We know doctors are at higher risk for suicide, but what we still don’t know is which workplace-level interventions could help.
A new Australian study has revealed a “sharp imbalance” of research into doctors’ mental health and suicidality, with the bulk of literature focusing on individualised interventions to organisational-wide issues.
The paper, published in Nature on Thursday, was a systematic review and meta-analysis of interventions to reduce or prevent symptoms of mental disorders and suicidality in physicians and looked at 24 studies.
Findings included “early indicators” that skills-based approaches like mindfulness and cognitive behavioural therapy were effective in reducing the symptoms of common mental disorders.
Meanwhile, psychoeducational approaches – i.e. programs that provide information about mental health without teaching practical skills – were identified as generally ineffective.
According to lead author Katherine Petrie, a PhD candidate at the UNSW school of psychiatry and researcher with the Black Dog Institute, another key takeaway from the paper was what researchers couldn’t find.
“There was a really concerning absence of research into organisational-level interventions … that target workplace factors,” she told HSD’s sister publication, The Medical Republic.
“We know that poor working conditions really drive psychological distress among doctors.
“But despite this, there have been no controlled studies that we identified that evaluated interventions that target these workplace factors at the organisational level.”
Part of the reason for the knowledge gap, the researchers theorised, was that organisational-level trials were resource intensive and expensive to implement and evaluate.
The paper called the need for workplace-level research “a clear and urgent priority”.
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“Due to the substantial evidence for the role of workplace factors in mental illness development, maintenance and exacerbation, the absence of any controlled research studies examining organisational-level interventions is concerning, especially when we consider the inherent workplace risk factors present for physicians, but also because multi-level approaches for workplace mental health are recommended as best practice in international guidelines,” the researchers wrote in Nature.
“Furthermore, if organisations do not address the stressors and hazards present in the working environment, it is imprudent (and unethical) to assume that skills-based interventions alone will have a meaningful or sustained effect.”
The evidence that does exist, Ms Petrie told TMR, shows that multi-level interventions addressing both organisational and individual risk factors are the most effective in creating mentally healthy workplaces.
There was a similar dearth of research on suicidality; just two of the 24 studies included in the qualitative synthesis examined interventions that targeted suicidal ideation.
“There’s a huge gap in suicide prevention research for this profession where it’s most needed,” Ms Petrie said.
Improving psychological safety in healthcare is mission of the A Better Culture project, which is led by GP and former medical director of the United Nations Dr Jillann Famer.
Dr Farmer said the lack of research on organisational-level interventions spoke to the fact that workplaces were still not taking responsibility for clinician health and wellbeing.
“We continue to perpetuate a culture that says to doctors, ‘if you’re struggling, it’s your problem … you’ve caused the problem, and even if your workplace caused the problem, it’s your problem to fix’,” she said.
“We’re not tackling it at the system level – what our work has tried to do is to say, ‘if this was a mine … and x percent of the workers were coming down with y disease, the mine would be shut until we fixed it’.
“We can’t shut healthcare, but we need to be thinking about it in the same way.”
In A Better Culture’s final report, which was released in June, Dr Farmer wrote that she had “formed a strong view that it is not sufficient for those who hold the fiscal and policy power over Australia’s healthcare system to abrogate responsibility for this work, leaving the burden to advocacy and peak bodies and unions”.
“We identified deficits and drivers in the healthcare system that have resulted in our current predicament – where all healthcare professionals (not just doctors) suffer from work environments that are often quite unsafe,” Dr Farmer wrote.
“And so, we unapologetically disappoint those who thought that the result of this project would be a training course or a ‘how to fix the culture’ manual – because improving the culture of healthcare workplaces is going to be a complex, difficult, protracted effort.
“It is going to require changes to things that some parts of the system desperately want to hold in stasis.”