Psychiatrists Describe Dangers in Physician ‘Burnout’ Becoming Catchall Term for Emotional Distress

Despite ongoing efforts by health care systems and professional medical organizations to create tools and practices to decrease physician burnout, physician depression and suicide prevention remain “relatively ignored,” wrote psychiatrists Maria A. Oquendo, M.D., Ph.D., Carol A. Bernstein, M.D., and Laurel E. S. Mayer, M.D., in an article appearing today in JAMA Psychiatry.

The authors described several factors that may contribute to the imbalance between attention paid to physician burnout versus major depressive disorder, including the ongoing stigma of mental illness and its treatment: “[T]he term burnout, which indicates a human reaction to something outside oneself, is less stigmatized [than major depressive disorder],” they wrote. This has allowed it “to become a catchall term for emotional distress experienced by physicians.”

Additionally, many symptoms of burnout overlap with symptoms of major depressive disorder (MDD), they noted. “The shifting definition of burnout, in concert with the overlap with psychiatric symptoms, sets the stage for a situation in which burnout can be invoked and a treatable diagnosis missed,” they wrote. “As a result, a physician dutifully completing a burnout screening inventory for self-evaluation, as now recommended by the Accreditation Council for Graduate Medical Education, could easily conclude that she or he has burnout rather than MDD.” Such missed opportunities may prevent or delay treatments, putting the physician in danger.

What can be done to resolve this problem? Oquendo, Bernstein, and Mayer suggested several solutions including screening physicians for depression, anxiety, and substance use disorders when screening for burnout and creating confidential and easily accessible psychiatric services for physicians and trainees.

“Ultimately, the biggest challenge is rolling back the corrosive effects of stigma so that more affected physicians will feel comfortable acknowledging, at least to themselves and their personal physician, that what ails them is a treatable brain disorder and not simply an impossible work situation,” the authors concluded.

Oquendo is a past APA president and a professor and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Bernstein is a past APA president and vice chair for faculty development at Albert Einstein College of Medicine/Montefiore Medical Center. Mayer is an associate professor of clinical psychiatry at the Columbia University Vagelos College of Physicians and Surgeons.

For more on burnout, including a Psychiatric News series on this topic, see APA’s Well-being and Burnout Resources.

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Older Patients Underreport Psychiatric Diagnoses, Study Finds

A study published in this week’s JAMA Psychiatry reported that mental disorders are still being underreported by patients, including those who are in midlife to late life.

Researchers in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health investigated the discrepancies in reporting past mental health disorders and general medical conditions among midlife to late-life adults. The study included 1,071 adults who were asked to report any previous diagnosis for psychiatric disorders—such as major depressive disorder and substance use disorder—and other general medical disorders, such as diabetes and cancer. Self-reports from patients were compared with criteria-based diagnoses from records dating back 24 years. The results showed that 81 percent of the participants with a diagnosis for mental illness underreported their condition, compared with 13 percent who underreported general medical conditions.

"Stigma associated with mental disorders, as well as the fluctuating course of mental illnesses, might partly explain the discrepancies as well as differences in ages of onset of mental and physical disorders,” said Ramin Mojtabai, M.D., Ph.D., M.P.H., an associate professor and senior author of the study. Mojtabai concluded that because symptoms associated with general medical illnesses may be more prevalent in late life, patients may feel the need to report current ones over past mental illnesses.

To read more about stigma associated with mental illness and psychiatric disorders and late-late adults, see the Psychiatric News articles “Jeste, Saks Discuss Stigma, Resilience, and Recovery From Mental Illness.”

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Antistigma Programs Increase in Workplace, but Effectiveness Needs Further Study

Workplace programs aimed at reducing stigma regarding mental illness have expanded in the last four years, especially among the military, according to a study published online April 1 in Psychiatric Services in Advance. Researchers at the University of Toronto searched peer-reviewed literature published from 2000 to 2011, along with an extensive Internet review, to identify and describe the principles and characteristics embedded in workplace mental health antistigma initiatives. Twenty-two antistigma interventions were included in the study.

Most of the initiatives appeared in the past four years and across national boundaries, reflecting the growing international interest in mental health issues in the workplace. A large proportion of the interventions use educational approaches to reducing stigma, and a substantial number target military personnel. What’s not clear is how effective these programs are. “Workplace antistigma initiatives have increased in recent years; however, few conclusions can be drawn about their effectiveness,” the researchers say. “Reasons include a small number of studies, a lack of use of evaluation tools with established psychometric properties, and a lack of long-term follow-up evaluation efforts and data.... Interventions need to address the multifaceted nature of stigma and consider the diverse needs of various stakeholders in the workplace setting.”

Read the study in PS in Advance here. To read more about how stigma impacts access to mental health care, see Psychiatric News here and here. 

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