Importance Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

Objective To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

Data Sources This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term “(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors))).” Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

Study Selection Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

Data Extraction and Synthesis The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I², and τ². For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

Main Outcomes and Measures Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

Results Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, −0.84 [95% CI, −1.26 to −0.42]; P < .001; female physicians: SMR, −1.96 [95% CI, −3.09 to −0.84]; P = .002). No evidence of publication bias was found.

Conclusions and Relevance In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

重要性 基于人群的医师自杀调查结果具有重大意义，因为这是一个重要且未被充分研究的主题。

目的 通过荟萃分析，模型研究和强调医师的系统评价，评估与1980年至今的男性和女性医师相比于一般人群的自杀风险，并测试1980年之后与1980年前相比队列中的SMR是否降低。自杀的危险因素。

数据来源 本研究使用从PubMed，Scielo，PsycINFO和Lilacs检索的研究，这些研究于2019年10月3日发布，用于人类研究，搜索词为（（（自杀）OR（自残）OR（自杀））AND（（医师或医生）。” 还从选择进行审查的文章中列出的国家/地区搜索数据库。其他作者也从现有文章中提取了数据，以便于比较1980年前的自杀率和1980以后的自杀率。

研究选择 包括评估男性和/或女性医师自杀的原创文章；对于荟萃分析，仅包括1980年至今的队列。

数据提取和综合 预先注册的系统评价和荟萃分析遵循Cochrane，PRISMA和MOOSE指南。根据预先指定的结构化检查表，将数据提取到标准化表中，并添加质量得分。异质性通过测试Q测试，余²，和τ ²。对于汇总效应估计，我们使用了随机效应模型。进行了Begg和Egger测试，敏感性分析和Meta回归。当无法提取SMR数据时，将显示比例死亡率。

主要结果和措施 从1980年至今，男性和女性医生的自杀SMR随时间而变化（1980年前和之后）。

结果 在7877个搜索结果中，有32篇文章被纳入系统评价，9篇文章和数据集进入荟萃分析。荟萃分析显示，女性医师的自杀SMR显着高于女性（1.46 [95％CI，1.02-1.91]），男性医师的自杀SMR显着低于男性（0.67 [95％CI，95％CI， 0.55-0.79]。1980年之后的男性和女性医师SMR与1980年前相比显着下降（男性医师：SMR，-0.84 [95％CI，-1.26至-0.42]; P  <.001;女性医师：SMR，-1.96 [95％CI，- 3.09至-0.84]；P  = .002）。没有发现出版偏见的证据。

结论与相关性 在这项研究中，自1980年以来，发现自杀性SMR在女性医师中较高，而在男性医师中较低，但随着时间的推移，两组的自杀性SMR均降低。医师自杀是多因素的，因此对这些因素的进一步研究至关重要。