By Dalia Sofer

Female nurses are significantly more likely to die by suicide than male nurses, physicians, and women in the general population, according to a recent study.

The researchers examined data on 159,372 suicides in the United States among people ages 30 and older from 2007 to 2018, identifying 2,374 suicides among nurses, 857 suicides among physicians, and 156,141 suicides in the general population. Overall, they found that the rate of suicide among all nurses was 23.8 per 100,000 population compared with 20.1 in the general population.

Being a female nurse, however, “was associated with an additional 8.5 suicides per 100,000” compared with women in the general population, the researchers wrote, noting spikes in certain years, such as 2017 to 2018, when the incidence of female nurse suicide was 17.1 per 100,000, nearly double that of the general female population.

The suicide rates for male nurses and physicians roughly matched those for men in the general population. Suicide rates for female physicians also did not vary significantly when compared with women in the general population. But female nurses, when compared with female physicians, had an additional 7 suicides per 100,000 population.

The study also examined how nurses and physicians lost their lives to suicide. It found that both professions were more likely than the general population to die by poisoning, using substances such as antidepressants, benzodiazepines, barbiturates, and opiates—a fact that the researchers attributed to greater access to these prescription drugs and knowledge about their effects.

Asked if the prevalence of suicide by poisoning was an indication of substance use disorder (SUD) in these clinicians, Christopher Friese, a study coauthor and professor at the University of Michigan School of Nursing in Ann Arbor, said that without adequate research funding to pursue such questions, “we lack a basic understanding of the relationships among stressors at home, stressors at work, substance use, and emotional well-being among RNs.” He added: “Our data point to the increased use of substances in deaths by suicide, so understanding the incidence and contributing factors of SUD among nurses is an important area, but not the only knowledge gap we need to address.”

A study targeted one such knowledge gap: the degree to which job-related problems contribute to nurse suicides. The study found that nurses who lose their position or leave the profession because of substance use, mental health issues, or chronic pain are at risk for suicide.

Friese emphasized the importance of adequate support for nurses in stressful work or life situations, especially in light of the COVID-19 pandemic. “There's no doubt that nurses, regardless of health care setting, have reported increased workloads, less support, increased administrative burdens, and increased verbal and physical abuse,” he said. In addition to intensified on-the-job pressures, Friese noted that nurses may have lost “patients, family members, and colleagues. They may have gotten ill themselves due to suboptimal PPE.” As the public health emergency subsides, Friese expects signs of posttraumatic stress in the nursing workforce. “It's important that we look out for each other right now and make sure nurses with difficulties receive rapid confidential support,” he said.

In an editorial accompanying the study, Constance Guille also cited the pandemic as possibly exacerbating the trend in nurse suicides. She urged quick implementation of preventive measures such as time for health-related activities, identification of at-risk individuals through such tools as confidential health screenings, and targeted therapy for those in need. Guille also recommended systemic evaluation of work-related stressors, including nurse-to-patient ratios, shift length, and scheduling, as well as acknowledgment of the stigma associated with mental health problems within the culture of medicine.