Physician vs military suicide rate

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Gither

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Figured who better to ask than you guys. Read a medscape article stating physician suicide rate is highest of all occupations, even military. Hard to believe. 28-40 per 100,000 whereas googling I found military to be 24-25 per 100,000. Read somewhere else APA had a presentation about this at annual meeting in 2018? Sources seemed legit as from CDC and Veteran affairs. Maybe it’s cause most veterans are not combat vets? Can’t find a percentage. Read somewhere a good proportion of homeless population are vets and may have died without identity verified? Obviously a lot of confounding factors but I was just surprised physician suicide was higher than veterans.
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Gither said:
Figured who better to ask than you guys. Read a medscape article stating physician suicide rate is highest of all occupations, even military. Hard to believe. 28-40 per 100,000 whereas googling I found military to be 24-25 per 100,000. Read somewhere else APA had a presentation about this at annual meeting in 2018? Sources seemed legit as from CDC and Veteran affairs. Maybe it’s cause most veterans are not combat vets? Can’t find a percentage. Read somewhere a good proportion of homeless population are vets and may have died without identity verified? Obviously a lot of confounding factors but I was just surprised physician suicide was higher than veterans.
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You seem to be assuming suicide is more frequent in combat veterans than in veterans who have not experienced combat. Recent research indicates that probably isn't the case.
 
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VA Hopeful Dr said:
Farming I get (there have been a lot of lay publications about that recently), forestry though I don't.
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Forestry is difficult because of the left leaning sentiments to not log forests. The belief in the Disney image of the old growth forest as the romantic ideal. Other movies like FernGully, Avatar, etc reinforce the cultural shift against using the forest as a natural resource to be harvested. As such, those in the forestry industry deal with frequent uncertainty very similar to farming.

Timber prices fluctuate just like grain. One day pine/fir is destined for the mill and Home Depot lumbar yards, another day its destined to be wood chipped and shipped to China for being made into paper pulp.
Timer prices are influenced by countries that subsidize, like Canada.
Ability to harvest one's company land, or one's multi-million dollar land lease/contract is thwarted by lawsuits from activists; on par to a farmer losing a crop because of water loss for protected fish.
Environmental radiation like the Spotted Owl, which annihilated most of the industry in the PNW. They have since noted that a competing owl may be the real culprit and not the logging industry.

These all create massive swings in labor demand, company solvency, and results in unemployment and financial insecurity in rural locations where people call home.
 
Thanks for the links. Very interesting read. I knew you guys/gals would point me in the right direction.
 
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clausewitz2 said:
No, I'm pretty sure he's pinning it on James Cameron.
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Maybe we can support this theory. Quick, let's look up the suicide rate of luxury liner craftsmen, travelers from the future trying to save John Connor, and Ellen Ripley. Do their suicide rates differ from the gen pop?
 
WisNeuro said:
Maybe we can support this theory. Quick, let's look up the suicide rate of luxury liner craftsmen, travelers from the future trying to save John Connor, and Ellen Ripley. Do their suicide rates differ from the gen pop?
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Depends on the definition. Given the mortality rate, one could argue that going back in time to save John Connor IS suicide.
 
WisNeuro said:
Sooooo...liberal environmental efforts are solely responsible for suicides in the forestry industry?
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No. I made no declaration of sole causation.

I simply pointed out the overlaps of the forestry industry with that of the agricultural industry and how these stressors can be contributions to the risk unique to these occupations.
 
Sushirolls said:
No. I made no declaration of sole causation.

I simply pointed out the overlaps of the forestry industry with that of the agricultural industry and how these stressors can be contributions to the risk unique to these occupations.
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Something like that. So, no James Cameron effect, though?
 
PSYDR said:
Food for thought:

But There Isn't An Epidemic Of Suicide In The US Military
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There was a study a few years back, maybe someone in the VA, I'll try to find that was advancing a similar line of thought. Obviously, it's fraught with politics and anything even remotely against the "VA=terrible for veterans" narrative gets shouted down pretty quickly. I'll see if I can find it when I get some time.
 
WisNeuro said:
There was a study a few years back, maybe someone in the VA, I'll try to find that was advancing a similar line of thought. Obviously, it's fraught with politics and anything even remotely against the "VA=terrible for veterans" narrative gets shouted down pretty quickly. I'll see if I can find it when I get some time.
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Cui Bono?

Same for Fox's research which shows the rate of school shooting are significantly less than the 1990s.
 
It's disheartening that physicians are ranked high up there for a while, especially psychiatry. Anyone know where to find the paper discussing high physician suicides rates by specialties? It specifically noted that psychiatry was near the top of medical specialties. I wonder how each specialty ranked and how far up psychiatry ranked by suicides.

All I could find was a recent NPR article that referenced a link to the literature review with no publication found.
 
