Suicidal Behaviors in Physicians

  • Michael F. MyersEmail author
Part of the Integrating Psychiatry and Primary Care book series (IPPC)


Physicians comprise an at-risk group for suicide and there is no evidence that an improvement or resolution is in sight. Nevertheless, there is now significant research into the internal and external forces that put doctors at risk of harming themselves. This chapter presents an overview of our understanding regarding suicidal behaviors in physicians and the centrality of early intervention, which includes both comprehensive assessment and broad-based treatments. By creating open discussions about a taboo subject and learning from loved ones of doctors who have died by suicide, we are chipping away at the pernicious stigma that prevents physicians from embracing life-saving psychiatric and psychological treatments.


Suicide Suicide attempts Suicidal thoughts Medical students Residents Doctors Treatment 


  1. Baxter EA. Personal accounts: the turn of the tide. Psychiatr Serv. 1998;49:1297–8.CrossRefPubMedGoogle Scholar
  2. Berman AL. Managing medicolegal risk when treating suicidal patients. International Association Suicide Research and American Foundation for Suicide Prevention International Summit on Suicide Research. October 11, 2015. New York, NY.Google Scholar
  3. Berman AL, Silverman MM. Suicide risk assessment and risk formulation part II: suicide risk formulation and the determination of levels of risk. Suicide Life Threat Behav. 2014;44(4):432–43.CrossRefPubMedGoogle Scholar
  4. Bostwick JM, Pabbati C, Geske JR, McKean AJ. Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. Am J Psychiatry. 2016;173(11):1094–100. CrossRefPubMedGoogle Scholar
  5. Braquehais MD, Eiroa-Orosa FJ, Holmes KM, Lusilla P, et al. Differences in physicians’ and nurses’ recent suicide attempts: an exploratory study. Arch Suicide Res. 2016;20(2):273–9.CrossRefPubMedGoogle Scholar
  6. Brigham T Accreditor lays out plan for resident well-being. 2016.
  7. CDC Fact Sheet. Suicide facts at a glance. National Center for Injury Prevention and Control. 2015.
  8. CDC. 10 leading causes of death by age group, United States – 2014. 2014. Accessed 2 May 2017.
  9. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289(23):3161–6.CrossRefPubMedGoogle Scholar
  10. Charles SC. Coping with a medical malpractice suit. West J Med. 2001;174:55–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cornette MM, deRoom-Cassini TA, Fosco GM, et al. Application of an interpersonal-psychological model of suicidal behavior to physicians and medical trainees. Arch Suicide Res. 2009;13:1–14.CrossRefPubMedGoogle Scholar
  12. Czyz EK, Horwitz AG, Eisenberg D, Kramer A, King CA. Self-reported barriers to professional help seeking among college students at elevated risk for suicide. J Am Coll Heal. 2013;61(7):398–406.CrossRefGoogle Scholar
  13. Dyrbye LN, West CP, Satele D, Boone S, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med. 2014;89(3):443–51.CrossRefPubMedGoogle Scholar
  14. Dyrbye LN, Eacker A, Durning SJ, Brazeau C, Moutier C, Massie FS, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med. 2015;90(7):961–9.CrossRefPubMedGoogle Scholar
  15. Eckleberry-Hunt J, Lick D. Physician depression and suicide: a shared responsibility. Teach Learn Med. 2015;27(3):341–5.CrossRefPubMedGoogle Scholar
  16. Eneroth M, Gustafsson Senden M, Lovseth LT, Schenck-Gustafsson K, Fridner A. A comparison of risk and protective factors related to suicide ideation among residents and specialists in academic medicine. BMC Public Health. 2014;14:271.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Erikson EH, Erikson JM. The lifecycle completed: extended version. New York: WW Norton; 1998.Google Scholar
  18. Ey S, Moffit M, Kinzie JM, Brunett PH. Feasibility of a comprehensive wellness and suicide prevention program: a decade of caring for physicians in training and practice. J Grad Med Educ. 2016;8(5):747–53.CrossRefPubMedGoogle Scholar
  19. Fink-Miller EL. An examination of the interpersonal psychological theory of suicidal behavior in physicians. Suicide Life Threat Behav. 2015;45(4):488–94.CrossRefPubMedGoogle Scholar
  20. Finlayson AJ, Iannelli RJ, Brown KP, Neufeld RE, DuPont RL, Campbell MD. Re: physician suicide and physician health programs. Gen Hosp Psychiatry. 2016;40:84–5.CrossRefPubMedGoogle Scholar
  21. Fortescue EB. Mercy. JAMA. 2015;314(12):1231–2.CrossRefPubMedGoogle Scholar
  22. Frank E, Dingle AD. Self-reported depression and suicide attempts among US women physicians. Am J Psychiatry. 1999;156(12):1887–94.PubMedGoogle Scholar
  23. Fridner A, Belkic K, Marini M, et al. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (The HOUPE Study): cross-sectional associations with work stressors. Gend Med. 2009;6:314–28.CrossRefPubMedGoogle Scholar
  24. Gabbard GO, Allison SE. Psychodynamic treatment. In: Simon RI, Hales RE, editors. The American psychiatric publishing textbook of suicide assessment and management. Washington, DC: American Psychiatric Publishing, Inc.; 2006. p. 221–34.Google Scholar
  25. Gask L. I’m a psychiatrist—and I live with depression. Psychiatr Times. 2016;33(1)Google Scholar
  26. Goebert D, Thompson D, Takeshita J, Beach C, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84:236–41.CrossRefPubMedGoogle Scholar
  27. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35(1):45–9.CrossRefPubMedGoogle Scholar
  28. Gold KJ, Andrew LB, Goldman EB, Schwenk TL. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016; doi: 10.1016/j.genhosppsych.2016.09.004.PubMedGoogle Scholar
