U-M Family Medicine researchers update physician suicide data after 16 years

Physician suicides have gained poignant attention during the COVID-19 pandemic, given the extraordinary pressures that many doctors are under to help those infected by the highly contagious virus and the sheer volume of patient cases.

But even before then, University of Michigan Department of Family Medicine researchers were studying data that showed that doctors were taking their own lives, despite working in a profession designed to promote healthy living.

Katherine J. Gold, M.D., M.S.W., M.S., associate professor of Family Medicine and Obstetrics and Gynecology at U-M has recently published updated numbers on doctors in the United States who die by suicide. Her paper is the first to update data in 16 years.

Her co-authors include Ananda Sen, Ph.D., research professor in the Department of Family Medicine and Biostatistics, and Thomas L. Schwenk, M.D., dean of the School of Medicine at the University of Nevada who served as chairman of the Department of Family Medicine at the University of Michigan for 25 years. Schwenk is also a professor emeritus with U-M’s Family Medicine.

Gold et al used data from the National Violent Death Report System (NVDRS) at the Centers for Disease Control to look at death records from 2010-2015 from 27 states. They compared data identifying suicide deaths among physicians or non-physicians and calculated the annual standardized mortality rates. Of 63,780 victims total, Gold et al identified 357 physicians over the six years (307 men and 50 women). Twenty-seven states had data that was searchable, with 16 states reporting data for six years and 11 states with data for one or more years.

The authors used nine variables to identify suicide victims who were physicians.

“I tried to be extremely conservative in how I counted physicians,” Gold said. “I think it’s important that we are looking at the right numbers. This is the first U.S. data set that included occupation and health status.”

Extrapolating available NVDRS data over 50 states -- which included an annual number of 51.2 male physicians and 8.3 female physician deaths by suicide -- the study estimated there would be approximately 119 physician suicides (104 males and 15 females) annually on a national basis.

Gold said that historically, counting the number of physician deaths by suicide has been challenging considering that not all states report such data and that many times, the cause of death isn’t specifically listed as suicide on death records or in databases. But, the numbers are now more exact than the general data that’s been typically used in the past.

“The numbers that are commonly used for physician suicide are an average graduating medical class or 300 to 400 people,” she said. “Neither of those numbers have great data behind them.”

Even today, despite more complete data, Gold said the results of the latest study likely underestimate physician suicides.

“I suspect that the number is higher than I found but this is as close as I could get,” she said. “It’s still about the size of a graduating medical class. You just wouldn’t expect that this group of people would be dying of suicide.”

Although doctors have access of health insurance, financial resources and support, they still face a substantial stigma around mental health issues and for seeking help. Gold said since the last time she reported physician suicide data in 2013, there has been an increase in male physicians seeking help for depression and verbalization of suicidal thoughts to their health colleagues, but that it has been less so for female physicians.

“I don’t think anyone really knows for sure why,” Gold said. “It may be that women physicians are under particular pressures. Previous research found that female doctors spent a little more time with patients. At the baseline, women have more mental health concerns and depression.”

Gold said that the stigma surrounding compromised mental health and the fear of reporting it is exacerbated by state medical licensing boards, which inquire about a physician’s mental health status on board applications.

“I think licensing is the very first thing we have to look at,” she said. “The medical boards ask about physical health and ask very invasive questions about mental health issues.”

If a physician responds yes to questions pertaining to compromised mental health, such as burn out or depression, the application then diverts them to a much longer questionnaire that probes more intensely into those health issues.

“That’s very intimidating,” Gold said. “There is a lot of fear and some of that is warranted.”

The authors note that physician mental health and well-being remain critical issues within U.S. health care as suicide is a potentially preventable cause of death and the death of a single physician can impact thousands of patients. They say that study results emphasize the importance of focusing on structural changes to reduce stigma around mental health in the medical community.

Gold added that the irony of the situation is that some doctors by their very nature of being in the profession can lead to mental health issues.

“The very qualities that got them into medical school – being very driven, putting others before themselves, and the drive for perfection -- are the same internal qualities that can drive depression,” she said. “I firmly believe that physician suicides are something that shouldn’t be happening.”

Article citation: Gold KJ, Schwenk TL, Sen A. Physician Suicide in the United States: Updated Estimates from the National Violent Death Reporting System. Psychology, Health & Medicine. 2021:1-13. doi:10.1080/13548506.2021.1903053.