Psychiatrist burnout: a meta-analysis of Maslach Burnout Inventory means

The RANZCP Workforce Report: Action is needed, now

OBJECTIVE

The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous research, discussing the implications and proposing potential interventions.

CONCLUSIONS

Members of the RANZCP reported worsening workforce shortages, with 9 in 10 respondents stating that these negatively impacted patient care, and 7 in 10 experiencing symptoms of burnout. Eighty per cent identified workforce shortages as the top contributing factor to such burnout. The aetiology of workforce shortages and burnout is likely due to operational and structural shortfalls in psychiatric services. However, public and private sector employment information was not included in the report. There are a range of strategic, evidence-based interventions to address the psychiatrist and trainee workforce challenges, comprising general healthcare service as well as specific initiatives. Based on the findings of the report, such interventions are needed, now.

Psychological Capital and Turnover Intention: The Mediating Role of Burnout among Healthcare Professionals

Psychological capital (PsyCap) has been identified as an individual's positive psychological state of development that can help to reduce negative organizational outcomes. However, there is still a gap in understanding how PsyCap influences different aspects of organizations. This study investigates the mediating role of burnout in the relationship between PsyCap and turnover intentions among healthcare professionals. A cross-sectional survey was conducted among 320 healthcare professionals. The estimation of the relationships between PsyCap, burnout, and turnover intentions was obtained through structural equation modelling (SEM). A mediation analysis was carried out using bootstrapping procedures. The results show that burnout has a significant and positive effect on turnover intention and PsyCap has a significant and negative effect on burnout. Moreover, burnout fully mediates the relationship between PsyCap and turnover intention. These findings suggest that PsyCap can effectively reduce negative outcomes like burnout, but its positive impact may be limited when considering other outcomes such as turnover intention.

Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years

BACKGROUND

This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years.

METHODS

At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported.

RESULTS

The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively.

CONCLUSIONS

Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established.

TRIAL REGISTRATION

The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.

Depression, anxiety, and burnout among psychiatrists during the COVID-19 pandemic: a cross-sectional study in Beijing, China

BACKGROUND

With the rise of reported mental disorders and behavioral issues after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, psychiatrists and mental health care are urgently needed more than ever before. The psychiatric career carries a high emotional burden and stressful demands, which bring issues on psychiatrists' mental health and well-being into question. To investigate the prevalence and risk factors of depression, anxiety, and work burnout among psychiatrists in Beijing during the COVID-19 pandemic.

METHODS

This cross-sectional survey was conducted from January 6 to January 30, 2022, two years after COVID-19 was declared a global pandemic. Recruitment was performed using a convenience sample approach by sending online questionnaires to psychiatrists in Beijing. The symptoms of depression, anxiety, and burnout were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). The perceived stress and social support were measured by the Chinese Perceived Stress Scale (CPSS) and Social Support Rating Scale (SSRS), respectively.

RESULTS

The data of 564 psychiatrists (median [interquartile range] age, 37 [30-43] years old) of all 1532 in Beijing were included in the statistical analysis. The prevalence of symptoms of depression, anxiety and burnout were 33.2% (95% CI, 29.3-37.1%, PHQ-9 ≥ 5), 25.4% (95% CI, 21.8-29.0%, GAD-7 ≥ 5) and 40.6% (95% CI, 36.5-44.7%, MBI-GS ≥ 3 in each of the three subdimensions), respectively. The psychiatrist with a higher score on perceived stress was more likely to suffer from depressive symptoms (adjusted odds ratios [ORs]: 4.431 [95%CI, 2.907-6.752]); the anxiety symptoms (adjusted ORs: 8.280 [95%CI, 5.255-13.049]), and the burnout conditions (adjusted ORs: 9.102 [95%CI, 5.795-14.298]). Receiving high social support was an independent protective factor against symptoms of depression (adjusted ORs: 0.176 [95%CI, [0.080-0.386]), anxiety (adjusted ORs: 0.265 [95%CI, 0.111-0.630]) and burnout (adjusted ORs: 0.319 [95%CI, 0.148-0.686]).

CONCLUSIONS

Our data suggest a considerable proportion of psychiatrists also suffer from depression, anxiety, and burnout. Perceived stress and social support influence depression, anxiety, and burnout. For public health, we must work together to reduce the pressure and increase social support to mitigate mental health risks in psychiatrists.

The prevalence and risk factors of burnout and its association with mental issues and quality of life among hungarian postal workers: a cross-sectional study

BACKGROUND

Burnout is one of the most extensively studied phenomena of the twenty-first century; which has been extensively studied among helping professions, although it can be broadened to several other types of occupation. Based on our knowledge and literature search, no similar studies have been carried out among postal workes to date.

