Nurses Consider Suicide More Than Other US Workers

Sap Partners | Schools of Nursing | <b>Mayo Clinic Comprehensive Cancer Center</b>

The 3 subscales of burnout—emotional exhaustion, depersonalization, and a low sense of personal accomplishment—may all contribute to an increase in suicidal ideation among American nurses.

Nurses are more likely to think about suicide compared with other American workers, and most nurses who experience suicidal ideation do so because of burnout, according to a study published in The American Journal of Nursing. Furthermore, nurses who carry said ideation are less likely to seek professional help than their counterparts.

A total of 403 (5.5%) out of 7378 nurse respondents answered that they had experienced suicidal ideation within the past 12 months. The majority of nurse respondents shared that they would be willing to seek professional help for a serious emotional problem; however, nurses who did experience suicidal ideation were less likely to be willing to seek professional help (85% vs 72.6%). After conducting a multivariable analysis of the nurses’ data, researchers determined that burnout and suicidal ideation were strongly linked.

“Burnout contributes to the risk of suicidal ideation. These issues warrant greater attention,” said Elizabeth A. Kelsey, DNP, APRN, CNP, of Mayo Clinic Minnesota, and colleagues, in the study. “Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalence of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help.”

The findings suggest that about 1 in 18 American nurses experience suicidal ideation within a year. These results are supported by the more recent survey conducted by the American Medical Association between April and December 2020. This survey revealed that 5% of the 2333 nurse respondents experienced suicidal ideation, emphasizing the risk factor for these health care professionals compared with other US workers.

The study included a cross-sectional survey that was distributed to 86,858 members of the American Nurses Association and a probability-based sample of 5198 American workers. Responses were anonymous and voluntarily given.

The cohort of 5198 American workers were randomly selected through telephone numbers and their residential address. Both the Mayo Clinic and Stanford University IRBs approved the other U.S. Workers survey. The received invitations to participate via telephone and email.

The study period lasted from November 1, 2017, to December 13, 2017. Anyone who participated was provided information on the national suicide hotline. Survey questions inquired about suicidal ideation, burnout, and depression.

To inquire about suicide ideation, the survey asked participants, “During the past 12 months, have you had thoughts of taking your own life?” This question has been used in the past to evaluate suicide ideation in physicians and medical students as well as in a large US epidemiological study. National Comorbidity Survey (NSC) reports suggest that one-third of people who experienced suicide ideation will then develop a plan, and that approximately three-fourths of those who have developed a plan will then attempt to execute it. The NSC reports also state that about 1 in 4 people with suicidal ideation have already attempted an unplanned suicide.

Burnout was assessed through the 22-item Maslach burnout Inventory-Human Services Survey (MBI-HSS). This tool provides insight into how participants rank on 3 subscales of burnout: emotional exhaustion, depersonalization, and a low sense of personal accomplishment. According to the study authors, the MBI-HHS is a validated and reliable survey tool for assessing burnout among health care professionals.

Depression was another important component of the survey. Depression-related questions included: “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” The survey then prompted participants to respond about their willingness to seek professional help if a serious emotional problem emerged. Participants could answer that they “would definitely go,” “would probably go,” “would probably not go,” and “would definitely not go.”

After researchers adjusted for personal and professional characteristics, the rate of burnout related to a 3-times higher risk of suicidal ideation.

Compared with other US workers, nurses were twice as likely to be willing to seek professional help. However, the responses from both nurses and other workers revealed that those most in need of professional mental health assistance were also those least willing to pursue it. Previous research has revealed similar findings from other health care professionals, such as physicians and medical students.

According to the study authors, relevant literature suggests that barriers to accessing mental health assistance include a fear of impacting one’s career, doubt about confidentiality, difficulties in obtaining time off work for treatment, and difficulties scheduling appointment. Similarly, the fact that some states inquire about mental health history on nursing licensure applications posits uncertainty about how systems stigmatize addressing mental health concerns. All of these factors merit additional research in order to better identify, understand, and address barriers to help seeking among nurses with suicidal ideation, the study authors concluded.

“Collectively, this evidence convincingly builds the case that health care organizations must address systems-level causes of burnout, for the good of both patients and health care workers… to be effective, systems-level interventions must take into account the differences in various health care roles. Such actions should concentrate on balancing job demands with job resources and on creating a constructive work culture,” said study authors.

“To these ends, strategies that focus on managing team conflict, ensuring appropriate staffing levels, creating fair work schedules, optimizing benefits, developing leaders, and facilitating professional growth and career advancement are useful. The implications for nursing practice, education, and policy should include steps to build psychological safety in the workplace and reduce stigma. Given the increased stress nurses are experiencing during the COVID-19 pandemic, the need to act has never been more acute.”

Reference

Kelsey EA, West CP, Cipriano PF, et al. Suicidal ideation and attitudes toward help seeking relative to the general working population. Am J Nurs. 2021;121(11):24-36. doi:10.1097/01.NAJ.0000798056.73563.fa