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Chahal K, Matwala K. A systematic review of the prevalence of burnout in orthopaedic surgeons. Ann R Coll Surg Engl 2024. [PMID: 38563052 DOI: 10.1308/rcsann.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Professional burnout is a syndrome of emotional exhaustion, depersonalisation and low sense of personal achievement related to the workplace. Orthopaedic surgeons train and practise in highly demanding environments. Understanding up-to-date trends in burnout, particularly following the COVID-19 pandemic, is vital. For this reason, we carried out a systematic review on this topic. METHODS A scoping literature review of two databases was conducted. Two authors independently screened articles and conflicts were resolved by panel discussion. Articles pertaining to orthopaedic surgeons that used validated scales and were peer reviewed research were included. Non-English or abstract-only results were excluded. RESULTS A total of 664 papers were identified in the literature search and 34 were included in the qualitative review. Among 8,471 orthopaedic surgeons, the mean burnout prevalence was 48.9%. The wide range in rate of burnout between the studies (15-90.4%) reflected the variety in setting, subspecialty and surgeon grade. Common protective factors comprised dedicated mentorship, surgeon seniority, sufficient exercise and family support. Substance abuse, malpractice claims, financial stress and onerous on-call responsibilities were risk factors. Burnout prevalence during the COVID-19 pandemic was not noticeably different; there were a number of pandemic-associated risk and protective factors. CONCLUSIONS Nearly one in two orthopaedic surgeons are burnt out. There is a paucity of data on the short and long-term impact of COVID-19 on burnout. Burnout has deep organisational, personal and clinical implications. Targeted organisational interventions are required to prevent burnout from irrevocably damaging the future of orthopaedic surgery.
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Affiliation(s)
- K Chahal
- Mid and South Essex NHS Foundation Trust, UK
| | - K Matwala
- Mid and South Essex NHS Foundation Trust, UK
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Egbe A, El Boghdady M. Anxiety and depression in surgeons: A systematic review. Surgeon 2024; 22:6-17. [PMID: 37852902 DOI: 10.1016/j.surge.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The unique pressures of a surgical career put surgeons at particular risk of mental health conditions, including anxiety and depression. Surgeons have previously been shown to have a high prevalence of psychological distress. This study aimed to systematically review the prevalence of anxiety and depression amongst surgeons, and to identify factors that can modify the risk of anxiety and depression in surgeons. METHODS A 10-year systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines to identify citations related to the keywords "anxiety" OR "depression" AND "surgeon" in PubMed/Medline and ScienceDirect databases. Inclusion and exclusion criteria were applied to produce a final list of citations. RESULTS Thirty-one citations were included with a total of 11,399 participants. The median percentage of anxiety in surgeons was 20 with a range of 54.6%. While the median percentage of depression was 24 with a range of 59%. Risk factors associated with a higher risk of anxiety and depression include female gender, younger age, concurrent burnout, and occupational concerns regarding the COVID-19 pandemic. Protective factors include institutional support and a sense of social belonging. CONCLUSIONS There was a high prevalence of anxiety and depression amongst surgeons over the past decade. It is imperative to develop strategies to mitigate the effect of anxiety and depression in surgeons.
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Affiliation(s)
- Azelle Egbe
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael El Boghdady
- St George's University Hospitals NHS Foundation Trust, London, UK; University of Edinburgh, UK.
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Navinés R, Olive V, Hidalgo-Mazzei D, Langohr K, Vieta E, Martin-Santos R. Burnout in residents during the first wave of the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1286101. [PMID: 38328517 PMCID: PMC10847582 DOI: 10.3389/fpsyt.2023.1286101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The high prevalence of burnout in resident physicians is expected to have increased as a result of the expansion of the pandemic. We conducted a systematic review with a meta-analysis of studies conducted during the first wave of the COVID-19 pandemic on burnout in residents and potential associated risk factors. Methods The search was done in the Web of Science, MEDLINE, Scopus, and Lillac databases (April 2020-October 2021) using a priori protocol based on the PRISMA guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. We estimated the pooled prevalence (95% CI) of burnout and the prevalence ratio (95% CI) of each risk factor associated. Results We included 23 studies from 451 potential initial articles and those written in the English language; all of the collected studies were cross-sectional with anonymous online surveys, involving 4,998 responders (34%), of which 53.2% were female responders, 51% were R1-2, and 71% were in direct contact with COVID-19 patients. Eighty-seven percent presented a low-to-moderate risk of bias. Publication bias was not shown. The estimated pooled prevalence of burnout was 40% (95% CI = 0.26 - 0.57). Burnout was associated with psychiatry history (PR = 4.60, 95% CI = 1.06 - 20.06). There were no differences by gender, civil status, children in-charge, year of residency, or time exposure to COVID-19. Discussion The overall prevalence of burnout in residents during the first wave of the pandemic was in line with the results described in this collective before the pandemic. The presence of a psychiatry history was a potential burnout risk factor, suggesting a high vulnerability during the peak of the stress period and the need to implement mental health surveillance for this subgroup.
