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. 2020 Dec 1;3(12):e2028780.
doi: 10.1001/jamanetworkopen.2020.28780.

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Nikitha K Menon  1 , Tait D Shanafelt  2 , Christine A Sinsky  3 , Mark Linzer  4 , Lindsey Carlasare  3 , Keri J S Brady  5 , Martin J Stillman  4 , Mickey T Trockel  1
Affiliations

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Nikitha K Menon et al. JAMA Netw Open. .

Erratum in

  • Error in the Methods Section.
    [No authors listed] [No authors listed] JAMA Netw Open. 2021 May 3;4(5):e2115436. doi: 10.1001/jamanetworkopen.2021.15436. JAMA Netw Open. 2021. PMID: 34037738 Free PMC article. No abstract available.

Abstract

Importance: Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression.

Objective: To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors.

Design, setting, and participants: This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate.

Main outcomes and measures: The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models.

Results: Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16).

Conclusions and relevance: The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shanafelt reported being co-inventor of the Physician Well-being Index, Medical Student Well-being Index, Nurse Well-being Index, Well-being Index, and Participatory Management Leadership Index; Mayo Clinic holds the copyright to these instruments and has licensed them for use outside of Mayo Clinic, and Dr Shanafelt receives a portion of any royalties paid to Mayo Clinic. Dr Shanafelt also reported receiving honoraria from grand rounds/keynote lecture presentations and advising for health care organizations outside the submitted work. Dr Linzer reported receiving grants from the American Medical Association during the conduct of the study and receiving grants from the American College of Physicians, the Institute for Healthcare Improvement, the American Board of Internal Medicine Foundation, and the Agency for Healthcare Research and Quality; receiving consulting fees from Harvard University; and receiving honoraria from Massachusetts General Hospital and The University of Chicago. Dr Carlasare was employed by the American Medical Association during the conduct of the study. No other disclosures were reported. Dr Trockel reported receiving honoraria for grand rounds and lecture presentations outside of the submitted work.

References

    1. Rotenstein LS, Ramos MA, Torre M, et al. . Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324 - DOI - PMC - PubMed
    1. Brazeau CMLR, Shanafelt T, Durning SJ, et al. . Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520-1525. doi:10.1097/ACM.0000000000000482 - DOI - PubMed
    1. Jiménez-López JL, Arenas-Osuna J, Angeles-Garay U. Depression, anxiety and suicide risk symptoms among medical residents over an academic year. Article in Spanish. Rev Med Inst Mex Seguro Soc. 2015;53(1):20-28. - PubMed
    1. Dyrbye LN, Thomas MR, Massie FS, et al. . Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334-341. doi:10.7326/0003-4819-149-5-200809020-00008 - DOI - PubMed
    1. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12):2295-2302. doi:10.1176/appi.ajp.161.12.2295 - DOI - PubMed

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