To the Editor: The article by Eva S. Schernhammer, M.D., and Graham A. Colditz, M.D., D.P.H. (1), is the first meta-analysis of suicide rates among physicians, to our knowledge, and is therefore most welcome.

The authors conducted electronic searches in four databases: MEDLINE, PsycINFO, AARP Ageline, and EBM Reviews Cochrane Database of Systematic Reviews. To conduct a comprehensive and systematic literature search, several databases should be used. In psychiatry, it is recommended to include at least Embase (Excerpta Medica) and Biosis (Biological Abstracts) in addition to MEDLINE (Index Medicus) and Psyclit/PsycINFO (Psychology Abstracts) (2). We would also recommend the Web of Science (http://www.isinet.com/products/citation/wos). Variations in the overlap between databases and the high proportion of journals indexed in only one of the databases emphasize the importance of searching all that we mentioned to ensure optimal coverage of the relevant literature (2, 3).

Drs. Schernhammer and Colditz concluded that since many studies were conducted more than a generation ago, there was a need for more recent studies. We recently published a nationwide study from Norway covering the period 1960–2000 (4). A total of 98 suicides among male physicians and 13 suicides among female physicians were studied. Suicide rates among physicians increased from the 1960s to the 1980s. However, in the 1990s, the rates were significantly lower than in the 1980s among male physicians, other university graduates, and the general population. Nevertheless, in the 1990s, physicians still had a higher suicide rate than other university graduates and the general population, both among men (43.0 per 100,000 person-years; 95% confidence interval [CI]=35.3–52.5) and women (26.1 per 100,000 person-years; 95% CI=15.1–44.9) compared to 23.5 per 100,000 person-years (95% CI=23.1–24.0) and 8.0 per 100,000 person-years (95% CI=7.8–8.3) among male and female nongraduates, respectively.

The suicide rate among female physicians was twice as high as that of the general population as well as other female graduates, even in the 1990s. Of interest, suicide rates increased steeply by age among physicians and other graduates, whereas for nongraduates, the rate was highest among those ages 40–60 years. Drs. Schernhammer and Colditz emphasized the elevated suicide rates among female physicians. However, the higher suicide rates among elderly physicians are also of concern and warrant further investigation.

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