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pbdoctor1 said:
It's disheartening that physicians are ranked high up there for a while, especially psychiatry. Anyone know where to find the paper discussing high physician suicides rates by specialties? It specifically noted that psychiatry was near the top of medical specialties. I wonder how each specialty ranked and how far up psychiatry ranked by suicides.

All I could find was a recent NPR article that referenced a link to the literature review with no publication found.
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I don't have any numbers in front of me but I would be really shocked if it turned out medical students applying to psychiatry were not much more likely to have a personal or family history of suicidality/mental illness/substance use.

So not a super fair comparison to, say, rheumatologists.
 
clausewitz2 said:
I don't have any numbers in front of me but I would be really shocked if it turned out medical students applying to psychiatry were not much more likely to have a personal or family history of suicidality/mental illness/substance use.

So not a super fair comparison to, say, rheumatologists.
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You may be right about this but it'd be good to know what the data shows. Curious to see what's high and low in comparison. It'd be interesting to see which field has the lowest suicide rate and if there is anything to be learned about it. Also would be interesting to see a trajectory of suicide rate changes among specialties that have actively tried to tackle physician suicide. It's tragic no matter which specialty. The hope is that we can held reduce this as much as possible across the field of medicine.
 
Environmental radiation like the Spotted Owl, which annihilated most of the industry in the PNW. They have since noted that a competing owl may be the real culprit and not the logging industry.
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When logging stopped the Spotted Owl population didn't improve suggesting it might've not been logging, but at the time it wasn't known. What was known was that the population was decreasing, logging was going on, and the owl required large amounts of forest to produce prey they could feed upon.

It, however, has not been proven it's all the competing owl. It could've also been that the logging caused the population to plummet but then the competing owl prevented recovery as has happened in other species in various studies. The "recovery" that might've not been needed in the first place without the logging. Further in the areas where the Spotted Owl was in danger, questions such as the long-term prospects of maintaining the logging industry weren't being addressed. E.g. Were they allowing pockets of land for trees to grow back so that industry in that area could be maintained? When this was asked, the locals admitted they didn't have long-term planning, and the argument then came back that they were then going to kill the goose laying the eggs anyway just further down the road unless the owl issue was addressed. The Spotted Owl became a political symbol on several fronts, not just to protect it but to point out that if the logging continued anyway the local economy would've gone down the tubes anyway (oh no liberal-agenda! maintaining industry!) and the owl was just a sign of things to come as is often the case when an ecosystem is affected.

To boil it down to "liberal activism" oversimplifies the issue plus transparently inserts an agenda into the argument. This type of thing often times happens with people with laymen knowledge on the issue.

E.g. the Mcdonald's hot coffee issue where they were effectively sued and had to pay large amounts court-ordered fines. What several don't report was that McDonald's was told to lower their coffee temperature for years and at that point not made to pay high fines, several had previously been injured by their coffee literally being given at temperatures far higher than a human could safely consume, Mcdonald's had data showing serving coffee at the prior high temperature would lead to further injuries but only lowered the temperature when they had to pay a huge fine, but the real story is usually not told, and the edited-misleading version told as if it's a "liberal conspiracy."

Do you for a FACT know that it was all the Barred Owl (that by the way is an invasive species) and not the tree cutting at all? Funny given that many experts in the field aren't sure. If not don't pretend to be an expert in the subject. Barred Owls are being killed to see if Spotted Owls will rise in number but it's still being studied. Why not tell the researchers to stop given that you seem to know the answer?

Further I know plenty of people in construction that say because of cutting down trees...allowing them to grow for about 10-20 years, then cutting them down again isn't good enough because the quality of wood from such a tree doesn't compare to trees that are much older and want even more "liberal activism," or more like some forests where the trees are allowed to grow for much longer, and these guys aren't liberal.

Medicine is a science. I'd no further advocate people prescribe based on political theories or to believe anti-vaxxers than to offer their opinion over science in non-medical fields.
 
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Monocles said:
The VA released new data last year and I think the military suicide rate is now down to 20.1 or something (used to be 21 a few years ago).

So I think physicians still have the highest rate. Either being a doctor is more miserable than other jobs or physicians are more lethal when they attempt suicide.
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Knowledge and access to means.
 
OldPsychDoc said:
Knowledge and access to means.
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Well to be fair the knowledge and means to kill oneself is some could say higher for the military given the easier access and better knowledge of gun use. I read that physician suicide by gun was a major method of suicide which is perplexing since most veterans are more likely to have access to guns yet somehow rates are lowering.

The question is, for physicians who have more training and knowledge in prevention and treatment why do so many end up still end up doing it. More importantly why is it lower for the VA in terms of rates declining vs physicians which I think is rising. Maybe it's that the military has pressure to take a more proactive approach on this issue. There is most likely a more rational reason why there is a parallel between the high rates of suicide in the military and medicine.
 
