Suicide Prevention: Why are Healthcare Workers More at Risk for Suicide and What Can be Done?

This article discusses the difficult topic of suicide and how it affects healthcare workers at a higher rate. It also explores what can be done to bring awareness along with risk factors and signs regarding suicide ideation. Nurses General Nursing Article

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Suicide Prevention: Why are Healthcare Workers More at Risk for Suicide and What Can be Done?

Suicide is the 10th leading cause of death, with a reported 45,970 suicides in the United States in 2020. One might automatically think of the general population; however, the CDC notes that healthcare workers are at a higher risk. This has been an issue even prior to the Covid-19 pandemic. In fact, a longitudinal study led by Judy Davidson, DNP in 2020, demonstrated this by comparing suicide rates of nurses to the general population between 2005-2016. The study found a higher suicide rate for female nurses (10/100,000) compared to females in the general population (7/100,000). The male nurse suicide rate was also higher (33/100,000) compared to the general male population (27/100,000). Unfortunately, there are several factors that can contribute to a higher risk for suicide that we need to be aware of. However, in order to make a real change, we must first drop the stigma and normalize the conversation about suicide among healthcare workers.

Why are healthcare workers more at risk?

Working within a healthcare setting can be stressful. This is especially true for certain professions within the healthcare sector. Frontline workers such as doctors, nurses, and some allied health professionals are an example of this. We are routinely exposed to patients' suffering, deaths, ethical conflicts, organizational deficits, and long shifts that can cause social disruption. In addition, healthcare workers are at constant risk of exposure to infectious diseases, workplace violence, and in some cases, bullying. This can all be emotionally fatiguing for the frontline worker, which causes anxiety, depression, and even PTSD, increasing the risk of suicide. Acknowledging psychological challenges is a good start toward change. Moreover, having open conversations about suicide can help normalize the topic and dispel the stigma surrounding it. This is important because many people do not report suicidal thoughts or ideations due to feelings of shame. Normalizing discussions about depression and suicide will make people more likely to be forthcoming in discussing their struggles and seek help.

What can healthcare facilities do to mitigate this risk?

Healthcare facilities can initiate change by offering a variety of educational resources for their employees, such as well-publicized mental health and wellness strategies, suicide prevention training, in-house support groups, and provide screenings tool that detect stress and depression, such as The Interactive Screening Program provided by the American Foundation of Suicide Prevention. This is a confidential web-based stress and depression questionnaire that also gives the option to connect with a counselor online. In addition to this, every effort should be made to decrease stress in the workplace, such as adequate staffing, practical workloads, and an aggressive “no bullying” campaign. Interventions such as these help to cultivate an environment that supports mental wellness.

What can you do as an individual?

Everyone should be aware of risk factors as well as common warning signs of someone who may be suicidal and be ready to start a conversation. Understanding these factors can also help you know when to get help for yourself.

Risk factors:

  • History of mental illness (I.e., depression, anxiety, PTSD)
  • Prolonged stress (I.e., bullying, harassment, relationship problems)
  • Chronic fatigue
  • Sufferers of serious health conditions including pain
  • Personality traits of aggression, impulsivity, and mood changes
  • Family history of suicide
  • Stressful life events such as divorce, financial crises, or loss
  • Substance abuse
  • Access to firearms or lethal means

Common warning signs:

  • Talking about killing themselves      
  • Feelings of hopelessness 
  • Endorsing shame/humiliation               
  • Loss of interest
  • Feeling depressed/anxious
  • Withdrawn
  • Increased agitation
  • Isolating from friends/family
  • Giving away valued possessions
  • “Wrapping up” affairs

What to do if you suspect someone is contemplating suicide?

Should you suspect someone might be contemplating suicide, have a nonjudgmental conversation and ask directly. Often individuals want help but have a tough time initiating the conversation due to feelings of embarrassment or stigma. By voicing your concerns and showing a willingness to talk about it, he/she may be more open to discussing what they have been feeling.