METHODS

This cross-sectional questionnaire-based epidemiological study was carried out between May 2021 and January 2022 in five counties in Hungary with the recruitment of postal delivery workers focusing on (1) the prevalence of burnout among postal delivery workers; (2) including the role of demographic parameters, duration of employment as well as the presence of secondary employment; (3) and also analyzed the role of several risk factors and medical conditions; (4) and we also examined the possible association between depression, insomnia and quality of life and burnout.

RESULTS

Overall 1300 questionnaires were successfully delivered and 1034 responses received (response rate of 79.5%). Three hundred sixty-eight males (35.6%) and six hundred sixty-six females (64.4%) participated in our study. The prevalence of burnout was 50.8% (525/1034) in this study population (mean score 2.74 ± 0.33). Logistic regression analysis showed that female gender [OR = 2.380, 95% CI: 1.731 to 2.554], first workplace [OR = 1.891, 95% CI: 1.582 to 2.162] and working more than 30 years [OR = 1.901, 95% CI: 1.608 to 2.326] have significantly increased the likelyhood of burnout as well as the history of muscoskeletal pain [OR = 1.156, 95% CI: 1.009 to1.342], current quality of life [OR = 1.602, 95% CI: 1.473 to 1.669] and the presence of sleep disturbance [OR = 1.289, 95% CI: 1.066 to 1.716].

CONCLUSION

This is the first study in Hungary to investigate the prevalence of burnout among postal workers and to explore the relationship between burnout and mental health problems. Our study underlines the clinical importance of burnout and draws attention to the need for appropriate prevention and treatment strategies.

Psychiatrist and trainee burnout: Commentary and recommendations on management

OBJECTIVE

To comment upon the evidence-base regarding psychiatrist and trainee burnout and provide recommendations on management.

CONCLUSIONS

Burnout has been conceptualised as a specific stress-related response, primarily related to work. There is a high prevalence of burnout amongst both trainees and psychiatrists internationally, with substantial consequences for personal and family wellbeing, organisational efficiency and patient care. We summarise the evidence on organisational and individual approaches to addressing burnout.

Burnout and psychological symptoms in healthcare workers during the COVID-19 pandemic: Comparisons of different medical professions in a regional hospital in Turkey

BACKGROUND: Early studies have revealed the psychological effects of the COVID-19 outbreak on healthcare workers (HCWs). Burnout and psychological outcomes of different medical professions during the pandemic have not yet been addressed. OBJECTIVE: The study aimed to investigate the burnout, depression, anxiety, and psychological distress levels of HCWs, and to determine the predictive factors of burnout in different professions of frontline HCWs during the pandemic. METHODS: This cross-sectional study included 253 HCWs (79 physicians, 95 nurses, and 79 other-HCWs). The Maslach Burnout Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and Impact of Event Scale-Revised, and Sociodemographic Form were used. RESULTS: Emotional exhaustion was significantly higher in physicians and nurses than in other frontline HCWs. While depersonalization was significantly higher in physicians than nurses / other HCWs, levels of avoidance, hyperarousal and intrusion were found to be higher in other HCWs / nurses than physicians. Depression was the most effective predicting variable for burnout, following age, quarantine, supervisor’s/team leader’s attitude, hyperarousal and avoidance. CONCLUSIONS: It has been observed that depending on the uncertainty and life risk of the pandemic in HCWs involved in the treatment of COVID-19, physicians who are the decision-making authorities in the treatment process used more depersonalization than nurses and other HCWs. Nurses and other-HCWs had significantly higher distress symptoms than physicians. Both future research and psychosocial services should address those with high depressive symptoms as a potentially fragile subgroup for burnout among HCWs, and investigate and develop evidence-based interventions that can provide mental well-being, and prevent burnout.

Prevalence of burnout among psychiatrists: A systematic review and meta-analysis

BACKGROUND

Burnout is a consequence of chronic occupational stress exposure. Psychiatrists are prone to burnout due to specific work-related factors. This study examined the burnout prevalence among psychiatrists.

METHODS

The study protocol was registered in PROSPERO (CRD42020204615). We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, Web of Science, ClinicalTrials.gov, and OpenGrey for relevant publications. Random-effect meta-analysis was performed. We used subgroup analysis and meta-regression to reveal any association of geographical region, survey year, participants' age, gender, and response rate with burnout.

