Resident Review  |   August 2019
Physician Wellness: New Concepts for an Old Problem
Article Information
Education / CPD / Patient Safety / Resident Review
Resident Review   |   August 2019
Physician Wellness: New Concepts for an Old Problem
ASA Monitor 8 2019, Vol.83, 58-59.
ASA Monitor 8 2019, Vol.83, 58-59.
The World Health Organization defines health as an optimal state of physical, mental and social well-being. Over the past decade, physician health and wellness has gained more recognition in residency programs and medical schools nationwide. This article seeks to highlight two key factors of physician wellness, burnout and depression, with the latest insights into how these factors are being addressed today.
According to the Centers for Disease Control and Prevention (CDC), suicide is the tenth overall cause of death in the U.S., with the rate among physicians significantly higher compared to the general population.1,2  Female physicians, in particular, have a much higher risk (relative risk 2.27), whereas male physicians have a mildly higher risk (relative risk 1.41) relative to the general population.3  Approximately 300 to 400 physicians each year in the U.S. die by suicide, which is equivalent to the approximate size of two medical school cohorts.2  Major risk factors of physician suicide include major depressive disorder (MDD), bipolar disorder, anxiety, adverse life events and substance abuse, with MDD being the most significant risk factor for suicide.4  These risk factors also adversely affect the mental health of trainees, as medical students are 27.2 percent more likely to have depression than the general population, according to the American Foundation for Suicide Prevention (AFSP).5  Indeed, a study of depressive symptoms among medical interns from 13 institutions and multiple specialties found that suicidal ideation increased over 370 percent in the first three months of the intern year.6  Medical interns who met the Patient Health Questionnaire (PHQ-9) criteria for depression increased from 3.9 percent prior to beginning internship (baseline) to 25.7 percent during internship.6  Several factors measured prior to internship (e.g., female sex, positive history of depression, lower baseline depressive symptom score, trained in a U.S. medical school, higher neurotic traits and difficult early family environment) and during internship (greater work hours, stressful life events, perceived medical errors) were associated with increased depressive symptoms during internship.6 
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