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A STUDY of suicide in the health professions is a pertinent reminder that those providing care for others are not only at risk of mental health issues themselves, but might also be more reluctant to talk about it.
The study, published today in the MJA, also highlights that certain groups, including women in both the medical and nursing professions, as well as men in the nursing profession, have a higher suicide rate than their peers working in non-health care occupations.
Co-author Dr Allison Milner Deakin University’s Centre for Population Health Research and the University of Melbourne’s Centre for Health Equity, told MJA InSight that further research was needed to unpack these gender and occupation-related results.
“What is remarkable and depressing is the continued elevated rate of suicide among female doctors, whereas with male doctors, you don’t see this pattern,” Dr Milner said.
The study collated nationwide data regarding cause of death and basic demographic information from the National Coronial Information System, and compared it with population-based data from the Australian Bureau of Statistics.
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From 2001 to 2012, 369 suicides were reported across a range of health professionals within the 9828 recorded across Australia during the 12-year study period. The rate of suicide among female health professional groups was 6.4 per 100 000 person-years for medical practitioners and 8.2 per 100 000 person-years for midwives and nurses – a higher rate than the 2.8 per 100 000 person-years for women in the broader workforce.
Dr Milner said that the explanation for these elevated levels among female health professionals could relate to gender and workplace dynamics, as well as more recent revelations of the systemic bullying of junior doctors in specialist training, though she added that this was speculative given the absence of in-depth research.
“I suspect that the issues people were writing about 15 years ago in regards to the gender challenges females face in medicine haven’t really gone away.
“There are also issues around the double pressure women face as carers both within and outside of the medical profession – this really needs some further attention,” she said.
“Could it also relate to the fact of discrimination or bullying? I would say all of these things are a likely part of this explanation.”
Dr Milner said males nurses were also not immune to the strictures of gender, which could help explain the higher rates of suicide among this group compared to males in the broader workforce.
“The idea that men are working in a traditionally female occupation and aren’t able to express their traditional traits of hegemonic masculinity as men in other occupational groups has been put forward,” Dr Milner said.
“I would speculate, based on previous research, that it has to do with working conditions; male nurses have lower job control with a higher job demand. Male doctors also have long working hours and high job demand, but they also have a lot more control over their work – such factors are very much protective in the workplace.”
Dr Milner said the study also made a case for the link between access to lethal means, such as prescription drugs by medical practitioners and some nurses, and elevated suicide rates.
Emeritus Professor Robert Goldney from the University of Adelaide said that focusing on the low-base rate data and the subsequent calculation of a suicide rate could be misleading. In his editorial for the MJA Professor Goldney wrote:
“For example, although the rate of suicide among female medical practitioners was significantly higher than in the broader female workforce, the term ‘suicide rate’ is not particularly helpful when one considers that the total number of suicides by female medical practitioners in Australia over 12 years was 17.”
By comparison, more than 2000 suicides are recorded each year in Australia.
Professor Goldney said that pragmatic solutions to support health care professionals would be more valuable.
“Even one suicide is too many, but the most important take-home message is that doctors and health care professionals aren’t immune to mental disorders, substance misuse and suicide,” Professor Goldney told MJA InSight.
“People in the health professions must be aware that they are susceptible to the same sorts of problems that everyone is susceptible to, and they often need to heed their own advice about seeking help.”
Professor Goldney said that mandatory reporting laws could also play a role in discouraging health professionals to seek help.
Since 2010, laws in Australian states and territories require health practitioners to report notifiable conduct, such as an impairment that could place the public at risk of harm, to the Australian Health Practitioner Regulation Agency.
“Reporting is deemed mandatory if the person is not able to cope, so that may well be a factor,” Professor Goldney said.
“There’s a fear that seeing someone about psychological problems could be perceived as a sign of weakness. While mandatory reporting doesn’t arise terribly often, it would be very interesting to study to see if this played a role.”
In a podcast with MJA InSight, Dr Milner said the perceived threat of mandatory reporting laws and the effect this might have on the help seeking behaviour of health professionals needed to be addressed.
