Figure 1
PRISMA diagram of study selection for inclusion
Table 1
Article characteristics from scoping review of literature on physician suicide, 1903–2018
| Publication date range | No. (%) of non-opinion articles | No. (%) of opinion articles |
| 1900–1919 | 0 | 1 (0.7%) |
| 1920–1949 | 0 | 1 (0.7%) |
| 1950–1959 | 0 | 0 |
| 1960–1969 | 5 (2.4%) | 9 (6.3%) |
| 1970–1979 | 24 (11.7%) | 19 (13.3%) |
| 1980–1989 | 20 (9.8%) | 18 (12.7%) |
| 1990–1999 | 26 (12.7%) | 14 (9.9%) |
| 2000–2009 | 42 (20.5%) | 37 (26.1%) |
| 2010–2018 | 88 (42.9%) | 43 (30.3%) |
| Study design or publication type | No. (%) of non-opinion articles | No. (%) of opinion articles N/A |
| Cross-sectional studies | 85 (41.5%) | |
| Survey-based | 63 | |
| Review | 34 (16.6%) | |
| Narrative | 30 | |
| Case report or case series | 22 (10.7%) | |
| Case–control | 19 (9.3%) | |
| Cohort studies | 14 (6.8%) | |
| Intervention† | 13 (6.3%) | |
| Other†† | 18 (8.8%) | |
Table 2
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 |
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)
Figure 3
Framework of common publication themes on physician suicide
Figure 4
Proposed framework to highlight priorities for continued work on physician suicide
| Date | Source | Query |
|---|---|---|
| 8/21/2017 | Investigators | n/a |
| 8/21/2017 | Ovid MEDLINE | 1. (((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 |
| 10/11/2017 | PsycINFO | 1. (((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 |
| 4/28/2018 | Scopus | ( 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* ) ) |