Between the stress of work, long shifts, and frequently watching patients die, working as a healthcare provider can take a toll on your psyche. Past research has shown that this has a very real consequence for nurses across the globe. One 2015 literature review, for example, found a troubling high prevalence of suicide among nurses, yet there’s also a shortage of research into this subject. But a slew of recent studies suggests the suicide rates among nurses are more alarming than previously thought. Here’s what the research says about nurse suicide in the US and what you can do about it. ‍

Nurses at Risk

As if the Covid-19 pandemic wasn’t enough, the US has been going through a suicide epidemic. In 2018, suicide was the second leading cause of death in America among ages 10 to 34, according to the National Institute of Mental Health. Moreover, the suicide rate increased by 35% from 1999 to 2018. But nurses have a higher risk of suicide than the general population, according to a February 2020 study published in WORLDviews on Evidence Based-Nursing.  

Researchers at the University of California San Diego School of Medicine and UC San Diego Health analyzed data from the CDC's 2005 to 2016 National Violent Death Reporting System dataset. They found that female nurse suicide rates from those years were higher than the general female population: 10 per 100,000 compared to 7 per 100,000, respectively. Similarly, suicide among male nurses was higher than the general male population: 33 per 100,000 versus 27 per 100,000 respectively. The researchers also found that female nurses most commonly committed suicide via drug overdose (opioids and benzodiazepines, specifically), while male nurses committed suicide by firearms more often than not. 

A more recent study, published in April 2021 in JAMA Psychiatry, paints a more concerning picture for female nurses. Using CDC mortality data from 2007 to 2018, the University of Michigan scientists found that female nurses are nearly twice as likely and about 70% more likely to die by suicide than the general female population and female physicians, respectively. Adding fuel to the fire, suicide by firearm among female nurses appears to be on the rise. A December 2020 study in the journal Nursing Forum, also authored by the UC researchers, found that in 2014, female nurses shifted from using pharmacological poisoning to firearms to commit suicide.

Given the unprecedented increase in firearm sales across the US in 2020, “this is sobering information,” study co-author Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention, said in a press release. What’s more, this uptick in gun sales has continued into 2021. ‍

Risk Factors for Nurse Suicide 

Of course, some nurses are more likely to commit suicide. There’s a long list of risk factors for suicide among nurses, which includes: 

• Exposure to frequent trauma and death.

• Long, consecutive shifts.

• Workplace bullying.

• Poor self-care.

• Social isolation or loneliness.

• Access to and knowledge of lethal substances, such as opioids.

• High, sustained workplace stress.

• Management issues.

• Feeling unsupported or unprepared for the job.

• Fear of harming patients.

• Depression and anxiety.

• Financial stress.

The Covid-19 pandemic has only worsened things by increasing risk factors like workplace stress, exposure to trauma and death, overtime, and social isolation.‍

How to Help

Nurses feeling depressed or suicidal are often in too much of a crisis to seek help independently. The first step in preventing suicide is recognizing the warning signs for it in others and yourself. 

These signs can include:

• Discussing suicide verbally or creatively (in writing or art) or Googling ways to commit suicide.

• Feeling or expressing hopelessness, being trapped, being in unbearable pain, or being a burden to other people.

• Using alcohol or drugs more often.

• Experiencing sleep issues.

• Feeling or expressing anxiousness, agitation, rage or vengeful thoughts, or extreme mood swings.

• Ruminating on negative thoughts, feelings, or experiences.

• Withdrawal.

• Reckless or self-injurious behavior.

• Giving away belongings.

If you spot these warning signs in another nurse, talk to them about it. Practice situational awareness (look for objects they could hurt themselves or you with) and call an EMS first if you feel at risk. Ask them directly if they are thinking about suicide and show interest by asking them to tell you more. 

During the conversation, it’s important to show empathy: 

• Paraphrase what they’ve told you and try to name their emotions.

• Be gentle and non-judgemental—don’t try to change or downplay their feelings.

• Acknowledge that their intent worries you, see if they have a plan, and ask if it’s OK to work with them to get help.

• Discuss when you can check in on them, but if they are having serious thoughts of suicide, call 911 as soon as possible.

Loneliness is a risk factor for those who are depressed—increase your contact with them, whether in person or through phone calls, video calls, or messaging services. Another tested approach to preventing suicide in people who are depressed is to remove their means to commit suicide, according to Dr. Moutier and her colleagues. For example, if you live with them, make sure firearms and ammunition are stored separately and safely locked away; if they live alone with a firearm in the home, make arrangements to remove it while being treated for depression. ‍

Getting Help for Yourself

If you are depressed or feeling suicidal, get help as soon as possible. Contact your organization’s employee assistance program, explore telehealth options, and participate in mental health screenings. There are also a lot of at-home practices you can engage in to reduce your stress levels, such as meditation, reflections of gratitude, getting at least seven hours of sleep, taking up a hobby, and exercising, among others. 

It would also be helpful to look into UC San Diego’s Healer Education Assessment and Referral (HEAR) program, which the American Medical Association identified as a best practice in suicide prevention. The HEAR program provides education about suicide risk factors; a confidential online assessment of stress, depression, and other related issues; and proactive screening focused on referring clinicians for untreated depression and suicide risk. 

A recent study showed that the pilot portable program has been successful and is ready to be replicated at other institutions.