suicides: dentist vs. air traffic controllers

I know that there is a stereotypical assumption that both dentists and air traffic controllers have high suicide rates. But which one is higher? And is there a profession that is even higher?

The Master Speaks

As does Dex

And the answer is - we don’t really know… Here in the UK, there has been recent concern about the rate of suicide amongst veterinary surgeons.

Grim

Lets assume for a moment that the actual suicide rate was exactly the same for dentists and vets as it was for, say, bakers and candlestick-makers. Unreasonable assumption, but stick with it for a second.

Bakers and candlestick-makers have at their disposal all of the usual means of self-destruction - jumping off a bridge or building, throwing onesself in front of a vehicle, hanging, overdose, exsanguination, etc. At least some of these methods might leave some doubt as to whether the death was suicide or accident.

Dentists and vets have fairly easy access to drugs that are not normally available to bakers and candlestick-makers; given that they are not generally meant to self-administer these drugs, and assuming that they might consider using them (as an extension of the usual choices available to bakers and candlestick-makers) to bring about their own demise, it would seem statistically more likely that the death of a dentist or vet could be ruled non-accidental.

I realise there are a lot of ifs and buts in there, and the argument could be applied to plenty of other groups too; I’d expect, for example, a higher statistical rate of suicide in gun owners (vs non-owners in the same cultural context), simply because, again, suicide by gun seems like it would be more conclusively identified as such than suicide by, say, traffic.

You know, Mangetout, when I first started reading this post I was nodding, yes, yes, but the further I went along, the less certain I was.

Do you believe suicidal overdoses are less likely to be recognized as suicides?
Why?

I autopsy people all the time who have committed suicide by overdose. I also autopsy people who have died accidental deaths due to prescription drug overdose.

The most important deciding factor in the watershed is the amount of drug. People who wish to commit suicide take huge amounts of drug. Or as much as they can get of multiple drugs. They must not be sure how much guarantees death. Or, in the condition of helplessness, hopelessness, and misery which brings on suicide, they feel better about emptying the bottle or knocking back the whole syringe than they do about just taking ten extra.

Accidental overdoses, on the other hand, tend to be normal to high levels of multiple drugs. It’s really easy to tell which is which.

If there are grey-zone cases, we turn to a whole panoply of scene information. Has the person been on anti-depressants? Has he been facing financial, legal, health, or romantic problems? Has he been accustomed to taking these drugs? Has he shown drug-seeking behavior? (first two - suicide; second two - accident) Are the drugs used those given for treatment of depression or pain? (I see many many more suicides on these than on “get high” drugs - though I have seen one suicide on cocaine.) Has he spoken to others about depressive symptoms, sadness, helplessness in the face of problems? Has he said nothing, but has been giving away belongings? Has he left any cryptic answering machine messages or voicemails that make sense in the light of suicide? Has he left a note? (one out of six leaves a note)

Using all these methods, the cases sort themselves into two zones rapidly and usually quite obviously. The number of times that we just aren’t sure if a person is a suicide or an accident, and thus have to put down Undetermined on the death certificate, is a vanishingly small proportion of cases. In my practice, fewer than one a year.

I have had only one suicide by injection in the past three years, incidentally. Wasn’t a dentist or a vet. Was a semi-homeless guy who self-injected with a large quantity of his sister’s insulin while staying overnight at her house.

I really don’t think significant numbers of suicides in dentists or vets are being missed because of use of readily available drugs versus hanging or gunshot wound. What may not be obvious to a normal person at the scene can be very obvious in the world of forensics weeks later, after appropriate testing can be performed.

Not sure what happened there, but my point was that (I think)suicidal overdoses of prescription or otherwise restricted meds would be more likely to be recognised as suicides, and that this could result in a positive skew of the suicide stats for those groups with access to said meds.

Or to put it more bluntly, a person who dies under the wheels of a truck or train may simply have fallen there. A dentist lying in his chair OD’ed on anaesthetics certainly didn’t get there by accident (the overdose might be an accident, but the situation itself can’t be)

Thanks for clarification. Still not clear, though. If the vets and dentists’ overdoses are more likely to be recognized because of the drugs they use, then why would the deaths of all the rest be less likely to be recognized?

The commonest methods of suicide in my American jurisdiction are guns, hanging, overdoses, jumping from high places, and drowning. Why would we be more likely to miss a suicide from these methods?

It’s ma job, man.

