). If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. In the map here we see suicides as a share of total deaths for countries across the world. Approximately 4,500 deaths by suicide per year. An unmarked version of your revised paper without tracked changes. - Additional information on the inclusion /exclusion criteria and how this impacted study selection is needed. Pospos S, Tal I, Iglewicz A, Newton IG, Tai-Seale M, Downs N, et al. Finch N (2014) Why are women more likely than men to extend paid work? WebMedical-related professions are at high suicide risk. The sentence now reads: For example, there, were tentative to regulate working time of physicians over the recent years, such as in, Europe with its European Working Time Directive (EWTD).. California, Florida, New York, and Texas suffer from the highest rates of officer suicides, with each reporting at least 10 police suicides last year. WebThere were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. The increased rate of suicide among physicians has been known since 1858; 1 however, physician suicide has remained a silent epidemic for the past 150 years. Male nurses (33 per 100,000) were higher than the We showed that the risk of suicide was not homogeneous between countries, in line with inequality of job satisfaction among physicians in many countries [96,97]. Suicide could be regarded as a lengthy process. Men who work in construction and extraction had the highest rates of suicide in the United States, according to a report published Thursday by the US Centers for Bmj 353: i2139. Family medicine: 46%. While I believe this manuscript may be of value to the broader literature, there are several spots where more information or discussion would greatly enhance the potential impact. The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Univ. PLOS authors have the option to publish the peer review history of their article (what does this mean?). The data by the ONS reveals that there were 83 suicides amongst medical B., Peluso, M. J., Guille, C., . Having mood swings, such as being emotionally high one day and deeply discouraged the next. University of Montpellier, Laboratory Epsylon EA, Dynamic of Human Abilities & Health Behaviors, CHU Montpellier, University Hospital of Montpellier, Occupational and Preventive Medicine, Montpellier, France, 12 Students were excluded because of the difference in responsibilities in comparisons with health-care workers, and because of the existence of previous recent meta-analyses focusing specifically on health-care students [21,22,23,24]; we included interns because they were not included in the aforementioned meta-analyses on prevalence of suicides, suicide attempts or suicidal ideation, and because they could have similar responsibilities to senior practitioners. The [REPLY] We wish to thank Richard May, native English, for providing assistance in improving the manuscript. 7. Among female nurses, the risk of death by suicide was The introduction now reads: Physicians working conditions varied substantially between countries and over contemporary times, these factors were never investigated in relationships with suicide in physicians. Why were studies on medical students excluded but those including interns included? Finally, none of the studies included specified whether some physicians were retired or not. As for physicians, some occupational settings were described as particularly stressful, such as working in emergency departments [137], with a high prevalence of shift work [138], exposure to aggressive and violent behavior from patients [139] and from situation relating to trauma, alcohol and intoxications [140]. Their suicide rate was 90.5 suicides per 100,000, according to the report. [REPLY] The methods section now reads: Students were excluded because of the difference in responsibilities in comparisons with health-care workers, and because of the existence of previous recent meta-analyses focusing specifically on health-care students [References]., Puthran, R., Zhang, M. W., Tam, W. W., & Ho, R. C. (2016). Researchers found that female nurse suicide rates from 2005 to 2016 were significantly higher (10 per 100,000) than the general female population (7 per 100,000). If eligible, we will contact you to opt in or out. WebIn fact, CDC data suggests that men over the age of 75 die by suicide at the highest rate (approximately 40 per 100,000), followed by men between 45 and 64 (31 per 100,000). Some groups have higher suicide rates than others. I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. This film can be used in medical school physician wellness, humanism and professionalism curricula. Data from the National Coronial Information System, commissioned by The Australian last year, cast a spotlight on some of the worst professions for suicide from 2011 to 2014. Medical students are three times more likely than The CDC took suicide data from 17 states and listed the 20 occupations with the highest suicide rates: Farmworkers, fishermen, forestry (85 suicides per 100,000). Suicide rates vary by race/ethnicity, age, and other factors, such as where someone lives. The leading suicide prevention organization for LGTBQ+ people under age 25, the Trevor Project offers a lifeline for people having thoughts of suicide. If published, this will include your full peer review and any attached files. Then all authors reviewed the eligible articles. We added a new Table 1 that gives