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Suicide by occupation: Systematic review and meta-analysis
Open accessAbstract
Background: Previous research has shown that those employed in certain occupations, such as doctors and farmers, have an elevated risk of suicide, yet little research has sought to synthesise these findings across working-age populations. Aims: To summarise published research in this area through systematic review and meta-analysis. Method: Random effects meta-analyses were used to calculate a pooled risk of suicide across occupational skill-level groups. Results: Thirty-four studies were included in the meta-analysis. Elementary professions (e.g. labourers and cleaners) were at elevated risk compared with the working-age population (rate ratio (RR) = 1.84, 95% CI 1.46–2.33), followed by machine operators and deck crew (RR = 1.78, 95% CI 1.22–2.60) and agricultural workers (RR = 1.64, 95% CI 1.19–2.28). Results suggested a stepwise gradient in risk, with the lowest skilled occupations being at greater risk of suicide than the highest skill-level group. Conclusions: This is the first comprehensive meta-analytical review of suicide and occupation. There is a need for future studies to investigate explanations for the observed skill-level differences, particularly in people employed in lower skill-level groups. Declaration on interest: None.
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“People in unskilled professions have an increased risk of suicide, which is partly explained by greater psychosocial stress; however, people in professions with access to lethal means for suicide have high rates, such as farmers, nurses, veterinarians, physicians, and police.29”
From Suicide (2020) · cites this paper as [29]
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“A past meta-analysis of international studies published over the period 1979 to 2012 indicated that suicide rates among lower skilled workers in construction were 80% higher than the general working age population [3].”
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Reducing Suicide Risk: Challenges and Opportunities in the Emergency Department
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“Another potential explanation is that males in rural areas are likely to be employed in occupations such as farming or forestry, which are associated with higher risk of suicide.(24) Further research examining both suicide and suicide attempts by sex could help clarify this relationship.”
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Perceval, M., Ross, V. L., Kõlves, K., Reddy, P., & Leo, D. D. (2018) · BMC Public Health · doi:10.1186/s12889-018-6287-7 · Cited by 60
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“People employed in blue collar employment categories are at a significantly higher risk of suicide than the general working age population, with men in these low skilled roles most at risk.(12,13) Research by Cohidon et al, 14 suggests that depressive symptoms experienced by individuals employed in lower skilled jobs…”
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“Parenthetically, unskilled workers and others at the lower end of the pay scale are also more vulnerable to suicide (Milner et al. 2013).”
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“In particular, research suggests that those in the highest occupational skill level group have lower rates of suicide, while those employed in the lowest skill level such as labourers, cleaners, or plant operators have higher rates of suicide [7].”
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“…local level have accountability for addressing these cultural changes as a matter of priority, not only because healthcare workers are already overrepresented in suicide statistics (Milner et al., 2013; Tramutola, 2015), but also because, as has been outlined, this is a vital patient safety issue.”
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Brigance, C., Más, F. S., Sánchez, V., & Handal, A. J. (2018) · Workplace Health & Safety · doi:10.1177/2165079918783211 · Cited by 54
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“org/publicdomain/ze inequalities in rates [8, 9].”
Self-citationDomains of Psychosocial Risk Factors Affecting Young Construction Workers: A Systematic Review
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Dalglish, S. L., Melchior, M., Younès, N., & Surkan, P. J. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0969-y · Cited by 53
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“There is growing evidence from around the world that males working in the construction sector are in one of the highest occupational risk groups for suicide [1,2].”
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“Similar results were found by a systematic review and meta-analysis for the association between suicide and occupation [39].”
ResultFactors Associated with Suicidal Behavior in Farmers: A Systematic Review
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Suicidal ideation and related factors in construction industry apprentices
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Self-citationFarm suicides in New Zealand, 2007–2015: A review of coroners’ records
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“…are consistent with the fact that there are more labourers than owners or managers on farms, they also reflect the fact that, as with most occupations, those with fewest skills, and least education, are at higher risk of suicide than those with superior skills and education (Milner et al., 2013).”
