NEW YORK — With one completed suicide every day, US physicians have the highest suicide rate of any profession. In addition, the number of physician suicides is more than twice that of the general population, new research shows.

A systematic literature review of physician suicide shows that the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population.

Physicians who die by suicide often suffer from untreated or undertreated depression or other mental illnesses, a fact that underscores the need for early intervention, study investigator Deepika Tanwar, MD, Psychiatric Program, Harlem Hospital Center, New York City, told Medscape Medical News.

"It's very surprising" that the suicide rate among physicians is higher than among those in the military, which is considered a very stressful occupation, Tanwar told Medscape Medical News.

The findings were presented here at the American Psychiatric Association (APA) 2018 annual meeting.

Stigma, Access to Lethal Means

Using MEDLINE and PubMed, the investigators conducted a systematic literature review of physician suicide that included articles published in peer-reviewed journals during the past 10 years.

The review showed that the physician suicide rate was 28 to 40 per 100,000; in the general population, the overall rate was 12.3 per 100,000.

The results also showed that although female physicians attempt suicide far less often than women in the general population, the completion rate for female physicians exceeds that of the general population by 2.5 to 4 times and equals that of male physicians.

Experts are trying to understand why physician suicide rates are so high, said Tanwar. She pointed out that their review shows that some of the most common diagnoses were mood disorders, alcoholism, and substance abuse.

One study showed that depression affects an estimated 12% of male physicians and up to 19.5% of female physicians, a prevalence that is on par with that of the general population.

Depression is more common in medical students and residents, with 15% to 30% screening positive for depressive symptoms.

The investigators note that mood disorders in the medical profession is not restricted to North America. Studies from Finland, Norway, Australia, Singapore, China, and elsewhere have shown an increase in the prevalence of anxiety, depression, and suicidality among medical students and practitioners alike.

Stigma, said Tanwar, is a major obstacle to seeking medical treatment. She pointed to a study in which 50% of 2106 female physicians who completed a Facebook questionnaire reported meeting criteria for a mental disorder but were reluctant to seek professional help because of the fear of stigma.

The new review showed that poisoning and hanging are among the most common means of physician suicide. The findings also suggest that greater knowledge of and easier access to lethal means account for the higher rate of suicide completion in physicians.

The review also showed that of all medical specialties, psychiatry is near the top in terms of suicide rates.

There is growing awareness of physician suicide, and initiatives to prevent it are increasing.

Tanwar noted that several sessions at this year's APA meeting address physician wellness and burnout, which may help reduce suicide rates.

Alarming Rates

Commenting on the findings for Medscape Medical News, Beth Brodsky, PhD, associate clinical professor of medical psychology in psychiatry at Columbia University and the Irving Medical Center, New York City, who is an expert in this field, said the very high rate of physician suicide is "alarming."

However, she added, it is not surprising, given the stressors physicians face.

The stress starts in medical school and continues in residency with the high demands, competitiveness, long hours, and lack of sleep. This may contribute to substance abuse, another risk factor for suicide, said Brodsky.

This high stress is exacerbated by dwindling healthcare resources and residency positions, she noted. There are many stories of individuals dying by suicide after not securing one of these coveted spots.

When medical students graduate and enter the profession, they face different but equally challenging stressors, said Brodsky.

As more women enter the medical profession, they are becoming increasingly vulnerable to the fallout from work stressors. As a result, their rate of suicide is also increasing, said Brodsky.

Brodsky is among the experts advocating for better ways of addressing these problems, which may start with simple semantics. People do not "commit" suicide but "die by suicide," she said. She noted that suicide is an "illness and not a crime."

Brodsky welcomes the APA's focus on physician suicide because it raises awareness of the issue and will ultimately lead to improved prevention and intervention initiatives.

Openly discussing suicide as an illness helps "bring it out of the darkness" and shed the stigma shadowing this problem, she said.

The investigators and Dr Brodsky have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2018. Abstract 1-227, presented May 5, 2018.

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