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Suicide risk among dentists: A multivariate analysis
Abstract and Figures
Dentists are recognized as an occupational group with a high incidence of suicide. Past work, however, has focused only on the bivariate dentist‐suicide relationship. It is not clear whether this risk of suicide is because of occupational stress or sociodemographic factors, such as gender and divorce, which are covariates of dentist status. The present study reassesses the link between dentistry and suicide by controlling for dentistry's covariates. Controlling for sociodemographic factors, dentists still have a significantly higher risk of suicide, indicating that occupational stress may be a source of their high suicidality.
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... A detailed evaluation in an article by Stack (11) was the first to attempt to sort through the conflicting data and arrive at some reasoned conclusions. Unfortunately, his analyses were flawed by the use of hearsay, public perceptions, assumptions and currently outdated practice information that may no longer be applicable. ...
... Although the profession is changing, many dentists still work in relative isolation, without daily peer interactions, and this is alleged to be a factor for stress, suicide or both (11). It has been alleged that the many personality traits that characterize a good dentist also can predispose them to depression (10). ...
... Dentists allegedly are "perfectionists" who become frustrated when cases do not turn out perfectly and are frustrated with patients' lack of motivation to pursue idealistic treatment goals. There are few reliable data to support these hypotheses, (12) and frustration is not unique to dentistry-Some patient interactions reportedly are characterized by terms like frustration, apprehension, discomfort, fear and hostility (9,10,11). ...
The fact that dentists are prone to commit suicide has been repeated so many times both in the specialist press and in the mass media that by carrying out a search on the internet, we found that large amount of news considered it to be true. The high suicide rate associated with our profession is treated in diverse ways in the scientific literature myth for few, generally dentists, and statistical data which need further studies for others. In this review we will try to analyse the scientific weight of the studies, searching for factors that may allow us to discover the relationship of the profession to the risk of suicide, analyzing the factors that are linked with dental activities.
... Stack tests only the demographic dimension of the full model. A series of earlier studies derived indicators of risk for individual occupations: labourers (Stack, 1995), dentists (Stack, 1996), and physicians (Stack, 1998). But the study of particular relevance to this thesis derives comparative statistics of suicide risk for thirty two occupations (Stack, 2001). ...
... A series of studies which derived indicators of suicide risk for individual occupations (as detailed in the introductory part of Section 3) demonstrated the importance of incorporating demographic controls into the analysis (Stack, 1995;Stack, 1996;Stack, 1998). For example, in the case of labourers, even though earlier studies suggest that the associated suicide risk is significantly higher than that of the general population, once controls for gender, marital status, and other covariates of labour status are introduced into the analysis, the relative risk of suicide for labourers is shown to be the same as for the rest of the working-age population (Stack, 1995). ...
... As was discussed in Chapter 2, research on suicide risk relating to specific occupations is often characterised by inconsistent findings, a phenomenon which may at least partly be explained by the failure to control for the demographic covariates of occupational status (Stack 2001). In seeking to address this shortcoming, Stack (1995Stack ( , 1996Stack ( , 1998Stack ( , 2001 proposes a logistic regression model of analysis of occupational suicide risk, with controls introduced for four demographic covariates of occupation: gender, race, age and marital status. This model allows the risk of suicide to be computed independent of these four demographic covariates of occupation. ...
... Several occupational groups appear to have a high risk for suicide, but the reasons for this are largely unknown (Boxer et al., 1995). High suicide rates have been identified among physicians (Lindeman et al., 1996), dentists (Stack, 1996), and nurses (Hawton &Vislisel, 1999). However, debates continue over the extent to which specific occupational groups are at risk for suicide (Stack, 2000). ...
... Balarajan (1989) also showed high suicide rates among dentists in England and Wales around the 1970 and 1980 censuses. Stack (1996) used US Public Health Service data from 21 States and determined that even after controls were taken into account, dentists had a suicide rate that was greater than that among the working-age population in general (Stack, 1996). ...
