The Alarming Increase in Female Health Care Worker Suicide

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Commentary

The increasing number of suicides and fatal overdoses of women health care workers has accompanied rises in sickness, disability, and women leaving the sector. The total social and economic costs of a workforce in despair are yet unknown. A shortfall of 10 million people in the health care workforce (of whom 80–90 percent is female) is projected by the World Health Organization (WHO) for 2030 and is of critical concern.

When the health of those who look out for people’s health is at risk, the whole population and economy are at risk. This is an emergency of unprecedented scale that needs attention at the highest public health level. Humanity and nutrition instead of medicalization as a coping strategy urgently need to return in the health care sector.

Alarming Warnings by Health Care Workers in Despair

Recent studies noticed death by suicide and the risk for fatal drug overdose among women in health care is much higher than in the general population (1–10). It is not only female physicians; the risk is even higher for nurses and other health care workers, especially for those with the lowest-paid jobs and heaviest mental and physical workload who have been most stretched to the limits (7). Worldwide over the past several years, thousands of health care workers have died by suicide or fatal overdose, leaving family, friends, and the workplace in shock and grief.

Suicide and self-harm have substantial social and economic costs (12). One death by suicide was calculated in the UK to cost the economy an average of 1.46 million pounds (13). In 2022, more than 360 nurses attempted suicide, and 72 medical professionals took their own lives in 2020 in the UK as data from the Office of National Statistics indicate. Analysis of mortality data from the U.S. Centers for Disease Control and Prevention from 2007 to 2018 identified 2,374 suicides among nurses, 857 among doctors, and 156,141 in the general population. However, the number of deaths by suicide or fatal overdose is grossly underreported. The WHO reports that more than 50 percent of suicides happen under the age of 50 years (14). To address this avoidable burden, a better understanding of effective and non-effective strategies is paramount.

Even before the COVID-19 pandemic started, women in health care reported substantial workplace stressors (9–11, 15–16). The past four years have put additional strain on women’s health. This is especially true for those women working as front-liners and first responders in highly demanding stressful situations. Increased complexity of care, understaffing, long working hours, additional bureaucratic tasks, moral injury, diminished autonomy, lack of decision-making ability, and low-paid jobs take a toll on their health.

Moreover, women routinely face tougher challenges at work and at home such as institutionalized barriers to career advancement and additional pressure for domestic labor by frequently being a caregiver for children or parents (9). In all parts of the world, health care workers are at high risk of violence, with 8–38 percent suffering some sort of violence in their careers. In 2023 for the first time in history, 75,000 health care workers in the United States went on strike (17).

Women are more frequently diagnosed with burnout, major depression, post-traumatic stress disorder, ME/CFS, and long COVID. Long COVID is more prevalent in health care workers (11,18–20). These diagnoses of chronic illnesses have many symptoms in common that are known to exacerbate the risk of suicidal thoughts, suicide attempts, and suicidal completion beyond occupation and established risk factors such as socioeconomic status and education (7–8,20–24).

An Epidemic of Emotional Trauma and Distress

Health care workers are trying to hide their symptoms by pushing themselves to work despite extreme pain, fatigue, memory inconsistency, exhaustion, and grief about not being able to deliver the quality of care patients need. Being overstressed, and with long-term understaffing, health care workers hardly take time to eat a nutritious meal.

Many have become undernourished and sleep-deprived. Potential disparities in help-seeking and health care access might manifest in non-medical use of prescription drugs among some health care workers, which has implications for workers’ safety and well-being (25). Many of the medicines used by health care workers might be unprescribed and unnoticed (1-8, 23).

Toxic Cocktails: A Danger for Women’s Health

Suicides among the health care workforce often take place at work. The most frequently used method of suicide is overdose or poisoning (1–8). New studies suggest that most overdoses are caused by psychiatric drugs and multiple medications in the person’s system. Co-administration of antidepressants and opioids deliberate or unplanned is common. Women are more likely to be prescribed and take medication such as antidepressants and birth control pills and seem to be more sensitive and experience more drug side effects than men. Pharmacokinetic interactions may increase the concentrations and severity of side effects of antidepressants (27–28).

Studies demonstrate potential side effects of psychiatric drugs and opioids as insomnia, burnout, fatigue, anxiety, pain, and suicidal thoughts (21–25). The risk of opioid-involved overdose death was nearly twice as high for health care support workers such as nursing home workers and home health aides as it was for other health care workers (7).