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OldPsychDoc said:
Knowledge and access to means.
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this and physicians are less likely to seek care for fear of repercussions to their career, stigmatization or narcissistic injury. i typically see physicians after they have attempted suicide. in my experience physicians tend to be expert minimizers and tell you everything is fine even after barely surviving a suicide attempt. many physicians are cheap and don't want to pay out of pocket
 
in my experience physicians tend to be expert minimizers and tell you everything is fine even after barely surviving a suicide attempt.
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I used to work in ER psychiatry. We had a former ER physician that allegedly raped several patients and was heavily prosecuted, lost his license and was then depressed and suicidal. He denied he raped anyone but there was video footage of him raping a patient that directly led to him being found guilty.

I was on duty and knew this guy would be admitted. Due to the exact reasons you mentioned I knew this guy would be a very tough case.

I was handling his ER evaluation and alerted the staff he was likely going to be an admit. I told the residents on duty to read up on the case because of the situation-a physician sex-offender at risk for suicide, and for the same reasons you mentioned none of wanted to be the inpatient doctor treating this case. All of them you can tell was hoping to not be the one to take the case.
 
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pbdoctor1 said:
It's disheartening that physicians are ranked high up there for a while, especially psychiatry. Anyone know where to find the paper discussing high physician suicides rates by specialties? It specifically noted that psychiatry was near the top of medical specialties. I wonder how each specialty ranked and how far up psychiatry ranked by suicides.

All I could find was a recent NPR article that referenced a link to the literature review with no publication found.
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The literature review cited in the Medscape article was a presentation given at the 2018 American Psychiatric Association meeting, so the paper probably isn't out yet if a quick search was any indication. However, an old paper using data from England and Wales from 1979 to 1995 found that there were significant differences in mortality ratios between specialties among senior doctors, with community health (8.0), anesthesiologists (6.8), psychiatrists (4.8), and general practitioners (3.6) having higher ratios than general medicine (baseline).

pbdoctor1 said:
The question is, for physicians who have more training and knowledge in prevention and treatment why do so many end up still end up doing it.
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Comparing the VA to physicians may be comparing apples to oranges. In any case, there was a study conducted a few years ago examining the interpersonal theory of suicide among physicians here that may be an interesting read.
 
Temperance said:
The literature review cited in the Medscape article was a presentation given at the 2018 American Psychiatric Association meeting, so the paper probably isn't out yet if a quick search was any indication. However, an old paper using data from England and Wales from 1979 to 1995 found that there were significant differences in mortality ratios between specialties among senior doctors, with community health (8.0), anesthesiologists (6.8), psychiatrists (4.8), and general practitioners (3.6) having higher ratios than general medicine (baseline).


Comparing the VA to physicians may be comparing apples to oranges. In any case, there was a study conducted a few years ago examining the interpersonal theory of suicide among physicians here that may be an interesting read.
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Thanks I'll take a look. I hope they release the new data from the conference soon to get a look at potential updates. Curious to see what else it discusses and gleam some new insights.
 
Being a doctor is a misery itself. Although I did not read the paper, I am not surprised by any means.
 
I think the CDC data about suicide rates among different professions is not valid or reliable enough. It is based on 17 states that choose to collect this information. How profession are categorized can be uneven.
CDC retracts widely cited study on farmer suicide rates

The variability in findings makes me question the report. The most recent data does not include physicians near the top
Suicide Increasing Among American Workers | CDC Online Newsroom | CDC

I think our best evidence indicates that white middle aged and older men with low levels of social support and access to lethal means are most likely to die by suicide (we can likely also infer you have an increased risk if you have lost social standing/prominence in recent years). The professions with these individuals are most likely to die, which makes sense why construction workers are on the list.

But more importantly, the profession data is not reliable compared to the general data. Being a physician is likely not a risk factor above and beyond the other ones I have mentioned.
 
DynamicDidactic said:
I think the CDC data about suicide rates among different professions is not valid or reliable enough. It is based on 17 states that choose to collect this information. How profession are categorized can be uneven.
CDC retracts widely cited study on farmer suicide rates

The variability in findings makes me question the report. The most recent data does not include physicians near the top
Suicide Increasing Among American Workers | CDC Online Newsroom | CDC

I think our best evidence indicates that white middle aged and older men with low levels of social support and access to lethal means are most likely to die by suicide (we can likely also infer you have an increased risk if you have lost social standing/prominence in recent years). The professions with these individuals are most likely to die, which makes sense why construction workers are on the list.

