224

Suicide and Life-Threatening Behavior 3 l(2) Summer 2001

0 2001 T h e American Association of Suicidology

Suicide in Police-A Critical Review

ERLENDHEM,MD, ANNE MARIEBERG,MA, AND 0 M N D EKEBERG,
MD

Police officers are commonly referred to as a high-risk group for suicide.

So far no comprehensive review has been published about epidemiologic studies
among police. This article systematically explores the worldwide literature on suicide in police. None of the recent nationwide studies show elevated suicide rates
among police. Other studies show inconsistent results. Conclusively, it is not documented that there is an elevated suicide rate in police. A particular problem in
previous research has been methodological shortcomings. There is need for further systematic research, and this review points out some strategies of research.

Suicide has in recent years attained considerable interest as one of the leading causes of
death (Janik & Kravitz, 1994). Several occupational groups appear to have a high risk of
suicide (Boxer, Burnett, & Swanson, 1995)
and should be studied carefully in order to
attempt prevention (Partanen, Jourenkova,
Welp, & Johansson, 1995; Violanti, Vena, &
Marshall, 1996; Lewis, Hawton, & Jones,
1997; Mortensen, 1999). It is widely argued
that policing is one of the most dangerous,
stressful, and health-threatening occupations
(Hill & Clawson, 1988); high levels of stress,
strain, alcoholism, divorce, suicide, and so
forth are attributed to this profession (Hill &
Clawson, 1988). Suicide in police has, in
fact, been described as an epidemic (Violanti,
1996a). In recent papers (Mohandie &
Hatcher, 1999; Slovenko, 1999) it is claimed

DR. ERIXND HEM and DR. 0 M N U

EKEBERG
are with the Department of Behavioral
Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway, and ANNE MARIE BERG
is with T h e National Police Academy, Oslo,
Norway.
Address correspondence to: Dr. Erlend
Hem, Department of Behavioral Sciences in Medicine, University of Oslo, PO Box 111 1 Blindern,
N-0317 Oslo, Norway. Tel.: + 4 7 22 85 10 23.
Fax: + 4 7 22 85 13 00. E-mail: erlend.hem@
basalmed.uio.no.

that the suicide rate of law enforcement personnel is between two and three times that
of the general population. However, research
on police suicide has yielded widely varying
rates, ranging from 5.8 suicides per 100,000
police per year in London (Heiman, 1975)
to 203.7 per 100,000 per year in Wyoming
(Nelson & Smith, 1970).

METHODOLOGICALPROBLEMS

Unfortunately, several methodological

problems limit the value of these studies
(Cantor, Tyman, & Slater, 1995). Rates often
have been calculated from inadequate sample
sizes. Cantor et al. (1995) reviewed ten studies of police suicide, and four of the studies
had sample sizes of 10 or fewer, among them
the study from Wyoming mentioned above
with the extremely high suicide rate (Nelson & Smith, 1970). Small sample sizes will
easily give chance fluctuations (effects of
variation in a low-frequency phenomenon)
(Loo, 1986; Stack & Kelley, 1994). In order
to minimize this problem, the present paper
will exclude studies comprising less than ten
suicides, as an arbitrary limit.
Different studies have addressed different periods, some dating back from before
1940 (Friedman, 1968). Friedmans report

