Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995

Study objective-To investigate the suicide risk of doctors in England and W ales, according to gender, seniority and specialty. Design-Retrospective cohort study. Suicide rates calculated by gender, age, specialty, seniority and time period. Standardised mortality ratios calcul ated for suicide (1991-1995), adjusted for age and sex. Setting-England and Wales. Subjects-Doctors in the National Health Service who died by suicide between 1979 and 1995, identified by death certificates. Population at risk based on Department of Health manpower data. Main results-Two hundred and twenty three medical practitioners in the Nati onal Health Service who died by suicide or undetermined cause were identifi ed. The annual suicide rates in male and female doctors were 19.2 and 18.8 per 100 000 respectively. The suicide rate in female doctors was higher tha n in the general population (SMR 201.8; 95% CI 99.7, 303.9), whereas the ra te in male doctors was less than that of the general population (SMR 66.8; 95% CI 46.6, 87.0). The difference between the mortality ratios of the fema le and male doctors was statistically significant (p=0.01), although the ab solute suicide risk was similar in the two genders. There were significant differences between specialties (p=0.0001), with anaesthetists, community h ealth doctors, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine. There were no differences with regard to seniority and time period. Conclusions-There is an increased risk of suicide in female doctors, but ma le doctors seem to be at less risk than men in the general population. The excess risk of suicide in female doctors highlights the need to tackle stre ss and mental health problems in doctors more effectively. The risk require s particular monitoring in the light of the very large increase in the numb ers of women entering medicine.