In one “emulated” clinical trial, longer workweeks were strongly linked to increased symptoms of depression, leading some first-year medical residents to experience moderate or severe depression.
In the study, working 90 or more hours a week was associated with changes in depression symptom scores. Photo: ShutterStock.
The research team, based at the University of Michigan, used advanced statistical methods to emulate a randomized clinical trial, taking into account many other factors in the personal and professional lives of physicians.
In the study, working 90 or more hours a week was associated with changes in depression symptom scores and was even three times higher than depression symptoms among those who worked 40 to 45 hours a week.
In addition, a large percentage of physicians had scores high enough to qualify for a diagnosis of moderate to severe depression, severe enough to warrant treatment.
The impact of a high number of working hours
This study comes as leading national organizations, such as the National Academy of Medicine and the Association of American Medical Colleges, grapple with how to address high rates of depression among physicians, physicians-in-training, and other health professionals. Although interns in the study reported a wide range of work hours, the most common work hour levels were between 65 and 80 hours per week.
A mature population for study
The new study uses a design called a emulated clinical trial, which simulates a randomized clinical trial in situations where an actual randomized trial is not feasible. Because nearly all interns across the country start around the same time of year and are subject to different work schedules set by their programs, studying people who go through this stage of medical training is ideal for emulating an essay. clinical.
This opportunity is what led the founder of the Intern Health Study, Srijan Sen, MD, Ph.D. to launch the research project in the first place: New doctors entering the most stressful year of their careers form a perfect group to study the role of many factors in the risk or onset of depression. The authors suggest that parallel studies to this work in physicians should be carried out in other high-level papers. stress and many hours of work. “We would expect that the negative effect of long working hours on physicians’ mental health would be present in other professions,” says Sen.
Regulation of working hours in the health area
The Accreditation Council for Graduate Medical Education, which sets national standards for residency programs, currently places an 80-hour limit on resident workweeks. ACGME also limits the length of a single shift and the number of days in a row that residents can work. Studies have shown mixed results on the impact these limits have had on resident well-being and patient safety risks.
The authors say their findings point to a clear need to further reduce the number of hours residents work each week on average.
“This analysis strongly suggests that reducing the average number of work hours would make a difference in the degree to which interns’ depressive symptoms increase over time and reduce the number of people who develop diagnosable depression,” says Amy Bohnert, Ph. D, one of the study authors and a professor at the UM School of Medicine. “The key is that people work fewer hours; can deal more effectively with stress or the frustrations of your job when you have more time to recover.”
Yu Fang, MSE, the study’s lead author and a research specialist at the Michigan Neuroscience Institute, notes that the number of hours is important, but so are the training opportunities that arise from time spent in hospitals and clinics. “It’s important to use time spent on the job for supervised learning opportunities and not for low-value clinical service tasks,” he says.
Population and important research findings
The average age of the doctors in the study was 27, and just over half were women. One in five were trained in surgical disciplines and 18% were from racial/ethnic groups traditionally underrepresented in the medical profession.
Fewer than 1 in 20 met criteria for moderate to severe depression at the start of the internship year. Overall, 46% had a stressful life event, such as the death or birth of a family member, or getting married, during their internship year, and 37% said they had been involved in at least one mistake medical during the year.
Analyzing the results, the researchers adjusted for gender, neuroticism, pre-internship history of depression, early family background, age, year internship began, marital status, parenting, and stressful events. of life and medical errors during the internship year.
Making a difference for today’s residents
“National physician wellness initiatives have placed increasing emphasis on the complex set of factors that affect physician wellness, including electronic health record, regulatory burden, resilience, workplace violence work and culture,” says Sen, director of EFDC and Eisenberg Professor of Depression and Neuroscience.
Sen is part of the National Academy of Medicine Task Force on Navigating the Impacts of COVID-19 on Clinician Wellbeing, part of a larger effort that recently issued a National Plan for Health Workforce Wellbeing. .
For his part, Fang also points out that data from US residents may apply to junior doctors, as they are called, in other nations. The Intern Health Study now also enrolls interns in China and Kenya.
Conclusion of the study and other related studies
The researchers found a “dose response” effect between hours worked and symptoms of depression, with an average increase in symptoms of 1.8 points on a standard scale for those working 40 to 45 hours, with a range of up to 5.2 points for those who worked more than 90 hours. They conclude that, among all the stressors that affect doctors, working long hours is one of the main contributors to depression.
Writing in the New England Journal of Medicine, the team from Michigan Medicine, the center medical UM scholar, reports his study findings of 11 years of data on more than 17,000 first-year medical residents. The newly graduated doctors were in training at hundreds of hospitals in the United States.
The data comes from the Intern Health Study, based at the Michigan Neuroscience Institute and the Eisenberg Family Depression Center. Each year, the study recruits new medical school graduates to participate in a year of tracking their depressive symptoms, work hours, sleep and more as they complete their first year of residency, also called an internship year.
Estimated mean change in PHQ-9 score for depressive symptoms during medical internship, by weekly work hour levels, among 17,082 participants in the Internal Health Study, 2009–2020.
Reference source here