Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Search
2.2. Inclusion Criteria
- (1)
- Types of study: This review included any type of original clinical interventional study, including randomized controlled clinical trials (RCTs), non-randomized controlled clinical trials (CCTs), and before–after studies. However, retrospective and observational studies were excluded. No restrictions were imposed on the language or status of publication.
- (2)
- Types of participant: Any type of HCW, including physicians and nurses, was included. No restrictions were imposed on the participants’ sex, age, or ethnicity.
- (3)
- Types of intervention: Any type of psychological intervention was included. Cognitive behavior therapy (CBT), acceptance and commitment therapy, dialectical behavior therapy, meditation, mindfulness-based intervention, autogenic training, yoga, tai chi, qigong, breathing exercises, music therapy, guided imagery, and biofeedback were regarded as psychological interventions of interest.
- (4)
- Types of control: For studies with controls, including RCTs and CCTs, there was no restriction on control intervention. That is, we allowed studies that involved no treatment, wait-list, treatment as usual, placebo or sham treatment, attention control, and active comparators.
- (5)
- Primary outcome: Any validated measure of suicidal ideation, such as the Beck scale for suicidal ideation [5], was considered the primary outcome. Secondary outcomes included any other measure of suicidal behavior, including suicidal ideation, attempt, or fulfilment.
2.3. Study Selection
2.4. Risk of Bias Assessment
2.5. Data Extraction
2.6. Data Analysis
3. Results
3.1. Study Search
3.2. Characteristics of Included Studies
3.3. Methodological Qualities of Included Studies
3.4. Main Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study (Reference) | Country | Sample Size | Mean Ages Mean ± SD (Range) | Type of HCWs | Pathological Condition of HCWs | Interventions Used | Control Interventions | Intervention Period |
---|---|---|---|---|---|---|---|---|
Guille [7] | U.S. | 1. CBT (n = 100) 2. AC (n = 99) | 1. CBT: 24.9 ± 8.7 2. AC: 25.4 ± 7.4 | Medical interns | History of depression (n, %) 1. CBT: 48 (48.0) 2. ACG: 47 (47.5) Current suicidal ideation (n, %) 1. CBT: 3 (3.0) 2. ACG: 3 (3.5) | 30 min web-based CBT, once a week | email, once a week | 4 weeks |
Taylor [8] | Australia | 1. Yoga (n = 11) 2. Fitness (n = 10) | 1. Yoga: 30 ± 5 (23 to 37) 2. Fitness: 30 ± 4 (26 to 37) | Junior doctors | NR | 1 h personalized yoga, once a week | 45–60 min group fitness, once every 2 weeks | 8 weeks |
Study | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 |
---|---|---|---|---|---|---|---|
Guille et al. [7] | L | L | L | L | L | SC | L |
Taylor et al. [8] | L | SC | SC | L | SC | SC | SC |
Research Gap | Previous Review by Dutheil et al., (2019) | Current Review by Nam et al., (2022) |
---|---|---|
Scope of review |
|
|
Database searched | PubMed, Cochrane Library, Science Direct and EMBASE | PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO |
Search period | Inception to April 2019 | From June 2022 to July 2022 |
Included studies | N = 61 | N = 2 |
Main findings | The overall SMR for suicide in physicians was 1.44 (95% CIs 1.16, 1.72), with an important heterogeneity (I2 = 93.9%, p < 0.001). Females were at higher risk (SMR = 1.9; 95% CIs 1.49, 2.58; and ES = 0.67; 95% CIs 0.19, 1.14; p < 0.001) compared with males. U.S. physicians were at higher risk (ES = 1.34; 95% CIs 1.28, 1.55; p < 0.001) than those in other parts of the world. Suicide rates decreased over time, especially in Europe (ES = −0.18; 95% CIs −0.37, −0.01; p = 0.044). Some specialists might be at higher risk, such as anesthesiologists, psychiatrists, general practitioners, and general surgeons. There were 1.0% (95% CIs 1.0, 2.0; p < 0.001) of suicide attempts and 17% (95% CIs 12, 21; p < 0.001) of suicidal ideation in physicians. | Only two studies were identified. According to Guille et al. [7], the CBT group generally showed significantly lower post-intervention suicidal ideation than the AC group on the PHQ-9. The CBT group was 60% less likely to report suicidal ideation during the internship year than those assigned to the AC group (RR = 0.40; 95% CIs 0.17, 0.91; p = 0.03). Taylor et al. [8] calculated between-group differences and found no significant difference between the yoga group (pre 9 ± 3, post 11 ± 1) and fitness group (pre 11 ± 6, post 10 ± 4) in SIDAS scores (z = 0.72, p = 0.47). |
Conclusions | Physicians have an at-risk profession of suicide, and females are particularly at risk. The rate of suicide among physicians decreased over time, especially in Europe. The high prevalence of physicians who attempted suicide, as well as those with suicidal ideation, should benefits from preventive strategies in the workplace. | No consistent conclusion can be drawn from the existing literature regarding psychosocial prevention strategies focusing on the suicide risk of HCWs. Intervention studies using psychosocial intervention to reduce the risk of suicide among HCWs are relatively scarce. |
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Nam, S.-H.; Nam, J.-H.; Kwon, C.-Y. Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 13121. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013121
Nam S-H, Nam J-H, Kwon C-Y. Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(20):13121. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013121
Chicago/Turabian StyleNam, Soo-Hyun, Jeong-Hyun Nam, and Chan-Young Kwon. 2022. "Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review" International Journal of Environmental Research and Public Health 19, no. 20: 13121. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013121