Er, no. I separate suicidal deaths from accidental deaths underneath the wheels of trucks and trains all the time. Behavior of the person beforehand is important. Not just observed behavior (although that is highly important), but scene evidence of behavior (fork and knife by the railroad track - tracks rarely used and on irregular schedule because they are for trains requiring repair - autopsy shows glancing blows from train sides - accident in a hobo who was preparing to eat a meal on the train tracks).

If you envision the scene of a person found underneath truck wheels (admittedly easier for me to do - I am familiar with so many of them), then go backwards in your mind in time to see how the person got under them, you will see there is a fairly major difference between “tripped and fell in the road”, and “jumped out to die”. In the case of a truck or car, the driver is almost always a witness. The train conductors know this well. They are the last person a suicide sees. The suicides often wave.

There are also significant autopsy differences. I won’t go into them unless requested, they get technical, and squucky. But the number of “grey zone” cases where we sign them out as Undetermined because we just can’t be sure is really extremely small.

Dunno; it was somewhat conjectural (and I’m quite prepared to abandon it as nonsensical) - I was thinking that there might be such things as suicides that appear to be road traffic accidents, industrial accidents, etc; of course there would be nothing to stop Dentists seeking that kind of demise, but in addition to that, they have the option of restricted med overdose, so the menu of suicide options easily open to the dentist includes one more choice than the menu available to bakers and candlestick makers, and that one extra option is not as readily misinterpretable as some of the options available by default.

By definition though, we don’t know how many suicides are incorrectly classified as accidents - if we knew, they wouldn’t be incorrectly classified.

Indeed true. And the most significant part of your statement.

However, if people were to open up and read the files on the last hundred accidents and suicides and the rare Undetermineds in any medical examiner’s office, they would find that the vast amount of scene information and autopsy information collected, separate the cases into two large fuzzy zones with surprisingly small overlap. The Venn diagram could be drawn as two spheres with a very small lozenge shared between them; a lozenge so small that it is hard to separate from the edges of the circles. If you could do a study nationwide or statewide in the USA, or in Britain, where you took any case that three or six separate auditors found fuzzy, and saw what the numbers of those cases did to the statistics, it is my belief that you would be changing a third or fourth decimal point. There are about 32 000 suicides a year in the USA. That’s a lot of numbers to play with.

I also have to take serious issue with SD Staff Dex’s comment, referenced above: “Let’s start by noting that suicide statistics are questionable at best. Many suicides are classified as “accident” to spare the family from publicity. So the statistics are only a rough indication.”

Dex, cite, please?

If this was ever true, say in the 1940’s, it is not true today. I would lose my license if I attempted to connive at such a thing. Nor would I. Nor would anyone I know in the field - and every one of us has been asked multiple times. We DO NOT call suicides accidents to spare any family. We DO NOT call accidents suicides to spare the insurance companies, either.

Among other things, whenever we call a case accident and there is some insurance owing, the insurance companies ask for a copy of the autopsy report, complete with drug levels, analysis of injuries, and conclusions. I’d love to see the position of a coroner who called a suicide accident to spare the family, when there was a drug level consistent with suicide. Subject of a lawsuit for collusion to commit insurance fraud, complicated by being out of a job. Do people think there is no oversight??

Maybe when general practitioners could call accident on a case – before the wide spread of forensics – but coroners have always been involved. For at least the last forty years anyone who performed this absurd fraud would have been caught at it. With 32,000 suicides a year to provide data, and every suicidal and accidental death in the USA required by law to go through the coroner or medical examiner, I don’t see where this opinion on the large number of fraud cases comes from.

Again I appeal – Dex - cite?

Apologies but I can’t provide a web cite, only an anecdote.

When I was in my second grade of college, one of my classmates suicided by Arsenic. The cause of death is known, the why he took it is known. But apparently one reason he chose Arsenic is that he’d seen in a magazine that it used to be considered a “make you intelligent pill”; he hadn’t been meeting paternal expectations and he chose to take the arsenic in spite of the risk of death and not in order to die. Or so we were told… it took him three days to die, he had time to speak with his family and stuff but of course the other 78 people in the class (his brother was a classmate as well) didn’t go to the ER.

So it was ruled “accidental suicide”. How much was accidental and how much was trying to spare his own family since anyway he’d sustained too much damage to live, I don’t think I’ll know it until I die, if then. My own theory is that there was a lot more of the second, but I’ve got a dirty mind.

Q: Why do dentists have the highest suicide rate?
A: Because they’re always down in the mouth

I’ve been waiting for someone to use this joke in this thread. I’m amazed that Cecil didn’t use it.

Sorry, I’ll leave now.