• suicidality
• suicide
• bullying
• job stressors
• working conditions

In this issue of Occupational and Environmental Medicine (OEM), Leach et al1 review the evidence that workplace bullying is associated with suicidal thoughts and behaviours. This is a rapidly developing area of enquiry, as it should be. In most Organisation for Economic Co-operation and Development (OECD) countries, suicide is a leading cause of mortality, particularly for men, who comprise on average of ¾ of completed suicides.2 While only a fraction of those experiencing suicidal thoughts will go on to self-harm, attempt suicide, or die by suicide, suicidal thoughts are a key upstream indicator of suicide risk and an appropriate target for prevention and control efforts. Finding strategies to reduce suicidality is a public health imperative.

Leach et al identified a dozen studies meeting their inclusion criteria. Eight of these studies (including 1 of ours) reported on the association between workplace bullying and suicidal ideation or behaviour. Although all eight showed positive associations, causal inference is very limited because most were cross-sectional (5/8), and few controlled for all important confounders, including job stressors other than bullying. Most of the reviewed studies assessed only suicidal ideation, with only one assessing suicidal behaviour. These qualitatively consistent results from a variety of sample types, occupational groups, countries, and exposure and outcome assessment methods, suggest that the association between workplace bullying and suicidal ideation might be ‘universal and generalisable’ (quoting the authors). The authors' …