Swintak, Cosima

Abstract Objective: Physicians, including psychiatrists and psychiatry trainees, are at higher risk of burnout compared to the average working population. The COVID-19 pandemic heightens this risk. The purpose of this pilot was to enhance professional fulfillment and sense of professional support while decreasing risk of burnout in Child and Adolescent Psychiatry (CAP) trainees’ through virtual delivery of a novel Balint-based well-being curriculum.Methods: The pilot included six CAP trainees. The 8 fortnightly 60 minute sessions were co-facilitated by a psychologist and psychiatrist. Sessions combined emotional awareness skills with a Balint-based approach to case review. The authors assessed trainee well-being, professional fulfillment, and sense of professional support pre- and post-intervention with the Well-being Index (WBI), Stanford Professional Fulfillment Index (PFI), and the authors’ own supplemental survey questions assessing sense of professional support.Results: Trainees found the curriculum feasible and useful. Pre- and post-intervention surveys showed a 23.3% reduction in burnout (p=0.027) as well as significant improvements in happiness at work, enthusiasm toward work, sensitivity to others, and connectedness with colleagues. The authors found positive trends in additional aspects of professional fulfillment and sense of professional support.Discussion: A novel well-being curriculum focused on combining emotional awareness skills with a Balint-like approach enhances professional fulfillment and a sense of professional support and decreases the risk of burnout, even when delivered virtually. Virtual delivery is especially important as such platforms play prominent roles during COVID-19. This pilot demonstrates feasibility and utility, and supports the planned expansion of this low-cost, high-value intervention for trainee well-being.

Purpose Physician suicide rates are reportedly higher than those of the general population, but medical student suicide rates are not well studied. It is difficult to determine whether physician suicide rates can be predicted by medical student risk factors for suicide and difficult to identify those risk factors without knowing medical student suicide rates. The authors systematically reviewed the literature to collate data on medical student suicide rates. Method The authors searched the PubMed, Web of Science, and Library of Congress databases for papers published in any language before November 11, 2017. They identified 3,429 papers; after the initial screening process, they assessed 82 full-text articles for eligibility. Twelve ultimately met the full inclusion criteria; meta-analysis was not possible. Data regarding medical student suicide numbers and rates were extracted and compared with contemporaneous general population suicide rates using public epidemiological data, when available. Results Medical student suicide rates were infrequently reported in the historical and international literature, and data collection techniques were inconsistent. Generally, U.S. medical student suicide rates were lower than those of the contemporaneous general population. Proportionate mortality of medical students (number of deaths by a particular cause such as suicide divided by total number of deaths) was not reported in the literature. Conclusions Gaps exist in knowledge of medical student suicide rates, risk factors, and targets for intervention. Significant barriers have impeded information collection. Yet, more comprehensive data collection is needed to understand suicide risk in this population and to implement and improve effective intervention strategies.

Major depressive disorder (MDD) is a severe illness that afflicts about 16.6% of people over their lifetime. MDD is highly correlated with suicidality, and often first presents in adolescence. Unfortunately, many pediatric patients suffering from MDD go undiagnosed, and current evidence-based treatment options in the U.S. are limited to psychotherapy and two selective serotonin reuptake inhibitors approved by the United States Food and Drug Administration. Molecular mechanisms have been shown to play a role in MDD pathogenesis, progression, and response to medication, yet few studies have explored the role of these pathways in pediatric MDD. In this review, we outline the gravity and importance of MDD in pediatric patients, some challenges in diagnosis and treatment, current treatments available for pediatric patients, and research to investigate differences between pediatric and adult MDD. We hope that this review will provide an outline of the current understanding and treatment of MDD in pediatric patients, and provide thoughtful insights for future work that could advance our understanding of MDD in pediatric populations, and also identify new therapeutic strategies.