Importance: Previous reports regarding comparative suicide incidence among US physicians vs nonphysicians have been inconclusive.Objective: To estimate the national incidence of male and female physician suicide and analyze associated factors, comparing findings to the general population.Design, Setting, and Participants: This retrospective cohort study investigated suicides among physicians and nonphysicians aged 25 years and older in the US from January 2017 to December 2021. The analysis took place from November 2023 to September 2024. National Violent Death Reporting System data from 30 US states and Washington, DC, were used. Decedents with missing age or sex were excluded for incidence, and missing race, ethnicity, or marital status for further analyses.Exposure: Physician occupation.Main Outcome and Measures: Suicide incidence rate ratios (IRRs) and odds ratios (aORs) adjusted by age, sex, race, ethnicity, and marital status were used to compare preceding circumstances, primary method, and substances.Results: A total of 448 physician (354 [79%] male and 94 [21%] female; mean [SD] age, 60 [16] years) and 97 467 general population (76 697 [79%] male and 20 770 [21%] female; mean [SD] age, 51 [17] years) suicides were identified. Female physicians had higher rates of suicide than female nonphysicians in 2017 (IRR, 1.88; 95% CI, 1.19-2.83) and 2019 (IRR, 1.75; 95% CI, 1.09-2.65), with overall higher 2017 to 2021 suicide risk (IRR, 1.53; 95% CI, 1.23-1.87). Male physicians had lower 2017 to 2021 suicide risk than male nonphysicians (IRR, 0.84; 95% CI, 0.75-0.93). Compared to the general population and including all available jurisdiction data, physicians had higher odds of depressed mood (aOR, 1.35; 95% CI, 1.14-1.61; P < .001) as well as mental health (aOR, 1.66; 95% CI, 1.39-1.97; P < .001), job (aOR, 2.66; 95% CI, 2.11-3.35; P < .001), and legal (aOR, 1.40, 95% CI, 1.06-1.84; P = .02) problems preceding suicide as well as use of poisoning (aOR, 1.85; 95% CI, 1.50-2.30; P < .001) and sharp instruments (aOR, 4.58; 95% CI, 3.47-6.06; P < .001). Physicians also had higher odds of positive toxicology for caffeine; poison; cardiovascular agents; benzodiazepines; anxiolytics, nonbenzodiazepines, or hypnotics; and drugs not prescribed for home use.Conclusion and Relevance: These findings show a higher incidence of suicide for US female physicians compared to female nonphysicians. Comprehensive and multimodal suicide prevention strategies remain warranted.

The intensive care unit (ICU) environment is designed for the care of acutely ill patients, with lighting conditions reflecting the needs of the busy clinical setting. Earlier ICU studies suggested that daytime and nighttime light levels were misaligned with those required for circadian rhythm entrainment, which can impact patient sleep-wake cycles and recovery from critical illness. In this investigation in San Diego, California, a coastal US city with over 260 days of sunshine annually, we performed a detailed evaluation of light levels in a contemporary academic medical-surgical ICU constructed in 2016, which features modern lighting and floor-to-ceiling windows in each of the 24 rooms. Using light meters mounted on poles and located directly behind the head of each patient's bed, our analysis of nearly 90,000 hours of data revealed daytime ICU light levels consistently lower than 150 lx, similar to studies in older ICUs and many magnitudes lower than outdoor levels at identical times. Hence, despite the modern design, we found that little to no light from the ~100 ft² windows reached the patient. While daytime light levels were low across all ICU rooms, those with windows facing South and Northwest featured higher light levels than those facing Southeast and Northeast, suggesting a contribution of window direction to ICU light levels.

Background/Objectives: Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. Methods: Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.g., benzodiazepine avoidance). Subsequent engagement by health system leadership motivated the development of an electronic health record dataset to evaluate unit-level outcomes, including CAM-ICU documentation and benzodiazepine administration. Results: Using a dataset that spanned 9 pre- and 37 post-project months and included 3612 patients, 4470 admissions, and 33,913 patient days, we observed that delirium education was followed by a dramatic rise in CAM-ICU documentation, from <1% for daytime and nighttime shifts to peaks of 73% and 71%, respectively (p < 0.0001 for trend), and a fall in the proportion of mechanically ventilated patients ever receiving benzodiazepine infusions (69% to 41%; p < 0.0001). Conclusions: An interdisciplinary delirium project comprising rigorous lectures on standard-of-care practices can yield significant improvements in documentation and sedative administration. This approach can help ICUs jumpstart efforts to build awareness and address longstanding gaps in standard-of-care delirium practices.

Purpose: Pharmacists and pharmacy technicians are essential healthcare professionals with limited data on their risk for suicide. Methods: Using the National Violent Death Reporting System, pharmacist, pharmacy technician, and general population suicides (for individuals 25 years of age or older) were identified. Suicide incidence was estimated from 2011 to 2022 due to data limitations, while suicide characteristics (preceding circumstances, method, and toxicology) were analyzed in adjusted Firth logistic regression models from 2005 to 2022. Results: A total of 369 pharmacist (87 [24%] female), 243 pharmacy technician (149 [61%] female), and 245,114 general population (52,890 [22%] female) suicides were found for the period from 2011 to 2022. When data were standardized by sex, pharmacists had a higher risk of suicide (incidence rate ratio [IRR], 1.21; 95% confidence interval [CI], 1.09-1.34) while pharmacy technicians had a lower risk (IRR, 0.86; 95% CI, 0.74-0.99) than individuals in the general population during the 2011-2022 study period. Male pharmacists had a higher risk of suicide than other males (IRR, 1.25; 95% CI, 1.11-1.41) while female technicians had a higher risk than other females (IRR, 1.22; 95% CI, 1.04-1.44) during the 2011-2022 study period. In terms of the features associated with suicide, compared to the general population, pharmacists had higher odds of preceding job problems, while pharmacy technicians had higher odds of mental health problems. Pharmacists also had higher odds of using poisoning as a method. Conclusion: Our findings suggest that pharmacists and female pharmacy technicians are at higher risk of suicide than their counterparts from the general population, possibly indicating that increased awareness and prevention are warranted.