... Balarajan (1989) also showed high suicide rates among dentists in England and Wales around the 1970 and 1980 censuses. Stack (1996) used US Public Health Service data from 21 States and determined that even after controls were taken into account, dentists had a suicide rate that was greater than that among the working-age population in general (Stack, 1996). ...
... Dentistry is considered one of the most stressful professions. 1 Occupational stress has been a main factor in the higher risk for suicide amongst dentists; even before graduation, 6% of dental students in the United States tested above the cut-off for clinically significant suicidal ideation. [2][3][4][5][6] A systematic review concluded that psychological problems have the strongest association with suicide. 7 Moreover, numerous studies have reported a high prevalence of psychological problems amongst dental students all over the world. ...
Aim:
To map psychological problems among undergraduate dental students with a focus on different time points in clinical work in seven Eastern European and Scandinavian countries.
Materials and methods:
1063 3rd -5th -year dental students (response rate 70%) participated in this pilot study and completed a pretested, structured questionnaire, which collected information on sociodemographic characteristics and self-reported psychological problems. Data was analyzed by bivariate and multivariate methods.
Results:
The majority of participants were female, and were younger than male participants. Most participants, though more females than males, agreed that the clinical work of dentistry was psychologically difficult. Almost half of participants felt nervous before working with patients (N=506, 48%) and experienced a lot of stress while working with patients (N=488, 46%); almost one-third (N=287, 27%) felt anxious/worried after working with patients. Being a 3rd - and 4th -year student (vs 5th -year) reduced the odds for anxiety after working with patients; being a 3rd -year student (vs 5th -year) increased the odds for stress while working with patients. Studying in countries other than Norway reduced the odds for stress while working with patients. Less than good self-perceived health, presence of psychological health complaints before starting dental education, female gender, and lack of physical activity increased the odds for psychological problems.
Conclusion:
A high number of undergraduate dental students reported psychological problems in connection to clinical work. It is unlikely that "one size fits all"; therefore, further qualitative investigations on stressors in clinical learning environments should be done in order to design tailor-made supportive strategies.
... The association between divorce and male suicide is also well known. Women's rates of suicide actually decrease following divorce 31,36,37 . Feminist writers suggest that while men benefit from marriage it is oppressive to women who are subjugated as wives and bear a higher burden of domestic and emotional labour 32 . ...
Men account for approximately 80% of suicide deaths within Australia and worldwide. While biomedical research literature searches for innate biological distinctions between men and women it struggles to link the higher rates of fatal suicides in men to either biological dysfunction or psychiatric illness. Emile Durkheim’s sociological examination of suicide in 1897 represented the beginnings of a rival discourse from social science; however the vast majority of social research literature continues to treat men and women as naturally distinct, homogeneous sex-categories. Despite the striking gender difference in suicide death rates, there remains a near absence of research exploring the gendered lives of men who have engaged in suicidal behaviour.
This study sought to make a preliminary investigation into the relationship between masculinity and male suicide and forms part of a larger research project in this area. Qualitative, life history case studies and gender relations theory were used to explore the relationship between the social construction of masculinity and suicidal behaviour in the lives of two Australian men.
Findings suggest that issues of masculinity could be implicated in male suicide. In the two life history cases the causes of suicide were outwardly different; in one case suicide was related to employment status and in the other to the breakdown of a marital relationship. Nevertheless, in both cases, hegemonic masculinity, the culturally idealised form of manhood against which men have come to measure themselves against, was the mechanism that mediated between these social factors and male suicide. The findings highlight that research utilising life history methodology and gender relations theory, across a broader group of men is warranted.
... [5] Many studies on the suicide rate of health care providers and dentists have been published since the 1975 ADA study. [6][7][8][9][10] It is not the intent of this paper to provide an in-depth review of all those studies. Please consult Alexander's article for a thorough review. ...
This article summarizes relevant scientific data on the alleged high suicide rate among dentists as compared to other health care professions. Potential contributing risk factors for the dental profession are identified. In addition, a brief review is provided for major depressive disorder, a contributor to increased suicide, along with its symptoms, underlying theory, drug treatment and coping skills to combat this disorder.