RESULTS

Thirty-six studies involving 5481 participants were included. The prevalence of overall burnout was 25.9% [11.1%-40.7%] as measured by a Maslach Burnout Inventory (MBI) and 50.3% [30.9%-69.8%] as measured by a Copenhagen Burnout Inventory (CBI). The pooled prevalence was 43.5% [27.9%-59%] for high emotional exhaustion (EE), 28.2% [17.5%-38.9%] for high depersonalization (DP), and 32.4% [3.4%-61.3%] for low personal accomplishment (PA). The mean scores of 22-item MBI subscales were 21.51 [18.64%-24.38%] for EE, 6.57 [5.53%-7.62%] for DP, and 31.83 [25.73%-37.94%] for PA. European psychiatrists revealed (p = 0.045) lower EE score (20.82; 95% CI 7.24-24.41) measured by 22-item MBI compared to their non-European colleagues (24.99; 95% CI 23.05-26.94). Other results include mean scores for 16-item MBI-General Survey, burnout rates, and scores in CBI subscales.

LIMITATIONS

The main limitation was high heterogeneity in terms of statistics, screening methods, burnout definitions, and cut-off points utilized in included studies.

CONCLUSIONS

Burnout is highly prevalent among psychiatrists. Future research should focus on finding consensus on burnout screening, longitudinal evaluation of psychiatrists' burnout predictors, and development of effective intervention strategies.

Reflections on, and responses to, managerial adverse reactions to healthcare advocacy by psychiatrists and trainees

OBJECTIVE

For psychiatrists and trainees, to reflect upon adverse managerial reactions to healthcare advocacy about patient care and safety, drawing upon examples from general healthcare settings, and to share approaches to addressing these reactions.

CONCLUSIONS

Psychiatrists and trainees engaging in healthcare advocacy may face adverse responses from healthcare management, with personal and professional consequences. Advocates need to consider counterstrategies to negative actions by management that may include workplace incivility, bullying and harassment. Health advocacy is more effective within a network of peers, patients and the broader community, including medico-political professional organisations, such as the Australian Medical Association, Royal Australian and New Zealand College of Psychiatrists, and Unions. These organisations should advocate openness to doctors highlighting healthcare safety and quality, as well as prevention of workplace bullying.

Acoustic and Facial Features From Clinical Interviews for Machine Learning-Based Psychiatric Diagnosis: Algorithm Development

BACKGROUND

In contrast to all other areas of medicine, psychiatry is still nearly entirely reliant on subjective assessments such as patient self-report and clinical observation. The lack of objective information on which to base clinical decisions can contribute to reduced quality of care. Behavioral health clinicians need objective and reliable patient data to support effective targeted interventions.

OBJECTIVE

We aimed to investigate whether reliable inferences-psychiatric signs, symptoms, and diagnoses-can be extracted from audiovisual patterns in recorded evaluation interviews of participants with schizophrenia spectrum disorders and bipolar disorder.

METHODS

We obtained audiovisual data from 89 participants (mean age 25.3 years; male: 48/89, 53.9%; female: 41/89, 46.1%): individuals with schizophrenia spectrum disorders (n=41), individuals with bipolar disorder (n=21), and healthy volunteers (n=27). We developed machine learning models based on acoustic and facial movement features extracted from participant interviews to predict diagnoses and detect clinician-coded neuropsychiatric symptoms, and we assessed model performance using area under the receiver operating characteristic curve (AUROC) in 5-fold cross-validation.

RESULTS

The model successfully differentiated between schizophrenia spectrum disorders and bipolar disorder (AUROC 0.73) when aggregating face and voice features. Facial action units including cheek-raising muscle (AUROC 0.64) and chin-raising muscle (AUROC 0.74) provided the strongest signal for men. Vocal features, such as energy in the frequency band 1 to 4 kHz (AUROC 0.80) and spectral harmonicity (AUROC 0.78), provided the strongest signal for women. Lip corner-pulling muscle signal discriminated between diagnoses for both men (AUROC 0.61) and women (AUROC 0.62). Several psychiatric signs and symptoms were successfully inferred: blunted affect (AUROC 0.81), avolition (AUROC 0.72), lack of vocal inflection (AUROC 0.71), asociality (AUROC 0.63), and worthlessness (AUROC 0.61).

CONCLUSIONS

This study represents advancement in efforts to capitalize on digital data to improve diagnostic assessment and supports the development of a new generation of innovative clinical tools by employing acoustic and facial data analysis.

Role Stress and Psychological Distress Among Chinese Nurses During the COVID-19 Pandemic: A Moderated Mediation Model of Social Support and Burnout

OBJECTIVE

Nurses are at high risk of psychological distress including stress, depression, and anxiety due to low personnel density and high work demand. Despite mounting evidence showing that role stress is a risk factor for nurses' psychological distress, the mediating and moderating mechanisms underlying this relationship are less known. This study tests the mediation effect of burnout in the association between role stress and psychological distress, and whether this mediation is moderated by social support.

