JAMA 子刊：美国护士和医生职业与自杀风险的关联

摘要

重要性  护士是美国卫生保健工作人员中最大的组成部分。最近的研究表明，护士自杀的风险可能很高。但是，关于此主题的研究很少。

目的  评估护士中全国自杀的发生率，并比较护士与医生和普通人群的自杀特征。

设计，地点和参与者  这项回顾性队列研究使用了2007年至2018年美国国家暴力死亡报告系统中报告的159372例自杀的美国数据。通过使用劳动力分母，在护士，医生，和一般人口（年龄，≥30岁）中，计算了医护人员类型和自杀方法与死亡时毒理学检查结果之间的关联，并根据社会人口统计学特征进行了调整。2020年10月16日到2021年1月10日进行统计分析。

暴露  职业为护士或医生。

主要结果和衡量方法  自杀的发生率和与自杀有关的特征。

结果  护士中共有2374例自杀（1912名女性[80.5％]；平均[SD]年龄为52.8 [11.8]岁），医生中共有857例自杀（男性723例[84.4％]；平均[SD]年龄为59.8[15.3]）年）和156 141例一般人群的自杀（121121例男性[77.8％]；平均[SD]年龄为53.1 [14.7]岁）。总体而言，与一般人群相比，护士自杀的发生率更高（2017-2018年，按性别调整的发生率，护士为每10万人23.8，而普通人群为每10万20.1；相对风险为1.18 [95％CI，1.03-1.36]。在2017-2018年的女性中，护士的自杀率是每10万人17.1（2 966 048中的506），而普通人群是每十万人8.6（103731387中的8879）（相对风险为1.99 [95％CI ：1.82-2.18]）。从绝对数来看，与普通女性相比，女护士与每十万人中增加8.5例自杀相关（95％CI：7.0-10）。就性别而言，除女性医师外，2011-2012年医师自杀率与一般人群没有统计学差异（女性医师的自杀率为每十万11.7 [95％CI：十万分之6.6-66.8]，而男性为每十万分之7.5 （95％CI：7.2-7.7；P= .04）。就自杀的特征而言，临床医务人员比一般人群更容易中毒。例如，有24.9％（95％CI，23.5％-26.4％）的护士中毒过，而普通自杀人群中有16.8％（95％CI，16.6％-17.0％）。在临床自杀者中，抗抑郁药，苯二氮卓类，巴比妥类药物和鸦片制剂的存在比普通人群中的自杀更为普遍。

结论与相关性  这项研究表明，在美国，护士的自杀风险与普通人群相比明显更高，而医生则没有。需要进一步的研究来评估干预措施是否与降低护士自杀风险的益处相关。

Abstract

Importance   Nurses are the largest component of the US health care workforce. Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist.

Objectives   To estimate the national incidence of suicide among nurses and examine characteristics of nurse suicides compared with physicians and the general population.

Design, Setting, and Participants     This retrospective cohort study used US data from 159 372 suicides reported in the National Violent Death Reporting System from 2007 to 2018. With the use of workforce denominators, sex-specific suicide incidence estimates were generated among nurses, physicians, and the general population (age, ≥30 years). Associations between clinician type and method of suicide and results of toxicology examination at death were calculated, adjusted for sociodemographic characteristics. Statistical analysis was performed from October 16, 2020, to January 10, 2021.

Exposure     Occupation as a nurse or physician.

Main Outcome and Measures  Suicide incidence and characteristics associated with suicides.

Results     A total of 2374 suicides among nurses (1912 women [80.5%]; mean [SD] age, 52.8 [11.8] years), 857 suicides among physicians (723 men [84.4%]; mean [SD] age, 59.8 [15.3] years), and 156 141 suicides in the general population (121 483 men [77.8%]; mean [SD] age, 53.1 [14.7] years) were identified. Overall, suicide was more common among nurses compared with the general population (sex-adjusted incidence in 2017-2018, 23.8 per 100 000 vs 20.1 per 100 000; relative risk, 1.18 [95% CI, 1.03-1.36]). Among women in 2017-2018, the suicide incidence among nurses was 17.1 per 100 000 (506 among 2 966 048) vs 8.6 per 100 000 (8879 among 103 731 387) in the general female population (relative risk, 1.99 [95% CI, 1.82-2.18]). In absolute terms, being a female nurse was associated with an additional 8.5 suicides per 100 000 (95% CI, 7.0-10.0 per 100 000) compared with the general population of women. By sex, physician suicide rates were not statistically different from the general population other than among female physicians in 2011-2012 (11.7 per 100 000 [95% CI, 6.6-16.8 per 100 000] female physicians vs 7.5 per 100 000 [95% CI, 7.2-7.7 per 100 000] general population; P = .04). In terms of the characteristics of suicides, clinicians were more likely to use poisoning than the general population; for example, 24.9% (95% CI, 23.5%-26.4%) of nurses used poisoning compared with 16.8% (95% CI, 16.6%-17.0%) of the general suicide population. The presence of antidepressants, benzodiazepines, barbiturates, and opiates was more common among clinician suicides than suicides in the general population.

Conclusion and Relevance  This study suggests that, in the US, the risk of suicide compared with the general population was significantly greater for nurses but not for physicians. Further research is needed to assess whether interventions would be associated with benefit in reducing suicide risk among nurses.

原文链接：

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2778209

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