details on studies including country. Have the authors made all data underlying the findings in their manuscript fully available? It is defined as the act of killing oneself. We found a significantly higher risk of suicide among male physicians than in the general population (SMR = 1.24; 95CI 1.05, 1.43; P < 0.001; I2 = 79.1%) and for suicide among female physicians than in the general population (SMR = 1.94; 95CI 1.49, 2.58; P < 0.041; I2 = 42.5%) (Fig 4). care workers reported burnout (defined as mental and physical exhaustion from chronic workplace stress), with the highest rate (69%) among our youngest staff those ages 18 to 29. The report indicated that 14 percent of all physicians surveyed were both burned out and depressed. Various occupational groups have called the National Center for Health Statistics There is a ten-fold difference in this share across the world. WebThe main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs). 1,2 Although burnout in oncology is acknowledged, the other stigmatized mental health aspects of medical practicedepression and suicideare rarely recorded or talked about. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Although income gender-inequalities have not been reported in physicians [97,98], some authors suggested that the medical field was mainly dominated by the male gender and reported a poor status integration of women physicians within the profession [7]. Death rates by suicide per 100,000 population in 2019 (by age and sex) 1. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. the European Working Time Directive (EWTD) in Europe. Korup AK, Sondergaard J, Lucchetti G, Ramakrishnan P, Baumann K, Lee E, et al. The Marine Corps' Camp Lejeune and the Army's Fort Bragg, both in North Carolina, saw 21 troops die by suicide in 2020, according to Pentagon data obtained by USA TODAY. On the contrary, psychiatrists and other physicians have the highest rates of suicide of any profession. Unsatisfactory working situations should be dealt with, Mortality and causes of death among Danish medical doctors 19731992, Hamtoft Henry and Mosbech Johannes (1963) Causes of death among the menidal profession in Denmark, The suicide mortality of working physicians and dentists, Pitts FN Jr., Schuller AB, Rich CL, Pitts AF (1979), Suicide among U.S. women physicians, 19671972, Causes of death and cancer among doctors and lawyers in Iceland, Suicide by male physicians during a five-year period, Rimpela AH, Nurminen MM, Pulkkinen PO, Rimpela MK, Valkonen T (1987). Medical school curriculum should also include programs to increase students self-confidence, to express their emotional needs, and to teach that anyone may be suicidalregardless of his status [133]. Frequently suicide occurs in the context of a major depressive episode, but it may also occur as a result of a substance use or other disorder. 1 Suicide was the: 2 nd leading cause of death among people 10 to 34 years of age. Finally, we demonstrated a higher risk of suicide in psychiatrists than other medical specialties (0.07; 95CI 0.02, 0.13; P = 0.009) and than surgeons (0.08; 95CI 0.02, 0.13; P = 0.005) (S1 Fig). However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of We would appreciate receiving your revised manuscript by Dec 19 2019 11:59PM. WebThe Army experienced the highest increase in suicides, where 49 service members died by suicide in the first three months of 2023, compared to 37 service members a year ago. An official website of the United States government. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). We included nine studies [1,5,15,34,35,36,37,38,82], and we demonstrated a prevalence of 1% (95CI 1, 1) with an important heterogeneity (I2 = 98.0%) (S4 Fig). In fact, nearly a dozen specialties experienced more than a 10 percent increase in burnout over those three years: Family medicine (51.3 percent of physicians reported burnout in 2011 versus 63.0 percent in 2014) General pediatrics (35.3 percent versus 46.3 percent) Urology (41.2 percent versus 63.6 percent) Is the manuscript presented in an intelligible fashion and written in standard English? (2016). Some specialties were higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. Particularly in Europe, working hours of physicians decreased significantly over the last decades following official instructions such as the European Working Time Directive (EWTD) [14], which may have contributed to a decreased risk of suicides.. Some specialties have been suggested to be particularly at risk of suicides [15,16] with occupational factors individualized in different medical or surgical specialties: heavy workload and working hours involved in the job such as long shifts and unpredictable hours (with the sleep deprivation associated) [17], stress of the situations (life and death emergencies) [18], and easy access to a means of committing suicide [19]. Did studies need to be peer-reviewed, present empirical data, etc. For example, there were tentative to regulate working time of physicians over the recent years, such as in Europe with its European Working Time Directive (EWTD) [14]. I believe the manuscript is much improved. International Classification of Diseases, 10th Revision. