Medical Radiology and Radiation Safety. 2026. Vol. 71. № 3
DOI:10.33266/1024-6177-2026-71-3-66-79
A.N. Koterov1, L.N. Ushenkova1, A.A. Wainson2, O.A. Tikhonova1, A.S. Kretov1, O.V. Parinov1, A.O. Lebedev1, A.Yu. Bushmanov1
Suicide Risk Among Nuclear Workers: Differences for Male and Female are Inverse to Population-Based Results (Synthetic Study). Report 2. Meta-Analyses and Pooled-Analyses
1 A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia
2 N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
Contact person: Alexey N. Koterov, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
This synthetic study, presented in two reports, is intended to, firstly, serve as an image-building tool for employment in the nuclear industry (assessing the psychological state of nuclear workers (NW), including comparisons with other professions). Secondly, it aims to identify the consequences of occupational stress, such as suicide, the frequency of which is an index of professional psychological well-being/ill-being. This is relevant for the psychological and psychophysiological support of contingents under the jurisdiction of the Federal Medical-Biological Agency of the Russian Federation.
At the initial stage of the study, the results of which were presented in the form of a systematic review in Report 1, full samples of studies on the standardized mortality ratio (SMR; compared to the general population) for suicides in foreign NW for male and female (15 nuclear installations from five countries) were compiled and characterized. The presented Report 2 is devoted to the implementation of a meta-analysis and a pooled analysis for the aforementioned samples. Firstly, a good agreement between the results of both synthetic approaches is demonstrated (which is of particular theoretical interest) and, secondly, a sharply different situation for male and female is discovered. While a statistically significant ‘Healthy Worker Effect’ was revealed for NW male, albeit not very high in magnitude (according to both the meta-analysis and pooled analysis, SMR = 0.85), such an effect was completely absent for NW female, although the index level was not higher than that of the population (SMR = 0.97–1.04). For the two gender samples, the SMR for suicides according to the Mann-Whitney U test showed a statistically significant difference (p = 0.019), as did the corresponding comparison of the mean values for the five installations for which the indexes for NW male and female were simultaneously studied (p = 0.021). Similar trends were also identified for the PO ‘Mayak’ NW, although these data were only qualitative due to the lack of suitable suicide risk indexes for analysis.
The magnitude of the inverse ‘gender paradox’ for suicides in NW, which distinguishes certain occupations from the general population (where the rate of fatal suicides is higher in female than in male), was the highest among all occupations for which similar data were found, including physicians, who were previously known to be most susceptible to this phenomenon.
The study was subject to a number of statistical and epidemiological limitations, but none of them could completely invalidate the aforementioned patterns or the reliability of the data obtained, with the exception of the hypothesis that gender-related initial selection for psychological characteristics may influence for NW male and female.
It was concluded that the occupational stress and psychological well-being index for female NW, regardless of the underlying cause, differ significantly from those for male NW, and this difference is likely more pronounced than that of any other profession. This requires a differentiated gender approach to psychological and psychophysiological support for NW. It would also be advisable to reduce the number of female NW directly involved in production in the nuclear industry.
Keywords: nuclear workers; fatal suicides, gender differences, meta-analysis, pooled analysis
For citation: Koterov AN, Ushenkova LN, Wainson AA, Tikhonova OA, Kretov AS, Parinov OV, Lebedev AO, Bushmanov AYu. Suicide Risk Among Nuclear Workers: Differences for Male and Female are Inverse to Population-Based Results (Synthetic Study). Report 2. Meta-Analyses And Pooled-Analyses. Medical Radiology and Radiation Safety. 2026;71(3):66–79. DOI:10.33266/1024-6177-2026-71-3-66-79
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Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.02.2026. Accepted for publication: 25.03.2026.