Mental health of Brazilian physicians: a nationwide cross-sectional study to investigate factors associated with the prevalence of suicide plans and attempts

Luz, Leonardo Servio; Cassenote, Alex Jones Flores; Valente, Emanuelle Pessa; Mariani, Ilaria; Lazzerini, Marzia; Lima, Carlos Vital Tavares Corrêa; Giamberardino Filho, Donizetti Dimer; Marques Filho, Edmilson de Freitas; von Tiesenhausen, Hermann Alexandre Vivacqua; Cabeça, Hideraldo Luis Souza; Damásio, Lia Cruz Vaz da Costa; de Souza Júnior, Milton Aparecido; de Souza, Paulo Henrique; Rocha, Rosylane Nascimento das Mercês; Zaher-Rutheford, Vera Lucia; Ribeiro, Mauro Luiz de Britto; da Silva, Antônio Geraldo; Gallo, José Hiran da Silva

doi:10.47626/1516-4446-2023-3393

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Brasil

Brazilian Journal of Psychiatry

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Brasil

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ORIGINAL ARTICLE • Braz J Psychiatry 46 • 2024 • https://doi.org/10.47626/1516-4446-2023-3393 copy

Mental health of Brazilian physicians: a nationwide cross-sectional study to investigate factors associated with the prevalence of suicide plans and attempts

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To report on suicide plans and attempts among Brazilian physicians and to investigate the associated risk factors.

Methods:

From January 2018 to January 2019, a nationwide online survey was conducted among Brazilian physicians using the Tool for Assessment of Suicide Risk and the Satisfaction with Life Scale. Multivariate exploratory associations of demographic, psychological, and work-related factors were performed on reports of suicide plans and attempts.

Results:

Of the 4,148 participants, 1,946 (53.5%) were male, 2,527 (60.9%) were 30 to 60 years old, 2,675 (64.5%) had two to four jobs, and 1,725 (41.6%) worked 40 to 60 hours a week. The overall prevalence of suicide plans was 8.8% (n=364), and suicide attempts were reported by 3.2% (n=133) of participants. Daily emotional exhaustion (OR_adj = 7.857; 95%CI 2.282-27.051, p = 0.002), weekly emotional exhaustion (OR_adj = 7.953; 95%CI 2.403-26.324, p = 0.001), daily frustration at work (OR_adj = 3.093; 95%CI 1.711-5.588, p < 0.001), and bisexuality (OR_adj = 5.083; 95%CI 2.544-10.158, p < 0.001) were significantly associated with higher odds of suicide. Extremely dissatisfied physicians reported suicide plans and attempts in 38.3% of cases, whereas extremely satisfied physicians reported suicide plans and attempts in only 2.8% of cases (p < 0.001).

Conclusion:

Brazilian physicians with a history of suicide plans and attempts express emotional exhaustion and frustration at work. There is an urgent need for actions to promote professional safeguards and resilience.

