Prevalence of suicidal thoughts and behaviours among medical professionals: a meta-analysis and systematic review. Issue 1 (October 2019) - Que, Jianyu
Abstract: Background: Suicidal thoughts and behaviours (STB) are common among medical professionals, which is a risk factor for death by suicide. However, the prevalence of STB among medical professionals is highly variable in published studies. We aimed to provide accurate prevalence estimates of STB. Methods: We searched PubMed, Embase, and PsycINFO for relevant studies published in English between Jan 1, 1990, and Dec 14, 2018, using the search terms "(suicide OR suicidal ideation OR suicide plan OR suicide attempt OR suicidal behaviour OR suicidality OR suicid*) AND (physician OR surgeon OR nurse OR medical graduate OR medical undergraduate OR internship OR residency OR health-care provider OR medical trainee OR doctor) AND (prevalence OR incidence)". Prevalence estimates for suicidal thoughts and attempts during lifetime, in the past 12 months, and recently (in the past 1 month) among medical professionals were pooled using random-effects meta-analyses. We evaluated heterogeneity using the I 2 statistic and did sensitivity analysis to identify the sources for substantial heterogeneity. We did subgroup analysis and meta-regression to assess the differences among screening instruments, income groups, and phases of medical practice. We assessed publication bias using Begg's and Egger's tests. Findings: Our search identified 5509 records, among which 73 longitudinal and cross-sectional studies were included. Pooled global prevalence estimates were 25·5% for lifetime suicidal thoughts, 9·8% for suicidal thoughts in the past 12 months, and 8·0% for recent suicidal thoughts among medical professionals. Pooled global prevalence estimates were 2·3% for lifetime suicide attempts and 0·5% for suicide attempts in the past 12 months. The aggregated estimates were substantially heterogeneous. Subgroup analysis and meta-regression showed that the prevalence of recent suicidal thoughts and lifetime suicide attempts among medical professionals from low-income and middle-income countries were higher than those from high-income countries. Medical students, compared with physicians and nurses, had a higher prevalence of suicidal thoughts within the past 12 months. The prevalence estimate of recent suicidal thoughts in women was higher than that in men. Interpretation: STB is a strong risk factor for suicide and early identification can be helpful to prevent the tragedies of committing suicide. The prevalence of STB among medical professionals is relatively high. Effective programmes are urgently needed to prevent death by suicide among medical professionals. Funding: National Natural Science Foundation of China.