Help APA Understand How Burnout Affects Different Groups

APA’s Committee on Well-being and Burnout wants to know more about psychiatrists’ experiences with burnout and/or depression.

APA members are urged to complete a new survey/self-assessment tool developed by the committee that includes questions about demographics (age, gender, geographic location, minority status, and other variables) and practice setting (private practice, group practice, community mental health center, academic medical center, etc.). The survey also includes questions about burnout using the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9 (PHQ-9) to screen for depression. The survey can be completed in under 20 minutes.

All data will be kept anonymous.

“We hope to learn more about well-being and burnout among psychiatrists in general and among minority and underrepresented psychiatrists, specifically,” said Uchenna Okoye, M.D., M.P.H., a member of the committee.

An earlier online survey created by the committee established that burnout was a significant issue among APA members. In a 2018 report to the Board of Trustees, the committee stated that of the more than 1,900 psychiatrists who had taken the survey, 73% scored above 35 on the Oldenburg Burnout Inventory—indicating they were at risk for burnout. The survey also found that 15% of the respondents had a PHQ-9 score greater than 10, which indicates the presence of moderate to severe depression. Burnout scores were correlated with gender (women typically had higher scores), recent medical school graduation, and perceived inability to control one’s schedule. Among non-depressed respondents, burnout scores were slightly lower for psychiatrists who worked in academic and academic-affiliated practice settings.

The new survey will help drill down further to understand whether burnout affects members of minority groups differently. “We know a lot about burnout, but we don’t know much about the rates or causes of burnout in minority and underrepresented psychiatrists,” Okoye said. “If you belong to one or more minority or underrepresented groups—for example, if you are a woman, belong to a racial or ethnic minority, are an international medical graduate, identify as LGBTQ+, or belong to another group—your voice may not have been heard in this national conversation.”

Past APA President Carol Bernstein, M.D., also a member of the committee, said research on how burnout affects particular groups will help all psychiatrists affected by the problem. “I urge members to log onto the survey,” she said. “Understanding more about this issue and developing potential strategies to address it are important for the field of psychiatry, and for all of us in it.”

Click here to learn more about what APA is doing to address burnout.

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Risk of Heart Disease Quadruples in Women Hospitalized for Bulimia

The risk of cardiovascular disease skyrockets for women who have been hospitalized for bulimia nervosa, a study in JAMA Psychiatry reports. The risk is greatest in the first two years after hospitalization and remains high for another three years before disappearing at the 10-year mark.

“Our findings suggest that women with a history of bulimia nervosa should be informed of an increased risk of cardiovascular disease and death in the first decade after the index admission for bulimia,” wrote Rasmi M. Tith, R.D., M.P.H., of the University of Waterloo in Ontario and colleagues. “These women may benefit from screening for prevention and treatment of cardiovascular risk factors.”

The study followed more than 416,000 women for up to 12 years from 2006 to 2018. Of the patients, 818 were hospitalized for bulimia, and the rest were hospitalized for pregnancy-related events such as delivery of a live or stillborn infant, abortion, or pregnancy outside the uterus (ectopic pregnancy). The average age of the women at hospitalization was 28 years.

“The comparison group was representative of most women in the province … because 99% of deliveries and a significant proportion of other pregnancy events occur in hospitals,” the researchers wrote.

Compared with women who had been hospitalized for pregnancy-related events, women who had been hospitalized for bulimia had nearly 22 times the risk of heart attack within two years of hospitalization and more than 14 times the risk at five years. Over the entire follow-up, they had more than four times the risk of any cardiovascular disease, including six times the risk of heart attack, seven times the risk of ischemic heart disease (heart problems caused by narrowed heart arteries), and seven times the risk of atherosclerosis. They also had five times the risk of death. Those who had multiple hospitalizations for bulimia had a higher risk of cardiovascular disease and death than those who had been hospitalized only once.

The researchers noted that bulimia has been associated with metabolic changes such as changes in lipids that may affect the risk of cardiovascular disease. They added that bulimia may cause endocrine abnormalities such as low estrogen levels, which may also increase cardiovascular risk.

“Although more studies are needed, the findings from the present study suggest that bulimia nervosa, especially bulimia that requires multiple hospitalizations for treatment, may be associated with a range of cardiovascular disorders,” the researchers concluded. “Bulimia nervosa may be an important contributor to premature cardiovascular disease in women.”

For related information, see the Psychiatric News article “Brief Update and Review on Treating Eating Disorders.”

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Continued Low Rate of Clozapine Use and Wide Variability Found in State Medicaid Programs

Clozapine continues to be dramatically underutilized—despite it being the only drug approved for treatment-resistant schizophrenia—and there appears to be significant variation among states in its use for patients in the Medicaid program.

That’s the finding from an analysis of Medicaid data in 46 states published Monday in Psychiatric Services in Advance. Mark Olfson, M.D., M.P.H. (pictured left), of Columbia University and colleagues updated a previous analysis from 2001 to 2005 to include data from 2006 to 2009.

Overall, clozapine accounted for 4.8% of antipsychotic use in schizophrenia from 2006 to 2009, with a slight decline during this period (5.7% in 2006 to 4.3% in 2009). Clozapine was least commonly used in the Deep South (Louisiana, Mississippi, and Alabama) and more commonly used in New England, the Rocky Mountain West, and Washington. The highest rate of clozapine prescribing was in South Dakota (15.6%) and the lowest was in Louisiana (2.0%).

The authors of the analysis noted several factors associated with low clozapine use: fiscal stress, inadequate staffing to monitor clozapine, patient reluctance about blood monitoring, and concerns over tolerability.

Recently, the Food and Drug Administration issued modifications to its requirements for blood monitoring for patients receiving clozapine in an effort to lessen the burden on clinicians and patients. “I think the new monitoring system will be quite helpful,” Olfson said in comments to Psychiatric News. “It simplifies the clinical evaluation of neutropenic events, increases access to clozapine for patients with benign neutropenia, and permits those who develop mild neutropenia to continue treatment.”

For related information, see the Psychiatric News article “Why Won’t Clinicians Use Clozapine Despite Proven Superiority?”