Systematic review of interventions to improve the psychological well-being of general practitioners

Abstract

BackgroundThe health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and ‘languishing to flourishing’ (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.MethodsMedline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.ResultsOnly four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.ConclusionThere is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0431-1) contains supplementary material, which is available to authorized users.

A systematic review of the impact of mindfulness on the well‐being of healthcare professionals

“…Although a number of reviews have already been conducted in this area, these have tended to have fairly narrow remits in terms of population and/or outcome. These include reviews focused only on certain healthcare professions, such as general practitioners (Murray, Murray, & Donnelly, 2016), social workers (Trowbridge & Lawson, 2016), and nurses (Botha, Gwin, & Purpora, 2015), all of which featured small numbers of studies. Or, such reviews have concentrated on HCPs more generally but were concerned only with specific outcomes, such as stress, as in the case of Burton, Burgess, Dean, Koutsopoulou, and Hugh-Jones (2017), who included only nine studies, or empathy and emotional competencies, as in the case of Lamothe, Rondeau, Malboeuf-Hurtubise, Duval, and Sultan (2016), who focused just on MBSR and identified 14 such studies.…”

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

“…16,17 In addition, much previous work has focused on the impact of physician wellbeing on patient outcomes, meaning the emphasis is not on the needs of GPs themselves. 8,18,19 The concept of resilience is problematic, as it places the responsibility for managing pressure with the individual, rather than the organisation, 20 and there is a need for research into health practitioner wellbeing, in order to value that wellbeing for its own sake.…”

“…7 Additionally, several authors cite concerns for patient safety as a result of GP distress. 8 Low levels of personally reported physician individual accomplishment have correlated with emotional exhaustion and depersonalisation, 11 and high levels of pressure may lead to decision fatigue. 3 However, findings have shown that patients' ratings do not reflect GPs' sense of being burnt out; patients rate 'burnt out' GPs as highly as healthy GPs.…”

“…6,7 Additional pressures for GPs in the UK come from sources such as the Quality and Outcomes Framework (QOF) and the implications of future cuts in NHS funding. 6 Reports of GPs feeling dissatisfied, 6 distressed, anxious, 7,8 and suicidal 9 are rising. Some GPs report misuse of substances, 7 while others feel exhausted, 'grumpy', and have feelings of hatred towards their work.…”

From burnout to resilient practice: is it a matter of the individual or the context?

“…However, research in this area is in its infancy and currently suffers from substantive methodological weaknesses. Two recent meta‐analyses of interventions developed to promote physician resilience highlighted the need for methodologically rigorous research to establish best practice . Therefore, to date, information on which organisational aspects of health care settings enhance physician resilience is scarce or non‐existent.…”