Are Your Physicians Afflicted With Burnout or Depression?

Misidentifying depression as burnout can have deadly consequences.

The response to physician burnout often overlooks a potentially life-threatening condition: major depressive disorder, physicians say in a new journal article.

Research indicates that nearly half of physicians nationwide are experiencing burnout symptoms, and a study published in October found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction. It is estimated that a physician commits suicide every day.

In a journal article published this month in JAMA Psychiatry, a trio of physicians wrote that the widespread focus on burnout could lead to missed diagnoses of serious mental illnesses among clinicians.

"It is critical that burnout not become the catchall term for emotional distress experienced by physicians. Identifying psychiatric disorders appropriately will enhance the likelihood that the correct treatment is sought. However, as long as stigma and shame are associated with psychiatric disorders, and we have a convenient, ready-made psychosocial formulation to explain away distress in the medical profession, there is a risk that psychiatric illnesses will be less likely to be acknowledged, recognized, and treated appropriately," the physicians wrote.

Symptoms of burnout such as exhaustion overlap with symptoms of major depressive disorder, and signs of MDD in clinicians such as suicidal ideation should prompt a thorough psychiatric evaluation, they wrote.

"Erroneously labeling a physician's distress as burnout may prevent or delay appropriate treatment of MDD, a serious and sometimes life-threatening mental disorder. … Given risks associated with suicidal ideation, it is imperative that the presence of suicidal ideation lead to an evaluation to rule out MDD."

Prejudice is a significant risk factor for distressed clinicians, the physicians wrote.

"Given the robust stigma around psychiatric conditions, the physician may be much more likely to conceptualize her or his problem as burnout rather than a psychiatric disorder. In this scenario, the physician might not seek effective pharmacologic or psychotherapeutic interventions for her or his MDD, but pursue commonly recommended stress reduction and relaxation strategies for burnout, such as yoga, mindfulness classes, or time off from work."

There are several approaches to help ensure that MDD is not mistaken as burnout, they wrote.

"Robust, evidence-based screening tools for depression exist, and many are brief. Complementing any screening for burnout with screens for depression, anxiety, and substance use disorders could mitigate the risk of conflating psychiatric diagnoses and burnout. Creating confidential psychiatric services that are easily accessible to physicians, especially trainees, might make a difference. Web-based and telepsychiatry platforms make this easier than ever. Ultimately, the biggest challenge is rolling back the corrosive effects of stigma."

Rising to the challenge
 

The lead author of the JAMA Psychiatry article told HealthLeaders that prejudice against medical staff with mental illness should be openly challenged.

"Educating people that it is not about weakness or moral failings is important. Calling out stigma also is key. As we understand more about the biology of MDD, it becomes more and more difficult to distinguish it from other medical conditions," said Maria Oquendo, MD, PhD, chair of psychiatry at the University of Pennsylvania's Perelman School of Medicine in Philadelphia.

Research shows that a substantial portion of clinicians experience MDD, Oquendo said. "Studies of physicians in training suggest that MDD might be present in as many as 25%. An Austrian study of physicians suggested a 10% prevalence of MDD, and that burnout increased the odds of MDD significantly. For those with mild burnout, the risk of MDD was three times greater; for moderate burnout, the risk was 10 times greater; and for severe burnout, the risk it was 47 times greater."

It is possible to achieve diagnostic clarity between burnout and MDD, she said. "MDD has clear diagnostic criteria. Burnout does not. However, whenever an individual meets the criteria for MDD, the diagnosis should be the focus of treatment, even if there are elements in the clinical picture that resemble burnout."