Suicide; self-injurious behavior; suicidal ideation; physicians

Characteristics	n	% (95%CI)	Physician population (%)²⁸28. Scheffer M. Demografia médica no Brasil 2020. São Paulo: FMUSP, CFM;2020.
Male	2,221	53.5 (52.0-55.1)	53.4
Age (years)^† † Age categories defined to be comparable to official data.
≤ 29	716	17.6 (16.4-18.8)	18.6
30-60	2,527	60.9 (59.4-62.4)	61.1
≥ 60	892	21.5 (20.3-22.8)	20.3
Specialist physician	2,489	60.0 (58.5-61.5)	61.3
Brazilian region
North	169	4.1 (3.5-4.7)	4.3
Northeast	682	16.4 (15.5-17.9)	19.7
Southeast	2,290	55.2 (53.7-56.7)	54.7
South	659	15.9 (14.8-17.0)	15.4
Midwest	348	8.4 (7.6-9.3)	7.8
State capitals	1,999	55.9 (54.3-57.6)	54.5
Local population
5,000	14	0.4 (0.2-0.6)	0.3
5,001-10,000	23	0.6 (0.4-0.9)	0.6
10,001-20,000	46	1.3 (1.0-1.7)	1.6
20,001-50,000	200	5.6 (4.9-6.4)	4.7
50,001-100,000	225	6.3 (5.5-7.1)	6.0
100,001-500,000	845	23.7 (22.3-25.1)	23.3
> 500,000	2,215	62.1 (60.5-63.7)	63.3
Religious beliefs or practices
No	916	22.1 (20.8-23.4)
Yes	3,232	77.9 (76.6-79.2)
Sexual orientation
Heterosexual	3,868	93.4 (92.6-94.1)
Bisexual	59	1.4 (1.1-1.8)
Homosexual	215	5.2 (4.5-5.9)
Workplace
Ambulatory	3,446	86.9 (85.9-88.0)
Emergency	1,946	49.1 (47.5-50.7)
Surgery	1,104	27.9 (26.5-29.3)
Other	357	9.0 (8.1-9.9)
Types of services
Public	1,357	32.7 (31.3-34.2)
Private	1,124	27.1 (25.8-28.5)
Dual practice	1,667	40.2 (38.7-41.7)
Number of work contracts
1	1,108	26.7 (25.4-28.1)
2-4	2,675	64.5 (63.0-65.9)
> 4	365	8.8 (8.0-9.7)
On-call work	2,192	52.8 (51.3-54.4)
Weekly workload (declared hours)
< 20	139	3.4 (2.8-3.9)
20-39	850	20.5 (19.3-21.7)
40-59	1,725	41.6 (40.1-43.1)
60-79	1,025	24.7 (23.4-26.0)
> 80	409	9.9 (9.0-10.8)
Weekly leisure activities (declared hours)
No practice or < 2	884	21.3 (20.1-22.6)
2-6	2,055	49.5 (48.0-51.1)
> 6	1,209	29.1 (27.8-30.5)
Weekly physical activities (declared hours)
Sedentary	2,122	51.2 (49.6-52.7)
2-6	1,663	40.1 (38.6-41.6)
> 6	363	8.8 (7.9-9.6)
Ease to seek mental health help
Very difficult	371	8.9 (8.1-9.8)
Difficult	856	20.6 (19.4-21.9)
Neutral	527	12.7 (11.7-13.7)
Easy	1,412	34.0 (32.6-35.5)
Very easy	982	23.7 (22.4-25.0)
Level of satisfaction with life
Extremely dissatisfied	81	2.0 (1.6-2.4)
Dissatisfied	264	6.4 (5.7-7.1)
Slightly dissatisfied	575	13.9 (12.8-14.9)
Neutral	144	3.5 (2.9-4.1)
Slightly satisfied	792	19.1 (17.9-20.3)
Satisfied	1,296	31.2 (29.8-32.7)
Extremely satisfied	996	24.0 (22.7-25.3)

Suicide plan/attempt	n (%)
Suicide ideation	1,218 (29.4)
Suicide plans	335 (8.1)
Suicide attempt	133 (3.2)
Suicide plans and attempts	364 (8.8)

