Written by Jason Lesnick
This cohort study of 1.8 million US healthcare workers (HCWs) found that registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide relative to non-HCWs.
Health care worker mental health needs help
This cohort study aimed to quantify the suicide risk of healthcare workers. Prior research has shown increased rates of suicide among physicians, and we have covered a paper that found increased rates of suicide in EMS personnel.
The authors reviewed a nationally representative sample of employed people ≥ 26 years old from the 2008 American Community Survey and linked these results to National Death Index records up to December 31st, 2019. The authors broke down HCWs according to these 6 categories: registered nurses, health care support workers, health technicians, social/behavioral health workers, other health care-diagnosing or treating practitioners, and physicians.
HCW age- and sex-standardized suicide rates per 100 000 person-years were compared with the entire employed cohort. This study adjusted for age, sex, race and ethnicity, marital status, education, residence, and income and found that standardized suicide rates were significantly higher for healthcare workers overall, with an adjusted hazard ratio of 1.31 (95%CI 1.12-1.53). This study also found specifically higher rates for RNs (1.73, [1.27-2.35]), health care support workers (1.66, [1.22-2.25]), and health technicians (1.39, [1.02-1.89]. Interestingly, this study found no significant increased risk of suicide in physicians (1.13, [0.73-1.76]).
The main limitation is that this was survey data, with potential response, non-response, recall, sampling bias, etc. Additionally, it did not measure key suicide risk factors, such as mental health disorders prior to occupation. Occupational status was based on a one-time assessment and could have changed throughout the time period, and the classification system used to determine cause of death could have under-classified suicides as other deaths.
How will this change my practice?
This study serves as a strong reminder that many of our close coworkers are at an increased risk of suicide. We can help create a workplace environment that is safer for mental health not only on every shift but by supporting administrative changes for stronger mental health support for HCWs. Given that this study ended prior to the COVID-19 pandemic, I would expect these results to look even worse if the data had been extended through 2023.
Suicide Risks of Health Care Workers in the US. JAMA vol. 330,12 (2023): 1161-1166. doi:10.1001/jama.2023.15787