Study indicates high self-rated lifetime prevalence of depression among psychiatrists

This study addresses depression and burn-out among a sample of psychiatrists collected at a professional congress. Within several constraints, the results indicate an high self-rated lifetime prevalence of depression of 41.6% among the sample. Also noteworthy is that a fifth (20.3%) of the sample showed evidence of acute depressive symptoms.

A study published in the current issue of Psychotherapy and Psychosomatics addresses depression and burn-out among psychiatrists. Numerous studies have shown that physicians have a high risk of developing depression or burnout syndrome. Data gained from smaller samples indicate that psychiatrists and psychotherapists are at particular risk of developing psychological problems. In this cross-sectional study, a group of German investigators examined the mental health of psychiatrists and psychotherapists in a larger German sample while focusing on depression, burnout and effort-reward imbalance. At the annual congress of the German Association of Psychiatry,

Psychotherapy and Nervous Diseases (DGPPN) in 2006, the investigators distributed 2,430 questionnaires (return rate 51.8%); 1,089 questionnaires of 570 males (52%) and 519 females (48%) formed the final sample. The mean age was 45.4 years (SD = 8.5, range 26-69 years). The questionnaire contained questions on personal status, work situation and medication intake.

The following self-rating scales were included: Beck Depression Inventory (BDI), Maslach Burnout Inventory-D and Effort-Reward Imbalance Questionnaire.  On the BDI, 868 of 1,089 (79.7%) scored < 11, indicating little or no current depression, 159 (14.6%) between 11 and 17 points, suggesting a mild depression, and 62 (5.7%) scored ≥ 18 points indicating at least moderate depression. Moreover, 450 of 1,081 (41.6%) psychiatrists indicated they had suffered at least one depressive episode according to the ICD-10 criteria; 152 of 472 (32.2%) reported a depressive episode diagnosed by a specialist; 23 of 1,082 (2.1%) had attempted suicide.

At the time of the study, 46 of 1,086 (4.2%) were undergoing psychotherapy, and 324 of 1,089 (29.7%) had completed psychotherapeutic treatments beyond the psychotherapy sessions mandatory for training in psychiatry. Of the 1,077 who replied, 13.3% took at least one psychotropic or analgesic medication regularly at the time of the study: 63 (5.9%) antidepressants, 27 (2.5%) sedatives, and 74 (6.9%) analgesics. An emotional exhaustion score of > 4.5 was reached by 131 of 1,089 (12.0%) of the sample, but only 8 (0.7%) scored > 4.5 for depersonalisation, and only 2 (0.2%) scored < 2.5 for personal accomplishment. A negative effort-reward imbalance (>1) was shown by 163 of 841 (19.3%) in the sample, whereas 114 (10.5%) of the total sample (n = 1,087) displayed evidence of overcommitment.

One substantial finding of the study is the high self-rated lifetime prevalence of depression of 41.6% among these psychiatrists. Also noteworthy is that a fifth (20.3%) of the sample showed evidence of acute depressive symptoms. One possible interpretation is that psychiatrists are subject to more strain than the normal population (e.g. the handling of suicidal or aggressive patients). On the other hand, psychiatrists are more sensitive to depressive symptoms, more aware of their own mental symptoms, and probably have a higher ability for introspection.

The major limitations of this study are that it is based on a sample collected at a professional congress and it is cross-sectional in nature; thus, the results are not generalisable to other collectives. Further longitudinal studies that compare, for example, psychiatrists with physicians of other medical specialisations are necessary to determine the specificity of the these results and to analyse how stress, due to a specific work, can cause burnout and depression.