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Female physicians were more likely to die by suicide than women in the general population in recent decades, but the same trend was not observed among male doctors, according to a meta-analysis of nine British and U.S. studies.

Compared with the general population, female physicians had a significantly higher suicide mortality ratio (SMR) from the 1980s to date (1.46, 95% CI 1.02-1.91), reported Dante Duarte, MD, PhD, of Harvard Medical School in Boston, and colleagues.

However, male physicians had a lower SMR than a matched group of the general population across the same time period (0.67, 95% CI 0.55-0.79), they wrote in .

"In the general population, men die of suicide at higher rates than women, so there are known sex-related trends," Duarte and co-author Mirret El-Hagrassy, MD, also of Harvard, told 乌鸦传媒 in an email. "Those trends seem to be reversed for physicians, which might be due to changes in either physician or population suicides."

SMRs are calculated through a ratio of observed and expected suicide deaths among physicians and matched comparators in the general population, Duarte's group explained. The decreased SMR among males observed in this study may be driven by the rate of suicides among doctors rather than population suicides, they noted.

"This may be because male physicians are relatively protected from workforce or unemployment factors affecting men of lower socioeconomic status, which may have obscured any burnout associated outcomes," the authors wrote.

The same claim could not be made for female physicians, perhaps because there were fewer female physicians before the 1980s, underpowering the data, Duarte added. He and his colleagues wrote that "greater female representation in the physician workforce may not have overcome the magnitude of their increased risk compared with women in general. It also raises the question of a lag in improved workforce conditions compared with workforce numbers."

Although physicians may have greater access to mental health services and knowledge about their beneficial effects, this doesn't always "overcome the deep shame and inadequacy felt by physicians in crisis," commented Katherine Gold, MD, MSW, of the University of Michigan in Ann Arbor, and Thomas Schwenk, MD, of the University of Reno in Nevada, in an .

"This burden is worsened by fears of being seen as less capable, an educational system that stresses care for others over care for self, and licensing and credentialing requirements that often punish physicians who accurately report their diagnoses and treatments," Gold and Schwenk said.

More women are entering medicine than they were before 1980, but women in the field still face a wage gap, a risk of sexual harassment, and other disparities that can contribute to mental health issues and suicide risk, commented Pamela Wible, MD, of the Ideal Medical Care Movement.

"Even in an optimal work environment where no one is bullying you or sexually harassing you, you're still seeing patients die every day, having to deliver terrible news, and seeing things that are creating mental health issues," Wible, who is a physician suicide prevention advocate and was not involved in the study, told 乌鸦传媒.

In this study, SMR decreased over time for both female (-1.96, 95% CI -3.09 to -0.84, P=0.002) and male physicians (-0.84, 95% CI -1.26 to -0.42, P<0.001) when the data were stratified into two time periods (before vs after 1980).

However, because researchers lack data on female physicians early on, it's difficult to trace intergenerational patterns of suicide risk over time, Wible cautioned.

For example, while 547 males died by suicide across the nine studies included, just 162 females were included in the analysis.

The "taboos" surrounding physician suicide and inaccurate reporting measures may lead to inaccuracies in mortality data that make it difficult to track the actual rate of suicides among this population, Wible added.

Duarte and El-Hagrassy agreed, noting that most deaths by "unintentional poisoning" in their datasets involved prescription drugs, making it seem "improbable that the overdoses were accidental."

"We have no doubt that an important limitation for the present study is the underreported data," they said.

If you or someone you know is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.

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