New Research Suggests Nurses At Increased Risk For Suicide


 
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By Shannon Firth

Nurses are at a higher risk of suicide and are more likely to have experienced a job problem prior to taking their lives compared to others in the general population, a prominent researcher in the field said here.

Something needs to be done to improve workplace wellness and lower nurses risk of suicide, said Judy Davidson, RN, DNP, a nurse scientist at the University of California San Diego, who spoke at the Fuld Institute for EBP National Summit on Friday afternoon.

"It's common for people not to want to accept that the job could be tipping people over the edge and be a primary risk factor," she said. "If we do nothing, we're going to stay right where we are."

There's often a tendency, when people talk about suicide, to blame a death on a personal weakness or a personal problem, Davidson said after the presentation.

But law enforcement agents and medical examiners investigate every suicide, and one of the risk factors they look for is whether the person who died had trouble at work.

What Davidson found, in examining 12 years of suicide data from 2005 to 2016, is that for nurses, both male and female, that answer was yes more often than in the general population.

"Nurses coded higher, statistically significantly higher, than the general population for having known job problems prior to death by suicide" in the CDC's National Violent Death Reporting System (NVDRS), where such information is documented, Davidson explained.

Female nurses who died by suicide were also actually less likely to have intimate partner problems than the general population, Davidson noted.

The data Davidson looked at also captures the method of suicide.

Opioids and benzodiazepines were the most commonly used method of suicide in female nurses, which suggests a need to increase support for nurses who have pain management problems and mental health needs, she said in an email. Use of firearms is most common for male nurses.

But over the past three years, gun suicides among female nurses has been increasing, she found. "We're going to have to look at it year-to-year, but the signal is there."

Female nurses were also more likely to have received mental illness treatment, either in the past or immediately prior to suicide, and were more likely to leave a suicide note.

Davidson said she expects her study to be published in January.

She began studying suicide rates after three nurses at her own institution took their lives in a 12-month period.

In addition to conducting research she has helped to expand a suicide prevention program originally geared towards UCSD physicians to include nurses.

"Internationally, there have been signals throughout time that nurses have a higher risk of suicide," Davidson said during the presentation on Friday.

Norway, Denmark, British Columbia, Australia, and China have all published studies about nurses' elevated risk of suicide, she said.

In the U.S., from about 1937 to 1990, there were "small signals from small studies ... hinting that we might have a problem." But then the literature went silent.

In July, Davidson and her colleagues published the first national investigation of nurse suicide in 20 years in Archives of Psychiatric Nursing.

That study used 2014 NVDRS data and compared male and female nurses' suicide rates to the general population and found they were significantly higher for nurses of both sexes.

Gender is a critical factor that should be teased out in suicide research, as men are three to four times more likely to complete suicide than women.

Davidson had earlier found higher rates of suicide in a pilot study comparing nurse and non-nurse suicides in San Diego using medical examiner data from 2005 to 2015.

At her talk here, Davidson presented her analysis of NVDRS data through 2016, and found suicide rates of 10 per 100,000 person-years among female nurses and 33 per 100,000 among male nurses, versus 7 and 27 per 100,000 person-years, respectively, for males and females in the general population (P<0.001).

That translated to incidence rate ratios of 1.4 for female and 1.2 for male nurses.

Rates of suicide nationally have risen by about 25% in the U.S. from 1999 to 2016, according to a 2018 CDC "Vital Signs" report.

One reason she's confident that nurses' suicide rates are not simply part of this wave is because nurses suicide rates have been elevated for much longer.

"As far back as we've had good data, [female] nurses have been at increased risk" for suicide, Davidson said. "This is not a fluke."

Among male nurses, their increased risk of suicide surfaced only after 2011, Davidson said, which may simply be due to smaller numbers of men included in earlier NVDRS data sets.

One limitation of her study is that not all 50 states have been included in the NVDRS data set.

But, she noted, "we feel much more confident because each time we look at [the NVDRS] with more and more data... we're finding the same answer," and that answer matches what's been shown around the world.

As for the finding that job problems are a significant risk, Davidson said she hopes to examine medical examiners' notes to better understand what specific work issues could be contributing to these suicides.

But she's adamant that hospitals and health systems need to take action.

"[J]ust having a yoga mat in the break room" isn't enough, she said.

"It's really about saving lives, about taking the stressors out of the workforce to decrease the risk of burnout, that can lead to depression that can lead to suicide."


 
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