In the first national investigation of nurse suicide in more than 20 years, researchers found significantly higher rates of suicide among both women and men working in nursing when compared with non-nurses.
Suicide incidence was 11.97 per 100,000 person-years among female nurses and 39.8 per 100,000 among male nurses, both of which were significantly higher compared to women and men in the general population (7.58 and 28.2 per 100,000 person-years, respectively, P<0.001), reported Judy Davidson, RN, DNP, of the University of California San Diego School of Medicine, and colleagues in Archives of Psychiatric Nursing.
“This national data confirms what we previously suspected given our local findings, that nurses are at higher risk of suicide than the general population,” Davidson told MedPage Today via email.
Her group also found that nurse anesthetists and retired nurses were at higher risk of taking their own lives than other nurses.
Overall, the suicide rate was 13.9 per 100,000 person-years among nurses versus 17.7 per 100,000 person-years for the general population. Access to gender data is important as males are three to four times more likely to complete suicide than females.
“We failed to detect significance in nurses vs the overall general population, explainable due to the higher proportion of females amongst nurses,” Davidson and co-authors wrote.
Method of nurse suicide more frequently involved pharmaceuticals than firearms (35.1% vs 33.7%, respectively). In the general population, suicide by firearm (51.5%) is far more common than by pharmaceutical poisoning (9.1%).
Curiously, while data suggest that approximately 400 physicians die by suicide each year, the issue of nurse suicides has been largely uncharted, the researchers noted. Both “outdated” national studies and more timely international research, including studies from Canada, Australia, England, and Wales, suggest that nurses are at higher risk of suicide than the general public, they said.
Davidson’s interest in nurse suicides began after three UC San Diego nurses took their own lives over a short period of time. She and colleagues spotlighted the problem in a 2018 National Academy of Medicine discussion paper, “Nurse Suicide: Breaking the Silence.”
Asked why the issue had been overlooked for so long, Davidson said that even though nurses have themselves studied suicide rates among other populations “it just didn’t occur to us to look inward.”
“Nurses are known not to care for themselves as much as they care for others. It’s just a part of who we are,” she told MedPage Today in a phone interview. “But now with this whole movement towards preventing burnout, increasing joy in the workplace, increasing resiliency, this is a piece of that puzzle … sadly it took a tragic event to get the ball rolling.”
The goal of the national study was to “quantify the incidence, methods, and predictive factors of nurse suicide in the United States,” the group wrote.
A 2018 pilot study from Davidson and colleagues based on nurse suicides in San Diego County — a longitudinal retrospective review of suicides from 2005-2015 — laid the groundwork for the current national study. While the rates of suicide were numerically higher among nurses when coded by gender versus the general population, her group did not see a statistically significant difference in the pilot study.
For their current study, Davidson’s and colleagues used 2014 data from the CDC’s National Violent Death Reporting System (NVDRS) database and the National Council of State Boards of Nursing (NCSBN) and Oklahoma Board of Nursing websites representing all active licensed practitioners.
For gender breakdowns, they estimated that 7% of nurses were men and 93% were women based on data from 18 states. Suicides rates were age-matched for adults over 20.
Further Findings
In total, across the 18 states included in the NVDRS data set, the researchers identified 14,774 suicides, with 205 nurse suicides among them.
“Nurses were statistically significantly more likely to have reported mental health problems, history of treatment for mental illness, history of previous suicide attempt, leaving a suicide note and physical health problems than the general population,” they wrote.
Davidson said she was “reassured” by the statistically significant findings she and her colleagues found concerning the higher rates of suicide by gender, which were similar to her findings in the San Diego-based pilot study.
Because the national study looked at the same year but a larger sample size, Davidson said she now has “more confidence” that findings in the pilot study didn’t reach significance due to the small sample size.
Limitations, Future Plans
One initial limitation of the study was that coroner codes for occupations were typically left blank and entered as free text, using terms such as “nurse,” “RN,” or something similar. If the codes had been entered in the way the database intended them to be, however, Davidson’s group would not have known that nurse anesthetists and retired nurses were at greater risk of suicide.
Another problem that did not have hidden benefits was the lack of true workforce data on gender, said Davidson. This is a significant barrier to research in the nursing profession.
The gender data that was collected was gathered through a sampling technique, but Davidson said she would have preferred to use actual workforce data if such data had been available.
The latest NVDRS data now includes 40 states.
Davidson has nearly completed a longitudinal analysis aimed at determining whether the trends she and her colleagues are seeing hold true over time. She is also planning a future study exploring substance use as it relates to clinician suicide.
(For more on this issue, read MedPage Today’s series on suicides among nurses, investigating the reasons, reactions from colleagues, and what can be done to prevent them. The series was published in partnership with KPBS.)
If you or someone you know is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.
Source: MedicalNewsToday.com
