By Gary Evans
The authors of a recent study identified an increased risk of suicide in registered nurses, health technicians, and healthcare support workers in the United States, compared to non-healthcare workers.
“We compared healthcare worker groups with non-healthcare workers,” says lead author Mark Olfson, MD, MPH, a psychiatrist at Columbia University. “The idea is that if these same people weren’t healthcare workers, they would be at lower risk [of suicide]. That’s the inference that we draw.”
Olfson and colleagues analyzed data from 2 million workers who participated in the American Community Survey (ACS) from 2008 through 2019. “Heightened suicide risk for registered nurses, healthcare support workers, and health technicians highlights the need for concerted efforts to support their mental health,” the researchers concluded.1
The suicide rate per 100,000 non-healthcare workers was 12.6, compared to an overall rate in healthcare personnel of 14.1. Elevated risk was identified in healthcare support workers, who had a suicide rate of 21.4 per 100,000 people. Registered nurses had a rate of 16 per 100,000, and health technicians followed closely with a 15.6 suicide rate.
Hospital Employee Health sought comment on the findings from suicide researcher Judy Davidson, DNP, RN, MCCM, FAAN, a nurse scientist at UC San Diego Health Sciences.
“I have read Dr. Olfson’s study and spoken to him about his findings,” Davidson says. “[The findings] ring true to me given what we see in our suicide prevention program. Suicide prevention measures need to be in place for the entire workforce — not just physicians or nurses. Wellness initiatives need to be equitably distributed throughout all levels in the organization.”
At UC San Diego Health, all employees are offered free, anonymous encrypted mental health screening yearly. “We successfully transfer many healthcare support staff into mental health treatment through this encrypted process,” Davidson says.
Employee health professionals can find out more about encrypted screening by contacting the American Foundation for Suicide Prevention at: https://afsp.org/.
Suicidal Ideation and Intervention
Davidson was the lead author of a groundbreaking 2021 study that revealed an ominous pattern: Nurses committed suicide after being fired or quitting their jobs due to substance use disorder, chronic pain, or mental health issues that are not controlled.2 The upshot is that these deaths could have been prevented if these issues had been recognized in time.
Olfson concurs, suggesting improved efforts to detect possible suicidal ideation in healthcare workers. “They may have started using alcohol or drugs,” he says. “They may have mood swings and outbursts of anger, become sad, and feel hopeless. They may withdraw themselves and not socialize with others. They may miss work and talk about how they’re a burden and they’re not helping with the healthcare of the patients. If we can spot some of these warning signs and get them help and support, we might be able to save some of these lives.”
One global meta-analysis reported an increase in suicidal ideation in healthcare workers during the pandemic, although the level of this uptick varied by study.3
“In [one] study,4 suicidal thoughts had a prevalence of 11% among healthcare workers compared to 6% in the general population,” the authors reported. “It should not be disregarded that suicidal ideation is a predictor of future suicide attempts and suicide deaths, hence the importance of addressing it at early stages.”
Caveat
The key caveat in the Olfson study is that the findings do not reflect the effect of the pandemic on healthcare suicide rates. “We got right up to Dec. 31, 2019, but of course, the pandemic really got started in March of 2020,” he notes.
It seems highly unlikely that healthcare worker suicide rates improved as COVID-19 besieged and overwhelmed caregivers for three years. However dramatic when it occurs, suicide is something of a lagging indicator in data gleaned for research analysis. There is little question that risk factors for suicidal ideation increased during the pandemic for healthcare workers, but there are many other contributing factors that have to be untangled.
The authors of a systematic review paper assessing the mental health problems in healthcare workers since the pandemic began reported that “nurses, women workers, frontline healthcare workers, younger medical staff, and workers in areas with higher infection rates had faced the highest level of psychological distress.”5
Imperfect Storm
Interestingly, a feared global spike in suicides in the public does not appear to have occurred, at least based on data early in the pandemic.
“In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period,” researchers found.6
However, they advised vigilance as the long-term mental health effects of the pandemic unfold. “There was a lot of fear and concern that this would be a perfect storm and the pandemic would result in an increased suicide risk in the [general] population, but that does not appear to have been borne out either in the United States or in other high-income countries,” Olfson concludes.
Healthcare workers remain at higher risk in any case, and stress points may go beyond work to pressures at home. “I don’t want to say that it’s all related to work,” Olfson notes. “Obviously, people lead complicated lives, and there are many factors that come to bear on the risk.”
Still, healthcare can be said to carry the occupational hazard of elevated suicide risks, and the pandemic brought into sharp relief the toll of the intense efforts to help patients.
“I think that might well be the case — more time with patients and the psychological strains of having to care for people who are severely ill,” Olfson says. “Sometimes, no matter what you do, you can’t really alter their course, and despite your best efforts, people end up with impairments or end up dying. These are obviously very stressful roles to serve in.”
REFERENCES
- Olfson M, Cosgrove CM, Wall MA, Blanco C. Suicide risks of health care workers in the US. JAMA 2023;330:1161-1166.
- Davidson JE, Ye G, Parra MC, et al. Job-related problems prior to nurse suicide, 2003-2017: A mixed methods analysis using natural language processing and thematic analysis. J Nurs Regul 2021;12:28-39.
- García-Iglesias JJ, Gómez-Salgado J, Fernández-Carrasco FJ, et al. Suicidal ideation and suicide attempts in healthcare professionals during the COVID-19 pandemic: A systematic review. Front Public Health 2022;10:1043216.
- Phiri P, Ramakrishnan R, Rathod S, et al. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021;34:100806.
- Vizheh M, Qorbani M, Arzaghi SM, et al. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. J Diabetes Metab Disord 2020;19:1967-1978.
- Pirkis J, John A, Shin S, et al. Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 2021;8:579-588.
The authors of a recent study identified an increased risk of suicide in registered nurses, health technicians, and healthcare support workers in the United States, compared to non-healthcare workers.
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