One is too many: suicidality among general surgery residents

Suicide was the leading cause of death in residency from 2015 to 2021. This study sought to investigate the -prevalence of suicidality as well as individual- and program-level factors associated with suicidality among general surgery residents.

A voluntary, cross-sectional survey was administered in January 2019 immediately after the 2019 American Board of Surgery In-Training Examination to all clinically active residents in ACGME-accredited US general surgery programs. Respondents were asked about demographics, their perceptions of the learning environment, mistreatment experiences, and whether they had considered suicide in the past year. Associations of individual- and program-level characteristics (learning environment and mistreatment domains) with suicidality were assessed.

Of 8,129 clinically active residents, 6,956 (85.6%) from 301 surgical programs responded to at least part of the survey. Of the 6,567 (94.4%) residents who completed the suicidality question, 289 (4.4%) responded affirmatively. Residents were statistically significantly more likely to have suicidal thoughts if they were single (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.06-2.00) or identified as LGBTQ+ (OR 1.67, 95% CI 1.02-2.75). Resident suicidality was also statistically significantly associated with frequent duty hour violations (OR 1.47, 95% CI 1.08-2.02), program emphasis on blame over learning after adverse events (OR 1.57, 95% CI 1.12-2.20), and a lack of meaning in work (e.g., low operative autonomy; OR 1.63, 95% CI 1.15-2.29), as well as mistreatment experiences (sexual harassment: OR 2.18, 95% CI 1.61-2.96; bullying: OR 2.42, 95% CI 1.55-3.79).

Individual factors (that may be non-modifiable), including being single and LGBTQ+ status, as well as modifiable aspects of the learning environment (frequent duty hours violations, program emphasis on blame over learning after adverse events, lack of meaning in work) were found to be associated with suicidality in general surgery residents. Systemic improvement may be possible with interventions and changes at the program level.