HEM~r AL.
indicated that police officers were 6.5 times
more likely to commit suicide than non-law
enforcement citizens (Roberts, 1975; Terry,
1985). Such old studies are primarily of historic interest. However, they are still frequently cited. T h e present paper will exclude
studies dating from before 1950, as an arbitrary limit. It may well be argued that data
from 1950 are of little interest for the police
today (Bedeian, 1982; Stack & Kelley, 1994;
Terry, 1985). However, they may be useful
for analyzing trends in suicide rates.
Another concern is that often there is
no specification of what kind of police work
is being done. A model of street-oriented, or
dangerous, police work may be assumed, but
most police officers work in less dangerous
roles or confront danger infrequently (Stack
& Kelley, 1994). For example, a study among
policemen in Rome consisted mainly of traffic wardens, and the stress they coped with
was traffic control rather than crime control
(Forastiere et al., 1994).
Almost all the studies have been conducted in limited specific police populations,
particularly in the United States. This can be
a problem because local and regional variations in suicide can affect the rates of police
suicide, and the reason for studying police
suicide in a specific region may be due to a
local epidemic of suicide in a subgroup.
Special circumstances in a region may also be
of importance; for example, the civil disorder
and rioting in Northern Ireland (Armour,
1996; Curran, Finlay, & McGarry, 1988).
This is a serious publication bias. There are
also important variations between groups; for
instance, the New York City cop versus the
London bobbie (Heiman, 1975). T h e organization of law enforcement agencies and
their reporting procedures are highly varied,
thus, comparisons may be difficult.
While the variability in reported suicide among police officers often has been attributed to underreporting due to social
stigma, religious and insurance reasons,
friendship to families, and loyalty to department (Janik & Kravitz, 1994), whether these
factors are more dominant in police than
other groups has hardly been empirically

225
studied (Violanti, Vena, Marshall, & Petralia,
1996).
Another methodological problem is
that previous research often has failed to
use appropriate comparison groups (Stack &
Kelley, 1994). A major bias introduced by using general population rates has been termed
the healthy worker effect. This is a selection
bias characterized by lower relative mortality
in an occupational cohort because relatively
healthy individuals are likely to gain employment and remain employed. In tnany ways
police officers, selected by strict criteria, typify a population in which a particularly strong
healthy worker effect would be expected (Demers et al., 1992). Hence, comparing police
suicide rates to general population suicide
rates may be misleading, as the general population includes more nonworkers and mentally ill than working populations (Violanti,
Vena, Marshall, & Petralia, 1996). T h e comparison group chosen is therefore of great
importance. Police officers have been used as
a reference population to firefighters in several mortality studies because they may have
a similar socioeconomic state, health benefits, and strict physical entry requirements
(Demers, Heyer, & Rosenstock, 1992; Feuer
& Rosenman, 1986). Vena, Violanti, Marshall, and Fiedler (1986) used all other municipal employees as reference population.
According to Stack & Kelley (1994),
their study was the first to employ Inultivariate analytic techniques for predicting the
probability of police deaths from suicide. In
earlier studies, race and gender tended not to
be controlled for, and age-adjustment was
not always done. Although policing traditionally has been a male-dominated work, the
ratio of women is increasing; for example, a t
the beginning of the 1990s women constituted 9% of the police force in the United
States and 11% of the police force in England and Wales (Brown & Fielding, 1993;
Martin & Jurik, 1996).
Finally, there are also examples of misinterpretations. It was said that the suicide
rate among police officers in Rome is high
(Violanti, 199613); however, in the original
paper the number of suicides was reported

SUICIDEIN POLICE

226
to be lower than expected (Forastiere et al.,
1994).
T he aim of this study is to summarize
the main results of methodologically adequate original studies by a systematic review.
T h e specific question is: What is the level
and variation of suicide risk of police officers
compared to the general population or other
groups?
METHODS

In this review we examine the worldwide literature relating to suicide and attempted suicide in police, emphasizing nationwide studies. T he search was done by
cross-re ferencing the keywords police, law enforcement, suicide, attempted suicide, and mortality. W e conducted a search of several
databases. T h e first was a noncomputerized bibliography (Farberow, 1972) covering
the periods 1897-1957 and 1958-1970. T h e
other sources were the following electronic
databases: Medline (1966-99), Psyclit (197499), Embase (1980-99), Criminal Justice Abstracts (1968-99), and Social Sciences Citation Index (1987-99). T h e search covered
literature cited in the databases until December 1999. Languages were not limited. Additionally, relevant sources were identified
through reference lists. T h e inclusion criteria
for an article were:
1. An original study in which suicide
mortality rates for a well-defined
police population in comparison to a
relevant, well-defined reference population were given.
2. T h e study area and period were not
overlapping substantially (more than
50%) with those of another study.
3. T h e study referred to suicide after
1950.
4. T h e study involved at least ten suicides.
RESULTS

