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Licensed Unlicensed Requires Authentication Published by De Gruyter July 19, 2013

Does the physician density affect suicide rates among adolescents and young adults?

  • Leo Sher EMAIL logo


Higher physician-per-population ratio may improve access to medical care, decrease waiting times, increase the opportunity for contact between the patient and physician, and has been associated with earlier stage of diagnosis and better prognosis in patients with some medical conditions. It appears that an increase in the physician density generally improves the quality of healthcare and should prevent suicides. However, several research reports suggest that of those people who committed suicide, many saw a physician shortly before their suicide completion. Besides, studies show that many physicians do not have adequate training in suicide evaluation techniques and treatment approaches to suicidal patients, especially young people. Therefore, we hypothesized that the physician density does not affect suicide rates among adolescents and young adults. Correlations were computed to examine relationships between suicide rates in 15–24-year-old and 25–34-year-old males and females and the physician density in European countries. Countries were also divided into two groups, according to the median split of the physician density. Suicide rates among 15–24-year-old and 25–34-year-old males and females in these two groups were compared using the t-test. We found no relationships between suicide rates and the physician density. The results of our study suggest that either physicians do not take an appropriate care of suicidal patients, or suicide is not preventable, or both. The results of this study should be treated with caution because many confounding variables are not taken into account.

Corresponding author: Leo Sher, MD, James J. Peters Veterans’ Administration Medical Center, 130 West Kingsbridge Road, Bronx, New York, NY 10468, USA


1. US Central Intelligence Agency World Factbook. Available at: Accessed on June 18, 2012.Search in Google Scholar

2. Ananthakrishnan AN, Hoffmann RG, Saeian K. Higher physician density is associated with lower incidence of late-stage colorectal cancer. J Gen Intern Med 2010;25:1164–71.10.1007/s11606-010-1457-zSearch in Google Scholar PubMed PubMed Central

3. Léonard C, Stordeur S, Roberfroid D. Association between physician density and health care consumption: a systematic review of the evidence. Health Policy 2009;91:121–34.10.1016/j.healthpol.2008.11.013Search in Google Scholar PubMed

4. Association of American Medical Colleges. AAMC statement on the physician workforce. Available at: Accessed on June 16, 2012.Search in Google Scholar

5. Sarma S, Peddigrew C. The relationship between family physician density and health related outcomes: the Canadian evidence. Can Sociol Demogr Med 2008;48:61–105.Search in Google Scholar

6. Chen MK, Lowenstein F. The physician/population ratio as a proxy measure of the adequacy of health care. Int J Epidemiol 1985;14:300–3.10.1093/ije/14.2.300Search in Google Scholar PubMed

7. Shi L, Starfield B. The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas. Am J Public Health 2001;91:1246–50.10.2105/AJPH.91.8.1246Search in Google Scholar PubMed PubMed Central

8. Jürges H, Pohl V. Medical guidelines, physician density, and quality of care: evidence from German SHARE data. Eur J Health Econ 2012;13:635–49.10.1007/s10198-011-0372-5Search in Google Scholar PubMed

9. Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. Physician density and hospitalization for inflammatory bowel disease. Inflamm Bowel Dis 2011;17:633–8.10.1002/ibd.21357Search in Google Scholar PubMed

10. Roetzheim RG, Pal N, van Durme DJ, Wathington D, Ferrante JM, et al. Increasing supplies of dermatologists and family physicians are associated with earlier stage of melanoma detection. J Am Acad Dermatol 2000;43:211–8.10.1067/mjd.2000.106242Search in Google Scholar PubMed

11. Campbell RJ, Ramirez AM, Perez K, Roetzheim RG. Cervical cancer rates and the supply of primary care physicians in Florida. Fam Med 2003;35:60–4.Search in Google Scholar

12. Ferrante JM, Gonzalez EC, Pal N, Roetzheim RG. Effects of physician supply on early detection of breast cancer. J Am Board Fam Pract 2000;13:408–14.10.3122/15572625-13-6-408Search in Google Scholar PubMed

