Association of Physician Burnout With Suicidal Ideation and Medical Errors.
Association of Physician Burnout With Suicidal Ideation and Medical Errors.
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DOI：
10.1001/jamanetworkopen.2020.28780
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Trockel MT
中科院分区：
文献类型：
--
作者：
Menon NK;Shanafelt TD;Sinsky CA;Linzer M;Carlasare L;Brady KJS;Stillman MJ;Trockel MT
这项横断面研究使用了美国医生完成的调查数据，以检查医生倦怠，自杀意念和自我报告的医疗错误之间的关联，调整抑郁症。在解释抑郁症后，医生的倦怠是否与自杀意念和自我报告的医疗错误增加有关？在这项对1354名美国医生的横断面研究中，倦怠与调整抑郁症之前而不是之后的自杀意念的几率增加显著相关，并且与调整抑郁症之前和之后自我报告的医疗错误的几率增加显著相关。在调整后的模型中，抑郁症与自杀意念的几率增加显著相关，但与自我报告的医疗错误无关。研究结果表明，抑郁而不是倦怠与医生的自杀意念直接相关。解决医生自杀问题需要了解其与可能的风险因素，如倦怠和抑郁症的关联。评估调整抑郁后的倦怠和自杀意念之间的关联，以及自我报告的医疗错误与倦怠和抑郁之间的关联。本横断面研究于2018年11月12日至2019年2月15日进行。从美国医学会医师主文件中随机抽样的主治医师和研究生实习医师通过电子邮件发送邀请，以完成一波又一波的在线调查，直到1200多名执业医师同意参与。主要结果是调整抑郁后的倦怠与自杀意念的关联。次要结果是倦怠和抑郁与自我报告的医疗错误的关联。使用斯坦福大学职业成就感指数、Maslach职业倦怠量表-医务人员人类服务调查、Mini-Z职业倦怠调查和患者报告结局测量信息系统抑郁简表的子量表测量职业倦怠、抑郁、自杀意念和医疗差错。使用多变量回归模型评估相关性。在1354名受访者中，893名（66.0%）为白色，1268名（93.6%）为非西班牙裔，762名（56.3%）为男性，912名（67.4%）为非初级保健医生，934名（69.0%）为主治医生，824名（60.9%）年龄小于45岁。倦怠的SD单位每增加一个，自杀意念的几率就增加85%（比值比[OR]，1.85; 95%CI，1.47-2.31）。在调整抑郁症后，不再存在相关性（OR，0.85; 95%CI，0.63-1.17）。在校正模型中，抑郁症的SD单位每增加一个，自杀意念的几率就增加202%（OR，3.02; 95%CI，2.30-3.95）。在自我报告医疗错误的调整模型中，倦怠的每个SD单位增加与自我报告医疗错误的增加相关（OR，1.48; 95%CI，1.28-1.71），而抑郁症与自我报告医疗错误无关（OR，1.01; 95%CI，0.88-1.16）。这项横断面研究的结果表明，抑郁症，而不是医生倦怠是直接相关的自杀意念。倦怠与自我报告的医疗错误有关。未来的研究可能会检查是否倦怠代表上游干预目标，以防止自杀意念，预防抑郁症。
This cross-sectional study uses data from surveys completed by US physicians to examine associations between physician burnout, suicidal ideation, and self-reported medical errors after adjusting for depression. Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression? In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors. The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians. Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory–Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non–primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.
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