Recurrence Rates in Ontario Physicians Monitored for Major Depression and Bipolar Disorder

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Physicians with recurrent conditions that may affect job performance are sometimes referred for monitoring to help ensure compliance with treatment, ongoing remission of illness, and patient safety. Little is known about recurrence rates among doctors monitored for mood disorders. Our primary objective was to describe recurrence rates among Ontario physicians monitored for recurrent unipolar depression and bipolar disorder (BD). Our secondary objective was to explore predictors of recurrence. We used a retrospective cohort design to describe the time to recurrence, defined as either stopping work owing to symptoms or any re-emergence of symptoms meeting a pre-established clinical threshold. Our exploratory analysis of recurrence predictors included age, sex, psychiatric diagnosis, psychiatric comorbidity, medical comorbidity, number of past episodes, past hospitalizations, and family history of psychiatric disorder. During a median observation of 24 months, 36% (18 of 50) of physicians stopped work owing to recurrence of symptoms, with the median time to stopping work being 11 months. As well, 52% (26 of 50) had a re-emergence of clinical symptoms, with the median time to any level of symptom re-emergence being 13 months. Physicians with psychiatric comorbidity stopped work sooner (hazard ratio [HR] 3.53; 95% CI 1.24 to 10.03, P = 0.01) and had more rapid symptom re-emergence (HR 2.96; 95% CI 1.34 to 6.52, P = 0.004) than those without comorbidity. The most common psychiatric comorbidity was a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, anxiety disorder. Recurrence rates are high among Ontario physicians referred for formal monitoring of recurrent unipolar depression and BD, and are markedly hastened by the presence of psychiatric comorbidity.