The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review

Abstract

IntroductionThe World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery.MethodsA mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis.ResultsSixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians.ConclusionThe systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.

Mental health and burnout during medical school: Longitudinal evolution and covariates

“…Indeed, it shows that mental health is more impacted by the generic stressors of the beginning of medical training, whereas burnout is more impacted by the specific stressors of the end of medical school, which might be characterized by occupational problematics. On the other hand, suicidal ideation and the emotional exhaustion dimension of burnout were influenced by both the stressors of the beginning and the end of medical school, which is in line with previous findings showing that suicidal ideation correlates with both depression and burnout [29] and that emotional exhaustion is the burnout dimension most strongly correlated to depression [30]. This study further shows that the most influential protective factors against medical students' mental health issues and burnout are less emotion-focused coping, more social support, and more satisfaction with health.…”

Mental health and burnout during medical school: Longitudinal evolution and covariates

“…Indeed, it shows that mental health is more impacted by the generic stressors of the beginning of medical training, whereas burnout is more impacted by the specific stressors of the end of medical school, which might be characterized by occupational problematics. On the other hand, suicidal ideation and the emotional exhaustion dimension of burnout were influenced by both the stressors of the beginning and the end of medical school, which is in line with previous findings showing that suicidal ideation correlates with both depression and burnout [ 34 ] and that emotional exhaustion is the burnout dimension most strongly correlated to depression [ 35 ].…”

On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021–2023

“…Not surprisingly, therefore, studies, including in this Special Issue (Greene et al, 2021 ; Patel et al, 2023 ), have documented how healthcare workers, especially those on the front-line caring for patients with severe coronavirus infections, have reported a plethora of psychological problems (e.g., anxiety, depression, somatisation, obsession/compulsions, insomnia) (Greene et al, 2021 ), primary and secondary traumatic stress symptoms (Greene et al, 2021 ; Hegarty et al, 2022 ), burnout (Alkhamees et al, 2023 ; Long et al, 2023 ; Rossi et al, 2023 ), and severe impairment and danger due to addiction and suicidality (Patel et al, 2023 ; Ryan et al, 2023 ; Uvais, 2021 ). Almost half of a sample of front-line healthcare workers assessed by structured interview during the pandemic met criteria for PTSD, and nearly 40% for major depressive disorder, with pandemic-related traumatic stressors appearing directly related to depression and to exacerbate the effects of pre-pandemic trauma exposure when PTSD occurred (Wild et al, 2022 ).…”