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13 were doctors. Physician assistants and medical students were excluded from the evaluation, although retired physicians were not.

Although physicians weren’t significantly more likely to have a current mental health disorder (46 percent versus 41 percent) or to have current blue mood (42 percent versus 39 percent) at the time of death than those in other professions, the difference became significant on multivariate analysis: Having a known mental illness was modestly associated with physician status, with an odds ratio of 1.34 after adjustment for gender, race, age, and marital status.

Known alcohol or substance misuse were less common, though, among doctors. High blood alcohol levels on toxicology during the period of death were really less common among doctors.

Notably, physicians were not significantly more likely to have antidepressants found on toxicology.

The substances that were more common among physicians than other suicide victims were:

  • Antipsychotics, with an odds ratio of 28.7
  • Benzodiazepines, with an odds ratio of 21.0
  • Barbiturates, with an odds ratio of 39.5

“The latter is especially important due to its infrequent use for healing purposes and its known deadly possibility,” the researchers noted.

“The equally stunning increased chance of quantifiable antipsychotics being discovered is uncertain as to its value, whether they were used for overdosage or because of an important difference in the prevalence of conditions for example bipolar disorder.”

Colleagues and gold cautioned that the data that was available could not distinguish whether the materials contributed by impairing judgment to suicide or were used with lethal intent.

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Firearms were the most frequent procedure used for suicide by both physicians and nonphysicians, at about half in both groups.

Poisoning came in next most common among doctor suicides, using a slightly higher proportion than among nonphysicians (24 percent versus 18 percent).

Psychosocial risks also differed between the groups.

A job problem that contributed to the suicide was 3.12 times more likely among physicians, whereas death of a buddy or family member and disaster in the earlier 2 weeks were less common, with odds ratios of 0.37 and 0.61, respectively.

“Doctor self-identity is usually centered around the professional function, which may permeate both work and residence aspects of the lives,” the investigators wrote. “For someone whose work helps you to explain their personal and professional identity, a disaster in a work situation might feel more threatening than for someone whose personal identity was less reliant on work satisfaction.”

They warned that the database used probably underestimated incidence and physician suicides of mental illness because of coverage as well as deliberate miscoding because of the stigma attached.

Other restrictions were that the violent death reporting system didn’t have statewide information for many states and was not a nationally-representative sample.

Source: Physician Suicide Linked to Work Pressure

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