Common mental disorders related to incidents and behaviour in physicians.
BACKGROUND
Common mental disorders (CMD-burnout, stress, depression and anxiety disorders) are prevalent in physicians.


OBJECTIVE
To investigate the relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians.


METHODS
PubMed was searched for all articles published between 2003 and 2013 that study a relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. The strength of evidence was assessed through five levels of evidence.


RESULTS
We included 15 studies. We found strong evidence for a significant association between burnout and the occurrence of medical incidents, based on two longitudinal and seven cross-sectional studies with a positive association [odds ratio (OR) 1.07-5.5]; one longitudinal study found a non-significant association (strong evidence). For the association between depression and medical incidents, four longitudinal studies and three cross-sectional studies found a significant positive association (strong evidence; OR 2.21-3.29). For the association between fatigue and medical incidents, one longitudinal study and one cross-sectional study showed a significant positive association, but one cross-sectional study showed a non-significant association (strong evidence; OR 1.37). For the association between sleepiness and medical incidents, one longitudinal study and two cross-sectional studies showed a significant positive association (strong evidence; OR 1.10-1.37). No significant association was found between burnout and unprofessional behaviour (inconsistent evidence). Nor was any evidence found for the association between unprofessional behaviour and depression, fatigue or sleepiness.


CONCLUSIONS
CMD in hospital physicians were associated with the occurrence of self-reported medical incidents, but there was inconsistent evidence for unprofessional behaviour.
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands.
M A
MA
de Jong
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands.
K
K
Nieuwenhuijsen
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands.
J K
JK
Sluiter
D000328:Adult; D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000145:classification* / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D015995:Prevalence; D000066553:Problem Behavior / Q000523:psychology; D017009:Professional Autonomy; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology
Burnout; depression; fatigue; medical error; physician; resident.