Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

Ahead of print

doi: 10.17219/acem/159423

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Cite as:


Yıldız M, Batun KD, Şahinoğlu H, et al. Suicide among doctors in Turkey: Differences across gender, medical specialty and the method of suicide [published online as ahead of print on March 7, 2023]. Adv Clin Exp Med. 2023. doi:10.17219/acem/159423

Suicide among doctors in Turkey: Differences across gender, medical specialty and the method of suicide

Mesut Yıldız1,A,B,C,D,E,F, Kerim Deniz Batun2,A,B,C,D,F, Hakan Şahinoğlu2,A,B,C,D,F, Muhammed Selim Eryılmaz2,A,B,C,D,F, Bilge Özel2,A,B,C,D,F, Beyzanur Ataoğlu3,A,B,C,D,F, Seyhan Ergin Hıdıroğlu3,A,B,C,D,E,F

1 Department of Psychiatry, Marmara University, Istanbul, Turkey

2 Intern at the Faculty of Medicine, Marmara University, Istanbul, Turkey

3 Department of Public Health, Marmara University, Istanbul, Turkey

Abstract

Background. Doctors have higher rates of mental illness and suicide than the general population worldwide. Suicides of doctors are known to be underreported in developing countries. To the best of our knowledge, there are no studies investigating suicides among medical students and doctors in Turkey.
Objectives. To investigate the characteristics of suicides in medical school students and doctors in Turkey.
Material and Methods. In this retrospective study, newspaper websites and Google search engine were searched for information on medical school student and doctor suicides in Turkey between 2011 and 2021. Cases of suicide attempt, parasuicide or deliberate self-harm were not included in the study.
Results. Sixty-one suicides were reported between 2011–2021. There was a male predominance (45 (73.8%)), and more than half of the suicides (32 (52.5%)) occurred among specialist doctors. Self-poisoning, jumping from heights and firearms were the most common methods of suicide (18 (29.5%), 17 (27.9%) and 15 (24.6%), respectively). Cardiovascular surgery, family medicine, gynecology, and obstetrics specialties had the highest numbers of suicide deaths. Depression/mental illness was the most common speculated etiology. These results show that suicides among medical students and doctors in Turkey have characteristics that differ from both suicided among the general population in Turkey and doctor suicides in other countries.
Conclusion. In this study, we identified the suicidal characteristics of medical students and doctors in Turkey for the first time. The results help us to better understand this understudied topic and provide an avenue for future studies. The data also indicate that it is important to monitor the individual and systemic difficulties experienced by doctors, starting from the medical education stage, and to provide individual and environmental support to help decrease the risk of suicide.

Key words

suicide, medical student, doctor

Graphical abstract


Graphical abstracts

References (73)