... Occupation adds another layer of complexity. Men in low status occupations such as manual work, as well as high status occupations such as dentistry, are more likely to die by suicide (Smalley et al., 2005;Stack, 1996Stack, , 2000b. Exploring the gendered meaning of paid work and occupation would offer important insights into these perplexing statistics. ...
Available on Amazon: http://www.amazon.com/Suicide-Men-Differ-Expressing-Distress/dp/0398087946
Die Aufnahme des Themas „Suizid“ in ein Handbuch soziale Probleme lässt sich nicht mehr so selbstverständlich wie in früheren Jahrzehnten begründen, weil sowohl die Zahl der Suizidfälle zurückgegangen ist als auch der moralische Diskurs über den Suizid deutlich an Schärfe verloren hat.
Barriers to occupational mobility were investigated to determine whether they increased reported suicide-related cognitions and behavior over 12 months. This was explored in a two-wave longitudinal study. Intention to leave, depression, perceived skill transferability, and suicide-related cognitions and behavior was measured at both time points approximately 12 months apart. Results indicated that when there was a high intention to leave at T1, reported suicide-related cognitions and behavior increased over 12 months only when skill transferability to other professions was perceived to be limited. Findings support the role of limited occupational mobility in suicide-related cognitions and behavior.
The aging of populations and the high prevalence of chronic diseases are risk factors for suicide, as well as the increasing prevalence of several mental disorders. The continuing growth of several other risk factors for suicide makes it possible to predict an increase in suicide rates worldwide unless resolute action is undertaken to prevent suicidal behavior. A major problem in that respect is that, in many countries, suicide is not seen as a major public health problem despite its frequency and the severity of its consequences. A textbook bringing together current knowledge about suicide, its causes and its prevention is a precious tool for public health efforts and for clinicians' daily work and provides useful information from psychological, sociological and cultural perspectives which will help health professionals and provide them with data that they can use in developing proposals for action.
Major works on suicide are reviewed and classified into four analytic categories according to their theoretical emphasis: cultural, economic, modernization, and social integration perspectives. The research under these paradigms is assessed in terms of four themes. First, attention is drawn to research evidence that questions traditional theories. An example is Durkheim's position on social class and suicide. Second, the review notes several new theories including Phillips’ imitation thesis and the author's own model of migration's effects on suicide. Third, the paper observes and reviews explanations of new trends in suicide rates such as the rapid increase in youth suicide and the decline in suicide among the elderly. Finally, the review calls attention to explanations of suicide, such as that linking suicide to low marital solidarity, that have withstood the test of the more rigorous empirical testing of recent times.
The literature on the effect of divorce on suicide has neglected the issue of whether or not the strength of the association would change over time. The present study addresses this question from the standpoint of two opposed explanations: status integration theory and the Durkheimian perspective. The former would predict a decline in the effect of divorce on suicide, given that status configurations based on divorce have become statistically more frequent. The latter would predict no change or an increase in suicide. The analysis uses micro- or individual-level data that were only recently made available. The results provide some support for both perspectives. The gap between the suicide rates of the divorced and married has narrowed as divorce has become more common. The gap is, however, still substantial, given the high egoism/anomie of the divorced. Finally, in an analysis of all four marital statuses, status integration theory was not supported.
Previous work on the effect of marital status on the risk of suicide has neglected alcohol consumption. It is unclear if marital status has a direct effect on suicide. The effect of low marital integration on suicide may be only indirect through alcohol consumption. The present study reassesses the linkage between marital status and suicide with individual-level data based on a national random sample of 10,906 deaths. Logistic regression results indicate that low marital integration significantly increases the odds of dying from suicide, independent of alcohol consumption. Low marital integration also affects suicide indirectly through its association with alcohol consumption. Alcohol consumption is, however, more closely related to risk of suicide than low marital integration. The analysis provides further evidence of the validity of the marital integration-suicide linkage.
