title: Suicide among physicians in the state of São Paulo, Brazil, across one decade.
abstract: OBJECTIVE
  To describe mortality by suicide among physicians in the state of São Paulo, Brazil, between 2000 and 2009.
  
  
  METHODS
  Secondary analysis of government mortality data. The variable of interest was "underlying cause of death", specifically deaths classified by the ICD-10 as intentional self-harm (X60 to X84).
  
  
  RESULTS
  The analyses examined 2,297 declarations of death, among which suicide accounted for 50 cases, i.e., 1.7% of all causes of death. Women comprised 13.2% of the total sample and represented 24% of the death-by-suicide group, indicating an overrepresentation of women in the latter (p = 0.02). Deaths by suicide occurred on average 20 years earlier than deaths by other causes (46.8 ± 14.2 years and 68.1 ± 15.8 years, respectively; p = 0.001). There was a significant association between single and/or divorced status and suicide (p < 0.001). The average mortality rate during the study period was 4.2 deaths per 100,000 physicians registered with the Regional Board of Medicine of the State of São Paulo.
  
  
  CONCLUSIONS
  Deaths by suicide occurred 20 years earlier than deaths by other causes. Medical institutions should develop strategies for the prevention and early detection of mental disorders and occupational stressors that elevate the risk of suicide among physicians.
authors.affiliation: Alcohol and Drugs Research Unit (UNIAD), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Hamer N
authors.initials: HN
authors.lastname: Palhares-Alves
authors.affiliation: Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Palhares
authors.affiliation: Alcohol and Drugs Research Unit (UNIAD), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ronaldo
authors.initials: R
authors.lastname: Laranjeira
authors.affiliation: Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Nogueira-Martins
authors.affiliation: Department of Preventive Medicine, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Zila M
authors.initials: ZM
authors.lastname: Sanchez
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D000092864:Suicide Prevention