METHODS

A sample of 623 Chinese nurses were recruited from all hepatological surgery departments in Hunan Province and filled out an online questionnaire to collect data on socio-demographics, role stress, burnout, psychological distress, and social support. Mediation and moderation analyses were carried out in SPSS macro-PROCESS.

RESULTS

Burnout partially mediated the positive association between role stress and psychological distress. Social support moderated the indirect effect of role stress on psychological distress via burnout, with the effect being stronger for nurses with low social support than those with high social support.

CONCLUSIONS

These findings demonstrated how role stress contributed to nurses' psychological distress both directly and indirectly through burnout, and how this indirect effect was moderated by social support. The results provide important practical implications for future prevention and intervention programs to improve nurses' mental health from multiple aspects such as decreasing role stress and burnout while increasing social support.

Identifying Risk Factors for Self-reported Mental Health Problems in Psychiatry Trainees and Psychiatrists in Mexico

OBJECTIVE

The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees.

METHODS

A cross-sectional, retrospective, comparative study was conducted on a total of 330 (48.2%) psychiatry trainees and 355 (51.8%) psychiatrists from Mexico through an online survey. Demographic features, professional activities and adversities, physical and mental health problems, self-care behaviors, and social support were examined. Comparative analyses and multiple logistic regression models were performed.

RESULTS

Major depression, anxiety, and burnout were the most common mental health problems reported with a higher frequency of anxiety disorders in psychiatry trainees. Being a woman, having a physical health problem, and lack of restful sleep were the main risk factors in both groups. Consultation in the government sector and having patients with severe suicidal ideation affected more psychiatry trainees. Perceived discrimination and inadequate eating schedules were risk factors for mental health problems for psychiatrists.

CONCLUSION

Psychiatry trainees constitute a vulnerable group for anxiety disorders. Particular attention should be paid to how students cope with the training experience to determine whether additional support is required. These professionals face major stressors leading to a high prevalence of depression, burnout, and anxiety. Encouraging psychiatrists to have better health habits is a step in the right direction, which must be accompanied by tangible organizational avenues to do so and creating a culture that truly promotes self-care.

Mindfulness-Based Interventions to Reduce Burnout in Primary Healthcare Professionals: A Systematic Review and Meta-Analysis

Mindfulness-based interventions (MBIs) are reported by experimental studies as practical approaches to reduce burnout in primary healthcare professionals (PHCP). However, to date, no research has synthesized the evidence to determine the overall effects of MBIs for reducing burnout in PHCP. We conducted a systematic review and meta-analysis to analyze the effects of MBIs to reduce burnout in PHCP. We searched articles in the PubMed/MEDLINE, Web of Science, Cochrane, and Scopus databases from inception to September 2021 using MeSH terms: "mindfulness", "burnout", and "primary healthcare". Two reviewers extracted the data and assessed the risk of bias. We used a random-effects meta-analysis to calculate the standardized mean differences (SMD) and mean differences (MD) with 95% confidence intervals (CI) of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) domains of burnout. Of 61 records, ten were included (n = 417). Overall, the studies were rated as having a high risk of bias and limited quality evidence. MBIs significantly reduced EE (SMD = -0.54, 95%CI: -0.72 to -0.36; MD = -5.89, 95%CI: -7.72 to -4.05), DP (SMD = -0.34, 95%CI: -0.52 to -0.17; MD = -1.96, 95%CI: -2.96 to -0.95), and significantly increased PA (SMD = 0.34, 95%CI: 0.17 to 0.52; MD = 2.05, 95%CI: 1.04 to 3.06). Although further high-quality research is needed, our findings support the implementation of MBIs for reducing burnout in PHCP.

Psychological impact of an acute intervention on medical-psychological emergency unit professionals: the example of hurricane Irma

BACKGROUND

Medical-psychological emergency units (Cellules d'Urgence Médico-Psychologiques, CUMP) are deployed following major events where there is a risk of psychological trauma, in order to provide acute and proper psychological care for the victims.

AIMS

To describe and evaluate the risk of a psychological impact on CUMP professionals after their participation in the aftermath of the hurricane Irma natural disaster. CUMP teams consist of medical and paramedical staff, who can have permanent or volunteer status. We reasoned that there might be a psychological and emotional impact on CUMP professionals, despite their own expertise in the field, after their intervention following hurricane Irma.

METHOD

A cross-sectional survey was conducted during a feedback meeting. Participating professionals completed a sociodemographic questionnaire and the Professional Quality of Life (ProQOL) scale (5th French version), which is composed of three subscales: compassion satisfaction, burnout and secondary traumatic stress (STS).