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“…illegitimate tasks, role conflict, role ambiguity) have been related to mental health outcomes (e.g., Choi, 2018; Demerouti et al., 2001; Milner et al., 2013, 2018; Niedhammer et al., 2021; Yarker et al., 2022), including elevated risk of death by suicide and suicidal behaviors (e.g.,…”
Working-Class Men’s Constructions of Help-Seeking When Feeling Depressed or Sad
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A Longitudinal Assessment of Two Suicide Prevention Training Programs for the Construction Industry
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García, C. I., Sáiz, P. A., Burón, P., Lasheras, F. S., Jiménez-Treviño, L., Fernández‐Artamendi, S., Al‐Halabí, S., Corcoran, P. E., García‐Portilla, M. P., & Bobes, J. (2017) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2016.04.005 · Cited by 47
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“Men are known to be at higher risk [2], as are those employed in certain occupations [3].”
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“Second, despite the comprehensive inclusion criteria and adjustment for a long list of covariates, we cannot completely rule out the possibility of residual confounding by unmeasured covariates, such as BMI (50) and socioeconomic status (51, 52).”
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“…and behaviors) among U.S. adults, recent policy statements have advocated specifically for the examination of at-risk subgroups (US Department of Health and Human Services, 2012), including high-risk occupational groups (McIntosh et al., 2016; Milner et al., 2015, 2013; Tiesman et al., 2015).”
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“Farmers are at an increased risk of suicide compared with other occupations in rural and remote communities [8-10].”
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“The socio-economic barriers to seeking care is of particular interest to men’s use of EAP services because workers in the lower skilled occupations (blue-collar workers), who are most likely to have limited social and economic resources and access to health care, have also been found to be at greater risk of suicide t…”
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“This is a limitation because previous research suggests that both the risk of workplace bullying ( 29 ) and the risk of suicide might differ according to occupation ( 30).”
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“A similar pattern has been observed with regard to suicide risk (52).”
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“Elementary workers had the highest suicide risk, which reflects the general finding of a gradient with the lowest skilled occupations experiencing a higher risk than highly skilled workers (3).”
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“Considering that occupational and employment status affects the risk of suicide and that socioeconomic level is a factor affecting death (Milner et al., 2013), LDE for people with lower-skill jobs may serve to reduce their suicide risk.”
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“perspective, employed males in lower skilled occupations are particularly exposed to poor working conditions(16) and have the highest rates of suicide.(17) These males are therefore likely to be particularly at risk.”
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“females are more likely to be nurses, while men are more likely to be employed in construction), but also in the fact that suicide rates vary in different occupations, with male-dominated occupations tending to have higher rates of suicide than female-dominated occupations (Milner et al., 2013).”
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“A previous meta-analysis found that less-skilled occupations have a higher risk of suicide when compared to more highly skilled occupations, such as managerial work, which shows the lowest risk of suicide (Milner et al., 2013).”
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“The lowest skilled groups may be at most risk, especially during the job uncertainty of recession [26].”
Background
Metadata
- Authors
- Milner, A., Spittal, M. J., Pirkis, J., & LaMontagne, A. D.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Milner, Allison
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-12
- Volume
- 203
- Issue
- 6
- Pages
- 409-416
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2159544002
- Cited by
- 387
- References
- 75
- Citations by year
- 2026: 22 · 2025: 41 · 2024: 42 · 2023: 31 · 2022: 46 · 2021: 39 · 2020: 26 · 2019: 39 · 2018: 29 · 2017: 23 · 2016: 18 · 2015: 20 · 2014: 9 · 2013: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (546248)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide, occupational risk, occupational skill level, low-skilled workers, agricultural labor, machine operators, labourers, working-age population
- MeSH terms
- Employment, Humans, Occupations, Regression Analysis, Risk Factors, Social Class, Suicide, Odds Ratio, Sex Distribution
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