title: Beyond the body: A systematic review of the nonphysical effects of a surgical career.
abstract: BACKGROUND
  Training as a physician has been demonstrated to be a source of personal and familial distress; we sought to assess and analyze the holistic impact of a surgical career by examining nonphysical effects on surgeons and their families.
  
  
  METHODS
  The MEDLINE database was searched systematically from inception to June 2014 in accordance with PRISMA guidance. Two reviewers independently reviewed articles using predefined inclusion and exclusion criteria.
  
  
  RESULTS
  We found 71 articles that met our inclusion criteria. Fifty-four studies (77%) assessed burnout with a reported prevalence of 12.6-58% (mean, 34.6%; SD, 11.0%). Workload was found to be the most significant contributor to burnout. Rates of psychiatric morbidity ranged between 16 and 37% (mean, 25.3%; SD, 6.6%) and rates of suicidal ideation, especially among more senior surgeons and those involved in malpractice, was higher than the general population. Depression was reported in 30.8-37.5% (mean, 33.9%; SD, 3.1%). All were strongly associated with workload and burnout, indicative of a likely synergistic effect. Other risk factors included junior status and younger age, poor professional relationships, work-home conflicts and poor work-life balance. Protective factors included marriage or spousal support, career satisfaction, autonomy, and academic practice.
  
  
  CONCLUSIONS
  Surgeons have a high prevalence of burnout, psychiatric morbidity, and depression, with suicidal ideation rates higher than the general population. Professional factors contribute significantly to these phenomena. Although personal and familial factors are protective, they are eroded by the overwhelming impact of professional factors; nevertheless, career satisfaction rates remain high.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London, UK. Electronic address: youssof.oskrochi@nhs.net.
authors.forename: Youssof
authors.initials: Y
authors.lastname: Oskrochi
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, MA.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Department of Orthopaedics, Hillingdon Hospital, Hillingdon Hospitals NHS Trust, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Henriksson
authors.affiliation: Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
authors.affiliation: Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
mesh_terms: D002055:Burnout, Professional / Q000523:psychology*; D002321:Career Choice; D003863:Depression / Q000209:etiology; D005195:Family Relations; D006801:Humans; D007588:Job Satisfaction; D008318:Malpractice; D008603:Mental Health; D013043:Specialties, Surgical; D019966:Substance-Related Disorders / Q000209:etiology; D059020:Suicidal Ideation; D066231:Surgeons / Q000523:psychology*; D016526:Workload / Q000523:psychology