T h e search resulted in 41 original

studies. T h e 20 studies fulfilling the inclusion

criteria are briefly described in Table 1. Most

studies (12) were excluded due to substantial
overlap in study area and period with other
studies. Of the 20 studies included, eight covered only the period before 1980. All studies
were from North America (13), Europe (6),
and Australia (1).
Three recent nationwide studies were
identified (Bourgoin, 1997; Kelly & Bunting,
1998; Schmidtke, Fricke, & Lester, 1999).
Bourgoin (1997) studied police suicide for
the years 1979 to 1996 in France. This study
is by far the largest study on police suicide
( N =749 suicides). In this study the comparison group is the general population, adjusted
for age and gender. T h e ratio between police
suicide and suicide in the comparison group
was 0.88 for the first 8-year period (197986), and 1.10 for the second 8-year period
(1986-94), which may indicate an increasing
trend. T h e mean value for the period as a
whole was 0.99; that is, a suicide rate of 34.8
per IO0,OOO per year in the police group
compared to 35.4 per 100,000 per year in the
comparison group. This study does not suggest an increased suicide rate in police.
Schmidtke et al. (1999) recently published a nationwide study from Germany
( N =23 1 suicides). T h e police organizations
here are comprised of Federal Customs, 16
state police, and 2 federal police organizations. T h e mean rate for the three police organizations during the period 1992-96 was
22.7 per 100,000 per year, compared to 23.7
per 100,000 per year for males in the same
age group (17-60 years) in the general population. In general, the rates did not differ significantly from the general age-adjusted rates
for the male population of the same age
group.
In a population-based study from England and Wales covering the period 198296, policing was listed among occupations
with the significantly lowest suicide mortality
ratio for men and women (Kelly & Bunting,
1998). T h e proportional mortality ratio
(PMR) increased from 61 in the first period
(1982-87) to 79 in the last period (1991-96).
However, the 95% confidence intervals overlapped (47-78 and 63-99, respectively).Hence,

HEMET

AL,.

no definite conclusion as to trends can be

drawn.
A frequently cited study from the
United States showed that the suicide rate of
police officers was 47.6 per 100,000 per
year in 1950 (Guralnick, 1963; Labovitz &
Hagedorn, 1971). This was the second highest suicide rate among 36 occupations (Labovitz & Hagedorn, 1971). Stack & Kelley
(1994) analyzed data from 16 states in 1985
( N =33), a sample representing all regions of
the nation. T h e suicide rate had then declined to 26 per 100,000 per year, and the
authors concluded that being a police officer
is not significantly associated with the odds
of death by suicide (Stack & Kelley, 1994).
These two studies are, by area, the most
comprehensive in the United States.
A group of police officers in Buffalo,
New York, has been studied extensively and
an increasing trend of suicide is reported (Violanti, 1995). In a study of this cohort for the
period 1950-79 based on 11 police suicides,
police officers had a significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9) (Vena et
al., 1986). However, the number of suicides
during 40 years (1950-90) is limited ( N =
26), and the confidence interval for suicide
(standardized mortality ratio) is just above 1
(95% confidence interval = 1.00-2.24) (Violanti, Vena, & Petralia, 1998). Other studies
from the United States show inconclusive results (see Table 1). For example, two studies
from Chicago showed highly inconsistent results from approximately the same period.
Cronin (1982) reported an average suicide
rate in Chicago police for the years 1970-78
of 29.5 per 100,000 per year. Wagner and
Brzeczek (1983) reported a suicide rate of
51.3 per 100,000 per year for the period
1977-79 (1.7 times higher than the figure in
Cronins report). These studies illustrate
chance fluctuations given small samples (Loo,
1986; Stack & Kelley, 1994). T h e suicide rates
among police officers and detectives in Washington state have been studied for three periods of time. For the period 1950-71, this
group had a slightly elevated suicide ratio
(PMR = 113) (Hill & Clawson, 1988). How-

