Concerning New Data on Female Physician Suicide

Suicide rates for female physicians in the United States between 2017-2021 were 47% higher than for women in the general population, results of a retrospective cohort study showed.

Unlike their female counterparts, male physicians had a lower rate for suicide relative to the general male population, investigators found.

“The results indicate we need added multimodal and comprehensive suicide prevention specific for physicians,” lead study author Hirsh Makhija, MS, postgraduate researcher, Department of Psychiatry, University of California San Diego School of Medicine, told Medscape Medical News.

“With depressed mood, mental health issues, and job problems all associated with physician suicides, there’s also a need for proactive mental health screening and treatment specific for physicians,” Makhija added.

The findings were published online on February 26 in JAMA Psychiatry.

More Recent Data

Data from the recently released Medscape Physicians and Suicide Report 2025 showed that at least 1 in 6 physicians surveyed had contemplated or attempted suicide. And nearly 40% of respondents said they knew at least one doctor who had experienced suicidal ideation.

The elevated risk for depression among US physicians is well established and studies have suggested suicide risk is higher among doctors than other professionals. However, the risk for physician suicide relative to the general public remains unclear. Much of the previous work on the topic included old data and many past studies often yielded conflicting results.

This new study is the first to look at US physician suicide compared with the general population using data collected after 2018. Investigators also used an age cut-off of 25 years to include resident physicians as well as those later in their training.

For the study, Makhija and his colleagues used data from the National Violent Death Reporting System (NVDRS) to identify American physicians and nonphysicians aged 25 years or older who died by suicide from 2017 to 2021. This anonymous database, considered one of the best resources for suicide research in the country, draws information from death certificates and reports from coroners, medical examiner, and law enforcement.

Researchers adjusted for age, sex, race, ethnicity, and marital status.

During the study period, 448 physicians (79% men; mean age, 60 years) and 97,467 nonphysicians (79% men; mean age, 51 years) from 30 states and Washington, DC, died by suicide.

The suicide risk was 47% higher among female physicians (incidence rate ratio [IRR], 1.53; 95% CI, 1.23-1.87) than female general population. During the same period, male physicians had a 16% lower risk for suicide than male nonphysicians (IRR, 0.84; 95% CI, 0.75-0.93).

The elevated rates of suicide among female physicians is perhaps not surprising, Makhija noted. The finding is similar to what he and his colleagues found in a similar study of suicide among nurses. And several international meta-analyses and systematic reviews had the same finding, although none were definitive.

“We believe possible contributors to this situation include under-recognition for similar work and achievements, inequitable pay and opportunities for promotion, greater domestic responsibilities leading to work-life imbalance, and risk of sexual harassment,” said Makhija.

But he noted women in the general population face many of the same challenges.

“There is likely an intersection between these contributors and the experience of being in the healthcare space that is leading female physicians to be at higher risk of suicide,” Makhija said.

Investigators also found that compared with the general population, physicians who died by suicide were more likely to have a history of depression (adjusted odds ratio [aOR], 1.35; P < .001), mental health problems (aOR, 1.66; P < .001), job problems (aOR, 2.66; P < .001), and legal problems (aOR, 1.40; P = .02).

Use of Sharp Objects

The most frequently used primary method of suicide for male physicians was firearms, whereas poisoning was the most common method used by female physicians.

Overall, suicide by poisoning (aOR, 1.85; P < .001) and sharp instruments (aOR, 4.58; P < .001) was significantly more likely among physicians than suicide among nonphysicians.

According to the NVDRS coding manual, “sharp instrument” refers to knives, razors, machetes, or pointed instruments such as a chisel, broken glass, or bow and arrow. Makhija noted the use of sharp instruments in the study was “quite surprising” and not seen in previous studies except for the one on nurses.

“Further exploration in terms of the type of sharp instruments and context in which the suicides occurred is needed,” the authors wrote. This, added Makhija, can help promote prevention efforts.

An analysis of toxicology reports revealed that physicians had significantly higher odds of using benzodiazepines, anxiolytics, nonbenzodiazepines, or hypnotics than the general population. They also were more apt to use opiates/opioids (aOR, 1.32; P = .006), cardiovascular agents (aOR, 1.77; P < .001), antidiabetic agents (aOR, 3.09; P < .001), and drugs not prescribed for home use (aOR, 8.62; P < .001), which includes drugs likely diverted from a clinical setting, including opiates.

“We believe it’s an indicator that some diversion of medications is taking place for the purpose of suicide and represents a target for suicide prevention,” said Makhija.

Cardiovascular and antidiabetic drugs could be taken for chronic conditions, but with a physician’s knowledge of drugs, these, too, could be used for suicide, commented Makhija.

The finding surrounding use of these drugs was also surprising and “has motivated us to do another paper doing a deep dive on these substances,” he said. The use of agents such as anxiolytics and hypnotics is “interesting in that this could represent self-treatment for mental health conditions,” he added.

As the analysis included only NVDRS data from available jurisdictions, the study may not be nationally representative. Also, given the COVID-19 pandemic, NVDRS sources and coders may have been overwhelmed, leading to errors or underreported suicides.

Reducing Risk

Reducing stigma could help lower suicide risk among physicians, Makhija said. As it stands, many in the healthcare space are discouraged from seeking mental health resources due to perceived stigma and potential effects on licensure, he noted.

In fact, 41% of physicians in the Medscape Medical News survey who did not seek help for suicide attempt or ideation cited potential disclosure to the medical board as the reason. Another 30% were concerned about the information appearing on insurance records.

Creating a proactive anonymous mental health screening and targeted resources could help reduce suicide risk, noted Makhija.

“We need to connect physicians who need help with mental health resources that are made for them,” he said.

Other options for suicide prevention could include limiting access to lethal means and changing how licensure asks physicians intrusive questions, he added.

Makhija noted several organizations, including the Lorna Breen Foundation, American Foundation for Suicide Prevention, National Academy of Medicine, Accreditation Council for Graduate Medical Education, and Mayo Clinic, have taken steps to try to remove existing barriers to physicians seeking treatment.

The US Surgeon General, American Hospital Association, and US Centers for Disease Control and Prevention, have all issued calls for action and recommendations for change within the healthcare workplace to address suicide risks, he said.

Urgent Need

In an accompanying editorial, Elena Frank, PhD, Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan, and colleagues noted that the study findings “underscore the urgent need for US healthcare systems and leaders to address the root causes of increased depression and suicide risk among physicians in general, with a specific focus on the factors that disproportionately affect women.”

The demands of work and family among female physicians are so severe that almost three quarters of female physicians apparently reduce their work hours to part-time or consider part-time work within 6 years of completing training, the authors noted.

Frank and her colleagues also pointed to the disproportionately high rates of sexual harassment in medicine and persistent gender inequities in promotion and pay.

“Upholding policies that support diversity, equity, and inclusion and target sexism and racism in medicine are necessary,” they wrote.

Editorial authors also suggested organizations create flexible practice environments, enabling physicians of all genders to meet their personal and professional obligations while minimizing risk for burnout, depression, or suicide.

Improving access to quality childcare options and improved parental leave policies could also help.

“Moving beyond the development and implementation of supportive policies, a shift in culture around work and family within medicine is critical to improving workplace conditions and mental health for female physicians,” they wrote.

Study funding was not disclosed. Makhija and Frank reported no relevant conflicts of interest. Full disclosures are included in the original articles.