  1. Ventriglio A, Watson C, Bhugra D. Suicide among doctors: A narrative review. Indian J Psychiatry. 2020;62(2):114–120. doi:10.4103/psychiatry.IndianJPsychiatry_767_19
  2. Bhugra D, Sauerteig SO, Bland D, et al. A descriptive study of mental health and wellbeing of doctors and medical students in the UK. Int Rev Psychiatry. 2019;31(7–8):563–568. doi:10.1080/09540261.2019.1648621
  3. Gerada C. Doctors, suicide and mental illness. BJPsych Bull. 2018;42(4):165–168. doi:10.1192/bjb.2018.11
  4. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA. 2015;314(22):2373–2383. doi:10.1001/jama.2015.15845
  5. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ. 2005;39(6):594–604. doi:10.1111/j.1365-2929.2005.02176.x
  6. Javadekar A, Javadekar S, Chaudhury S, Saldanha D. Depression, anxiety, stress, and sleep disturbances in doctors and general population during COVID-19 pandemic. Ind Psychiatry J. 2021;30(Suppl 1):S20–S24. doi:10.4103/0972-6748.328783
  7. Goodwin L, Ben-Zion I, Fear NT, Hotopf M, Stansfeld SA, Wessely S. Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies. PLoS One. 2013;8(11):e78693. doi:10.1371/journal.pone.0078693
  8. Padurariu M, Prepelita R, Ciobica A, et al. Concept of suicide: Neurophysiological/genetic theories and possible oxytocin relevance. Neurophysiology. 2016;48(4):312–321. doi:10.1007/s11062-016-9603-9
  9. Beyond Blue. National Survey of Mental Health of Doctors and Medical Students. https://medicine.uq.edu.au/files/42088/Beyondblue%20Doctors%20Mental%20health.pdf. Accessed December 12, 2021.
  10. Irigoyen-Otiñano M, Castro-Herranz S, Romero-Agüit S, et al. Suicide among physicians: Major risk for women physicians. Psychiatry Res. 2022;310:114441. doi:10.1016/j.psychres.2022.114441
  11. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One. 2019;14(12):e0226361. doi:10.1371/journal.pone.0226361
  12. Kishor M, Chandran S, Vinay H, Ram D. Suicide among Indian doctors. Indian J Psychiatry. 2021;63(3):279–284. doi:10.4103/psychiatry.IndianJPsychiatry_137_20
  13. National Occupational Mortality Surveillance (NOMS). PMR query system for industry (1999, 2003–2004, 2007–2014). 2018. https://wwwn.cdc.gov/niosh-noms/industry2.aspx. Accessed December 14, 2021.
  14. Yaghmour NA, Brigham TP, Richter T, et al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: Implications for the learning environment. Acad Med. 2017;92(7):976–983. doi:10.1097/ACM.0000000000001736
  15. Duarte D, El-Hagrassy MM, Couto TCE, Gurgel W, Fregni F, Correa H. Male and female physician suicidality: A systematic review and meta-analysis. JAMA Psychiatry. 2020;77(6):587–597. doi:10.1001/jamapsychiatry.2020.0011
  16. Rose KD. Physicians who kill themselves. Arch Gen Psychiatry. 1973;29(6):800–805. doi:10.1001/archpsyc.1973.04200060072011
  17. Harvey SB, Epstein RM, Glozier N, et al. Mental illness and suicide among physicians. Lancet. 2021;398(10303):920–930. doi:10.1016/S0140-6736(21)01596-8
  18. Chen C. Recent advances in the study of the comorbidity of depressive and anxiety disorders. Adv Clin Exp Med. 2022;31(4):355–358. doi:10.17219/acem/147441
  19. Liu W, Wu Z, Sun M, et al. Association between fasting blood glucose and thyroid stimulating hormones and suicidal tendency and disease severity in patients with major depressive disorder. Bosn J Basic Med Sci. 2022;22(4):635–642. doi:10.17305/bjbms.2021.6754
  20. Kowalczyk P, Sulejczak D, Kleczkowska P, et al. Mitochondrial oxidative stress: A causative factor and therapeutic target in many diseases. Int J Mol Sci. 2021;22(24):13384. doi:10.3390/ijms222413384
  21. Hussain H, Ahmad S, Shah SWA, et al. Investigation of antistress and antidepressant activities of synthetic curcumin analogues: Behavioral and biomarker approach. Biomedicines. 2022;10(10):2385. doi:10.3390/biomedicines10102385
  22. Kucukkarapinar M, Yay-Pence A, Yildiz Y, et al. Psychological outcomes of COVID-19 survivors at sixth months after diagnose: The role of kynurenine pathway metabolites in depression, anxiety, and stress. J Neural Transm. 2022;129(8):1077–1089. doi:10.1007/s00702-022-02525-1
  23. Lin CC, Cheng PY, Hsiao M, Liu YP. Effects of RU486 in treatment of traumatic stress-induced glucocorticoid dysregulation and fear-related abnormalities: Early versus late intervention. Int J Mol Sci. 2022;23(10):5494. doi:10.3390/ijms23105494
  24. Tanaka M, Vécsei L. Monitoring the kynurenine system: Concentrations, ratios or what else? Adv Clin Exp Med. 2021;30(8):775–778. doi:10.17219/acem/139572