227
ever, for the periods 1950-79 and 1950-89,
the suicide ratio among police was not elevated (Milham, 1983; Milham, 1997).
Pre-retired and retired police officers
have been of particular interest in two studies.
Gaska (1980) found a tenfold increase in suicide rate (334.7 vs. 33.5) among retired policemen in Detroit compared to white males ages
27-78 in the general population of the United
States for the period 1944-78 ( N = 18). In
three cities in the northwest United States the
suicide rate among police in the same period
was not significantly elevated relative to U.S.
rates, with one exception: policemen with 30
or more years on duty (N = 15, SMR = 301,
95% confidence interval 169-497) (Demers,
unpublished manuscript).
T h e two available reports froin Canada study a special group of police, the Royal
Canadian Mounted Police (RCMP), which
hardly is representative of the general police
force in Canada (Boxer, Burnett, & Swanson,
1995). These studies find a low suicide rate
in the RCMP (Andrews, 1996; Loo, 1986).
In Queensland, Australia, a unique material is available. T h e register dates police
suicide back to 1843. T h e suicide rates have
been declining and recently have been the
same as the suicide rate in the general employed Queensland male population (Cantor
et al., 1995).
Few countries have gathered statistics
on suicide in police officers. This fact may be
exemplified by a survey sent to 47 countries
participating in Interpol asking for information on suicides among police officers (Lester, 1992). This survey was excluded from
our study because the number of suicides was
not given. T h e rate for 26 countries was calculated, l l countries reported no suicides.
T h e other 2 1 countries reported that they do
not keep records or have incomplete data of
suicides in police (Lester, 1992). It was striking that far fewer countries gathered statistics
on suicide in police officers as compared to
the murder of police officers. T h e review
concluded that the suicide rate for police officers did not appear to be higher (or lower)
than the suicide rate for men in general in
the countries reporting data.

94
26
10

Labovitz & Hagedorn

(1971); Guralnick (1963)
Violanti et al. (1998)

28

33

Feuer & Rosenman (1986)

Cronin (1982)

Gaska (1980)

Demers (unpublished
manuscript)

Stack & Kelley (1994)

1977-88

1974-80

1970-78

1944-78

1944-79

1985

Los Angeles

New Jersey

Chicago

Detroit (retired policemen)

Seattle and Tacoma,

Washington; Portland, Oregon
16 states, United States

18

39

19

Josephson & Reiser (1990)

1950-90

United States (nationwide)

Buffalo, New York

1950

40

Hill & Clawson (1988)

1950-71

Washington State

66

Ivanoff (1994)

1985-94

New York

74

Heiman (1975)

Authors (year)

1960-73

Years

North America
New York

Location

TABLE 1
International Rates of Police Suicide

25.6

334.7

29.5

12.0

47.6

29

19.1

Rate per
100,00O/year

SMR= 118
(95% C I =
79- 170)

SMR= 153
(95% CI=
100-224)

