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Physician Suicide: A Scoping Literature Review to Highlight Opportunities for Prevention


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Figure 1

PRISMA diagram of study selection for inclusion
PRISMA diagram of study selection for inclusion

Figure 2

Death by suicide was the only and primary measure or thesis in a larger proportion of all articles; suicide attempts were the least well-studied or discussed (a). Attending or practicing physicians were the most studied population (b), especially when death by suicide was the primary thesis, while medical students were the second most studied population, with a focus on suicidal ideation (data not shown)
Death by suicide was the only and primary measure or thesis in a larger proportion of all articles; suicide attempts were the least well-studied or discussed (a). Attending or practicing physicians were the most studied population (b), especially when death by suicide was the primary thesis, while medical students were the second most studied population, with a focus on suicidal ideation (data not shown)

Figure 3

Framework of common publication themes on physician suicide
Framework of common publication themes on physician suicide

Figure 4

Proposed framework to highlight priorities for continued work on physician suicide
Proposed framework to highlight priorities for continued work on physician suicide

DateSourceQuery
8/21/2017Investigatorsn/a
8/21/2017Ovid MEDLINE1. (((physician* or intern or interns or internship or fellow or resident* or residency or medical student* or doctor* or ‘medical student*’) adj5 ($suicid$ or self$harm or self$injury)) not ($assisted or euthanasia)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]2. exp Physicians/3. Students, Medical/4. exp Education, Medical/5. 2 or 3 or 4 6. Suicide/7. (5 and 6) not ($assisted or euthanasia).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]8. 1 or 7
10/11/2017PsycINFO1. (((physician* or intern or interns or internship or fellow or resident* or residency or medical student* or doctor* or ‘medical student*’) adj5 ($suicid$ or self$harm or self$injury)) not ($assisted or euthanasia)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 2. exp Physicians/3. Students, Medical/4. exp Education, Medical/5. 2 or 3 or 4 6. Suicide/7. (5 and 6) not ($assisted or euthanasia).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] 8. 1 or 7
4/28/2018Scopus( TITLE-ABS-KEY ( medical AND student* ) OR TITLE-ABS-KEY ( physician* OR fellow OR residency OR doctor* ) W/5 TITLE-ABS-KEY ( suicid* OR self-harm OR self-injury ) ) AND NOT ( TITLE-ABS-KEY ( *assisted OR euthanasia OR nurs* OR patient* OR undergraduate* ) )

Article characteristics from scoping review of literature on physician suicide, 1903–2018

Publication date rangeNo. (%) of non-opinion articlesNo. (%) of opinion articles
1900–191901 (0.7%)
1920–194901 (0.7%)
1950–195900
1960–19695 (2.4%)9 (6.3%)
1970–197924 (11.7%)19 (13.3%)
1980–198920 (9.8%)18 (12.7%)
1990–199926 (12.7%)14 (9.9%)
2000–200942 (20.5%)37 (26.1%)
2010–201888 (42.9%)43 (30.3%)
Study design or publication typeNo. (%) of non-opinion articlesNo. (%) of opinion articlesN/A
Cross-sectional studies85 (41.5%)
Survey-based63
Review34 (16.6%)
Narrative30
Case report or case series22 (10.7%)
Case–control19 (9.3%)
Cohort studies14 (6.8%)
Intervention13 (6.3%)
Other††18 (8.8%)

Methods of ascertainment of suicidal behaviors and related risk factors for 204 non-opinion publications

Methods of ascertainment
Suicide death
Death certificates (vital statistics by U.S. state or non-U.S. country)
Forensic, pathology, or autopsy reports, for example, from a medical examiner’s office
Medical chart reviews of physician patients
Professional membership masterfiles
Obituaries published in journals (e.g. JAMA)
Family confirmation or interviews
Suicide attempt
Paykel’s Instrument (assesses suicidal ideation and suicide attempts)
Beck Hopelessness Scale
Investigator-developed question(s) or questionnaire
Suicidal thoughts or ideation
Patient Health Questionnaire 9
Beck Scale for Suicidal Ideation
Acquired Capability for Suicide Scale
Self-harm Behavior Questionnaire
Suicidal Behaviors Questionnaire
Investigator-developed question(s) or questionnaire