Resources for Mental Health Crisis

Should you feel you may hurt yourself or know someone who may, get immediate help. Call a mental health specialist, a suicide hotline such as The Suicide Crisis Hotline: 988 (call or text), or call 911.

References/Resources

UC San Diego Health: National Study Confirms Nurses at Higher Risk of Suicide than General Population

American Foundation for Suicide Prevention: ISP connects individuals to mental health services before crises emerge

American Foundation for Suicide Prevention.: Risk factors, protective factors, and warning signs

The Centers for Disease Control and Prevention: Suicide Prevention for Healthcare Workers

National Institute of Mental Health: Suicide

Mayo Clinic: Are you thinking about suicide? How to stay safe and find treatment

American Association of Critical-Care Nurses: Suicide: A Dark Cloud Over Nursing

Frontiers Media S.A.: Suicide in Healthcare Workers: Determinants, Challenges, and the Impact of COVID-19

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Kimika Medina

About Kimika Medina, BSN

Kimika Medina has 2 years experience and specializes in Psychiatric nursing.

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Specializes in Primary Care, Military.

While I find this to be a necessary topic for us to consider among our colleagues, it's also important to remember how dangerous a topic that it can be, too. Disclosing a history of depression, PTSD, or other mental illness, even if completely stable and in treatment now, to the wrong person can result in career difficulties if you're put in the BON's spotlight. All it takes is for the wrong person with the wrong beliefs to start questioning and criticizing your every decision and a report, no matter how frivolous, to be filed and you're facing the same probationary measures as someone who has diverted narcotics. All due to a medical condition that can very well be exacerbated by poor working conditions. It's a horrible situation that many find themselves in. They may require assistance, but fear requesting any due to the significant stigma that is still attached to these diagnoses. 

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Specializes in Psychiatric nurse.

HarveyvQuinn,

I agree, there is such a stigma attached to many mental health diagnoses that prevent people from seeking help, especially medical professionals for the reasons you have stated. This is very unfortunate as mental illnesses are medical conditions that can be treated. We have to have healthy conversations around this issue to encourage normality. No one should have to suffer in silence because they are concerned about backlash. These conversations can save lives! 

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Specializes in Psych (25 years), Medical (15 years).

In working in the mental health field for approximately 25 of the 40+ years I worked as a professional caregiver, I was involved with literally thousands of patients claiming to be suicidal. Of those thousands of patients with which I directly worked with over the years, only two had completed suicides.

Interesting that those two patients who committed suicide, never spoke of any suicidal thoughts.

I know of two professionals who worked in the field, a lab tech and security guard, who committed suicide and also did not speak of suicidal thoughts.

Perhaps those who received treatment for their voiced suicidal thoughts dealt with their feelings which prevented the suicidal act. Or perhaps those who are actually suicidal threats do not voice their thoughts.

There were many recidivistic behavioral health patients who regularly checked in to the psych ward claiming to be suicidal. It was a staff consensus that these recidivistic patients either wanted "three hots and a cot" or enjoyed the attention.

"The squeaky wheel gets the grease" as the idiom goes, but often it is the wheel that doesn't squeak which truly requires the intervention.

Addendum: Both completed suicidal patients were males who hung themselves. Both professionals who completed suicides were female. One hung herself, while the other died from a GSW.

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Specializes in Psych (25 years), Medical (15 years).

Risk Factors
*Family history of suicide

In the book "Night Falls Fast", the author cited that a true suicidal risk is more prevalent among those who had a blood relative who had a completed suicide.

Suicide could be a genetically predisposed personality trait rather than the amount of occupational stress an individual experiences.

In a quick search, it was found that the suicide rate is slightly higher with performing artists than the rate cited with male nurses in the above article, at a rate of 33.7/100,000. We can surmise that a personality which has an intense need for external gratification is more prone to committing suicide. 

