Nurse Suicide: Breaking the SilencePage 6 of 10

4 A General Internet Search

A general internet search produced no public data identifying a national nurse suicide rate, yet data on suicide rates were readily available for physicians, teachers, police officers, firefighters, and military personnel (Table 1, below).

This rudimentary review further confirmed that nurse suicide in the United States appeared, indeed, invisible. There was no dialogue about incidence of nurse suicide, not even on the expansive reach of the internet.

From discussion with the San Diego County medical examiner [17], we found that transparency in this area is complicated by a lack of standardized reporting of death by suicide. The reporting characteristics vary from county to county; some do not include occupation.

Further, in states that do report occupation, the occupation code is usually entered in free text, resulting in difficulty constructing a methodology for accurate data analysis. The Center for Disease Control and Prevention (CDC) maintains a restricted National Violent Death Reporting System (NVDRS), which is the most comprehensive death registry by suicide coded by occupation. It has been growing yearly, and at the time of this writing, data are available for 40 states, the District of Columbia, and Puerto Rico [18]. The NVDRS dataset is available only by application.

We confirmed that no one has queried this dataset to search for nurse suicide statistics. Despite the challenge of occupation coding in CDC mortality data and restricted access to the incomplete NVDRS dataset, it is curious that the incidence rates for other professions were reported on the internet, yet nurses have not addressed this issue to date.

U.S. Nurse Suicide Literature Review

From the global review of lay postings on the internet, we moved to a search of the professional literature. With the support of a medical librarian, a search strategy was developed and executed in PubMed, CINAHL, and PsycINFO for English-language papers, with no limitations on time period or publication type.

A National Center for Biotechnology Information alert using this search strategy ((suicide) and nurse) not “assisted suicide”) not euthanasia)) was then created to generate weekly updates. Many anecdotal reflections were located. These were published by nurses whose colleagues had completed suicide [19-26].

The literature search yielded only five dated descriptive studies regarding incidence of nurse suicide in the United States. Two additional studies were obtained by tracing older references from review papers. All references from relevant papers were combed in an attempt to identify additional studies.

Studies reporting data regarding nurse suicide in the United States are summarized in Table 2, next chapter. Because of the dearth of current literature on this subject, older references are included, further highlighting the need for current attention to the topic of US nurse suicide.

A 1999 review [11] of nurse suicide data—including Doebbert [5], Katz [3], Milhelm [4], and Powell [2] from the United States—concluded “There is a remarkable paucity of empirically based information from which to identify clear causal factors and, equally important, preventive factors.”

Nearly 20 years later, that statement holds true.

Notes: [a] American Foundation for Suicide Prevention, 2013, Physician and medical student depression and suicide prevention, https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention (accessed June 3, 2017);
[b] Teacher Mental Health, 2011, Teacher suicide rates, http://www.teachermentalhealth.org.uk/teachersuicide.html (accessed May 20, 2017);
[c] The Badge of Life, 2016, A study of police suicide 2008–2016, http://www.policesuicidestudy.com (accessed May 1, 2017);
[d] Fire Companies, 2017, Firefighter close calls 2017, http://www.firefighterclosecalls.com/?s=suicide (accessed April 15, 2017);
[e] Kessler, R., M. Stein, P. Bliese, et al., 2015, Occupational differences in U.S. Army suicide rates, Psychological Medicine 45(15):3293–3304.

Source: Davidson et al., “Nurse Suicide: Breaking the Silence,” National Academy of Medicine.

Table 1| Suicide Rates for Occupations Providing Services to the Public

Occupation

U.S. rate (year)

Physician [a]

300–400 per year (2015–2016)

Educator [b]

63 per year (2011)

Police officer [c]

108 per year (2016)

Firefighter [d]

89 per year (2016)

Military officer: [e]

 

Combat: Infantry (closed to women)

37.2/100,000 (2004–2009)

Combat: Infantry, engineer, never deployed (closed to women)

41.2/100,000 (2004–2009)

Combat service support: Medical

18.5/100,000 (2004–2009)

Nurses

????