Psychiatric morbidity, burnout and distress in Australian physician trainees
Carmen Axisa A B G , Louise Nash C D , Patrick Kelly E and Simon Willcock B FA Faculty of Health, University of Technology Sydney, Building 10, Level 7, 235 Jones Street, Ultimo, NSW 2007, Australia.
B Discipline of General Practice, Sydney Medical School, The University of Sydney, Level 2, Medical Foundation Building (K25), 92–95 Parramatta Road, Camperdown, NSW 2050, Australia. Email: simon.willcock@mqhealth.org.au
C Brain and Mind Centre, The University of Sydney, Level 5, 94 Mallett Street, Camperdown, NSW 2050, Australia. Email: louise.nash@sydney.edu.au
D Health Education and Training Institute, Building 12, Gladesville Hospital, Shea Close (off Victoria Road), Gladesville, NSW 2111, Australia.
E Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, The University of Sydney, NSW 2006, Australia. Email: p.kelly@sydney.edu.au
F MQ Health, Level 3, 2 Technology Place, Macquarie University, NSW 2109, Australia.
G Corresponding author. Email: carmen.axisa@uts.edu.au
Australian Health Review 44(1) 31-38 https://doi.org/10.1071/AH18076
Submitted: 22 May 2018 Accepted: 30 October 2018 Published: 25 March 2019
Abstract
Objective The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors.
Methods A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test.
Results Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P = 0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6 h each day.
Conclusion The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision.
What is known about the topic? Doctors’ health and patient care can be affected when doctors experience burnout and psychiatric morbidity.
What does this paper add? This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors.
What are the implications for practitioners? The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs.
References
[1] Elliot L, Tan J, Norris S. The mental health of doctors a systematic literature review. Melbourne: beyondblue: the national depression initiative; 2010.[2] beyondblue. National mental health survey of doctors and medical students. 2013. Available at: https://web.archive.org/web/20180313013615/https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report---nmhdmss-full-report_web [verified 2 January 2019].
[3] Australian Medical Association (AMA). AMA survey report on junior doctor health and wellbeing. Canberra: AMA; 2008.
[4] Markwell AL, Wainer Z. The health and wellbeing of junior doctors: insights from a national survey. Med J Aust 2009; 191 441–4.
| 19835538PubMed |
[5] Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Med J Aust 2004; 181 357–60.
| 15462649PubMed |
[6] Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008; 336 488–91.
| Rates of medication errors among depressed and burnt out residents: prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 18258931PubMed |
[7] Adams EF, Lee AJ, Pritchard CW, White RJ. What stops us from healing the healers: a survey of help-seeking behaviour, stigmatisation and depression within the medical profession. Int J Soc Psychiatry 2010; 56 359–70.
| What stops us from healing the healers: a survey of help-seeking behaviour, stigmatisation and depression within the medical profession.Crossref | GoogleScholarGoogle Scholar | 19617278PubMed |
[8] Nash LM, Daly MG, Kelly PJ, van Ekert EH, Walter G, Walton M, Willcock SM, Tennant CC. Factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors. Med J Aust 2010; 193 161–6.
| 20678045PubMed |
[9] Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002; 136 358–67.
| Burnout and self-reported patient care in an internal medicine residency program.Crossref | GoogleScholarGoogle Scholar | 11874308PubMed |
[10] West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA 2009; 302 1294–300.
| Association of resident fatigue and distress with perceived medical errors.Crossref | GoogleScholarGoogle Scholar | 19773564PubMed |
[11] Eddy R. Sleep deprivation among physicians. BCMJ 2005; 47 176–80.
[12] Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. Br J Gen Pract 2008; 58 501–8.
| Doctors as patients: a systematic review of doctors’ health access and the barriers they experience.Crossref | GoogleScholarGoogle Scholar | 18611318PubMed |
[13] Bright RP, Krahn L. Depression and suicide among physicians. Curr Psychiatry 2011; 10 16–30.
[14] Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009; 374 1714–21.
| Physician wellness: a missing quality indicator.Crossref | GoogleScholarGoogle Scholar | 19914516PubMed |
[15] Anonymous. Medicine’s dark, rotten secret. Sydney Morning Herald 9 February 2017. Available at: http://www.smh.com.au/comment/three-of-my-colleagues-have-killed-themselves-medicines-dark-secret-cant-be-allowed-to-go-on-20170209-gu9crd.html [verified 23 August 2018].
[16] Medical Training Review Panel. Eighteenth report. Canberra: Australian Government Department of Health; 2015. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/06186F3D9088F7CACA257E490009C084/$File/Medical%20Training%20Review%20Panel%20eighteenth%20report.pdf [verified 26 August 2018].
[17] Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test: guidelines for use in primary care. 2nd edn. Geneva: World Health Organization; 2001.
[18] Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd edn. Sydney: Psychology Foundation; 1995.
[19] Stamm BH. The concise ProQOL manual. 2nd edn. Pocatello: ProQOL.org; 2010.
[20] Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005; 44 227–39.
| The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample.Crossref | GoogleScholarGoogle Scholar | 16004657PubMed |
[21] Chambers C. Burnout in New Zealand’s senior medical profession. The Specialist October 2016; 3–6. Available at: https://www.asms.org.nz/wp-content/uploads/2016/10/11210-The-Specialist-Issue-108-WEB.pdf [verified 13 December 2018].
[22] Chin B, Murphy ML, Janicki-Deverts D, Cohen S. Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults. Psychoneuroendocrinology 2017; 78 68–75.
| Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults.Crossref | GoogleScholarGoogle Scholar | 28171850PubMed |
[23] Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC, Adams Hillard PJ. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 2015; 1 40–3.
| National Sleep Foundation’s sleep time duration recommendations: methodology and results summary.Crossref | GoogleScholarGoogle Scholar | 29073412PubMed |
[24] Australian Government Department of Health. Australia’s physical activity and sedentary behaviour guidelines for adults (18–64 years). 2014. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines [verified 4 August 2018].
[25] Jacka FN, Berk M. Depression, diet and exercise. Med J Aust 2013; 199 S21–3.
| Depression, diet and exercise.Crossref | GoogleScholarGoogle Scholar | 25370279PubMed |
[26] Australian Medical Association (AMA). Managing the risk of fatigue in the medical workforce. AMA Safe Hours Audit 2011. Canberra: AMA; 2011.
[27] Workplace Research Centre, The University of Sydney. Working conditions of doctors and nurses in NSW public hospitals survey for submission to the Garling Inquiry. Sydney: The University of Sydney; 2008.
[28] Australian Bureau of Statistics. 4839.0 – Patient experiences in Australia: summary of findings, 2014–15. 2015. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4839.02014-15?OpenDocument [verified 7 August 2018].
