Suicide in doctors
Doctors have a higher rate of suicide than the general population.1,2 For male doctors, it is a little higher than an aged matched cohort, but for female doctors it is between two and five times the rate in the general population, meaning that doctors are the only group where the suicide rate is the same for men and women.
Since 2009 I have led a confidential service for doctors with mental illness and addiction problems (www.php.nhs.uk) and, over the years, around 8000 patients have presented for care. Sadly, some of these patients and others we have become aware of have killed themselves: individuals such as a paediatrician who, aged 26, killed herself during her morning and afternoon clinic; or a consultant cardiologist, who left his clinic to drive to a well-known suicide spot and jumped to his death; and a doctor who was interrupted mid-attempt by his son, yet went on to kill himself once his child had left room. Each of these events not only impacted the individual involved, but also their family and friends. Their relatives all now attend a support group I run for those bereaved following death through suicide, or sudden accidental death of doctors. At the moment it meets every two months and, sadly, its membership grows each time. Given our collective experience, myself as a doctors’ doctor and the group members through their intimate relationship with the bereaved, we try and understand the ‘why?’ – why do doctors have such high rates of suicide? Why, given the host of positive factors this group of intelligent, outwardly successful individuals in secure, well paid, high status jobs, take their own lives? The answer is not always clear.
A medical degree does not confer immunity from developing mental illness (in fact, doctors have higher rates) and drug or alcohol misuse can play a part. However, it is not the whole story. Not all doctors who kill themselves have an underlying mental illness; or at least not outwardly, as doctors are very good at hiding their own distress.
Personal, professional and institutional stigma prevents doctors from seeking timely help, which might explain why mentally ill doctors often present in crises or following arrest for drink driving. Sudden death (deliberate or accidental) might be the first presentation of drug use, given the easier access doctors have to dangerous drugs and knowledge of how to use them. This helps explain the higher rate of death amongst anaesthetist and accident and emergency doctors.
Complaints and, importantly, how they are handled is also a major contributor to doctors’ mental illness. A study by researchers, in partnership with the British Medical Association, showed that receiving a complaint was associated with an increased rate of moderate/severe depression compared to doctors with no complaints (16.9% versus 9.5%, respectively) and distress increased with complaint severity, with the highest levels after General Medical Council referral (26.3% depression, 22.3% anxiety). Doctors with current or recent complaints were over two times more likely to report thoughts of self-harm or suicidal ideation.3
Although suicide is still a rare event it does not mean that we should not be addressing the problem. Interventions that are likely to work on doctors should be aimed at reducing the overall burden of mental distress within the organisations that doctors work. It should ensure that doctors have the time, space and resource to meet with peers to discuss the emotional impact of their work; and, for those in need, to have access to confidential, supportive mental health services. Only interventions such as these will make my bereavement group redundant. For now, its membership only grows.
What are your thoughts? Can anything be done to help ease the mental burden on doctors?
Clare Gerada, Medical Director, Practitioner Health Programme
1. Hawton K, Agerbo E, Simkin S, et al. Risk of suicide in medical and related occupation groups: A national study based on Danish case population-based registers. J Affect Disord 2011 Nov;134(1-3):320-6.
2. Milner A, Maheen H, Bismark M, Spittal M. Suicide by health professionals: a retrospective mortality study in Australia, Med J Aust 2016 Sep 19;205(6):260-5.
3. Bourne T, De Cock B, Wynants L, et al. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open 2015 Jan 15;5(1):e006687. doi: 10.1136/bmjopen-2014-006687.