High Suicide Rate Places Surgery As Most Stressful Occupation

Although one out every 16 surgeons in the United States reported suicidal ideation (SI) in the previous year, few sought psychiatric or psychological help, according to a new survey.

Researchers at the Mayo Clinic (Rochester, MN, USA), the American College of Surgeons (ACS, Chicago, IL, USA), and other institutions sent members of the ACS an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life.

The results of the study showed that of the 7,905 participating surgeons, 501 (6.3%) reported SI during the previous 12 months. Among individuals 45 years and older, SI was 1.5 to 3 times more common among surgeons than the general population. Only 130 surgeons with recent SI had sought psychiatric or psychological help, while 301 were reluctant to seek help due to concern that it could affect their medical license. Recent SI had a large, statistically significant adverse relationship with all three domains of burnout (emotional exhaustion, depersonalization, and low personal accomplishment) and symptoms of depression. Burnout and depression were independently associated with SI after controlling for personal and professional characteristics. Other personal and professional characteristics also related to the prevalence of SI. The study was published in the January 2011 issue of Archives of Surgery.

"The perception of having made a major medical error in the previous three months was associated with a three-fold increased risk of suicidal ideation, with 16.2% of surgeons who reported a recent major error experiencing suicidal ideation compared with 5.4% of surgeons not reporting an error,” concluded lead author Tait Shanafelt, MD, of the Mayo Clinic, and colleagues. "Additional studies are needed to evaluate the unique factors that contribute to the higher rate of suicidal ideation among surgeons in conjunction with efforts to reduce surgeons' distress and eliminate barriers that lead to underuse of mental health resources.”

Although suicide is strongly linked to depression, the lifetime risk of depression among physicians is similar to that of the general US population. This observation suggests that other factors may contribute to the increased risk of suicide among physicians. Access to lethal medications and knowledge of how to use them has been suggested as one factor; however, the influence of professional characteristics and forms of distress other than depression, such as burnout, are largely unexplored.

Related Links:
Mayo Clinic
American College of Surgeons