P M R = 113

SMR or PMR

~~~~

~~

Comparison group

Rate ratio = 1.08. Rate compared to male,

age matched controls = 2 3.8

Los Angeles County suicide rates for

adults age 20-69:
1980 = 14.3
1987 = 13.4
Rate ratio = 0.73 and 1.03 compared to
white U.S. males and white New Jersey
males, respectively
National rate = 24.7; cited from Violanti
(1996a)
Rate = 3 3.5 among white males aged
27-78 in the general population of the
United States

Rate almost twice that of its white-male

urban population
Rate 4 times the New York City general
population, and twofold increase over
other workers; cited from Violanti
(1996a)
Rate not significantly elevated compared to
all other occupations
Rate 1.8 times higher than the general population; cited from Violanti (1996a)

N
00

1984-95

1960-73

1978-86

1982-87

1991-96

1979-96

1992-96

1950-92

Canada (RCMP)

Europe
London

Northern Ireland

England and Wales

England and Wales

France (nationwide)

Germany (nationwide)

Australia
Queensland

Cantor et al. (1995)

Schmidtke et al. (1999)

Bourgoin (1997)

Kelly & Bunting (1998)

30

23 1

749

81

66

21.6

22.7

36.9

26.8

2 8

Curran et al. (1988)

Kelly & Bunting (1998)

5.8

16.0

14.1

16

29

35

Heiman (1975)

Andrews (1996)

LOO(1986)

PMR = 61
(95% CI =
47-78)
PMR = 79
(95% CI =
63-99)

suicide rates recently have been the same

as the employed male population

Rate virtually no different from its whitemale urban population

Rate compared to the general adult male
population 12.2
Police listed among occupations with the
significantly lowest suicide mortality
ratio
Police listed among occupations with the
significantly lowest suicide mortality
ratio
34.8 = mean annual suicide rate for
1979-94 compared to 35.4 in the age
and gender matched general population
In general, the rates do not differ significantly from the general age-adjusted
rates for the male population of the
same age group

Rate about half that of the comparable Canadian rate for males in the same age
range
Rate = 26.3 among the Canadian males in
the same age group

John M. Violanti, personal communication.

Annual average rate.
The article covers the period until October 1987 (5 suicides from January 1987 to October 1987, hence, a total of 33 suicides), but we review only
full years.
Men aged 20-64.
This study includes data dating back to 1843.
SMR = standardized mortality ratio (observed/expected)
PMR = proportionate mortality ratio (observed/expected)

1960-83

Canada (RCMP)

h)

h)

!2
3
F

230

SUICIDEIN POLICE
DISCUSSION

Even though several articles on suicide

in police have been published, the present
paper is apparently the first systematic review
in which strict methodological inclusion criteria are applied to the original studies.
The main finding is the inconclusive
results of previous research. The three recent
nationwide studies from France, Germany,
and England and Wales do not show increased rates. Among the others, some studies report an elevated suicide rate, while others find an average or low suicide rate among
police. Hence, it is not documented that
there is an elevated suicide rate in police. Often the differences between the police and
comparison group were modest. There are
exceptions to the nonelevated suicide rates,
such as the high rate among police officers in
Northern Ireland (Armour, 1996; Curran et
al., 1988).
The studies included in this review are
considered as methodologically adequate
original studies; however, even though they
fulfil the inclusion criteria, the validity of the
studies may be questionable (Violanti, Vena,
Marshall, & Petralia, 1996). Therefore it is
not reasonable to make any further calculations (e.g., of confidence intervals). Bonifacio
(199 1) states that the literature on suicide
among police is sparse due to several reasons:

years after suicide is often unreliable

(Heiman, 197.5).
Despite the limited literature, repetitive citations may have given the impression that the
suicide rate among the police is appreciably
greater than for other occupational groups
(Bedeian, 1982). However, the present review does not support this assumption.

Limitations and Possible Biases

First, it is possible that we did not find
even the majority of all relevant original
studies in our search (Dickersin, Scherer, &
Lefebvre, 1994); for example, the publications from national statistical bureaus are not
indexed in the databases. It is also possible
that there are reports on mortality by occupational groups in which the suicide mortality of police is just one row or column in the
tables (Lindeman, Laara, Hakko, & Lonnqvist, 1996). Unpublished data exist, but only
one of those we are aware of meets the inclusion criteria of this review (Demers, unpublished manuscript). However, it is unlikely
that this bias would qualitatively change the
overall conclusion. Second, the study populations in this review represented a fairly narrow spectrum of sociocultural environments,