  25. Tanaka M, Szabó Á, Vécsei L. Integrating armchair, bench, and bedside research for behavioral neurology and neuropsychiatry: Editorial. Biomedicines. 2022;10(12):2999. doi:10.3390/biomedicines10122999
  26. Battaglia S, Thayer JF. Functional interplay between central and autonomic nervous systems in human fear conditioning. Trends Neurosci. 2022;45(7):504–506. doi:10.1016/j.tins.2022.04.003
  27. Battaglia S, Harrison BJ, Fullana MA. Does the human ventromedial prefrontal cortex support fear learning, fear extinction or both? A commentary on subregional contributions. Mol Psychiatry. 2022;27(2):784–786. doi:10.1038/s41380-021-01326-4
  28. Battaglia S, Garofalo S, di Pellegrino G, Starita F. Revaluing the role of vmPFC in the acquisition of Pavlovian threat conditioning in humans. J Neurosci. 2020;40(44):8491–8500. doi:10.1523/JNEUROSCI.0304-20.2020
  29. Brundin L, Bryleva EY, Thirtamara Rajamani K. Role of inflammation in suicide: From mechanisms to treatment. Neuropsychopharmacology. 2017;42(1):271–283. doi:10.1038/npp.2016.116
  30. Tanaka M, Vécsei L. Editorial of Special Issue “Crosstalk between Depression, Anxiety, and Dementia: Comorbidity in Behavioral Neurology and Neuropsychiatry.” Biomedicines. 2021;9(5):517. doi:10.3390/biomedicines9050517
  31. Tanaka M, Szabó Á, Spekker E, Polyák H, Tóth F, Vécsei L. Mitochondrial impairment: A common motif in neuropsychiatric presentation? The link to the tryptophan–kynurenine metabolic system. Cells. 2022;11(16):2607. doi:10.3390/cells11162607
  32. Carrera-González M del P, Cantón-Habas V, Rich-Ruiz M. Aging, depression and dementia: The inflammatory process. Adv Clin Exp Med. 2022;31(5):469–473. doi:10.17219/acem/149897
  33. Stępień T, Heitzman J, Wierzba-Bobrowicz T, et al. Neuropathological changes in the brains of suicide killers. Biomolecules. 2021;11(11):1674. doi:10.3390/biom11111674
  34. Tanaka M, Vécsei L. Editorial of Special Issue ‘Dissecting Neurological and Neuropsychiatric Diseases: Neurodegeneration and Neuroprotection.’ Int J Mol Sci. 2022;23(13):6991. doi:10.3390/ijms23136991
  35. Brasso C, Bellino S, Blua C, Bozzatello P, Rocca P. The impact of SARS-CoV-2 infection on youth mental health: A narrative review. Biomedicines. 2022;10(4):772. doi:10.3390/biomedicines10040772
  36. Banerjee D, Varshney P, Vajawat B. “Guarding the gatekeepers”: Suicides among mental health professionals and scope of prevention. A review. Psychiatry Res. 2020;294:113501. doi:10.1016/j.psychres.2020.113501
  37. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: Contributors, consequences and solutions. J Intern Med. 2018;283(6):516–529. doi:10.1111/joim.12752
  38. Onchev G. Changes in psychopathology and mental health resilience. Front Psychiatry. 2021;12:676492. doi:10.3389/fpsyt.2021.676492
  39. Sahebi A, Nejati-Zarnaqi B, Moayedi S, Yousefi K, Torres M, Golitaleb M. The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: An umbrella review of meta-analyses. Prog Neuropsychopharmacol Biol Psychiatry. 2021;107:110247. doi:10.1016/j.pnpbp.2021.110247
  40. Edwards N. Unhappy doctors: What are the causes and what can be done? BMJ. 2002;324(7341):835–838. doi:10.1136/bmj.324.7341.835
  41. Kelly S, Bunting J. Trends in suicide in England and Wales, 1982–96. Popul Trends. 1998;(92):29–41. PMID:9679269.
  42. Hawton K, Malmberg A, Simkin S. Suicide in doctors: A psychological autopsy study. J Psychosom Res. 2004;57(1):1–4. doi:10.1016/S0022-3999(03)00372-6
  43. Hawton K. Doctors who kill themselves: A study of the methods used for suicide. QJM. 2000;93(6):351–357. doi:10.1093/qjmed/93.6.351
  44. Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–471. doi:10.1097/SLA.0b013e3181ac4dfd
  45. Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Med Educ. 2007;7(1):6. doi:10.1186/1472-6920-7-6
  46. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–1190. doi:10.1001/jama.2010.1300
  47. Brooks SK, Gerada C, Chalder T. Review of literature on the mental health of doctors: Are specialist services needed? J Ment Health. 2011;20(2):146–156. doi:10.3109/09638237.2010.541300
  48. Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: A comprehensive look at help-seeking. Acad Psychiatry. 2015;39(1):37–46. doi:10.1007/s40596-014-0202-z
  49. Firth-Cozens J. Interventions to improve physicians’ well-being and patient care. Soc Sci Med. 2001;52(2):215–222. doi:10.1016/S0277-9536(00)00221-5