“Anything that stops people from disclosing suicide or feeling comfortable about the fact that they need help is a problem, and may play a role,” she said.
“I do see it as being problematic, and potentially contributing, but I don’t know because the data can’t tell us that.”
General practitioner Dr Karyn Alexander said that medical professionals could be reluctant to discuss mental health issues given concerns it might have consequences on their career.
“People may feel they will be criticised if it’s found they have a mental illness, or that they’re not adequate for the job,” Dr Alexander said.
“We need to ensure that support services and mechanisms for confidentiality are in place.”
A podcast with Dr Allison Milner is available here.
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It is terrible that those who should know best how to help others with suicidal intentions, are those that are most susceptible.
It is easy to blame the ‘culture of bullying” as the cause. As a 60 year male doctor, with extensive public and private experience, I have not seen nor experienced bullying. At times as a student and registrar I felt a bit inadequate in my knowledge, but was never bullied nor ridiculed. The feeling of being intimidated and bullied can be quite subjective.
Perhaps the issue goes further, and involves the selection process for new medical students. The struggle to get the highest ENTER scores so as to choose medicine or law, due their perceived prestige in the community may lead to false expectations. An intern in casualty soon realizes that he/she is not respected by a large number of its attendees, and abuse by the public is quite widespread. ( Often alcohol or drug related.) This can be quite distressing at the time. The long hours and unpaid overtime forced upon young doctors in their formative years are placed upon them by the hospital administrative staff, so as to improve their bottom line. Hence, if people are to be considered as bullies, perhaps, the issue lies in this area. Of course the administration is under pressure by external forces via government, to perform within unrealistic budgets.
The other factor which may influence doctors/nurses mood is the impact of death and injury around them. Debriefing of serious cases was non existent in the past, but I understand, is now more forthcoming.
The overall situation does need to be faced up to quickly and frankly and multiple issues assessed and remedied.
Its deeply concerning to see such high rates of suicide in the health care profession. I was aware of the high rates of suicide in female doctors, but not aware of the high rates of suicide in nurses. One suicide is too many and these results have been around for a long time. It begs the question as to why there are such high rates of suicide? Do we have a culture of care and support for health care professionals with systemic care and attention to their health and well-being in a non-stigmatised fashion? Or is there rather a culture of bullying and intimidation as is increasingly being exposed. People are naturally caring, and it doesn’t seem correct to automatically consider that because people are caring they can’t handle life and thus take their lives. Something is endemic in the culture of health care that needs addressing seriously, and globally as these results are not just national but reflect a global trend in the ill mental health of health care professionals. We need to truly support and care for our health care professionals.
When “Beyond Blue” reported an increased rate of Depression amongst Doctors compared to the general public, I asked what suicide rate their stay reported.
The réponse was “we don’t look for this data”.
My réponse ” If Suicide is not Beyond Blue, what is?”.
Misunderstanding the legislation of reporting Depression, in my case in NZ, resulted in mandatory monthly visits to a GP and Counselling sessions with the Medical Board Psychologist. The fact that I was not only Practising safely and studying ( successfully ) online for a Diploma in Cardiff, made not a jot of difference to the bureaucrats. But created an extra load on me personally as I tried to point out the legislation’s intent!
Within 6 months of my working in Christchurch NZ in 2002, two male GPs suicided. On returning to Australia in 2011 ( after the Earthquakes in Christchurch, for my wife’s health, also a doctor who died of Advanced Ovarian Caner last year ) , I sat in a chair of a female Doctor who was depressed awaiting for this female Doctor to recover. Sadly this female Doctor committed suicide.
As President of the Central Coast Medical Association for 3 years in the 90’s I saw the need to include Doctors Partners to all meetings, as partners often have more awareness than Doctors themselves, like myself, when they are on the slippery slope to a unnecessary premature grave. The meetings I organised were focused on Doctors needs not patients needs and interests and curiosities in medicine, things like Altitude Sickness, Euthanasia…not on drugs and procedures.
Statistically, numbers matter in this article, but so does the health of those who spend their lives caring.