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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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Mental Health in the Construction Industry: a Rapid Review
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“Research (Meltzer et al. 2008; Milner et al. 2013) is consistent in showing that male construction workers have a higher rate of suicide when compared to”
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“A recent meta-analysis found that the risk of suicide was higher among lower skilled occupations.(23) Among the relatively few studies examining differences in liver cirrhosis mortality by occupation, a higher rate was reported among blue collar jobs and in jobs with easy access to alcohol.”
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“Another possible 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.(31) A third explanation is that there is less access to care in rural areas, and this lack of access may be more detrimental to males in rura…”
BackgroundAssociation of workplace bullying and burnout with nurses’ suicidal ideation in Bangladesh
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“The methods used for the meta-analysis have been published previously (Milner et al. 2013) but are briefly summarized below.”
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Self-citationA Descriptive Study of Police Officer Access to Mental Health Services
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“Psychologically, officers have relatively high rates of depression and suicidal ideation, as well as high rates of suicide itself (Milner et al. 2013; Violanti et al. 2016).”
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“…studies showed consistently that both physicians (Dutheil et al., 2019) and nurses (Davis et al., 2021) are at high risk for suicide compared to other employed people (Milner et al., 2013), in part related to high access to lethal means and low willingness to seek help (Harvey et al., 2021).”
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“Second, the majority of clients from identified occupations include labourers and operators, consistent with previous evidence of an elevated suicide risk within these occupational groups [3,4].”
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Castelpietra, G., Balestrieri, M., & Bovenzi, M. (2019) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2019.1611864 · Cited by 12
Canu, I. G., Bovio, N., Wild, P. P., Bopp, M., & (SNC), F. T. S. N. C. (2021) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12746 · Cited by 12
Prevalence of work-related common psychiatric disorders in primary care: The French Héraclès study
Rivière, M., Plancke, L., Leroyer, A., Blanchon, T., Prazuck, T., Prouvost, H., Sobczak, B., Pauw, C. D., Carreira, L. F., Toullic, Y., et al. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.008 · Cited by 11
“psychiatric disorders, contrary to previous studies (Cohidon et al., 2009; Cohidon et al., 2010; Milner et al., 2013).”
ResultSuicide attempts and deaths in older persons in Ghana: A media surveillance approach
Quarshie, E. N., Asante, K. O., Andoh–Arthur, J., Asare‐Doku, W., & Navelle, P. L. (2018) · Current Psychology · doi:10.1007/s12144-018-9932-5 · Cited by 11
Stigma and help-seeking behaviours of men with depression: a literature review
Covello, K. (2020) · Mental Health Practice · doi:10.7748/mhp.2020.e1474 · Cited by 11
Do tenants suffer from status syndrome? Homeownership, norms, and suicide in Belgium
Damiens, J., & Schnor, C. (2022) · Demographic Research · doi:10.4054/demres.2022.46.16 · Cited by 11
“…and women to a lesser extent, are at a significantly higher risk of suicide when they are unemployed (Artazcoz et al. 2004) or have lower education, and this is partly mediated by working conditions (Blakely, Collings, and Atkinson 2003) and employment status (Milner et al. 2013; Min et al. 2015).”
BackgroundDepressive symptoms and suicide attempts among farmers exposed to pesticides
Zheng, R., Rey, R. R.-D., Ruiz-Moreno, F., García‐González, J., Requena, M., Navarro-Mena, A. Á., López-Villén, A., & Alarcón, R. (2024) · Environmental Toxicology and Pharmacology · doi:10.1016/j.etap.2024.104461 · Cited by 10
Baker, C. N., Strong, R., McCord, C., & Redwine, T. (2022) · Advancements in Agricultural Development · doi:10.37433/aad.v3i1.179 · Cited by 11
Tyler, S., Gunn, K. M., Clifford, B., & Procter, N. G. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1144314 · Cited by 13
Epidemiology of coronial deaths from pesticide ingestion in Australia
Osborne, N. J., Cairns, R. F., Dawson, A. H., Chitty, K. M., & Buckley, N. A. (2017) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2017.01.009 · Cited by 10
Opinion paper: poor response to treatment of depression in people in high occupational levels
Mandelli, L., Serretti, A., Porcelli, S., Souery, D., Mendlewicz, J., Kasper, S. F., Montgomery, S., & Zohar, J. (2018) · Psychological Medicine · doi:10.1017/s003329171800288x · Cited by 10
“According to a systematic review of the literature, although suicidal risk is higher in low occupational levels, middle–high skilled occupations have a substantially higher risk of suicide compared with the entire working-age population (rate ratio = 0.9–1.2) (Milner et al., 2013).”
BackgroundInfluentialSuicide deaths by occupation skill level and educational attainment in the United States
Messias, E., Azasu, E., Nayeem, N., Lin, P., & Grucza, R. A. (2024) · Journal of Occupational Health · doi:10.1093/joccuh/uiae078 · Cited by 9
“1,23 However, more research is needed to fully understand these complex relationships among Hispanic people.”