  50. Brimstone R, Thistlethwaite JE, Quirk F. Behaviour of medical students in seeking mental and physical health care: Exploration and comparison with psychology students. Med Educ. 2007;41(1):74–83. doi:10.1111/j.1365-2929.2006.02649.x
  51. George S, Hanson J, Jackson JL. Physician, heal thyself: A qualitative study of physician health behaviors. Acad Psychiatry. 2014;38(1):19–25. doi:10.1007/s40596-013-0014-6
  52. Yıldırım Öztürk EN, Öztürk M. The crude incidence rate of suicide and related factors in Turkey between 2009 and 2018. Deu Med J. 2021;35(1):23–32. doi:10.5505/deutfd.2021.52385
  53. 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):45–49. doi:10.1016/j.genhosppsych.2012.08.005
  54. Palhares-Alves HN, Palhares DM, Laranjeira R, Nogueira-Martins LA, Sanchez ZM. Suicide among physicians in the state of São Paulo, Brazil, across one decade. Rev Bras Psiquiatr. 2015;37(2):146–149. doi:10.1590/1516-4446-2014-1534
  55. Chahal S, Nadda A, Govil N, et al. Suicide deaths among medical students, residents and physicians in India spanning a decade (2010–2019): An exploratory study using on line news portals and Google database. Int J Soc Psychiatry. 2022;68(4):718–728. doi:10.1177/00207640211011365
  56. Gould MS, Kleinman MH, Lake AM, Forman J, Midle JB. Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988–96: A retrospective, population-based, case-control study. Lancet Psychiatry. 2014;1(1):34–43. doi:10.1016/S2215-0366(14)70225-1
  57. Cheng J, Kumar S, Nelson E, Harris T, Coverdale J. A National survey of medical student suicides. Acad Psychiatry. 2014;38(5):542–546. doi:10.1007/s40596-014-0075-1
  58. Kamski L, Frank E, Wenzel V. Suizidalität von Medizinstudierenden: Fallserie. Anaesthesist. 2012;61(11):984–988. doi:10.1007/s00101-012-2094-1
  59. Zivanovic R, McMillan J, Lovato C, Roston C. Death by suicide among Canadian medical students: A national survey-based study. Can J Psychiatry. 2018;63(3):178–181. doi:10.1177/0706743717746663
  60. Alptekin K. How was the distribution of suicide rates by socio-demographic factors between the years of 2007–2016 in Turkey? J Psychiatr Nurs. 2019;10(4):270–276. doi:10.14744/phd.2019.59354
  61. Freeman A, Mergl R, Kohls E, et al. A cross-national study on gender differences in suicide intent. BMC Psychiatry. 2017;17:234. doi:10.1186/s12888-017-1398-8
  62. Lindeman S, Läärä E, Hakko H, Lönnqvist J. A systematic review on gender-specific suicide mortality in medical doctors. Br J Psychiatry. 1996;168(3):274–279. doi:10.1192/bjp.168.3.274
  63. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One. 2019;14(12):e0226361. doi:10.1371/journal.pone.0226361
  64. Hawton K. 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(5):296–300. doi:10.1136/jech.55.5.296
  65. Aasland OG, Ekeberg Ø, Schweder T. Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups. Soc Sci Med. 2001;52(2):259–265. doi:10.1016/S0277-9536(00)00226-4
  66. Kõlves K, de Leo D. Suicide in medical doctors and nurses: An analysis of the Queensland Suicide Register. J Nerv Ment Dis. 2013;201(11):987–990. doi:10.1097/NMD.0000000000000047
  67. Yilmaz V, Bilir MK. A rights-based critique of the Turkish mental healthcare reform: Deinstitutionalisation without independent living?. Disabil Soc. 2022:37(6);933–954. doi:10.1080/09687599.2020.1867072
  68. Egger Halbeis CB, Cvachovec K, Scherpereel P, Mellin-Olsen J, Drobnik L, Sondore A. Anaesthesia workforce in Europe. Eur J Anesthesiol. 2007;24(12):991–1007. doi:10.1017/S0265021507000762
  69. Kervan Ü. Distribution and service quality of the cardiovascular surgery clinics in Turkey. Turk J Thorac Cardiovasc Surg. 2011;19(4):483–489. doi:10.5606/tgkdc.dergisi.2011.074
  70. Cvejic E, Parker G, Harvey SB, et al. The health and well-being of Australia’s future medical doctors: Protocol for a 5-year observational cohort study of medical trainees. BMJ Open. 2017;7(9):e016837. doi:10.1136/bmjopen-2017-016837
  71. Iannelli RJ, Finlayson AJR, Brown KP, et al. Suicidal behavior among physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry. 2014;36(6):732–736. doi:10.1016/j.genhosppsych.2014.06.008
  72. Stratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis. PLoS One. 2017;12(12):e0189904. doi:10.1371/journal.pone.0189904
  73. 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 Psychiatry. 2015;72(12):1192–1198. doi:10.1001/jamapsychiatry.2015.1880