Tutty, Michael

Abstract Purpose This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. Method This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020-March 2021. Of 7360 survey respondents, 6497 (88.3%) completed the SI question. A probability-based sample included 2508 nonphysician individuals from the US population employed at the time of survey administration, with 2501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate the associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. Results The study included 6497 physicians and 2501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P = .09). In a multivariable model, workers in other fields with a bachelor’s or master’s degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). Conclusions IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.

Abstract Purpose To evaluate the correlation between occupational burnout and depression, frequency with which they coexist, how often 1 condition may be present in the absence of the other, and their association with suicidal ideation. Method The authors conducted a secondary analysis of cross-sectional national surveys of practicing U.S. physicians (conducted October 19, 2023, to March 3, 2024) and residents/fellows (“trainees”; conducted November 30, 2023, to January 2, 2024). They measured correlation between emotional exhaustion (EE) and depersonalization (DP) scores using the Maslach Burnout Inventory and depression T-scores using the National Institutes of Health Patient Reported Outcomes Measurement Information System Depression scale. Results A total of 5993 practicing physicians and 2676 trainees were included in the analysis. The pooled R2 value between EE and depression scores for physicians and trainees was 0.42 (P < .001) and between DP and depression scores was 0.28 (P < .001). Among the 4087 practicing physicians with normal depression scores, 1201 (29.4%) had high EE and/or high DP. Among the 1601 trainees with normal depression scores, 485 (30.3%) had high EE and/or high DP. On multivariable logistic regression adjusting for age, gender, relationship status, and work hours, each 1-point increase in depression T-score was associated with 15% higher odds of suicidal ideation among practicing physicians (OR 1.15; 95% CI, 1.13–1.17; P < .001) and trainees (OR 1.15, 95% CI, 1.13–1.17; P < .001). No statistically significant association between EE or DP scores and suicidal ideation was observed. Conclusions Occupational burnout and depression are correlated but distinct constructs with distinct outcomes. Less than half the variation in burnout is explained by depression (and vice versa). Population health approaches to improve physician well-being should address both conditions. Organizational efforts should go beyond providing support for individuals experiencing distress and also address the work environment factors that contribute to it.