  29. Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiat. 2015;72(5):411–2.CrossRefGoogle Scholar
  30. Guille C, Zhao Z, Krystal J, Nichols B, Brady K, Sen S. Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: a randomized clinical trial. JAMA Psychiat. 2015;72(12):1192–8.CrossRefGoogle Scholar
  31. Gunter TD. Physician death by suicide: problems seeking stakeholder solutions. Arch Depress Anxiety. 2016;2(1):020–5.Google Scholar
  32. Győrffy Z, Dweik D, Girasek E. Workload, mental health and burnout indicators among female physicians. Hum Resour Health. 2016;14(1):1.CrossRefGoogle Scholar
  33. Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D'Augelli AR, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2010;58(1):10–51.CrossRefGoogle Scholar
  34. Hawton K, Clements A, Sakarovitch C, Simkin S, Deeks JJ. Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. J Epidemiol Community Health. 2001;55:296–300.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Hawton K, Clements A, Simkin S, Malmberg A. Doctors who kill themselves: a study of the methods used for suicide. QJM. 2000;93:351–7.CrossRefPubMedGoogle Scholar
  36. Iannelli RJ, Finlayson AJ, Brown KP, Neufeld R, Gray R, Dietrich MS, et al. Suicidal behavior among physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry. 2014;36(6):732–6.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Jobes DA, Au JS, Siegelman A. Psychological approaches to suicide treatment and prevention. Curr Treat Options Psychiatry. 2015;2(4):363–70.CrossRefGoogle Scholar
  38. Joiner TE. Why people die by suicide. Cambridge MA: Harvard University Press; 2005.Google Scholar
  39. Kisch J, Leino EV, Silverman MM. Aspects of suicidal behavior, depression and treatment in college students: results from the spring 2000 national college health assessment survey. Suicide Life Threat Behav. 2005;35:3–13.CrossRefPubMedGoogle Scholar
  40. Legha RK. A history of physician suicide in America. J Med Humanit. 2012;33(4):219–44.CrossRefPubMedGoogle Scholar
  41. Leslie Q. Take a look at me now. JAMA. 2015;313(2):137–8.CrossRefPubMedGoogle Scholar
  42. Lheureux F, Truchot D, Borteyrou X. Suicidal tendency, physical health problems and addictive behaviours among general practitioners: their relationship with burnout. Work Stress. 2016;30(2):173–92.CrossRefGoogle Scholar
  43. Lindfors P, Meretoja O, Luukkonen R, Elovainio M, Leino T. Suicidality among Finnish anaesthesiologists. Acta Anaesthesiol Scand. 2009;53(8):1027–35.CrossRefPubMedGoogle Scholar
  44. Mann JJ, Waternaux C, Haas GL, et al. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;156:181–9.PubMedGoogle Scholar
  45. Miller K. Fighting stigma begins at home. Psychiatric News. 2015;50(16) doi: 10.1176/
  46. Myers MF. When physicians die by suicide: reflections of those they leave behind. Vancouver, BC: Producer Videotape; 1998.Google Scholar
  47. Myers MF Toward preventing physician suicide: incorporating the insights of those they leave behind. Paper presented International Conference on Physician Health. September 19, 2016. Boston, MA.Google Scholar
  48. Myers MF, Gabbard GO. The physician as patient: a clinical handbook for mental health professionals. Washington, DC: American Psychiatric Publishing Inc.; 2008a. p. 186.Google Scholar
  49. Myers MF, Gabbard GO. The physician as patient: a clinical handbook for mental health professionals. Washington, DC: American Psychiatric Publishing Inc.; 2008b. p. 196.Google Scholar
  50. Nuland SB. Lost in America: a journey with my father. New York: Knopf; 2003.Google Scholar
  51. Olfson M, Wall M, Wang S, Crystal S, Liu SM, Gerhard T, Blanco C. Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiat. 2016;73(11):1119–26.CrossRefGoogle Scholar
  52. Oquendo MA, Baca-Garcia E. Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: advantages outweigh limitations. World Psychiatry. 2014;13(2):128–30.CrossRefPubMedPubMedCentralGoogle Scholar
  53. Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Amer J Addict. 2015;24:30–8.CrossRefGoogle Scholar
  54. Oskrochi Y, Maruthappu M, Henriksson M, Davies AH, Shalhoub J. Beyond the body: a systematic review of the nonphysical effects of a surgical career. Surgery. 2016;159(2):650–64.CrossRefPubMedGoogle Scholar
  55. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36.CrossRefPubMedGoogle Scholar
  56. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161:2295–302.CrossRefPubMedGoogle Scholar
  57. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–90.Google Scholar
  58. Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, et al. Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62.CrossRefPubMedGoogle Scholar
  59. Silverman M. Physicians and suicide. In: Goldman LS, Myers M, Dickstein LJ, editors. The handbook of physician health: an essential guide to understanding the healthcare needs of physicians. Chicago, IL: American Medical Association; 2000. p. 95–117.Google Scholar
  60. Struggling in Silence: physician depression and suicide. DVD American Foundation for Suicide Prevention. 2008.
  61. Tucker RP, Michaels MS, Rogers ML, Wingate LR, Joiner TE. Construct validity of a proposed new diagnostic entity: acute suicidal affective disturbance (ASAD). J Affect Disord. 2016;189:365–78.CrossRefPubMedGoogle Scholar
  62. Tyssen R, Hem E, Vaglum P, Gronvold NT, Ekeberg O. The process of suicidal planning among medical doctors: predictors in a longitudinal Norwegian sample. J Affect Disord. 2004;80(2–3):191–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of PsychiatryState University of New York, Downstate Medical CenterBrooklynUSA

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