Depression, but not burnout, appears to be associated with greater suicidal ideation in U.S. physicians, according to a study in JAMA Network Open. In contrast, burnout, but not depression, was associated with self-reported medical errors.
“Approximately 1 in 10 medical students, 1 in 4 interns, and 1 in 16 practicing physicians report some degree of suicidal ideation,” wrote senior author Mickey T. Trockel, M.D., Ph.D., of Stanford University School of Medicine and colleagues. “Addressing physician well-being and reducing suicide risk require understanding the associations between physician distress, including burnout and depression, and personal and professional outcomes.”
Previous studies have suggested burnout is a risk factor for depression and suicide in physicians and physicians in training. Few, however, have examined the association between burnout and suicidal ideation after adjusting for depression, according to Trockel and colleagues. To examine this association after accounting for concurrent symptoms of depression, the authors invited a random sample of U.S. attending and postgraduate trainee physicians to complete a survey assessing burnout, depression, and suicidal ideation. This cross-sectional study was conducted from November 12, 2018, to February 15, 2019.
The participants were evaluated using subscales of the Stanford Professional Fulfillment Index (PFI), Maslach Burnout Inventory–Human Services Survey for Medical Personnel, Mini-Z burnout survey, and the Patient-Reported Outcomes Measurement Information System (PROMIS) depression Short Form. In addition, the participants were asked about suicidal ideation, as well as any history of making medical errors and the types of errors made.
The authors analyzed the responses of 1,354 survey participants, 75 (5.5%) of whom reported having thoughts of taking their own life in the previous 12 months. Burnout was significantly associated with increased odds of suicidal ideation before but not after the data were adjusted for depression. In contrast, after the data were adjusted for overall burnout (PFI), sex, race/ethnicity, training status, and age category, each increase of one standardized point on the PROMIS depression scale was associated with 202% greater odds of suicidal ideation.
The authors found the opposite was true when examining the relationship between burnout, depression, and medical errors: Burnout, not depression, was associated with self-reported medical errors.
Trockel and colleagues noted several limitations to the study, including their inability to assess causality. “Future investigations are warranted to evaluate causal relationships between burnout, depression, suicidal ideation, and medical error,” they concluded.
For related information, see the Psychiatric News article “New Findings and Controversies in Physician Well-Being and Burnout” and the American Journal of Psychiatry article “The Elephant in the Room: What Burnout Is and What It Is Not.”
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