Leo Sher, M.D.

My research article, “Are suicide rates related to the psychiatrist density? A cross-national study” was published 5 years ago, in January 2016, in Frontiers in Public Health (1).

Treatment of psychiatric disorders should reduce the number of suicides. Higher psychiatrist-per-­population ratio increases the opportunity for contact between the patient and psychiatrist. Generally, an increase in the physician density tends to lead to physician-induced demand. People living in countries with greater psychiatrist density had a higher probability of seeing a psychiatrist. It is reasonable to hypothesize that the higher psychiatrist density is associated with lower suicide rates. To test this hypothesis, I performed an ecological cross-sectional study. The aim of this study is to examine the association between suicide rates and the psychiatrist density in the European Union countries (Austria. Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and United Kingdom). These countries are economically and culturally connected and located on the same continent. This is an attempt to study a relatively homogenous sample.

Correlations were computed to examine relationships between age-­standardized suicide rates in women and men, the psychiatrist density, and the gross national income per capita. Partial correlations were used to examine the relation between the psychiatrist density and age-standardized suicide rates in women and men controlling for the gross national income per capita.

Higher suicide rates in women correlated with the higher psychiatrist density. Controlling for the gross national income per capita, the psychiatrist density positively correlated with suicide rates both in women and in men. There was a trend toward a negative correlation between the gross national income per capita and suicide rates in men. The psychiatrist density was positively associated with the gross national income per capita.

This study suggests that higher suicide rates are associated with higher number of psychiatrists working in mental health per 100,000 people. Probably, higher suicide rates directly and/or indirectly affect the decisions made by policy- and lawmakers regarding mental health services and how many psychiatrists need to be trained. The results of this study should be treated with caution because many confounding variables are not taken into account.

Reference

1. Sher L. Are suicide rates related to the psychiatrist density? A cross-national study. Front Public Health. 2016 Jan 6;3:280. doi: 10.3389/fpubh.2015.00280.