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Affiliation(s)
- Ricard Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Victoria Olive
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
- Department of Occupational Risk and Prevention, Hospital Clinic, University of Barcelona (UB), Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Klaus Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona Tech, Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
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Zohn JH, Hovis S. The impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers: A narrative review. J Clin Nurs 2024; 33:224-241. [PMID: 36797214 DOI: 10.1111/jocn.16651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in the United States. Worldwide, over 700,000 people die by suicide each year. Healthcare workers are more vulnerable to suicide risk factors than the general population. The global COVID-19 pandemic presents additional workplace and health concerns that relate to suicide risk factors in healthcare workers. It is important to recognise suicide risk factors in healthcare workers and to implement strategies to reduce these risk factors. OBJECTIVES This study describes the impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers and identifies evidence-based strategies and resources to reduce suicide risk factors in healthcare workers. DESIGN The authors conducted a thematic analysis and narrative review of the literature. METHODS Using health science databases, the authors searched the literature, selected and analyzed studies, identified themes, synthesised findings and created a narrative review. The STROBE checklist was used in this study. RESULTS Two themes were identified (1) The impact of the COVID-19 pandemic on work-related suicide risk factors in healthcare workers; (2) The impact of the COVID-19 pandemic on mental health-related suicide risk factors in healthcare workers. The pandemic has affected suicide risk factors in healthcare workers. Many studies discussed evidence-based strategies and resources that can be used to reduce suicide risk factors. CONCLUSION The global COVID-19 pandemic has negatively impacted suicide risk factors in healthcare workers. It is time for individuals and healthcare delivery systems to implement suicide risk prevention strategies to protect healthcare workers now and in the future. RELEVANCE TO CLINICAL PRACTICE This review increases awareness of the pandemic's impact on healthcare workers' risk factors for suicide and identifies evidence-based suicide risk prevention strategies and resources for healthcare workers. PATIENT OR PUBLIC CONTRIBUTION Library services supported this research by generating search strategies and providing resources and tools.
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Affiliation(s)
- Jennifer H Zohn
- University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
| | - Sophia Hovis
- University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
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Gordon AM, Elali FR, Ton A, Schwartz JM, Miller C, Alluri RK. Preoperative Depression Screening in Primary Lumbar Fusion: An Evaluation of Its Modifiability on Outcomes in Patients with Diagnosed Depressive Disorder. World Neurosurg 2023; 176:e173-e180. [PMID: 37178911 DOI: 10.1016/j.wneu.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Studies have reported the detrimental effects of depression following spine surgery; however, none have evaluated whether preoperative depression screening in patients with a history of depression is protective from adverse outcomes and lowers health care costs. We studied whether depression screenings/psychotherapy visits within 3 months before 1- to 2-level lumbar fusion were associated with lower medical complications, emergency department utilization, readmissions, and health care costs. METHODS The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1- to 2-level lumbar fusion. Two cohorts were 1:5 ratio matched and included DD patients with (n = 2,622) and DD patients without (n = 13,058) a preoperative depression screen/psychotherapy visit within 3 months of lumbar fusion. A 90-day surveillance period was used to compare outcomes. Logistic regression models computed odds ratio (OR) of complications and readmissions. P value < 0.003 was significant. RESULTS DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR 2.71, P < 0.0001). Rates of emergency department utilization were increased in patients without screening versus screening (15.78% vs. 4.23%; OR 4.25, P < 0.0001), despite no difference in readmissions (9.31% vs. 9.53%; OR 0.97, P = 0.721). Finally, 90-day reimbursements ($51,160 vs. $54,731) were significantly lower in the screened cohort (all P < 0.0001). CONCLUSIONS Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, emergency department utilization, and health care costs. Spine surgeons may use these data to counsel their patients with depression before surgical intervention.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA; Questrom School of Business, Boston University, Boston, Massachusetts, USA.