13. Fleisher JM, Lou JQ, Farrell M. Relationship between physician supply and breast cancer survival: a geographic approach. J Commun Health 2008;33:179–82.10.1007/s10900-008-9090-zSearch in Google Scholar PubMed

14. Eide MJ, Weinstock MA, Clark MA. The association of physician-specialty density and melanoma prognosis in the United States, 1988–1993. J Am Acad Dermatol 2009;60:51–8.10.1016/j.jaad.2008.08.040Search in Google Scholar PubMed PubMed Central

15. Sundmacher L, Busse R. The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis. Health Policy 2011;103:53–62.10.1016/j.healthpol.2011.08.004Search in Google Scholar

16. Blumenthal SJ. Suicide: a guide to risk factors, assessment, and treatment of suicidal patients. Med Clin North Am 1988;72:937–71.10.1016/S0025-7125(16)30754-4Search in Google Scholar

17. Pirkis J, Burgess P. Suicide and recency of health care contacts. A systematic review. Br J Psychiatry 1998;173:462–74.10.1192/bjp.173.6.462Search in Google Scholar PubMed

18. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 2002;159:909–16.10.1176/appi.ajp.159.6.909Search in Google Scholar PubMed PubMed Central

19. Robins E, Murphy GE, Wilkinson RH Jr, Grassner J, Kayes J. Some clinical considerations in the prevention of suicide based on a study of 13 successful suicides. Am J Pub Health 1959;49:888–99.10.2105/AJPH.49.7.888Search in Google Scholar

20. Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, et al. Let’s not talk about it: suicide inquiry in primary care. Ann Fam Med 2007;5:412–8.10.1370/afm.719Search in Google Scholar PubMed PubMed Central

21. Hooper LM, Epstein SA, Weinfurt KP, DeCoster J, Qu L, et al. Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res 2012;39:103–15.10.1007/s11414-011-9268-5Search in Google Scholar PubMed PubMed Central

22. US Department of Health and Human Services. National strategy for suicide prevention: goals and objectives for action. Rockville, MD: Public Health Service, 2001.Search in Google Scholar

23. Taliaferro LA, Borowsky IW. Perspective: physician education: a promising strategy to prevent adolescent suicide. Acad Med 2011;86:342–7.10.1097/ACM.0b013e31820984adSearch in Google Scholar PubMed

24. Sher L. Teaching medical professionals about suicide prevention: what’s missing? Q J Med 2011;104:1005–8.10.1093/qjmed/hcr125Search in Google Scholar PubMed

25. Sudak D, Roy A, Sudak H, Lipschitz A, Maltsberger J, et al. Deficiencies in suicide training in primary care specialties: a survey of training directors. Acad Psychiatry 2007;31:345–9.10.1176/appi.ap.31.5.345Search in Google Scholar PubMed

26. Bongar B, Harmatz M. Clinical psychology graduate education in the study of suicide: availability, resources, and importance. Suicide Life Threat Behav 1991;21:231–44.Search in Google Scholar

27. Bongar B, Harmatz M. Graduate training in clinical psychology and the study of suicide. Professional Psychol Res Pract 1989;20:209–13.10.1037/0735-7028.20.4.209Search in Google Scholar

28. Weissberg M. The meagerness of physicians’ training in emergency psychiatric intervention. Acad Med 1990;65:747–50.10.1097/00001888-199012000-00009Search in Google Scholar PubMed

29. Boris NW, Fritz GK. Pediatric residents’ experiences with suicidal patients: implications for training. Acad Psychiatry 1998;22:21–8.10.1007/BF03341440Search in Google Scholar PubMed

30. Boeke M, Griffin T, Reidenberg DJ. The physician’s role in suicide prevention: lessons learned from a public awareness campaign. Minn Med 2011;94:44–6.Search in Google Scholar

