Association of Physician Burnout With Suicidal Ideation and Medical Errors

Nikitha K Menon,Lindsey Carlasare,Tait D Shanafelt,Mark Linzer,Mickey T Trockel,Martin J Stillman,Christine A Sinsky,Keri J S Brady

doi:10.1001/jamanetworkopen.2020.28780

Abstract

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

Highlights

Studies have shown that a career in medicine is associated with increased risk of suicide.[1,2,3,4,5,6] A recent analysis[7] suggests that the increased risk for suicide among attending physicians may be declining or previously overestimated
Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation
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)

Summary

Introduction

Studies have shown that a career in medicine is associated with increased risk of suicide.[1,2,3,4,5,6] A recent analysis[7] suggests that the increased risk for suicide among attending physicians may be declining or previously overestimated. Whether burnout increases risk of suicide after accounting for symptoms of depression is unclear; studies suggesting that burnout is associated with increased risk for suicidal ideation lack control for comorbid depression,[9,16,19] and the few that control for it often use the Primary Care Evaluation of Mental Disorders (PRIME-MD),[4,9] a 2-item screening tool that may not be an optimal measure of symptom severity or specificity.[20,21] An analogous pattern exists between physician distress and patient care outcomes; both burnout and depression are associated with occupational consequences,[22,23,24,25,26] including errors,[27] in studies that often do not optimally account for both.[20,28,29]

Methods

Results

Discussion

Conclusion