Tuesday, October 31, 2017

Alleviating Conflict Between Work, Home Life May Improve Physician Mental Health

The medical internship year can be a challenging time for many physician trainees. A study published yesterday in JAMA Internal Medicine found that female medical interns are more likely than male medical interns to experience symptoms of depression. The study also found that the sex disparity in depression during the internship year may be driven in part by increasing conflict between work and personal obligations (work-family conflict). 

“Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians,” wrote psychiatrist Constance Guille, M.D., of the Medical University of South Carolina and colleagues. “Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.”

Guille and colleagues invited medical students matching to residency programs across all specialties throughout the United States during the 2015-2016 academic year to complete online assessments two months prior to the start of the internship year and again at six months into the internship year. As part of these assessments, the participants were asked to report depressive symptoms using the Patient Health Questionnaire (PHQ-9) and the degree to which work responsibilities interfered with family life (“family” was defined from participants’ perspective) using the Work and Family Conflict Scale.

Of the 3,121 students entering internships who completed the initial survey, 2,108 completed the six-month survey. The authors found that while men and women experienced a marked increase in depressive symptoms and work-family conflict over the first six months of their internship year, the increase in depressive symptoms among women was higher than the increase among men (mean increase in PHQ-9: 3.20 versus 2.5). When work-family conflict was accounted for, the sex disparity in the increase in depressive symptoms decreased by 36%.

The findings suggest that “work-family conflict [is] an important potentially modifiable factor associated with elevated depressive symptoms in training physicians,” Guille and colleagues wrote.

“Pilot programs designed to ease work-family conflicts among physicians through providing free home-delivered meals, childcare, and housecleaning are in their infancy,” the authors wrote. “Our findings suggest that these programs should be expanded in scope and number and that they should be rigorously tested to see if they not only reduce work-family conflict but also depression and its consequences, such as physician suicide, poor quality of patient care, medical errors, and career attrition.” 

For more about what APA is doing to address physician burnout and wellness, see the Psychiatric News article “Working Toward Wellness: Exploring Burnout and Resiliency in Physicians” by APA President Anita Everett, M.D. Addressing physician burnout and improving wellness is one of Dr. Everett's presidential initiatives.

For additional related information, see the Psychiatric News articles “How I Became Active in Fight For Trainee Wellness” by Matthew L. Goldman, M.D., M.S., and “Suicides of Young Physicians Raise Alarm About Burnout Among Trainees” by Carol Bernstein, M.D.

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