Study Pinpoints 6 Job-related Stressors Linked with Physician Suicide

Factors contributing to physicians considering and committing suicide include poor physical and mental health, substance use, relationships, and finances, according to a study from researchers at the University of California San Diego (UCSD) that used a novel approach to characterize specific stressors that precede a clinician suicide.

One in 15 physicians reports suicidal ideation, according to a UCSD press statement, but despite consistent evidence that physicians are more likely than nonphysicians to experience work-related stress leading up to suicide, a clear understanding of what creates that burden is lacking.

The UCSD research team identified 6 overarching themes contributing to physician job stress and suicide.

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

6 job-related stressors

Kim and colleagues used a mixed methods approach to examine 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, identifying 6 primary themes:

• 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

Kim and the research team outlined both short- and long-term strategies for health care systems to consider.

Short term approaches include improving access for physicians to primary care services, creating ways to minimize scheduling challenges, and addressing physicians’ long-standing concerns about confidentiality. Where they are available, Kim encourages health care providers to access targeted clinician support programs. She describes the UCSD 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.

Considering long-term solutions, the authors call for broader structural and cultural changes to address workplace stress and poor physician self-care. They suggest, too, that health care systems and medical schools should provide clinicians with additional personal finance education and legal support.

Foremost is cultivating a sense of safety and community among physicians

“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.”

Reference: Kim K, Ye GY, Haddad AM, et al. Thematic analysis and natural language processing of job-related problems prior to physician suicide in 2003–2018. Suicide Life Threat Behav. Published online ahead of print June 29, 2022. doi.org/10.1111/sltb.12896