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Posted by on Jul 7, 2008 in Ethics, Neuropsychiatry

Physicians Who Commit Suicide: Not So Much “Why” as “How”

Physicians Who Commit Suicide: Not So Much “Why” as “How”

Just about every physician has known another physician who has committed suicide. And the medical community’s reaction to the physician who kills himselfat least from personal experienceis like that to any suicide: devastation, self-reproach, anger, resignation. But doctors, who deal with depression, stress, and death on a regular basis, may be particularly likely to view a colleague’s self-induced death as a statistical inevitabilityperhaps even as a “particularly brutal form of social Darwinism,” as Scott Anderson puts it in his excellent piece, “The Urge to End It All,” in yesterday’s NYT Magazine.

However, Anderson indicates that our sense of futility about suicide prevention, either generally or among highly stressed medical professionals, may be a function of our misguided concentration on the “why” of suicide, instead of the “how.” He suggests that we should, perhaps, focus on reducing the means to committing suicide to reduce its incidence.

The idea, Anderson points out, is supported by the phenomenon of the “British coal-gas story,” in which England’s suicide rate dropped by approximately one third after the nation converted from coal-derived gas to cleaner, natural gas for domestic heat and stove fuel. With the conversion, people could no longer kill themselves by carbon monoxide asphyxiation from their unlit ovens. And most important, their means of suicide wasn’t supplanted by some other method. Anderson explains,

At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly—“the execution chamber in everyone’s kitchen,” as one psychologist described it—and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

Anderson indicates that the same conclusion can be made by examining impulsive suicides from bridge jumps. Even a small maneuver, like raising a fence barrier a few feet on a preferred “suicide bridge” can be enough to thwart the act. And what’s really curious is that most would-be suicides don’t have backup methods for killing themselves. So if you obstruct one way of committing suicide, you typically prevent the suicide.

But what about physicians who commit suicide? In a 2004 meta-analysis, Schernhammer and Colditz reported that the suicide rate is approximately 40% higher among male physicians and nearly 130% higher among female physicians* than the general population. Are physicians, therefore, more successful at committing suicide, because they choose less “impulsive” and more reliable ways to commit suicide? The general conclusion is yes, but that doesn’t mean that physician suicides cannot be prevented by obstructing preferred methods for committing the act.

According to a 2000 study of suicide methods among physicians in England and Wales (and I had a devil of a time finding data specific to US physicians), the overwhelming preferred method for committing suicide among doctors is, not surprisingly, drug poisoning. And the most preferred death-inducing drug is a barbiturate; although one half of anesthesiologists choose to kill themselves with an anesthetic agent.

Suicide Method

Doctors, %
(n = 272)

General Population, %
(n = 59,096)

Poisoning—drugs

57.0

26.6

Hanging, strangulation, suffocation

13.2

22.7

Gas, including CO

9.9

21.5

Cutting, piercing

5.9

1.9

Firearms, explosives

4.4

3.8

Drowning

3.7

7.8

Poisoning—other

1.5

1.5

Jumping

0.7

4.7

Other/unspecified means

3.7

9.4

Drug

Percentage

Barbiturates

21.5

Gas, including CO

15.8

Analgesics

13.5

Opiates

12.3

Antidepressants

9.6

Anesthetic agents

8.8

Minor tranquilizers

8.8

Major tranquilizers

3.5

Insulin

3.1

Other prescribed drugs

7.0

Chemicals

1.7

Recreational drugs

0.9

Unknown

8.3

Those who study physician suicide conclude that doctors’ suicide rates are higher because they have relatively easy access to medications and possess knowledge of their use. The conclusion is supported by data from the 1970s, which showed that suicide rates increased in Australia after a law facilitated access to barbiturates. 

So the proposal here is that, although a physician’s hoarding of prescription medications may be difficult to gauge, it is certainly possible to more closely monitor self-prescribed controlled substances, like barbiturates or opiates, which may be intended for abuse or, ultimately, suicide.

* Publication bias may explain the substantially higher relative risk of suicide among female physicians.

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.