Abstract
Background: Health care professionals face elevated suicide risk, yet longitudinal studies during occupational crises are lacking. We investigated factors associated with suicide attempts and psychiatric hospitalizations in health care workers seeking emotional support during COVID-19.
Methods: We prospectively evaluated 3,087 Brazilian health care professionals enrolled in a digital mental health trial (May–July 2020). Participants were recruited nationwide from May 2020 to December 2021. From this cohort, 2,815 with complete baseline data comprised the intention-to-treat (ITT) sample. Outcomes were assessed at 4, 12, and 24 weeks. Baseline predictors included demographics, Patient Health Questionnaire-9 item 9 (suicidal ideation), Patient-Reported Outcomes Measurement Information System T-scores (depression, anxiety, irritability, sleep), life satisfaction, and burnout. Cox models examined associations; inverse probability weighting addressed attrition. Additive interaction was quantified using relative excess risk due to interaction (RERI).
Results: In the total sample, 53 participants (1.59%) attempted suicide. In the ITT sample (86% female, mean age 36.5), 46 (1.63%) attempted suicide (64 events), and 60 (2.22%) required psychiatric hospitalization. Nearly every day ideation (hazard ratio [HR]=39.58, 95% CI, 14.03–111.64, P<.001), severe sleep disturbances (HR=17.39, 95% CI, 2.05–147.46, P=.009), and male sex (HR=2.08, 95% CI, 1.01–4.26, P=.046) independently predicted attempts. The 24-week attempt probability reached 57.1% for individuals with both ideation and sleep problems versus 1.2% with neither, with 40% of the combined risk attributable to synergistic interaction (RERI=11.51). Notably, 28.3% of attempts occurred among individuals denying baseline ideation. For hospitalizations, only nearly every day ideation remained significant (HR=8.11, 95% CI, 3.10–21.18, P<.001). Results remained robust after weighting.
Conclusions: Daily suicidal ideation and severe sleep disturbances synergistically elevate suicide risk among health care professionals. Findings support a comprehensive assessment incorporating sleep disturbances and multicomponent interventions targeting both domains simultaneously.
Trial Registration: ClinicalTrials.gov identifiers: NCT04635618, NCT04632082.
J Clin Psychiatry 2026;87(1):25m15858
Author affiliations are listed at the end of this article.
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