Suicide in doctors: A psychological autopsy study
Introduction
Doctors, especially females, have a relatively high risk of suicide [1], [2], [3]. The reasons are unclear, although availability of methods [4] and occupational stress [5] have been implicated. We have used the psychological autopsy approach [6], [7] to conduct a descriptive study of doctors who died by suicide, focussing on those who were working at or shortly before the time of death.
Section snippets
Subjects
The Office for National Statistics (ONS) notified us of all individuals in England and Wales, who died between January 1991 and December 1993, received a coroner's verdict of suicide or an open verdict (“undetermined cause”) and were described as medical practitioners on their death certificates. For open verdicts, all available information was reviewed, and only those where the likelihood of suicide was judged to be moderate or high were included in the study.
Sources of information
Elsewhere, we have described in
Subjects
ONS notified us of 60 deaths. Four were excluded: two doctors practicing overseas who died while visiting the UK and two whose deaths (with open verdicts) appeared to have been accidents. Of the remaining 56 doctors, 44 had suicide verdicts (78.6%) and 12 had open verdicts (21.4%). The 38 of these who at the time of death were either working (32), very recently retired (1) or had the possibility of returning to medicine after a temporary absence (5) formed the study sample.
Sources of information
Coroners' Notes of
Discussion
We know of only one previous psychological autopsy study of suicide in doctors worldwide, which was of a much smaller sample [14]. This approach to the study of suicide is associated with well-known methodological problems, including dealing with retrospective information subject to recall bias and the varying quality and quantity of information between subjects [7]. The most serious methodological problem in this descriptive study was the amount of missing information, largely resulting from
Conclusions
In conclusion, while acknowledging the methodological limitations of the study, we suggest that the following strategies might have helped prevent the suicides of some of the doctors in this study:
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Continued emphasis on the adequate treatment of depression in doctors who should be encouraged to take time off work and be admitted to hospital if appropriate.
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Improved mechanisms for identifying medical students and young doctors with mental health problems and supporting them through training.
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Acknowledgements
The study was supported by a grant from the Department of Health. K.H. was also supported by Oxford Mental Healthcare Trust. We should like to thank the Office for National Statistics and the coroners, GPs, psychiatrists and Family Health Service Authorities who provided information, Samaritans for advice and financial support for the production of the Bereavement Information Pack and most importantly the relatives and other informants who participated in the study.
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