CARERC Pilot: Characteristics of Nurse Suicide Deaths in Kentucky, 2005 - 2019

Central Appalachian Education and Resource Center Pilot Grant Abstract PROJECT TITLE Characteristics of Nurse Suicide Deaths in Kentucky, 2005 – 2019. BACKGROUND Nurses consistently report occupational stress in the form of shift work, low decision-making control, psychologically demanding work environments related to high acuity patients, and disproportionate nurse-to-patient ratios. 4, 11, 19 Consequently, studies show elevated occupational stress can combine with cultural stigma about help-seeking behaviors that contribute to increased alcohol and substance misuse among nurses. 4, 11, 19 Research shows the prevalence of alcohol and substance misuse among nurses is 10 -20% higher than the general population.4, 5, 10, 11, 13, 19 In general, nurses are more likely to experience depression, anxiety, and take anti-depressive medication, which can exacerbate self-directed violence behavior when combined with alcohol and substance misuse.7, 17, 20 The culmination of exposures and comorbid conditions places nurses at greater risk for suicide than other healthcare professions. A longitudinal study of nurses using NVDRS data documented a greater risk of suicide for female nurses (IRR=1.395) than male nurses (IRR-1.205).20 Female nurses were more likely to use medications as the mechanism of death while males used firearms.20 Both sexes showed higher odds of suicide in the presence of a job problem and mental health challenges; however, females experience nearly two-fold odds of suicide in the presence of a job problem.20 Research demonstrates the need to address suicide risk factors among nurses; however, the corpus of research on suicide and its predictors is based on national samples and surveillance data. To date, few state-based studies exist regarding contextual characteristics of nurse suicide. Given the policy, licensure requirements, and nurse workforce differences across states, it is imperative to conduct state-based suicide studies to determine contextual characteristics of nurse suicide. In states like Kentucky, efforts are underway to address nurse suicide; however, little is known about the prevalence of nurse suicide and the characteristics of decedents in Kentucky. Therefore, this study aims to determine the total number of nurse suicide decedents in Kentucky, investigate contextual characteristics of nurse suicide decedents, and calculate nurse suicide rates. Proposed Analytic Strategy Aim 1: The outcome of interest for aim 1 is to determine and evaluate differences in demographic and contextual characteristics of suicide mortality among Kentucky nurse suicide decedents. Occupation will be determined using the Census 2021_occupation coding in addition to scanning the industry, occupation, and investigator free text fields using a glossary of nursing occupation terms to produce a summary file specific to nurse decedent occupations. An expert interrater panel of study collaborators with data access will review the summary file to codes decedents as a nurse or non-nurse. We will categorize decedent occupation as a nurse, excluding non-nurse occupations from our study group. Descriptive statistics will be used to evaluate demographic and contextual characteristics of male and female nurse suicide decedents. Cells with fewer than five decedents will be suppressed. We will employ a qualitative content analysis of incident narratives from law enforcement and coroner/medical examiner reports to identify life events or stressors that may have contributed to the nurse''s suicide death.32, 33 The narratives in the KVDRS law enforcement and coroner/medical examiner fields contain information about processes, patterns, and psychosocial dynamics, which are relevant to each suicide event that is not well-captured in KVDRS quantitative variables.32, 33 Content analysis will occur using coding structures and Central Appalachian Education and Resource Center Pilot Grant Abstract incident narrative coding methods initially developed by Holland et al. and employed by Brown and Seals for the KVDRS.33 Aim 2: The primary outcome of aim 2 is to determine sex-specific Nurse suicide rates from 2005-2019. We will obtain the rate numerator from aim 1, and the rate denominator will be obtained using license data from the Kentucky Board of Nursing (KBN) licensure registry (2005- 2019). The numerator and denominator will be aggregated over time to prevent small (<20) cell sizes and obtain stable rates estimates. SIGNIFICANCE/PUBLIC HEALTH BENEFITS Prior nurse suicide research using violent death data explored contextual characteristics, assessed associations between quantitative characteristics and suicide deaths for nurses as well as compared