But more importantly, the profession data is not reliable compared to the general data. Being a physician is likely not a risk factor above and beyond the other ones I have mentioned.
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Let's not throw the baby out with the bath water here based purely on CDC data collection methods. There are still multiples studies that indicate that physician suicide risk is higher and a continuous problem. There are studies based on meta analysis of ISCO (International standard of occupation) that indicates a more accurate trend among health professionals as having a high rate of committing suicide globally. They cite numerous papers reflecting a more accurate pattern of suicide risk by various professions globally and physicians still are high up there. Their studies suggest an association between psychosocial job stressors (for example low job control, low social support, and high job demands) and suicide. They also cite numerous studies that show that variation in SES disadvantage cannot explain the elevated suicide rates among those employed in highly skilled occupations, as these people are likely to be well paid and highly educated.

Suicide by occupation: Systematic review and meta-analysis | The British Journal of Psychiatry | Cambridge Core

What's more concerning is we've known physician suicide rates have been higher (over 2-4 times the general population according to the literature) and various methods to reduce these rates over the years haven't worked according to the research. We can't chalk this up to being a purely under diagnosed mental illness problem of individual physicians because they lack the other risk factors (grueling work, isolation, poverty) mentioned above that are likely attributable to other occupations.

According to the studies the culmination of the unreasonable workload, stigma, and culture of medicine contributes to this. The articles mention that it begins early on in medical school and residency with harassment and belittling of trainees in the medical community playing a role in addition to other stressors which add up and never appear and go away. (some correlate residency programs creating trauma for trainees similar to PTSD for soldiers after war) Studies show that almost 50% of all interns across the field develop depression. It alludes to the education and training essentially creating burnout and subsequent mental illness (depression) or suicides, both during and down the road. More so the data shows that suicides are higher in practitioners after they are done. This may mean that the culmination of stressors developed in training may lead to more depression and suicide. This sounds counterintuitive given the higher income, higher education, intrinsic knowledge of mental illness, higher access to care that don't appear to be protective in suicide prevention. Curious to see what the APA paper reveals.

It would be nice if psychiatry as a field can seriously take charge of this issue and focus on reducing it, starting from within its own field. We really can do better for the future of medicine.

Physician Suicide: Overview, Depression in Physicians, Problems With Treating Physician Depression
Doctors' Suicide Rate Highest of Any Profession
 
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@pbdoctor1 sorry for the delay in getting back to this thread.

I think you are correct that we should not dismiss the importance of understanding suicide in physicians. I also appreciate the additional resources you posted that were new to me. I admit that I have never looked at the research on suicide in physicians. I looked over the systematic review and the 2 other links. I was not able to find anything that showed an effect of being a physician that was above and beyond the more common risk factors for suicide. Particularly, the systematic review even states that the likely reason for suicide rates in medical professionals is simply access to means.

Access to lethal suicide methods through work may also explain some of the observed results, particularly the higher risk of suicide in ISCO categories containing farmers, police, military and medical professionals than other occupations. 18,19,62 An investigation of the methods used in suicide by occupational groups conducted in New Zealand 52 found that farmers were more likely to use firearms as a method to take their own life, whereas health professionals were more likely to overdose on drugs.
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Now, it is interesting that psychiatry seems to have an elevated risk compared to other medical professionals. I would love to see research examining if this is due to self-selection or something inherent to psychiatry. Since I am not a physician and have stayed out of medical settings aside from my predoctoral internship, I am very ignorant of the entire matter. It would be a very intriguing line of research if anyone did it but controlled for the general risk factors.
 
DynamicDidactic said:
@pbdoctor1 sorry for the delay in getting back to this thread.

I think you are correct that we should not dismiss the importance of understanding suicide in physicians. I also appreciate the additional resources you posted that were new to me. I admit that I have never looked at the research on suicide in physicians. I looked over the systematic review and the 2 other links. I was not able to find anything that showed an effect of being a physician that was above and beyond the more common risk factors for suicide. Particularly, the systematic review even states that the likely reason for suicide rates in medical professionals is simply access to means.



Now, it is interesting that psychiatry seems to have an elevated risk compared to other medical professionals. I would love to see research examining if this is due to self-selection or something inherent to psychiatry. Since I am not a physician and have stayed out of medical settings aside from my predoctoral internship, I am very ignorant of the entire matter. It would be a very intriguing line of research if anyone did it but controlled for the general risk factors.
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Agreed I hope the research published by the APA article sheds more insight to what is going on with suicide and burnout within medicine and psychiatry in particular. I am hopeful these types of research can help educate and inspire a new generation of positive progressive physicians because the current stop gap of wellbeing are ineffective and disingenuous at worst. The statistics are fairly daunting especially in a field that is the epitomizes positive outcomes in mental health. There is a concern that we are creating mental illness among our colleagues and trainees and we need to move quickly to tackle and change this problem.
 
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