The focus of this research is to better understand occupational stress within the dental profession and how this may contribute to why dentists as an occupational group may have such a high incidence of suicide. Attention is given to the socially related working conditions that dentists encounter and the occupational role demands they face. Data are based upon 25 in‐depth, unstructured interviews with dentists from a large mid‐western city. The findings of this research include that the occupational role of dentists facilitates social tension and stress and that dentists experience a status dilemma, especially when compared to physicians. We suggest that these conditions may contribute to a dentist's choice to commit suicide.
A suicide rate among blue collar workers was found 44.2 compared to 17.8 for white collar or higher status workers. The suicide rate for the low status laborers was 4.6 times as high as that of the highly educated professional-technical group. While there are some departures from a general inverse relationship between occupational status and suicide, the data tend strongly to support such a relationship. This finding upholds the economic theory of suicide as opposed to Durkheim's theory as it applies to occupational status.
The correlation between the NORC prestige scale of 1947 with 1950 suicide rates is extremely low for thirty-six specific occupations. The low correlation calls into question the findings of previous studies which employed gross occupational categories and impressionistic prestige rankings. The results indicate that client dependency and two multivariate models, status inconsistency and distributive justice, deserve further exploration in predicting suicide rates for occupations.
The relationship between occupational status and suicide was examined using data from Sacramento County, California. Data were obtained from coroner's records filed routinely on all cases of sudden, violent, or unexpected death since 1925. Occupation- and age-specific suicide rates were calculated for males and age-adjusted for overall comparison for the decades 1945–1954, 1955–1964, and 1965–1974. Findings show an inverse relationship between occupational status and suicide for all age groups over the past 30 years. Over time, male suicide rates have increased particularly for employed males over 65, employed males aged 14 to 24, and males in low-status occupations. General economic insecurity among workers of low socioeconomic status (SES), particularly the elderly, is suggested as a contributing factor to these trends.
In der Zeit vom 1.1. 1963–31.12. 1978 ereigneten sich in Oberbayern 67 Suicide von Ärzten, 27 Suicide von Ärztinnen, 19 Suicide von Zahnärzten und 6 Suicide von Zanärztinnen. Diese Suicide konnten umfassend anhand der Unterlagen der Bayer. Landesärztekammer und Zahnärztekammer über alle verstorbenen Ärzte und Zahnärzte, sowie anhand der staatsanwaltschaftlichen Ermittlungsberichte gefunden und ausgewertet werden. Das Suicidgeschehen liegt bei den Ärzten 1,6-fach, bei den Ärztinnen 3,0-fach, bei den Zahnärztinnen 2,9-fach signifikant, bei den Zahnärzten 1,3-fach nicht signifikant über dem Suicidgeschehen der über 25-jährigen männlichen bzw. weiblichen Bevölkerung Oberbayerns. Alle vier Gruppen weisen in der Stadt München ein niedrigeres Suicidgeschehen als in Oberbayern ohne München auf. Als häufigste Suicidmethode wurden Medikamente verwandt. Überwiegend starben die Ärzte im Alter unter 55 Jahren, die Zahnärzte im Alter über 55 Jahren und die Ärztinnen und Zahnärztinnen zwischen dem 45. und 65. Lebensjahr durch Suicid. Die Mehrzahl kommt hinsichtlich des Geburtsortes aus anderen Regionen. Ein intaktes Familienleben mit Ehepartner und/oder Eltern hat entweder nie bestanden, ist vor kurzem zerbrochen oder drohte zu zerfallen (Tod, Scheidung oder Trennung). Sie sind kinderlos oder die Kinder leben nicht mehr im Haushalt. Sie sind kaum ärztlich tätig, eher im Ruhestand, arbeitslos, seit Monaten krank oder berufsfremd tätig. Sie sind tatsächlich oder in ihrer Vorstellung somatisch schwer krank oder chronisch behindert, insbesondere psychisch krank, vor allem depressiv und/oder süchtig, haben schon Suicidversuche hinter sich und sind bereits ambulant oder stationär psychiatrisch vorbehandelt.