Data from a recent study show a clear need to further reduce the number of hours residents work each week on average to decrease the occurrence of depression.
A greater percentage of participants who worked many hours in a stressful job had scores that would qualify them for a diagnosis of moderate to severe depression compared with those working fewer hours, according to data presented in a recent study. Using advanced statistical methods, the research team created a clinical trial that accounts for multiple other factors in doctors’ personal and professional lives.
A “dose response” effect was found between hours worked and depression symptoms, with an average symptom increase of 1.8 points on a standard scale for those working 40 to 45 hours, ranging up to 5.2 points for those working more than 90 hours. The study authors concluded that among all stressors affecting physicians, working a lot of hours is a major contributor to depression.
The findings were based off studying 11 years’ worth of data on more than 17,000 first-year medical residents who were training in hundreds of hospitals across the United States. The Intern Health Study, based at the Michigan Neuroscience Institute and the Eisenberg Family Depression Center, recruits new medical school graduates each year to take part in a year of tracking their depressive symptoms, work hours, sleep, and more while completing their first year of residency, or their intern year.
The interns in the study reported a wide range of previous-week work hours, with the most common work hour levels between 65 to 80 hours per week. The Accreditation Council for Graduate Medical Education (ACGME), which sets national standards for residency programs, currently sets an 80-hour limit on residents’ work weeks, but that can be averaged over 4 weeks with possible exceptions.
Additionally, AGCME limits the length of a single shift and the number of days in a row that residents can work. The studies have shown mixed results about the impact these limits have had on resident wellness and patient safety risks.
The study authors noted that their findings point to a clear need to further reduce the number of hours residents work each week on average.
"This analysis suggests strongly 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 who develop diagnosable depression," said study senior author Amy Bohnert, PhD, a professor at the U-M Medical School, in a press release. "The key thing is to have people work fewer hours; you can more effectively deal with the stresses or frustrations of your job when you have more time to recover."
The recent study uses a design called an emulated clinical trial, which mimics a randomized clinical trial in scenarios where conducting a real randomized trial is not feasible. Due to the nature of all interns nationwide beginning at the same time of year and being subject to varying work schedules set by their programs, analyzing people going through this stage of medical trial is crucial for the clinical trial.
The study authors suggest that studies parallel to this work on physicians should be conducted in other high-stress and high-work-hour jobs.
"We would expect that the negative effect of long work hours on physician mental health would be present in other professions," Srijan Sen, MD, PhD, founder of the Intern Health Study, said in a press release.
The average age of physicians in the study was 27 years; additionally, 1 in 5 were training in surgical disciplines and 18% were from racial or ethnic groups traditionally underrepresented in the medical profession.
Furthermore, less than 1 in 20 met the criteria for moderate to severe depression at the start of the intern year. In total, 46% had a stressful life event such as family death or birth, or getting married, during their intern year. Moreover, 37% stated they had been involved in at least 1 medical error during the year.
The researchers noted that while analyzing the results, they adjusted for gender, neuroticism, pre-internship history of depression, early family environment, age, year they began internship, marital status, whether they had children, and stressful life events and medical errors during the intern year.
"National initiatives on clinician wellbeing have put increasing emphasis on the complex set of factors that affect clinician well-being, including the electronic health record, regulatory burden, resilience, workplace violence and culture," Sen said in a press release. "I think this emphasis has inadvertently led to the feeling that the problem is infinitely complicated and making real progress is hopeless. This paper demonstrates how big of an impact that the single factor of work hours has on clinician depression and wellbeing."
In stressful jobs, depression risk rises with hours worked, study in new doctors finds. ScienceDaily. October 19, 2022. Accessed October 25, 2022. https://www.sciencedaily.com/releases/2022/10/221019172305.htm