Abstract
Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature. To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors. A systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science was performed from database inception to December 31, 2018. Peer-reviewed empirical studies that reported on a valid measure of physician depressive symptoms associated with perceived or observed medical errors were included. No language restrictions were applied. Study characteristics and RR estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Relative risk estimates for the associations between physician depressive symptoms and medical errors. In total, 11 studies involving 21 517 physicians were included. Data were extracted from 7 longitudinal studies (64%; with 5595 individuals) and 4 cross-sectional studies (36%; with 15 922 individuals). The overall RR for medical errors among physicians with a positive screening for depression was 1.95 (95% CI, 1.63-2.33), with high heterogeneity across the studies (χ2 = 49.91; P < .001; I2 = 82%; τ2 = 0.06). Among the variables assessed, study design explained the most heterogeneity across studies, with lower RR estimates associated with medical errors in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84; χ2 = 5.77; P = .33; I2 = 13%; τ2 < 0.01) and higher RR estimates in cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83; χ2 = 5.44; P = .14; I2 = 45%; τ2 < 0.01). Similar to the results for the meta-analysis of physician depressive symptoms associated with subsequent medical errors, the meta-analysis of 4 longitudinal studies (involving 4462 individuals) found that medical errors associated with subsequent depressive symptoms had a pooled RR of 1.67 (95% CI, 1.48-1.87; χ2 = 1.85; P = .60; I2 = 0%; τ2 = 0), suggesting that the association between physician depressive symptoms and medical errors is bidirectional. Results of this study suggest that physicians with a positive screening for depressive symptoms are at higher risk for medical errors. Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could play a role in mitigating medical errors and thus improving physician well-being and patient care.
Highlights
Medical errors are a major source of patient harm
Study design explained the most heterogeneity across studies, with lower relative risk (RR) estimates associated with medical errors in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84; χ2 = 5.77; P = .33; I2 = 13%; τ2 < 0.01) and higher RR estimates in cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83; χ2 = 5.44; P = .14; I2 = 45%; τ2 < 0.01)
Similar to the results for the meta-analysis of physician depressive symptoms associated with subsequent medical errors, the meta-analysis of 4 longitudinal studies found that medical errors associated with subsequent depressive symptoms had a pooled RR of 1.67, suggesting that the association between physician depressive symptoms and medical errors is bidirectional
Summary
Medical errors are a major source of patient harm. Studies estimate that, in the United States, as many as 98 000 to 251 000 hospitalized patients die each year as result of a preventable adverse event.[1,2,3,4] In addition, medical errors are a major source of morbidity[5] and account for billions of dollars in financial losses to health care systems every year.[6,7,8,9]Depressive symptoms are highly prevalent among physicians,[10,11] and several studies have investigated the associations between physician depressive symptoms and medical errors.[12,13,14,15,16] most studies on physician depressive symptoms and medical errors have identified a substantial association, their results are not unanimous, and questions regarding the direction of these associations remain open in recent literature.[17]Depressive symptoms have well-established clinical criteria, and a large body of work has demonstrated that depression is a preventable and treatable condition.[18,19,20] Several studies with physicians have identified potential individual and work environment sources of interventions to prevent the development of depressive symptoms among these professionals,[21,22,23,24] and scarce, research on the efficacy of interventions to reduce depressive symptoms in physicians has shown positive results.[25]. In the United States, as many as 98 000 to 251 000 hospitalized patients die each year as result of a preventable adverse event.[1,2,3,4] In addition, medical errors are a major source of morbidity[5] and account for billions of dollars in financial losses to health care systems every year.[6,7,8,9]. Depressive symptoms have well-established clinical criteria, and a large body of work has demonstrated that depression is a preventable and treatable condition.[18,19,20] Several studies with physicians have identified potential individual and work environment sources of interventions to prevent the development of depressive symptoms among these professionals,[21,22,23,24] and scarce, research on the efficacy of interventions to reduce depressive symptoms in physicians has shown positive results.[25]
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