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Health workers had an increased risk for suicide compared with workers in other sectors, according to a nationally representative cohort study.

Using data from 2008 to 2019, the risk of suicide was 32% higher among the 176,000 healthcare workers in the study (adjusted hazard ratio [aHR] 1.32, 95% CI 1.13-1.54), and was highest among support staff followed by registered nurses and health technicians:

• Support workers: aHR 1.81 (95% CI 1.35-2.42)
• Nurses: aHR 1.64 (95% CI 1.21-2.23)
• Technicians: aHR 1.39 (95% CI 1.02-1.89)

No increased suicide risk was seen among physicians or other healthcare workers included in the study, reported researchers led by Mark Olfson, MD, MPH, of the New York State Psychiatric Institute in New York City.

Writing in , they noted that most prior studies examining suicide risk in healthcare have focused on physicians, who represent only about 5% of the workforce.

"These data make the case that we need to do things to improve the detection and treatment of healthcare workers who are experiencing mental health problems [and] crises," Olfson told MedPage Today.

Support workers, whose work is often low-paid and repetitive, rarely see opportunity for advancement, he noted. "We need to look at their working conditions and try to make reforms to provide them greater support, flexibility in their work routines, and timely access to mental healthcare."

Healthcare support workers also have an "exceptionally high risk for work-related injuries," he said. In a previous study, Olfson and colleagues found a higher risk for overdose deaths among certain healthcare workers, including support staff, and workplace injuries often precede such problems.

In the current study, an exploratory analysis revealed that the association between the increased risk for suicide among the health workers was greater for women compared with men (P=0.03 for interaction).

"That's a new finding," said Olfson. "We don't know what's driving that."

Various factors could be at play, he speculated, including that female clinicians tend to spend more time in direct clinical care and are more frequently mistreated, more likely to develop insomnia, more likely to report lower job satisfaction, and more prone to burnout.

These psychological risk factors may "hit women harder than men," said Olfson, and might contribute to this finding. Olfson, however, stressed that even among healthcare workers, the absolute risk of suicide was still far higher among men than women (20.3 vs 7.0 per 100,000 person-years, respectively, as compared with 19.5 vs 4.7 per 100,000 person-years among non-healthcare workers).

Altogether, the study underscored the importance of training healthcare workers to identify warning signs of depression, suicidality, and other mental health problems, Olfson said, as well as the importance of making treatment options readily accessible and confidential.

If healthcare workers' only option for receiving mental health counseling or care lies within their own organization, that also can be a barrier to access, he added.

For the study, Olfson's team used the Mortality Disparities in American Communities data set, linking participants age 26 years and older from the 2008 American Community Survey to National Death Index records through the end of 2019.

The study population consisted of 1.84 million adults, including 176,000 health workers and 1.66 million non-healthcare workers (median age 44 years; 43.4% women). During follow-up, suicides occurred in 200 healthcare workers and 2,500 non-healthcare workers.

Registered nurses comprised the largest share (n=42,000; 91.1% women) of the six healthcare worker groups, followed by healthcare support staff (n=39,000; 89.6% women), health technicians (n=32,500; 78.3% women), social/behavioral health workers (n=27,000; 72.5% women), other healthcare-diagnosing or treating practitioners (n=22,500; 60.9% women), and physicians (n=13,000; 32.4% women).

Annual standardized suicide rates per 100,000 person-years were 21.4 for healthcare support workers, 16.0 for registered nurses, 15.6 for health technicians, 13.1 for physicians, 10.1 for social/behavioral health workers, and 7.6 for other healthcare-diagnosing or treating practitioners, as compared with 12.6 for non-healthcare workers.

Adjusted hazards showed no significant increase in suicide risk for physicians (aHR 1.11, 95% CI 0.71-1.72), social/behavioral health workers (aHR 1.14, 95% CI 0.75-1.72), or other health care-diagnosing or treating practitioners (aHR 0.61, 95% CI 0.36-1.03).

Despite not finding an increased risk of suicide among physicians, Olfson cautioned against ignoring the "substantial" stressors physicians face -- from longer hours and greater dissatisfaction with their work-life balance to elevated levels of burnout.

And he pointed out that the study sample was too small to tease apart the risk of suicide among female doctors, noting that previous research has shown differences between male and female physicians when it comes to suicide risk.

A study limitation included that suicide deaths of healthcare workers may be more likely to be underreported than those of other professionals, due to stigma. In some cases, a colleague of the deceased may complete the death certificate, Olfson said, and "with the family in mind ... may not count it as a suicide."

If you or someone you know is considering suicide, call the .

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