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. (2006), On-call stress among Finnish anaesthetists, The moral loneliness of the General Practitioner, Mental health, job satisfaction, and job stress among general practitioners, Dutheil F, Boudet G, Perrier C, Lac G, Ouchchane L, Chamoux A, et al. We hypothesized that 1) physicians are more at risk to commit suicide than the general population, 2) women physicians are more at risk to commit suicide than their male counterparts, 3) some countries would have higher rates of suicide in physicians, 4) with an improvement over time, 5) some medical or surgical specialties would be at higher risk of suicide, 6) physicians would also exhibit higher rates of suicide attempts and suicidal ideation, and 7) other health care workers would also be at risk of suicide. Veterinarians are 2.7 times more likely than the general public to die by suicide, according to a 2020 study from Merck Animal Health in partnership with the American Veterinary Medical Association. Is the manuscript presented in an intelligible fashion and written in standard English? However, nurses remained at high-risk of suicide with various stressful factors comparable to those previously described for physicians, such as patients cares, teams conflicts, heavy workload, lack of autonomy, and work-family conflicts [135,136]. It has been shown that female physicians/internships react by imposing themselves an additional pressure to demonstrate their male counterparts that they are as strong, self-sufficient and worthy as them [99].. Jama 293: 2609-2617. As there are few exploitable studies about dental surgeons, nurses and other health-care workers, we didnt treat them in that meta-analysis. Specialties with the highest rates of reported depression were: Ob-gyns: 20 percent. (2008) [, Cost/effectiveness comparison of the vaccine campaign and reduction of sick leave, after vaccination against influenza among the Clermont-Ferrand University Hospital staff, Dutheil F, Kelly C, Biat I, Provost D, Baud O, Laurichesse H, et al. In this year's report, Medscape explores how physicians are coping with burnout and how it affects their view of their profession. (2013), The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement, http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols, http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf, Anaesthesiologists, psychiatrists, general practitioners, general surgeons, General practitioners, general surgeons, internal medicine, psychiatrists, obstetricians, anaesthesiologists, pathology, paediatrics, radiology, internships, General practitioners, radiology, psychiatrists, Internal medicine, dermatologists, paediatrics, psychiatrists, general surgeons, orthopaedists, ophthalmology, plastic surgeons, ENT, obstetricians, radiology, anaesthesiologists, General practitioners, anaesthesiologists, internal medicine, obstetricians, psychiatrists, general surgeons, internships, General practitioners, internal medicine, general surgeons, psychiatrists, obstetricians, paediatrics, radiology, anaesthesiologists, pathology, ophthalmology, orthopaedists, General practitioners, internal medicine, general surgeons, radiology, paediatrics, Dermatologists, emergency, internal medicine, obstetricians, paediatrics, cardiology, neurology, urology, ophthalmology, anaesthesiologists. We hope our work will be considered favorably and look forward to hearing from you. Suicide by occupation, England and Wales, 2011 to 2019 registrations Release date: 30 October 2019. Hundreds more harbor serious thoughts of suicide. We have addressed the comments of the reviewers in a revised manuscript and enclose a point-by-point response. Suicide rates for male medical practitioners were not significantly higher than for other occupations, but the suicide rate for male nurses and midwives was significantly higher than for men working outside the health professions (IRR, 1.50; 95% CI 1.122.01; P = 0.006). All relevant data are within the manuscript and its Supporting Information files. Murray A, Montgomery JE, Chang H, Rogers WH, Inui T, Safran DG (2001), Doctor discontent. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. New research shows that the number of doctor suicides - up to 40 per 100,000- is three times that of the general population. We agree that there was a need to provide further details on each included articles. the ratio between the observed and expected number of death among physicians, stratified by sex (Fig 4; and Fig 5 for metaregressions), geographic zones (Fig 6), epochs of time, and by categories of specialties (main groups of specialities (Fig 7 and S1 Fig), surgical specialties (Fig 8 and S2 Fig), then medical specialities (Fig 9 and S3 Fig), 2) meta-analyses on the prevalence of health-care workers died by suicide among all health-care workers death (Fig 10), 3) meta-analyses on the prevalence of health-care workers died by suicide among all the deaths by suicide in the general population (S4 Fig), 4) meta-analyses on suicide attempts (S5 Fig) and suicidal ideation (Fig 11). Currently the figures just note North America, but analyses also target the US. [ii] Males are over 3.5 times more likely than females to die by suicide, and white Texans are over two times as likely to die by suicide as Asian, black, and Hispanic Texans. 121. Particularly in Europe, working hours of physicians decreased significantly over the last decades following official instructions such as the European Working Time Directive (EWTD) [14], which may have contributed to a decreased risk of suicides.
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medical profession with highest suicidal death