In the quest for happiness and self-satisfaction, we often believe that if we meet others' needs, or make others happy, we too shall be happy. When the realization that this endeavor does not result in happiness, our life endeavor was for naught.

 This realization can be illuminatingly upsetting, and our life can seen as being worthless. Hence, a worthless life is not worth living and suicide is a viable option.

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Specializes in Primary Care, Military.
15 hours ago, Davey Do said:

Risk Factors
*Family history of suicide

In the book "Night Falls Fast", the author cited that a true suicidal risk is more prevalent among those who had a blood relative who had a completed suicide.

Suicide could be a genetically predisposed personality trait rather than the amount of occupational stress an individual experiences.

In a quick search, it was found that the suicide rate is slightly higher with performing artists than the rate cited with male nurses in the above article, at a rate of 33.7/100,000. We can surmise that a personality which has an intense need for external gratification is more prone to committing suicide. 

In the quest for happiness and self-satisfaction, we often believe that if we meet others' needs, or make others happy, we too shall be happy. When the realization that this endeavor does not result in happiness, our life endeavor was for naught.

 This realization can be illuminatingly upsetting, and our life can seen as being worthless. Hence, a worthless life is not worth living and suicide is a viable option.

Don't forget situational risk factors, too. The hospital where I began my career lost a talented CRNA after a tragic case. A woman died of an infection after her c-section and the team blamed the CRNA who performed the epidural, claiming this CRNA was the cause of the infection that killed her. The CRNA committed suicide prior to the results turning out that the infection was present prior to the delivery and that it wasn't the CRNA's fault at all. The source wasn't from the epidural. This was a military hospital and military CRNA. Young, talented, and supposed to have a bright future ahead. 

 I know military service creates different risk profiles, but so can some situations for healthcare workers. Loss, even the loss of a patient, can be very difficult for some. Especially if they don't have strong support systems in place. I've seen organizations and teams that handle debriefing very well and others that do a very poor job of it. 

 I also spent a few years working in inpatient mental health. I saw many of the same types of patients with what was called chronic suicidality as you describe. A case that will forever stay with me is a frequent patient, homeless, with alcohol abuse problems that always came in with suicidal ideation and a plan to set himself on fire actually followed through one night. He died from his injuries a few days after. I had worked with this man closely during many of his stays. Maybe, statistically, if someone chronically voices suicidal thoughts they could be at lower risk, but I don't think I want to take the chance of missing the time the plan and intent are there, either. Basically, we should really do a better job looking out for each other instead of tearing each other down. 

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Specializes in Psych (25 years), Medical (15 years).
8 hours ago, HarleyvQuinn said:

Don't forget situational risk factors, too.

Joseph Campbell said, "Mystics swim in the waters where others drown".

Some persevere through their trials and tribulations, experience illuminating revelations and attain a higher consciousness, while others allow their grief to overcome them and make a permanent solution out of a temporary problem.

William Wright, in his classic book, "Born That Way" proves behavior is more of a result of nature than nurture.

On 9/16/2022 at 8:44 AM, Davey Do said:

Suicide could be a genetically predisposed personality trait rather than the amount of occupational stress an individual experiences.

Some of us are wired one way while others are wired another.

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Specializes in Primary Care, Military.
On 9/17/2022 at 10:57 AM, Davey Do said:

Joseph Campbell said, "Mystics swim in the waters where others drown".

Some persevere through their trials and tribulations, experience illuminating revelations and attain a higher consciousness, while others allow their grief to overcome them and make a permanent solution out of a temporary problem.

William Wright, in his classic book, "Born That Way" proves behavior is more of a result of nature than nurture.

Some of us are wired one way while others are wired another.

Family history is definitely a major risk factor. I've told you before that I love your posts, right? I've learned a lot from you and really relate when I read your stories about working behavioral health. ?

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Specializes in Psych, Substance Abuse.

I've assessed many patients who claimed to be suicidal. Then they get a bit too comfortable and admit they just need a place to sleep.

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