Objectives To estimate age standardised suicide rate ratios in male and female physicians compared with the general population, and to examine heterogeneity across study results. Design Systematic review and meta-analysis. Data sources Studies published between 1960 and 31 March 2024 were retrieved from Embase, Medline, and PsycINFO. There were no language restrictions. Forward and backwards reference screening was performed for selected studies using Google Scholar. Eligibility criteria for selecting studies Observational studies with directly or indirectly age standardised mortality ratios for physician deaths by suicide, or suicide rates per 100 000 person years of physicians and a reference group similar to the general population, or extractable data on physician deaths by suicide suitable for the calculation of ratios. Two independent reviewers extracted data and assessed the risk of bias using an adapted version of the Joanna Briggs Institute checklist for prevalence studies. Mean effect estimates for male and female physicians were calculated based on random effects models, with subgroup analyses for geographical region and a secondary analysis of deaths by suicide in physicians compared with other professions. Results Among 39 included studies, 38 studies for male physicians and 26 for female physicians were eligible for analyses, with a total of 3303 suicides in male physicians and 587 in female physicians (observation periods 1935-2020 and 1960-2020, respectively). Across all studies, the suicide rate ratio for male physicians was 1.05 (95% confidence interval 0.90 to 1.22). For female physicians, the rate ratio was significantly higher at 1.76 (1.40 to 2.21). Heterogeneity was high for both analyses. Meta-regression revealed a significant effect of the midpoint of study observation period, indicating decreasing effect sizes over time. The suicide rate ratio for male physicians compared with other professions was 1.81 (1.55 to 2.12). Conclusion Standardised suicide rate ratios for male and female physicians decreased over time. However, the rates remained increased for female physicians. The findings of this meta-analysis are limited by a scarcity of studies from regions outside of Europe, the United States, and Australasia. These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at risk subgroups. Systematic review registration PROSPERO CRD42019118956. Additional data are available from the corresponding author at eva.schernhammer@muv.ac.at upon request.

中文翻译：

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20 个国家的研究中医生自杀率与普通人群的比较：性别分层系统评价和荟萃分析


目的 估计男性和女性医生与一般人群相比的年龄标准化自杀率比率，并检查研究结果的异质性。设计系统回顾和荟萃分析。数据来源 1960 年至 2024 年 3 月 31 日期间发表的研究检索自 Embase、Medline 和 PsycINFO。没有语言限制。使用谷歌学术对选定的研究进行前向和后向参考筛选。选择研究的资格标准 直接或间接采用年龄标准化医生自杀死亡率的观察性研究，或医生每 10 万人年的自杀率和与一般人群类似的参照组，或可提取的医生自杀死亡数据用于计算比率。两名独立评审员提取数据，并使用乔安娜·布里格斯研究所患病率研究清单的改编版本评估偏倚风险。男性和女性医生的平均效应估计是根据随机效应模型计算的，并对地理区域进行了亚组分析，并对医生与其他职业相比自杀死亡进行了二次分析。结果 在纳入的 39 项研究中，有 38 项针对男医生的研究和 26 项针对女医生的研究符合分析资格，共有 3303 例男医生自杀和 587 例女医生自杀（观察期分别为 1935-2020 年和 1960-2020 年）。在所有研究中，男医生的自杀率为 1.05（95% 置信区间为 0.90 至 1.22）。对于女医生来说，比率明显较高，为 1.76（1.40 至 2.21）。两项分析的异质性都很高。 元回归揭示了研究观察期中点的显着影响，表明效应大小随着时间的推移而减小。男医生与其他职业的自杀率之比为1.81（1.55比2.12）。结论 男性和女性医生的标准化自杀率比率随着时间的推移而下降。然而，女医生的比例仍然上升。由于缺乏来自欧洲、美国和澳大利亚以外地区的研究，这项荟萃分析的结果受到限制。这些结果呼吁继续努力研究和预防医生自杀死亡，特别是女医生和高危亚组。系统审评注册PROSPERO CRD42019118956。如需更多数据，请通过通讯作者 eva.schernhammer@muv.ac.at 索取。