Health care workers face higher suicide risk, study shows

Key takeaways:

• The risk for suicide was particularly higher for registered nurses, health care support workers and health technicians.
• Reducing the stigma of seeking health care could help, one researcher said.

Health care workers overall face a higher risk for suicide, especially registered nurses, health care support workers and health technicians, according to the results of research published in JAMA.

Mark Olfson, MD, MPH, the Elizabeth K Dollard Professor of Psychiatry, Medicine and Law and a professor of epidemiology at Columbia University Irving Medical Center, told Healio that “suicide deaths are tragic yet preventable events that devastate family members, friends and sometimes entire communities,” and knowledge of who is at a higher risk “can lead to proactive and sometimes life-saving efforts to provide support and mental health care as needed.”

“Previous research on suicide risk of health care workers has primarily focused on the risks of physicians, even though physicians represent only about 5% of all health care workers,” said Olfson, who is also a research psychiatrist at the New York State Psychiatric Institute. “The dearth of research on suicide risks of other health care workers prompted us to pursue a broader study of suicide risk across all the major groups of health care workers in the United States.”

Olfson and colleagues conducted a cohort study evaluating a nationally representative sample of 1,842,000 workers from the 2008 American Community Survey.

They found the annual standardized suicide rate per 100,000 people was 12.6 (95% CI, 12.1-13.1) for non-health care workers. The numbers for health care workers were:

• 21.4 (95% CI, 15.4-27.4) for health care support workers;
• 16 (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, 6-14.3) for social/behavioral health workers; and
• 7.6 (95% CI, 3.7-11.5) for other health care-diagnosing or treating practitioners.

The adjusted HRs for suicide were increased for health care workers overall (aHR = 1.32; 95% CI, 1.13-1.54), and specifically for health technicians (aHR = 1.39; 95% CI, 1.02-1.89), registered nurses (aHR = 1.64; 95% CI, 1.21-2.23) and health care support workers (aHR = 1.81; 95% CI, 1.35-2.42). However, they were not increased for social/behavioral health workers (aHR = 1.14; 95% CI, 0.75-1.72), physicians (aHR = 1.11; 95% CI, 0.71-1.72) and other health care-diagnosing or treating practitioners (aHR = 0.61; 95% CI, 0.36-1.03).

Although the absolute risk was higher for men than for women, Olfson said that “the increased suicide threat of health care work was significantly stronger for women than men.”

“The message from this new study is clear: we need to do a better job of supporting the mental health of health care workers, especially female health care workers in front-line roles,” he said. “This may mean providing more support, improving detection of health care workers who are experiencing mental health problems and crises, and ensuring they receive prompt access to confidential mental health services.”

At cultural and organizational levels, Olfson said “efforts are needed to overcome the social stigma that is often attached to seeking mental health care.”

“Instead of health care workers internalizing shame and avoiding speaking up and getting help, work environments should be made safer for workers to share their experiences with their supervisors who can help them get help without fear that the workers will lose their jobs or experience other adverse consequences,” he said.

Having additional mental health resources for accessible, confidential care “to manage crises and to provide ongoing support” and training to help health care workers recognize the warning signs of suicide both in their colleagues and in themselves would also be helpful, he said.

“There are many warning signs of suicide risk, including using alcohol or other drugs, talking about wanting to hurt oneself, extreme mood swings, outbursts of anger or sadness, hopelessness, social withdrawal or isolation, missing work, talking about being a burden to coworkers and so forth,” he said.

Anyone in crisis can contact the 988 Suicide & Crisis Lifeline by texting or calling 988 or reaching out online at 988lifeline.org.