Anglo-Saxon and European countries, and
thus it is not possible to generalize the results
to police in other parts of the world.

1. Retrieving enough suicides in one

single occupational group may be

difficult (Heiman, 197.5).
2. Police suicide is a sensitive issue and
permission to official files is not always granted (Heiman, 197.5).
3. Records may not be available over
the desired study period (Heiman,
197.5).
4. Modern police departments may be
reluctant to participate in this kind
of study (Loo, 1986).
5. Several police departments do not
keep such information (Hill & Clawson, 1988).
6. Interviewing relatives 10 or more

Future Research
Some studies find elevated suicide
rates among police officers; others find an average or low rate of suicide. The rates vary
widely, are inconsistent, and are inconclusive,
especially due to methodological shortcomings. Violanti (1996a) states that perhaps the
greatest challenge is the lack of empirical, reliable evidence on police suicide. Therefore,
it is important to conduct systematic studies
of suicide in police from nationwide samples.
Lester (1992) recommends that all countries
should systematically collect data on suicide
in their police officers, both in-service and

23 1

HEM ET AI,.

retired. It would also be useful for nations to

cooperate on research to explore the causes
of suicide in police officers and to identify
effective ways of reducing the rates.
In accordance with Hawton and Vislisels (1 999) report for another occupational
group, there is a need for three types of study
among police. First, a more detailed epidemiology of suicide among police officers is
needed. These studies should focus on both
the degree of risk and reveal protecting
and precipitating factors for suicide and attempted suicide in particular, such as what
characterizes regions with high and low suicide rates, respectively. Relative risk at various stages of career, including during training, needs to be ascertained (Hawton &
Vislisel, 1999). Studies focusing on suicide
among pre-retired and retired police officers
may be of special importance, because these
groups may be at particular risk (Demers, unpublished manuscript; Gaska, 1980; Violanti,
1992; Violanti, 1996a).
Police suicide research has largely
failed to systematically examine biopsychosocia1 factors (Cantor, et al., 1995). There has
been considerable speculation as to why police officers commit suicide (Violanti, 1995),
and numerous proposals have been made.
Police officers may be prone to sudden and
unexpected situations, violence and potential
death of others and themselves. This threat
may have psychological consequences, such
as posttraumatic stress disorder or burnout
(Paton & Violanti, 1996; Paton & Violanti,
1999), which are often assumed to contribute
to suicidal behavior (Schmidtke et al., 1999).
It has been claimed that access to firearms
as a suicide means is a specific professional
exposure (Friedman, 1968; Loo, 1986; Cantor et al., 1995; Schmidtke et al., 1999).
Causal factors of increased suicide mortality
among police have been highly speculative

and need more explicit study (Loo, 1986).

Examination of risk with other factors, such
as marital status and type of policing, is required. occurrence of certain predisposing
traits, like personality, stressful life events,
depression, and other mental and somatic
diseases must be registered. Although difficult to conduct, prospective studies would be
most valuable.
Attempted suicide and suicidal ideation also have to be investigated. T h e literature on these topics among police is sparse
(Janik & Kravitz, 1994; Lennings, 1995). It is
of importance to determine the contribution
of a range of factors and possible mechanisms
that protect against the translation of suicidal
ideation into suicidal acts (Hawton & Vislisel, 1999).
Finally, there is a need for psychological autopsy studies of police officers who
have died in suicide. This approach may ascertain diagnoses or circumstances preceding
death individually for diagnostic-specific comparisons. T h e psychological autopsy studies
should examine the contribution of a variety
of items, such as mental disorder, family history of mental disorder and suicide, personality factors, religion, specific stressors, social
support, and access to means. Such studies
require comparison with a control group
(Hawton et al., 1998).

CONCLUSION

It is not documented that there is an

elevated suicide rate among police officers;
the findings on suicide rate in police are, in
fact, inconclusive. T h e main reason for this
is the lack of methodologically sound studies.
We therefore call for systematic studies on
suicide, attempted suicide, and suicidal ideation among police.

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Manuscript Received: March 13, 2000
Revision Accepted: July 1, 2000