	n	% (95%CI)	Unadjusted analyses OR (95%CI)	p-value	Adjusted analyses OR (95%CI)	p-value
Gender
Female	194	10.1 (8.8-11.5)	Ref.	-	Ref.	-
Male	170	7.7 (6.6-8.8)	0.740 (0.597-0.919)	0.006	0.796 (0.621-1.021)	0.072
Age (years)
< 35	164	13.6 (11.2-16.2)	Ref.	-	Ref.	-
35-50	125	8.9 (7.8-10.1)	0.622 (0.483-0.800)	< 0.001	0.753 (0.575-0.988)	0.040
> 50	75	4.5 (3.3-6.0)	0.299 (0.204-0.437)	0.001	0.505 (0.362-0.704)	< 0.001
Religious beliefs or practices
No	101	11.0 (9.1-13.2)	Ref.	-	Ref.	-
Yes	263	8.1 (7.2-9.1)	0.972 (0.950-0.993)	< 0.001	0.699 (0.527-0.926)	< 0.013
Sexual orientation
Heterosexual	315	8.1 (7.3-9.0)	Ref.	-	Ref.	-
Bisexual	19	32.2 (21.4-44.8)	5.358 (3.066-9.362)	< 0.001	5.083 (2.544-10.158)	< 0.001
Homosexual	28	13.0 (9.0-18.0)	1.689 (1.117-2.554)	0.037	1.402 (0.886-2.219)	0.149
Self-prescription of antidepressants or anxiolytics
No	140	5.6 (4.7-6.5)	Ref.	-	Ref.	-
Yes	224	13.6 (12.0-15.4)	2.670 (2.140-3.331)	< 0.001	1.870 (1.464-2.390)	< 0.001
Substance dependence (current or past)
No	333	8.3 (7.5-9.2)	Ref.	-	Ref.	-
Yes	31	22.5 (16.1-30.0)	2.670 (2.140-3.331)	< 0.001	1.795 (1.058-3.046)	< 0.001
Current unresolved serious problem
No	241	6.8 (6.0-7.7)	Ref.	-	Ref.	-
Yes	123	20.3 (17.2-23.6)	3.488 (2.751-4.422)	< 0.001	2.074 (1.571-2.736)	< 0.001
Weekly workload
Reduced	21	10.6 (6.9-15.5)	Ref.	-	Ref.	-
Almost adequate, possible to increase	27	10.0 (6.8-14.0)	0.933 (0.511-1.703)	0.821	0.523 (0.794-1.611)	0.523
Adequate, impossible to increase	113	6.2 (5.1-7.3)	0.554 (0.339-0.905)	0.018	0.631 (0.347-1.146)	0.130
Overloaded	203	11.0 (9.6-12.5)	1.041 (0.647-1.675)	0.867	0.505 (0.362-0.704)	0.020
Weekly leisure activities (hours)
< 2	124	14.0 (11.9-16.4)	Ref.	-	Ref.	-
2-6	177	8.6 (7.5-9.9)	0.578 (0.452-0.738)	< 0.001	0.821 (0.623-1.083)	0.162
> 6	63	5.2 (4.1-6.6)	0.337 (0.245-0.463)	< 0.001	0.530 (0.363-0.774)	< 0.001
Emotional exhaustion at work
Never	4	0.8 (0.3-2.0)	Ref.	-	Ref.	-
Once a month	38	4.8 (3.5-6.5)	5.944 (2.108-16.761)	0.001	5.105 (1.530-17.030)	0.008
Once a week	76	6.7 (5.3-8.2)	8.381 (3.048-23.040)	< 0.001	5.234 (1.585-17.288)	0.007
Several times a week	159	12.0 (10.3-13.8)	15.955 (5.881-43.283)	< 0.001	7.953 (2.403-26.324)	0.001
Every day	87	20.3 (16.7-24.3)	29.850 (10.85-82.115)	< 0.001	7.857 (2.282-27.051)	0.002
Frustration at work
Never	27	2.7 (1.9-3.9)	Ref.	-	Ref.	-
Once a month	71	6.5 (5.2-8.1)	2.480 (1.578-3.896)	< 0.001	1.599 (0.973-2.630)	0.064
Once a week	54	7.7 (5.9-9.8)	2.954 (1.841-4.738)	< 0.001	1.393 (0.817-2.377)	0.224
Several times a week	137	12.7 (10.8-14.8)	5.182 (3.397-7.906)	< 0.001	1.799 (1.087-2.979)	0.022
Every day	75	25.8 (21.0-31.0)	12.346 (7.763-19.635)	< 0.001	3.093 (1.711-5.588)	< 0.001
Perception of current income
Little, so I have several jobs	108	15.8 (13.2-18.7)	Ref.	-	Ref.	-
Good but not enough to maintain consumption standards	57	10.3 (8.0-13.0)	0.612 (0.434-0.862)	0.004	0.744 (0.508-1.088)	0.127
Enough to meet my needs	121	9.1 (7.7-10.7)	0.534 (0.404-0.705)	< 0.001	0.139 (0.788-0.575)	0.139
Enough to meet my needs and save for the future	56	4.5 (3.5-5.8)	0.253 (0.180-0.355)	< 0.001	0.482 (0.329-0.774)	< 0.001
Very good, I have no financial problems	22	6.3 (4.1-9.2)	0.358 (0.222-0.578)	< 0.001	0.875 (0.500-1.533)	0.624

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E-mail: editorial@abp.org.br

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[1] Correspondence:
Emanuelle Pessa Valente, Institute for Maternal and Child Health IRCCS Burlo Garofolo, WHO Collaborating Centre for Maternal and Child Health, Via dell’Istria 65/1, 34137, Trieste, Italy. E-mail: valente.emanuelle@gmail.com