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Physician-directed interventions benefit physicians’ mental health

Results from meta-analyses revealed that physician-directed interventions eased symptoms of depression, anxiety and suicidality in physicians.

Most prior research on physicians' mental health has focused on broad proxy measures of well-being, like burnout and workplace stress, Samuel B. Harvey, PhD, Black Dog Institute, University of New South Wales, Australia, and colleagues explained in The Lancet Psychiatry.

“Although evidence exists that both stress and burnout are related to depression, anxiety and suicidality, they are distinct constructs and might be affected by different workplace factors,” they wrote. “Whether interventions that have been shown to reduce stress and burnout also reduce symptoms of mental disorder and suicidality, and whether any suggested effects hold in physician-only samples remains unclear.”

The investigators examined whether interventions can effectively decrease or prevent symptoms of common mental health disorders or suicidality in physicians in this systematic review and meta-analysis using data from online clinical databases. They included randomized, controlled studies or controlled before–after studies of interventions — both organizational-level and physician-directed — that sought to lower depression, anxiety or suicidality symptoms in physicians following intervention.

Eight articles encompassing 1,023 physicians were included in analyses — seven of which were randomized, controlled trials and one of which was a controlled before–after study. Five interventions were delivered via a group-based format and three on an individual basis, which the researchers classified into two groups: interventions based on cognitive behavioral therapy (n = 2) or mindfulness values (n = 2) and interventions based on other approaches (n = 3), according to the study.

When the investigators conducted separate analyses, they found that physician-directed interventions lead to lower symptoms of depression, anxiety and suicidality.

Results from studies that examined symptoms of depression, anxiety or a combined measure indicated a moderate effect in favor of the physician-directed interventions for reducing symptoms (standardized mean difference = 0.62; 95% CI, 0.4-0.83). A study that evaluated suicidal ideation revealed that intern physicians who took part in a web-based CBT intervention were 60% less likely to report suicidal ideation during an internship year than the attention-control group (RR = 0.4; 95% CI, 0.17-0.91).

There was no evidence of significant heterogeneity, according to Harvey and colleagues.

“The available research data suggest that some interventions directed at physicians can reduce mental health symptoms,” they wrote. “Given the prevalence of mental health morbidity among physicians, these findings should both guide the type of physician-focused interventions that are adopted among this group and serve as a call to action for the urgent need for more comprehensive rigorous research regarding individual and organizational interventions aimed at improving the mental health of physicians.” – by Savannah Demko

Disclosures: All authors report support from the Australian Government, iCare Foundation and NSW Health. Please see the study for all other relevant financial disclosures.