Abstract
Objective
Doctors in training, especially psychiatrists, are at high risk of depression and burnout, which have been linked to increased medical errors. This study looks at prevalence and risk factors of depression and perceived stress among psychiatry residents in Singapore.
Methods
An anonymous online questionnaire was completed by 65.3% (47/72) of residents, which included the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale (PSS), and 2 burnout screening questions. They were asked if they were concerned about making a medical error.
Results
Majority of residents (70.2%) slept 6–8 h/night, while 55.3% worked < 60 h/week. Based on PHQ-9 score ≥ 10, 38.3% had depression. Depression was associated with sleeping < 6 h/night (OR 13.62, 2.96–62.6; p = 0.0008) and working ≥ 60 h/week (OR 3.8, 1.096–13.18; p = 0.035). Six residents (12.8%) endorsed suicidal ideation. The mean score on the PSS scale was 23.89 ± 1.95. Higher PSS scores were associated with sleeping < 6 h/night (OR 4.92, 1.51–8.33; p = 0.007). One third of residents (34%) reported feeling burnt out fairly or very often. Residents who slept < 6 h/night were more likely to report feeling burnt out (OR 6.69, 1.69–26.45; p = 0.0068). PHQ scores correlated highly with PSS scores and burnout measures. Self-perceived medical errors were associated with depressive symptoms, suicidal thoughts, and < 6 h/night of sleep.
Conclusions
Less sleep and longer working hours were associated with higher risk of depression, suicidality, stress, and perceived medical errors in Singapore psychiatry residents. It is important to address depression and stress as it can affect physician well-being and patient care.
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References
Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314:2373–83.
Tyssen R, Vaglum P. Mental health problems among young doctors: an updated review of prospective studies. Harvard Rev Psychiatry. 2002;10:154–65.
Steinert Y, Magonet G, Rubin G, Carson K. Emotional well-being of house staff: comparison of residency training programs. Can Fam Physician. 1991;37:2130–8.
Deary IJ, Agius RM, Sadler A. Personality and stress in consultant psychiatrists. Int J Soc Psychiatry. 1996;42:112–23.
Lam TP, Wong JG, Ip MS, Lam KF, Pang SL. Psychological well-being of interns in Hong Kong: what causes them stress and what helps them. Med Teach. 2010;32:e120–6.
West CP, Huschka MM, Novotny PJ, et al. Associated of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296:1071–8.
Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336:488–91.
Lee PT, Loh J, Sng G, Tung J, Yeo KK. Empathy and burnout: a study on residents from a Singapore institution. Singapore Med J. 2018;59:50–4.
See KC, Lim TK, Kua EH, Phua J, Chua GS, Ho KY. Stress and burnout among physicians: prevalence and risk factors in a Singapore internal medicine programme. Ann Acad Med Singapore. 2016;45:471–4.
Yang S, Meredith P, Khan A. Stress and burnout among healthcare professionals working in a mental health setting in Singapore. Asian J Psychiatr. 2015;15:15–20.
Levis B, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 2019;365:I1476
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.
West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24:1318–21.
Hsieh YH, Hsu CY, Liu CY, Huang TL. The levels of stress and depression among interns and clerks in three medical centers in Taiwan – a cross-sectional study. Chang Gung Med J. 2011;34:278–85.
Yousuf A, Ishaque S, Qidwai W. Depression and its associated risk factors in medical and surgical post graduate trainees at a teaching hospital: a cross sectional survey from a developing country. J Pak Med Assoc. 2011;61:968–73.
Chan AO, Chan YH. Influence of work environment on emotional health in a health care setting. Occup Med. 2004;54:207–12.
Kalmbach DA, Arnedt JT, Xong PX, Guille C, Sen S. Sleep disturbance and short sleep as risk factors for depression and perceived medical errors in first-year residents. Sleep 2017;40:zsw073
Lebensohn P, Dodds S, Benn R, et al. Resident wellness behaviors: relationship to stress, depression, and burnout. Fam Med. 2013;45:541–9.
Firth-Cozens J. Emotional distress in junior house officers. BMJ. 1987;295:533–6.
Lebares CC, Guvva EV, Ascher N, et al. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226:80–90.
Acknowledgments
The author would like to thank Ms Li HuiHua for assistance with statistical analysis and Dr Lee Huei Yen for her support.
The study results were presented as a poster at the American Psychiatric Association 2019 Annual Meeting, San Francisco, United States.
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Kwok, C. Depression, Stress, and Perceived Medical Errors in Singapore Psychiatry Residents. Acad Psychiatry 45, 169–173 (2021). https://doi.org/10.1007/s40596-020-01376-w
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DOI: https://doi.org/10.1007/s40596-020-01376-w