National Incidence of Physician Suicide and Associated Features.

Importance: Previous reports regarding comparative suicide incidence among US physicians vs nonphysicians have been inconclusive.

Objective: To estimate the national incidence of male and female physician suicide and analyze associated factors, comparing findings to the general population.

Design, setting, and participants: This retrospective cohort study investigated suicides among physicians and nonphysicians aged 25 years and older in the US from January 2017 to December 2021. The analysis took place from November 2023 to September 2024. National Violent Death Reporting System data from 30 US states and Washington, DC, were used. Decedents with missing age or sex were excluded for incidence, and missing race, ethnicity, or marital status for further analyses.

Exposure: Physician occupation.

Main outcome and measures: Suicide incidence rate ratios (IRRs) and odds ratios (aORs) adjusted by age, sex, race, ethnicity, and marital status were used to compare preceding circumstances, primary method, and substances.

Results: A total of 448 physician (354 [79%] male and 94 [21%] female; mean [SD] age, 60 [16] years) and 97 467 general population (76 697 [79%] male and 20 770 [21%] female; mean [SD] age, 51 [17] years) suicides were identified. Female physicians had higher rates of suicide than female nonphysicians in 2017 (IRR, 1.88; 95% CI, 1.19-2.83) and 2019 (IRR, 1.75; 95% CI, 1.09-2.65), with overall higher 2017 to 2021 suicide risk (IRR, 1.53; 95% CI, 1.23-1.87). Male physicians had lower 2017 to 2021 suicide risk than male nonphysicians (IRR, 0.84; 95% CI, 0.75-0.93). Compared to the general population and including all available jurisdiction data, physicians had higher odds of depressed mood (aOR, 1.35; 95% CI, 1.14-1.61; P < .001) as well as mental health (aOR, 1.66; 95% CI, 1.39-1.97; P < .001), job (aOR, 2.66; 95% CI, 2.11-3.35; P < .001), and legal (aOR, 1.40, 95% CI, 1.06-1.84; P = .02) problems preceding suicide as well as use of poisoning (aOR, 1.85; 95% CI, 1.50-2.30; P < .001) and sharp instruments (aOR, 4.58; 95% CI, 3.47-6.06; P < .001). Physicians also had higher odds of positive toxicology for caffeine; poison; cardiovascular agents; benzodiazepines; anxiolytics, nonbenzodiazepines, or hypnotics; and drugs not prescribed for home use.

Conclusion and relevance: These findings show a higher incidence of suicide for US female physicians compared to female nonphysicians. Comprehensive and multimodal suicide prevention strategies remain warranted.