Interventions for Burnout and Depression Among Doctors

The well-being of doctors is under significant strain, with acute and chronic stress, psychological trauma, ethical dilemmas, and negative experiences contributing to burnout and depression. This issue affects not only healthcare professionals themselves but also their patients and the whole healthcare system.

A recent review in The New England Journal of Medicine summarizes research on the prevalence of burnout and depression among doctors while highlighting effective countermeasures. The authors offered suggestions for further research and actionable steps for clinics, medical organizations, and policymakers to address these challenges effectively.

“This review highlights an important aspect of occupational health management that has gained traction in German hospitals in recent years,” said Peter Zwanzger, MD, chief physician in general psychiatry and psychosomatics at the kbo-Inn-Salzach clinic in Wasserburg am Inn, Germany, and a board member of the German Society for Psychiatry and Psychotherapy, Psychosomatics, and Neurology.

Depression as the Core Diagnosis

The authors of the review, Constance Guille, MD, and Srijan Sen, MD, PhD, psychiatrists at the University of South Carolina, Columbia, South Carolina, and the University of Michigan, Ann Arbor, Michigan, emphasized that depression is a better-defined diagnosis than burnout. Their analysis of 182 studies found 142 different definitions of burnout, leading to prevalence rates among doctors ranging from 0% to 80.5%. This variation prompted the authors to concentrate on studies related to depression.

“These concepts — depression and burnout — are not equivalent, scientifically recognized diagnoses,” Zwanzger clarified. “Depression is a well-established, scientifically validated diagnosis found in all major diagnostic systems. In contrast, burnout is not a recognized diagnosis but rather a risk state, often related to occupational stress.”

Symptoms that lead to a diagnosis of depression include low energy, lack of enjoyment, sleep and appetite disturbances, and negative thoughts, even including suicidal ideation. Symptoms are similar whether depression is triggered by external factors or internal pathological states.

Workload as a Key Factor

Excessive workload is a major cause of depression and burnout among doctors. In one study, young residents experienced up to a sixfold increase in depression rates after beginning clinical work, with shifts extending to as much as 90 hours per week. In comparison, a 40-45 hour working week caused a doubling in the incidence of depression.

“One of the most important steps to counteract general overload is the regulation of working hours established under European labor laws,” Zwanzger explained. “This means that, particularly for residents, excessively long shifts and significant weekly hours should be a thing of the past.”

Accessible Mental Health Measures

Other systemic triggers of depression include lack of access to mental health services, frequent job-related frustrations, and inadequate sleep, according to the review authors. Women and minorities, including non-native speakers, are disproportionately affected, often due to additional family pressures on women and less social integration for minorities.

“In Germany, it’s also observed that high-intensity workloads in some medical specialties lead to mental health complaints, including depression, burnout, and a higher risk of substance abuse and dependency,” Zwanzger said. “In response, workplace health management in German hospitals has advanced significantly in recent years. Many institutions have implemented screening programs for mental health concerns through occupational health services.”

Recommendations for Medical Organizations and Hospitals

The authors outline several recommendations:

• Substantial Investment in Reducing Administrative Tasks: Cutting the burden of paperwork for doctors allows them to focus more on patient care, potentially reducing feelings of guilt associated with administrative work. 
• Easier Access to Mental Health Support: Increasing access to services targeting depressive symptoms and substance dependency for doctors can help reduce stigma for affected colleagues. 
• Supporting Family Life: Consider options such as part-time working and on-site childcare facilities within hospitals to support doctors with families. 
• Promoting Equality: Implement measures to ensure equal opportunities for women, ethnic, religious, and other minority groups, and to prevent sexual harassment and discrimination. 
• Monitoring and Evaluating Initiatives: Consistently document and assess all measures to provide evidence-based recommendations for ongoing improvement and expansion of these interventions.

This story was translated from Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.