US health care workers face elevated risk of suicide, new study finds

By Jacqueline Howard, CNN

(CNN) — Compared with people who don’t work in the medical field, health care workers face an increased risk of suicide, especially registered nurses, health care support workers and health technicians, according to a new study.

The study, published Tuesday in the medical journal JAMA, estimates that the annual suicide rate in the United States among health care workers alone is about 14 per 100,000 person-years compared with about 13 per 100,000 person-years among non-health care workers. Person-years is a measurement that represents the number of people in a study multiplied by the years following them.

“Our results extend earlier research from outside the United States that health care workers compared with non-healthcare workers have greater risks for mental health problems and long-term work absences due to mental disorders,” Dr. Mark Olfson, a professor at Columbia University and an author of the new study, said in a news release. “The importance of increased suicide risk of health care support workers is underscored by their growth from nearly 4 million in 2008 to 6.6 million in 2021.”

The researchers, from Columbia University and other US institutions, analyzed data from the US Census Bureau’s Mortality Disparities in American Communities data set. They took a close look at causes of death, including suicide, among about 1.84 million employed adults in the United States who were observed from 2008 through 2019.

In the data, the researchers examined annual suicide rates among non-health care workers versus six groups of health care workers: registered nurses, health care support workers, health technologists and technicians, social and behavioral health workers, health care diagnosing or treating practitioners like dentists or physician assistants, and physicians.

“Compared with the general population, physicians tend to live longer and have healthier lives. In their occupational roles, however, physicians and other health care workers routinely engage in stressful tasks of caring for severely ill individuals and managing heavy workloads, with little control over patient outcomes,” the researchers wrote in their study. “Because health care occupations vary in their emotional demands, they may also vary in suicide risk.”

The data showed that the annual suicide rates per 100,000 person-years ranged from 21.4 for health care support workers, to 16 for registered nurses, to 15.6 for health technicians, to 13.1 for physicians, compared with 12.6 for non–health care workers. The suicide rates for social and behavioral health workers as well as other diagnosing or treating practitioners, like dentists or physician assistants, were much lower at 10.1 and 7.6 per 100,000, respectively.

The new study is publishing at a time when some health care workers are preparing for a possible strike due to staffing shortages and worker burnout.

“So, we both have burnout driving the health care workforce to leave, and we have this compounding mental health crisis that is making the environment untenable,” said Corey Feist, co-founder and chief executive officer of the Dr. Lorna Breen Heroes’ Foundation. The foundation was established in memory of Feist’s sister-in-law, Breen, with a goal to reduce health care workers’ burnout. Breen was a frontline emergency department physician who treated Covid-19 patients before she died by suicide in 2020.

“Over 20% of the physicians in this country are experiencing depression yet they have ramifications if they take care of themselves. It’s no wonder that health care workers from across the country are leaving in droves and not returning,” Feist said, referring to licensure, credentialing services and liability insurance that ask about past mental health, addiction or substance use history on applications.

“Despite a growing body of evidence demonstrating that asking questions about mental health, addiction or substance use history on licensing and other applications deters physicians from seeking care, several state medical license applications and credentialing applications continue to ask these questions,” according to the American Medical Association.

The association emphasizes on its website that neither the Joint Commission nor the Federation of State Medical Boards require that licensing and credentialing organizations – such as state licensure, physician credentialing services and professional liability insurance carriers – ask probing questions about clinicians’ past mental health and strongly encourage them to refrain from asking such questions.

“We need to understand that licensed health care professionals in this country are suffering from very high degrees of depression and mental health concerns,” he said. “And yet they uniquely have penalties when they just simply obtain the same mental health treatment that you or I can obtain, they could potentially lose their license or lose their ability to work in a hospital,” Feist said.

In July, the American Hospital Association, in partnership with the US Centers for Disease Control and Prevention, created a suicide prevention guide for the health care workforce.

Yet some health care workers might be hesitant to disclose their struggles or seek mental health resources for fear that it could impact their careers or even their medical licenses.

“We do need to address licensing and accreditation questions that are intrusive and lead to workers being afraid to seek mental health treatment because of ramifications to the job or license,” Judy Davidson, a nurse scientist at the University of San Diego, California, said in an email. “Safe access to care can also be deployed through anonymous encrypted screening for those at risk using tested programs such as the American Foundation of Suicide Preventions Interactive Screening Program.”

The new study findings place “an urgent need” for health care executives to re-examine the wellness programs they offer to their staff to assure that workers have a safe pathway to access mental health treatment, said Davidson, who was not involved in the new paper but has separately studied suicide risks among nurses.

“Every healthcare executive can address the findings immediately by deploying a task force to conduct a gap analysis using the new resources developed by the American Hospital Association,” Davidson said. “The time for action is now. “

CNN’s Carma Hassan contributed to this report.

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