Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Department of Medicine, Stanford University School of Medicine, Stanford, California.
JAMA Netw Open. 2020 Dec 1;3(12):e2028780. doi: 10.1001/jamanetworkopen.2020.28780.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
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）的关联。
评估倦怠与抑郁调整后自杀意念之间的关联，以及倦怠和抑郁与自我报告的医疗失误之间的关联。
设计、地点和参与者：这是一项从 2018 年 11 月 12 日至 2019 年 2 月 15 日进行的横断面研究。从美国医学协会医师主文件中随机抽取的主治医生和住院医师，通过电子邮件邀请他们参加在线调查，分波进行，直到有 1200 多名以上的执业医生同意参加。
主要结果是调整抑郁后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失误的关联。使用斯坦福专业满意度指数、马斯拉赫倦怠量表-医疗人员人力服务调查和迷你 Z 倦怠量表以及患者报告的结果测量信息系统抑郁简短形式的子量表来衡量倦怠、抑郁、自杀意念和医疗失误。使用多变量回归模型评估关联。
在 1354 名受访者中，893 名（66.0%）为白人，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。倦怠每增加一个标准差单位，自杀意念的几率就会增加 85%（比值比[OR]，1.85；95%置信区间[CI]，1.47-2.31）。调整抑郁后，两者之间不再存在关联（OR，0.85；95%CI，0.63-1.17）。在调整后的模型中，抑郁每增加一个标准差单位，自杀意念的几率就会增加 202%（OR，3.02；95%CI，2.30-3.95）。在自我报告的医疗失误的调整模型中，倦怠每增加一个标准差单位，自我报告的医疗失误就会增加（OR，1.48；95%CI，1.28-1.71），而抑郁与自我报告的医疗失误无关（OR，1.01；95%CI，0.88-1.16）。
这项横断面研究的结果表明，抑郁而不是医生倦怠与自杀意念直接相关。倦怠与自我报告的医疗失误有关。未来的研究可能会探讨倦怠是否代表通过预防抑郁来预防自杀意念的上游干预目标。
