Doctors in training who are depressed are more than six times as likely to make medication errors as their non-depressed colleagues, finds a US study published on bmj.com today.
Depression and burnout are highly prevalent among doctors in training in the US. Studies have found rates of burnout to be between 41 and 76%, while rates of depression range from 7 to 56%. Medication errors are also very common. In the US, up to 98,000 patients die each year due to medication errors, while in the UK, adverse events occur in more than 10% of hospital admissions, half of which may be preventable.
The stress of resident training, including sleep deprivation and lack of leisure time, are the most commonly cited explanations, yet few studies have sought to quantify the relationship with patient safety. So researchers set out to determine the prevalence of depression and burnout among 123 paediatric residents at three children's hospitals in the United States and to establish if a relationship exists between these disorders and medication errors.
One in five (20%) of the participating residents were depressed and almost three quarters (74%) were burned out, according to recognised criteria. During the survey period, a total of 45 medication errors were made by participants. Those who were depressed made 6.2 times as many medication errors as their non-depressed colleagues.
However, burnout did not appear to be associated with higher rates of medication errors. These findings indicate that mental health may be a more important contributor to patient safety than previously suspected, say the authors. The high burnout rate in this study, which is consistent with other studies, also raises questions about whether current methods of doctors' training generate avoidable stress that is detrimental to the health of residents, they add.
The authors acknowledge several study limitations, including the fact that they collected their data before the implementation of work hour limits for residents in the US. However, recent studies suggest that work hour changes significantly decreased burnout scores but did not alter rates for depression.
Our results highlight the need for better research on the mental health of doctors, write the authors. Further efforts to study and improve the working conditions and mental health of doctors should be a priority, they conclude.
Although the suggestion that medication errors may be linked to depression and burnout seems reasonable, these results are far from conclusive, warn researchers from the University of Aberdeen in an accompanying editorial. Large, prospective, and appropriately designed studies are needed to clarify the roles of individual factors involved in error generation, they say.