Study identifies six overarching themes in physician suicides

Access to primary care a key solution to help burnout, researchers said.

Physical health, substance abuse, relationships, and finances are among six main contributing factors when physicians commit suicide.

As physician burnout and suicide grow, the researchers said the study was the first of its kind to analyze the exact nature of stressors, and they identified six overarching themes in job stress and suicide, according to a news release.

“There is a lot of work to be done,” corresponding author Kristen Kim, MD, said in a news release. “But identifying and acknowledging the problem is always the first step towards a solution, and that’s exactly what we’re doing.”

Areas of stress

The study examined death investigation narratives from 200 physician suicides, collected by the National Violent Death Reporting System database between 2003 and 2018. The researchers used natural language processing and thematic analysis to interpret data from the reports.

The factors are:

  • An incapacity to work due to deterioration of physical health
  • Substance use that was jeopardizing employment
  • The interaction between mental health and work-related issues
  • Relationship conflicts affecting work
  • Legal problems
  • Increased financial stress

“We often overlook the physical health of our health care workers, but poor health can lead to difficulty performing tasks at work, which then leads to job stress and mental health issues,” said Kim, a resident physician in psychiatry at UC San Diego Health.

Possible solutions

The researchers proffered several short- and long-term solutions for health care systems to use.

Physicians need better access to primary care services, and ways to minimize scheduling challenges and address concerns about confidentiality. Kim said one example is the UC San Diego Healer Education Assessment and Referral program, which provides access to confidential mental health counseling. That program, now serving physicians and nurses at more than 60 medical campuses, was endorsed in the U.S. Surgeon General’s health worker burnout advisory published in May.

In the long-term, the authors called for broader structural and cultural changes to address workplace stress and poor physician self-care. A sense of safety and community among physicians is important, and the authors suggested health care systems and medical schools should provide additional personal finance education and legal support.

“The unspoken culture of medicine encourages self-sacrifice, deferred needs and delayed rewards,” Kim said. “We always want to put our patients first, but healers cannot optimally heal unless they themselves are first whole.”

The study, “Thematic analysis and natural language processing of job-related problems prior to physician suicide in 2003–2018,” was published June 29 in the journal Suicide and Life-Threatening Behavior, with coauthors Gordon Y. Ye, Nicholas Kos, Sidney Zisook and Judy E. Davidson at UC San Diego, and Angela Maria Haddad at Universidad Autónoma de Guadalajara.