| | - Faisal R Elali
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA; College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jake M Schwartz
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Chaim Miller
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Schmerler J, Solon L, Harris AB, Best MJ, LaPorte D. Publication Trends in Research on Mental Health and Mental Illness in Orthopaedic Surgery: A Systematic Review. JBJS Rev 2023; 11:01874474-202306000-00014. [PMID: 37327350 DOI: 10.2106/jbjs.rvw.23.00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mental health conditions affect tens of millions of Americans. In recent years, particularly with the advent of the coronavirus disease 2019 pandemic, there has been a burst of interest in mental health and mental illness among orthopaedic surgical patients. The mental health of orthopaedic surgeons themselves has also come into focus, with high reported rates of burnout and depression. The aim of this article was to evaluate trends in publication on mental health and mental illness in orthopaedic surgery. METHODS Web of Science and PubMed were queried to conduct a systematic review. Studies that discussed orthopaedic surgery and mental illnesses or mental health topics over 2001 to 2022 were included. Publications were analyzed by article-, author-, and topic-level characteristics. RESULTS A total of 416 studies were analyzed after application of inclusion and exclusion criteria. Publication volume increased dramatically, demonstrating quadratic growth over 2001 to 2022 (p < 0.001). Eighty-eight percent of studies focused on patients and 10% on surgeons, with studies about patients more likely to focus on mental illness and those about surgeons more likely to focus on mental health (p < 0.001). Twenty percent of publications had a female senior author, and 5 authors collectively accounted for 10% of all publications. Eight journals published more than 10 publications, accounting for 35% of all publications. The most productive subspecialties were arthroplasty (135, 30%), general orthopaedics (87, 21%), and spine (69, 17%). Mental illnesses that were least represented included schizophrenia, bipolar disorder, eating disorders, attention-deficit/hyperactivity disorder, and personality disorders (1% or less of total publications each). CONCLUSION This analysis showed a dramatically increasing trend in publications on mental health and mental illness in orthopaedic surgery. A high concentration of publications came from a subset of journals and senior authors, and women were overrepresented as senior authors relative to their representation in the field. The results of this analysis identified gaps in the literature, including underrepresented subspecialties, understudied mental illnesses, and study of orthopaedic surgeon mental health, and thus highlighted areas for future investigation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Parija S, Dash N, Patra S, Nayak S. Mental health status of ophthalmology residents during COVID-19 pandemic-A national online survey. Indian J Ophthalmol 2023; 71:2287-2290. [PMID: 37202976 PMCID: PMC10391508 DOI: 10.4103/ijo.ijo_2209_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Affiliation(s)
- Sucheta Parija
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nikita Dash
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Saurav Nayak
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Klimberg VS. Teletransformation: Global Telesolutions and the Transformation of Surgical Care and Education. J Am Coll Surg 2023; 236:535-542. [PMID: 36633315 DOI: 10.1097/xcs.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- V Suzanne Klimberg
- From the Department of Surgery, UTMB Cancer Center: The University of Texas Medical Branch at Galveston Cancer Center, Galveston, TX
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Alkhamees AA, Aljohani MS, Kalani S, Ali AM, Almatham F, Alwabili A, Alsughier NA, Rutledge T. Physician's Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054598. [PMID: 36901612 PMCID: PMC10001574 DOI: 10.3390/ijerph20054598] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 05/09/2023]
Abstract
The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and abstracts of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for eligibility, which resulted in 30 studies being included in the final reviews and subsequent analyses. Among them, the prevalence of physicians' burnout rate ranged from 6.0-99.8%. This wide variation could be due to the heterogeneity among burnout definitions, different applied assessment tools, and even cultural factors. Further studies may consider other factors when assessing burnout (e.g., the presence of a psychiatric disorders, other work-related and cultural factors). In conclusion, a consistent diagnostic indices for the assessment of burnout is required to enable consistent methods of scoring and interpretation.
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Affiliation(s)
- Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
- Correspondence:
| | - Moath S. Aljohani
- Department of Family and Community Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Simindokht Kalani
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan 8174673441, Iran
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 5424041, Egypt
| | - Fahad Almatham
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Afnan Alwabili
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Naif Abdullah Alsughier
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Thomas Rutledge
- VA San Diego Healthcare System, Department of Psychiatry, Psychology Service, University of California San Diego, San Diego, CA 92093, USA
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Burnout und Abhängigkeit bei ärztlichem Personal zeitlos und während der COVID-19-Pandemie am Beispiel der Chirurgie und Anästhesie. DIE CHIRURGIE 2022; 93:1063-1071. [PMID: 35737018 PMCID: PMC9219363 DOI: 10.1007/s00104-022-01675-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/02/2022]
Abstract
Hintergrund Die COVID-19(„coronavirus disease 2019“)-Pandemie wirkt sich auf die psychische Gesundheit und das berufliche Verhalten von Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen aus und scheint einen Einfluss auf die Substanzabhängigkeit zu haben. Fragestellung Welche Gründe gibt es für das Auftreten einer Substanzabhängigkeit und einem Burnout bei Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen zeitlos und während der COVID-19-Pandemie und welche Verbesserungsmaßnahmen könnten im klinischen Alltag helfen? Material und Methoden Es wurde eine Literaturrecherche in Form einer systematischen Übersicht („systematic review“) zu Studien und Übersichtsarbeiten durchgeführt, die für das Thema relevant sind. Ergebnisse Im Laufe der Jahre hat sich gezeigt, dass Chirurgen bzw. Chirurginnen und Anästhesisten bzw. Anästhesistinnen aufgrund ihres direkten Zugangs zu Medikamenten in der Klinik und der arbeitsbezogenen Stressbelastung zur Drogenabhängigkeit neigen. Insbesondere Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen schienen eine erhöhte Neigung zur Suchterkrankungen und ein erhöhtes Burnout-Risiko in der Pandemie vorzuweisen. Schlussfolgerungen Präventive Maßnahmen zugunsten besserer Arbeitsbedingungen in der Chirurgie und Anästhesie und eine bessere Drogenkontrolle (nicht nur wegen der Ausgabe, sondern auch wegen der richtigen Drogentests) sowie mehr Therapie- und Wiedereingliederungsprogramme unter psychiatrischer Begleitung und in Zusammenarbeit mit einem multidisziplinären Team sind sinnvoll.
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