RESULTS

A total of 53 participants were included with 24 (45.3%) psychiatrists, 15 (28.3%) paramedical staff and 14 (26.4%) psychologists. The median age was 46 years (range 39-55.5) and 29 (54.7%) were women. We found that psychiatrists compared with other professions had higher secondary traumatic stress scores (P = 0.007) and that volunteer psychiatrists had higher burnout scores than permanent psychiatrists (P = 0.03).

CONCLUSIONS

These preliminary results suggest a psychological impact attributable to leadership status, which was reserved for psychiatrists. The results also underline the need for a supportive accompaniment for such teams by promoting formation improvement, psychological support and team cohesion.

Development of an enhanced acute care surgery service in response to the COVID-19 global pandemic

BACKGROUND

As the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions.

METHODS

An enhanced ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed.

RESULTS

There were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 min) and time from surgery to discharge (2.4-hours). The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised.

CONCLUSION

In healthcare systems not overwhelmed by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.

Thai psychiatrists and burnout: A national survey

Objectives

To explore the prevalence and factors that contribute to burnout among Thai psychiatrists.

Background

The practice of psychiatry can lead to emotional fatigue. As rates of emotional illness in Thailand continue to climb, increasing demands are placed on a limited number of psychiatrists. This can lead to burnout, and multiple negative physical and mental health outcomes.

Materials and methods

Electronic questionnaires were sent to all 882 Thai psychiatrists and residents via a private social media group managed by the Psychiatric Association of Thailand. The questionnaire included demographic data, the Maslach Burnout Inventory (MBI), the Proactive Coping Inventory, and questions about strategies that Thai psychiatrists believed reduce/prevent burnout.

Results

Questionnaires were sent and 227 (25.7%) responded. According to MBI, 112 (49.3%) of respondents reported high level of emotional exhaustion, and 60 (26.4%) had a high level of depersonalization. Nearly all respondents (99.6%) maintained a high level of personal accomplishment. Working more than 50 hours per week (p = 0.003) and more patients per day (p = 0.20) were associated with higher levels of burnout. Feeling satisfied with work (p<0.001) and having a good support system from family (p = 0.027) and colleagues (p = 0.033) were associated with lower levels of burnout. The coping mechanisms related to lower levels of burnout included more emotional support seeking (p = 0.005), more proactive coping (p = 0.047), and less avoidance (p = 0.005).

Conclusions

Compared to a previous study on burnout among Thai psychiatrists in 2011, in this study, the prevalence of high levels of burnout had increased dramatically from 17.1% to 49.3%. An intervention to decrease workload, strengthen social support and encourage proactive coping mechanisms may be beneficial for relieving burnout.

Surviving the Heart of Darkness: reflections on the experience of psychiatrists working in public mental health services in Australia

OBJECTIVE

We reflect upon the bleak experiential landscape of psychiatrists working in underfunded, under-resourced and demoralised public mental health services through the metaphorical narrative of Joseph Conrad's Heart of Darkness.

CONCLUSION

It remains difficult to navigate through the Heart of Darkness. We suggest some navigable markers that may stave off metaphorical running aground.

Update on Addressing Mental Health and Burnout in Physicians: What Is the Role for Psychiatry?

PURPOSE OF REVIEW

To highlight an emerging understanding of burnout and physician mental health. This review will provide a discussion of conceptual and diagnostic issues of the burnout syndrome with its relevance to psychiatry, and how psychiatry may interface with other medical disciplines to provide support in creating burnout prevention and treatment programs.

RECENT FINDINGS

Descriptive data of burnout correlations and risk factors are available while an understanding of burnout best practices is lacking but growing. Two recent meta-analyses provide efficacy data along with key subgroup analyses that point to greater efficacy among systemic/organizational over individual level interventions. Among individual interventions, groups work better than individual therapy and the incorporation of Mindfulness-Based Stress Reduction and/or Cognitive Behavioral Therapy modalities provide greater efficacy over other therapies. Ultimately, addressing burnout will be an iterative process specific to institutional cultures and therefore should be thought of as quality improvement initiatives involving leadership to adopt the quadruple aim of physician wellness and to seek institution-specific collaboration and feedback. Psychiatry is uniquely positioned to help change institutional cultures regarding the burnout syndrome, which has been labeled a national crisis. Combinatorial strategies that combine efficacious individual-level interventions with systemic-level interventions that enhance workflow will likely provide the most sustainable model for preventing and treating burnout. Psychiatry should be involved, especially at the level of the liaison psychiatrist to assist with how these types of interventions may be best implemented in specific institutions.