Physician Health

When doctors ponder suicide, depression—not burnout—is key driver

Sara Berg, MS , News Editor

Depression, substance-use disorder, impaired relationships and self-destructive tendency have been reported to be associated with physician suicide. Suicidal ideation has also been linked with occupation-specific factors in medicine such as increased workload volume and medical errors, among others. Previous research also links physician burnout to depression and suicide, but a recent investigation presents a more complicated picture.

Physician burnout demands urgent action

The AMA is leading the national effort to solve the growing physician burnout crisis. We're working to eliminate the dysfunction in health care by removing the obstacles and burdens that interfere with patient care.

Using survey data collected between November 2018 and February 2019 from 1,354 physicians practicing throughout the U.S., researchers found that each standard deviation unit increase in burnout was associated with 85% increased odds of suicidal ideation. After adjusting for depression, there was no longer an association between burnout and risk of suicidal ideation.

Yet in adjusted models, depression was associated with 202% increased odds of suicidal ideation. Conversely, in terms of patient care consequences, an opposite pattern emerges; each increase in burnout was associated with self-reported medical errors whereas depression was not in models accounting for both, says the study, “Association of Physician Burnout With Suicidal Ideation and Medical Errors,” published in JAMA Network Open.

“Although burnout has been identified as a risk factor for depression and suicide in physicians, previous studies haven't fully accounted for the effects of both,” said Nikitha K. Menon, lead author of the study and a social science researcher in the psychiatry department at Stanford University School of Medicine. “On top of that, some controversy remains over whether burnout and depression are truly separate constructs or simply gradations of the same underlying disorder.

“We explore their overlap as well as how each of them—burnout and depression—relate to odds of suicidal ideation and self-reported medical error after fully accounting for their effects,” she added. “Our findings suggest that burnout and depression are separate experiences, with separate consequences for physicians and their patients.”

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Menon added that “depression is linked to substantially higher odds of suicidal ideation, even after adjusting for burnout.”

The AMA’s Christine A. Sinsky, MD, vice president of professional satisfaction, and Lindsey Carlasare, research manager at the AMA, also were listed as authors of the study, part of an eminent group of researchers from Stanford University School of Medicine, the University of Minnesota Medical School, and Boston University School of Public Health.

Need to adjust interventions

“Although burnout has received attention as an epidemic in medicine resulting from a dysfunctional system rather than an individual failing,” said Menon. “Depression and other mental illnesses remain stigmatized in medicine.

“This cultural stigma around mental illness likely exacerbates the barriers faced by physicians that are affected, preventing them from seeking help when they need it,” she added.

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Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.