Suicide at sea: navigating in restricted visibility
Baumler, R., & Carrera-Arce, M. (2025) · MAST. Maritime studies/Maritime studies · doi:10.1007/s40152-025-00422-3 · Cited by 9
“…seafarers have higher suicide rates than those in other occupations and the general population (Lefkowitz and Slade 2019; Mellbye and Carter 2017; Milner et al. 2013; Roberts et al. 2013, 2014; Samp-son and Ellis 2019; Wickstrom and Leivonniemi 1985), which has been confirmed by a recent…”
Effective Elements for Workplace Responses to Critical Incidents and Suicide: A Rapid Review
Pearce, T., Bugeja, L. C., Wayland, S., & Maple, M. J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094821 · Cited by 9
“industries employing unskilled male workers compared to males occupying highly skilled non-manual positions [7].”
BackgroundTorok, M. H., Shand, F., Phillips, M., Meteoro, N., Martin, D., & Larsen, M. E. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01716-8 · Cited by 9
Long-Term Effects of a Comprehensive Police Suicide Prevention Program
Mishara, B. L., & Fortin, L.-F. (2021) · Crisis · doi:10.1027/0227-5910/a000774 · Cited by 10
“Milner et al. (2013, 2017) reported that suicide rates in protective and emergency service employees, which include police, defense forces, and ambulance and fire services, are significantly higher than corresponding rates in members of the general working population.”
ResultTrauma and critical incident exposure in law enforcement
Jørgensen, L. K., & Elklit, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-816544-7.00005-x · Cited by 8
Dying at work. Work-related suicide – how does the UK regulatory context measure up?
Waters, S., & Palmer, H. (2022) · Journal of Public Mental Health · doi:10.1108/jpmh-09-2021-0114 · Cited by 8
Antoniou, M., Estival, D., Lam‐Cassettari, C., Li, W., Dwyer, A., & Neto, A. D. A. (2022) · JMIR Formative Research · doi:10.2196/33036 · Cited by 17
“In particular, farmers are more likely to commit suicide than other occupations [4-6].”
BackgroundBulliard, J., Bovio, N., Arveux, P., Bergeron, Y., Chioléro, A., Fournier, E., Germann, S., Konzelmann, I., Maspoli, M., Rapiti, E., et al. (2022) · Cancers · doi:10.3390/cancers14153713 · Cited by 8
“[20], and based on the one-digit ISCO-88 codes.”
MethodRoy, N., Paul, K. D., Tamanna, S. S., Paul, A. K., ALmerab, M. M., & Mamun, M. A. (2024) · PLoS ONE · doi:10.1371/journal.pone.0307895 · Cited by 8
Long-term occupational trajectories and suicide: a 22-year follow-up of the GAZEL cohort study
Silva, M. A. D., Younès, N., Leroyer, A., Plancke, L., Lemogne, C., Goldberg, M., Rivière, M., & Melchior, M. (2018) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3767 · Cited by 8
“there is an occupational gradient in relation to suicide, whereby individuals in less qualified occupations are more likely to commit suicide than those who are at the top of the hierarchy (5).”
Suicidal Behaviors in the Ghana Police Service
Quarshie, E. N., Odame, S. K., & Annor, F. (2020) · Crisis · doi:10.1027/0227-5910/a000707 · Cited by 8
Baker, C. N., Strong, R., McCord, C., & Redwine, T. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912110 · Cited by 8
“As a result, recent studies have examined rates of self-harm and suicide within the agricultural industry—many of which note that laborers, specifically farmers are at greater risk of suicide [1,2].”
ResultKlingelschmidt, J., Chastang, J., Khireddine-Medouni, I., Chérié-Challine, L., & Niedhammer, I. (2019) · Revue d Épidémiologie et de Santé Publique · doi:10.1016/j.respe.2019.09.008 · Cited by 9
Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway
Letnes, J. M., Torske, M. O., Hilt, B., Bjørngaard, J. H., & Krokstad, S. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010783 · Cited by 7
Itua, I., Shah, K., Galway, P., Chaudhry, F., Georgiadi, T., Rastogi, J., Naleer, S., & Knipe, D. W. (2024) · Archives of Suicide Research · doi:10.1080/13811118.2024.2322144 · Cited by 8
Suicide among transport industry workers: A systematic review and meta-analysis
Mathieu, S. L., Ross, V. L., Wardhani, R., Brough, P. A., Wishart, D. E., Chan, X. W., & Kõlves, K. (2022) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.4059 · Cited by 7
“commercial pilots obtain higher occupational skill levels compared to a ship’s deck crew, and previous research has shown that those working in professions with lower skill levels (including maritime and transit/driving professions) have a higher risk of suicide (21).”
BackgroundMethodResultInfluential
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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