quantitative differences between nurses, non-nurse occupations, and the general population.12, 20, 34 However, few studies assess demographic and contextual factors by state and usually focus on estimating rates and decedent characteristics by major occupational category.4, 10-12 We propose to evaluate demographic and contextual characteristics and assess qualitative differences across Kentucky nurse suicide decedents. Further, we plan to estimate a state-based nurse suicide rate to understand the burden of nurse suicide mortality among Kentucky nurses. Using results from this study, nurse leaders in Kentucky can collaborate and advocate for tailored nurse suicide prevention efforts via established partnerships with the Kentucky Board of Nursing, Kentucky Hospital Association, Kentucky Healthcare Systems, and state nursing schools to address nurse-specific suicide factors identified in this study. Further, the results from this study will be used to direct suicide prevention efforts currently underway with the Kentucky Nurses Association and Kentucky Nurses Action Coalition.35 Central Appalachian Education and Resource Center Pilot Grant Abstract References 1. Davis MA, Cher BAY, Friese CR, Bynum JPW. Association of US Nurse and Physician Occupation With Risk of Suicide. JAMA psychiatry (Chicago, Ill). 2021;78(6):651-658. doi:10.1001/jamapsychiatry.2021.0154 2. Bourbonnais R, Comeau M, Vézina M. Job Strain and Evolution of Mental Health Among Nurses. Journal of Occupational Health Psychology. 1999;4(2):95-107. doi:10.1037/1076-8998.4.2.95 3. Monroe BT, Kenaga SH, Dietrich AM, Carter LM, Cowan LR. The Prevalence of Employed Nurses Identified or Enrolled in Substance Use Monitoring Programs. Nursing Research. 2013;62(1):10-15. doi:10.1097/NNR.0b013e31826ba3ca 4. Trinkoff A, Storr C. Substance use among nurses: Differences between specialties. American Journal of Public Health. 1998;88(4):581-585. doi:10.2105/AJPH.88.4.581 5. Trinkoff MA, Eaton WW, Anthony CJ. The Prevalence of Substance Abuse Among Registered Nurses. Nursing Research. 1991;40(3):172-174. doi:10.1097/00006199- 199105000-00011 6. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Annals of internal medicine. 2010;152(2):85. doi:10.7326/0003-4819-152-2-201001190-00006 7. Bennett J, O''Donovan D. Substance misuse by doctors, nurses and other healthcare workers. Current Opinion in Psychiatry. 2001;14(3):195-199. 8. Blegen AM, Spector RN, Lynn TM, Barnsteiner TJ, Ulrich TB. Newly Licensed RN Retention: Hospital and Nurse Characteristics. JONA: The Journal of Nursing Administration. 2017;47(10):508-514. doi:10.1097/NNA.0000000000000523 9. Davidson JE, Proudfoot J, Lee K, Terterian G, Zisook S. A Longitudinal Analysis of Nurse Suicide in the United States (2005–2016) With Recommendations for Action. Worldviews on evidence-based nursing. 2020;17(1):6-15. doi:10.1111/wvn.12419 10. Dunn D. Substance abuse among nurses—Defining the issue. AORN journal. 2005;82(4):572,577,585,592-575,582,588,596. doi:10.1016/S0001-2092(06)60028-8 11. Epstein PM, Burns C, Conlon HA. Substance abuse among registered nurses. American Association of Occupational Health Nurses. 2010;58(12):513-516. doi:10.3928/08910162-20101116-03 12. Feskanich D, Hastrup JL, Marshall J, et al. Stress and suicide in the Nurses'' health study. Journal of Epidemiology & Community Health. 2002;56(2):95-98. 13. Ivey M. Substance Abuse Among Nurses. Kentucky nurse. 2015;63(4):8. 14. Roberts RK, Grubb PL. The Consequences of Nursing Stress and Need for Integrated Solutions. Rehabilitation Nursing. 2014;39(2):62-69. doi:10.1002/rnj.97 15. Snow D, Hughes T. Prevalence of Alcohol and Other Drug Use and Abuse Among Nurses. Journal of Addictions Nursing, 2003, Vol14(3), p165-167. 2003;14(3):165-167. doi:10.1080/jan.14.3.165.167 16. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, et al. Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study. Journal of intensive care medicine. 2017:885066617696853. doi:10.1177/0885066617696853 17. Huang CL-C, Wu M-P, Ho C-H, Wang J-J. Risks of treated anxiety, depression, and insomnia among nurses: A nationwide longitudinal cohort study. PloS one. 2018;13(9):e0204224-e0204224. doi:10.1371/journal.pone.0204224 18. Letvak S, Ruhm CJ, McCoy T. Depression in Hospital-Employed Nurses. Clinical nurse specialist. 2012;26(3):177-182. doi:10.1097/NUR.0b013e3182503ef0 19. Talbert JJ. Substance abuse among nurses. Clinical journal of oncology nursing. 2009;13(1):17. doi:10.1188/09.CJON.17-19 Central Appalachian Education and Resource Center Pilot Grant Abstract 20. Thun E, Bjorvatn B, Torsheim T, Moen BE, Magerøy N, Pallesen S. Night work and symptoms of anxiety and depression among nurses: A longitudinal study. Work & Stress. 2014;28(4):376-386. doi:10.1080/02678373.2014.969362