Suicidal ideation in physicians linked to depression, not burnout

Although physician burnout is associated with increased medical errors, it is not associated with an increased risk for suicidal ideation after adjusting for depression, according to research published in JAMA Network Open.

“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, and the few that control for it often use the Primary Care Evaluation of Mental Disorders (PRIME-MD), a two-item screening tool that may not be an optimal measure of symptom severity or specificity,” Nikitha K. Menon, of the department of psychiatry and behavioral sciences at the Stanford University School of Medicine, and colleagues wrote. “An analogous pattern exists between physician distress and patient care outcomes; both burnout and depression are associated with occupational consequences, including errors, in studies that often do not optimally account for both.”

Menon and colleagues completed a cross-sectional study of attending and postgraduate physician trainees who were randomly sampled from the AMA Physician Masterfile. Those who participated were offered small financial incentives to complete confidential, voluntary electronic surveys.

The researchers used the Stanford Professional Fulfillment Index, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and the Mini-Z Burnout and the Patient-Reported Outcomes Measurement Information System for depression Short Form to assess participants’ burnout, suicidal ideation, depression and medical errors.

A total of 1,354 respondents were included in the analyses, of whom 67.4% were non-primary care physicians, 69% were attending physicians and 60.9% were aged younger than 45 years.

Menon and colleagues found that each unit increase in burnout score was linked to an 85% increase in odds for suicidal ideation (OR = 1.85; 95% CI, 1.47-2.31). However, after they adjusted for depression, the researchers determined that there was no longer an association between burnout and suicidal ideation (OR = 0.85; 95% CI, 0.63-1.17).

In their adjusted model, Menon and colleagues determined that each unit increase in depression was associated with a 202% increase in odds for suicidal ideation (OR = 3.02; 95% CI, 2.30-3.95).

In a model that adjusted for self-reported medical errors, the researchers found that each unit increase in burnout score was linked to increased self-reported medical errors (OR = 1.48; 95% CI, 1.28-1.71). They did not find an association between depression and self-reported medical errors (OR = 1.01; 95% CI, 0.88-1.16).

The researchers said these findings suggest that depression, not burnout, is directly associated with increased suicidal ideation among physicians.

“In addition, the results suggest that burnout, not depression, is directly associated with an increased risk of self-reported medical errors,” Menon and colleagues wrote. “The findings of this study suggest that burnout without depression does not increase suicide risk and can therefore be safely addressed outside of mental health care.”