31. Gaynes BN, West SL, Ford CA, Frame P, Klein J, et al.; U.S. Preventive Services Task Force. Screening for suicide risk in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004;140:822–35.Search in Google Scholar

32. Rutz W, Walinder J, von Knorring L, Rihmer Z, Pihlgren H. Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland study. Int J Psychiatry Clin Pract 1997;1:39–46.10.3109/13651509709069204Search in Google Scholar PubMed

33. Henriksson S, Isacsson G. Increased antidepressant use and fewer suicides in Jamtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatr Scand 2006;114:159–67.10.1111/j.1600-0447.2006.00822.xSearch in Google Scholar PubMed

34. Szanto K, Kalmar S, Hendin H, Rihmer Z, Mann JJ. A suicide prevention program in a region with a very high suicide rate. Arch Gen Psychiatry 2007;64:914–20.10.1001/archpsyc.64.8.914Search in Google Scholar PubMed

35. Hegerl U, Althaus D, Schmidtke A, Niklewski G. The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med 2006;36:1225–33.10.1017/S003329170600780XSearch in Google Scholar PubMed

36. Bongar B, Lomax JW, Harmatz M. Training and supervisory issues in the assessment and management of the suicidal patient. In Bongar B, editor. Suicide: guidelines for assessment, management, and treatment. New York: Oxford University Press, 1992:253–67.Search in Google Scholar

37. Ellis TE, Dickey TO. Procedures surrounding the suicide of a trainee’s patient: a national survey of psychology internships and psychiatry residency programs. Professional Psychol Res Pract 1998;29:492–7.10.1037/0735-7028.29.5.492Search in Google Scholar

38. Ellis TE, Dickey TO, Jones EC. Patient suicide in psychiatry residency programs: a national survey of training and postvention practices. Acad Psychol 1998;22:181–9.10.1007/BF03341922Search in Google Scholar PubMed

39. Kleespies PM, editor. Emergencies in mental health practice: evaluation and management. New York: Guilford, 1998.Search in Google Scholar

40. Way BB, Allen MH, Mumpower JL, Stewart TR, Banks SM. Interrater agreement among psychiatrists in psychiatric emergency assessments. Am J Psychiatry 1998;155:1423–8.10.1176/ajp.155.10.1423Search in Google Scholar PubMed

41. Sher L. Teaching medical professionals and trainees about adolescent suicide prevention: five key problems. Int J Adolesc Med Health 2012;24:121–3.10.1515/ijamh.2012.018Search in Google Scholar

42. National Center for the Prevention of Youth Suicide. Youth suicidal behavior fact sheet. Available at: Accessed on October 3, 2012.Search in Google Scholar

43. World Health Organization. Mental health. Country reports and charts available. Available at: Accessed on June 21, 2012.Search in Google Scholar

44. Sher L. Preventing suicide. Q J Med 2004;97:677–80.10.1093/qjmed/hch106Search in Google Scholar

45. Crosby AE, Cheltenham MP, Sacks JJ. Incidence of suicidal ideation and behavior in the United States, 1994. Suicide Life Threat Behav 1999;29:131–40.Search in Google Scholar

46. Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. Natl Vital Stat Rep 2002;50:1–119.Search in Google Scholar

47. Maris RW. Suicide. Lancet 2002;360:319–26.10.1016/S0140-6736(02)09556-9Search in Google Scholar

48. Sher L, Oquendo MA, Mann JJ. Risk of suicide in mood disorders. Clin Neurosci Res 2001;1:337–44.10.1016/S1566-2772(01)00035-4Search in Google Scholar

49. Sher L. Alcohol use and suicide rates. Med Hypotheses 2005;65:1010–2.10.1016/j.mehy.2005.07.003Search in Google Scholar PubMed

50. Murphy GE. The prediction of suicide: why is it so difficult? Am J Psychother 1984;38:341–9.10.1176/appi.psychotherapy.1984.38.3.341Search in Google Scholar PubMed

Published Online: 2013-07-19
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

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