The interaction and side effects of the use of multiple medicines and concentrations are mostly unknown. This is especially true for women as most drugs have been poorly studied in women. Some medicine might even have more disastrous side effects than any benefit as seems to be the case for psychotropic medicine (26). Moreover, interactions of psychotropic drugs with immunosuppressive capabilities and COVID-19 mRNA vaccines have been reported (17).

Furthermore, pandemic measures that have been mandated for health care workers including long-term wearing of medical facemasks (with potential inhalation of toxins) and repeated COVID-19 vaccinations with women reporting more side effects than men (30–31) might have exacerbated potential risks. Recent publications repeatedly reported a global burden of absenteeism related to COVID-19 vaccine side effects that could negatively affect the strained health care system and jeopardize patient care (32–33).

Medicalization as a Coping Strategy

During the pandemic, prescription of antidepressants and use of other over-the-counter medication such as acetaminophen (paracetamol) which is often advised to temper vaccine side effects, has grown substantially. Although harmless in low doses, acetaminophen has direct hepatotoxic effects when taken in overdose or a wrong combination and may cause acute liver failure. Accidental or unintentional overdose usually occurs in patients who have been fasting or are critically ill with a concurrent illness, alcoholism, or malnutrition or have preexisting chronic liver disease (34).

Acetominophen (single or combination products) is one of the most used medications in the United States, with 25 billion tablets sold in 2016. It is expected that treatment of trauma ailments and increase in chronic illness will fuel an increase in market sales from $9.8 billion in 2022 to $15.2 billion in 2033. However, after a report showed 8,700 poisonings with high rates of hospitalization and liver injury in 2019–2020 with a sharp rise among females, the Australian medicine regulator is considering restrictions on who can buy paracetamol (35). In Sweden, the sale of acetaminophen in supermarkets was banned in 2015 after the country experienced an overdose hike. Increased use of over-the-counter and controlled drugs may fuel a rise in acute liver failure.

Awareness of potential unintentional irreversible harm is highly needed among health care workers and the public, as many new drugs and vaccines have been introduced since the pandemic.

Drug Theft and Diversion

Job stress and occupational burnout have been associated with increased risk of opioid use disorder, which in turn can increase risk of overdose. Those who prescribe or administer medication have ready access to opioids and other controlled prescription drugs. Drug theft and diversion of controlled drugs in hospitals and nursing homes appear to have accelerated worldwide, putting health care workers and patients at risk (36–38). Taking prescription medicine at work, almost 100 health care workers have been fired in the Netherlands. Moreover, the problems with understaffing in the Dutch health care sector have introduced the use of falsified certificates, with people from illegal drug networks entering health care organizations pushing the system to more errors and deficits (39).

Increasing stress at work and too many night shifts in a row have contributed to a 70 percent increase in medicine thefts. Almost 50 percent of calming and sleeping pills were not delivered to patients, putting them at risk of suboptimal treatment or contaminations and errors (40). Drug use may gradually become an attractive and convenient coping mechanism. Although professionals often think knowledge of the medicine may control their use, dependence may slowly develop. Many impaired health care workers feel guilt and despair and suffer from physical and mental problems and may be indifferent to the risk of overdose (38).

A Return to Humanity in Health Care

The problem of the rise in sudden death of health care workers comes against the background of increasing long-term sick leaves, permanent disabilities, and hundreds of thousands of health care workers leaving the sector, choosing less stressful and better-paid jobs.

This is an unprecedented sign by dedicated women that they are no longer willing to work in a toxic and overstressed environment with complex tasks for often severely ill patients, for which they are underpaid. The health care system is facing increased clinical error rates and liability exposures, and patient satisfaction and organizational reputation are being adversely affected. This may develop into a catastrophe when public health officials do not take responsibility for a highly needed change ensuring that the workforce has the tools and resources needed to turn the wheel.

Hard times may turn positive when CEOs and insurance companies start to embrace the idea that quality of care and reputation start with a healthy, fairly paid workforce, gender equity, and a working environment choosing humanity and good nutrition. A well-nourished and empowered health care workforce that is occupied to guide people to health and work will be a win for all.

Note: A shortened version of this article was posted as a rapid response in the British Medical Journal on Jan. 23, 2025.

Peeters C. Increasing suicides of women healthcare workers: a sign of a population at risk Re: To get Britain working we need to get Britain healthy. https://www.bmj.com/content/388/bmj.r76/rr

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From the Brownstone Institute

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