Long hours double junior doctors' risk of mental illness and suicide

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Junior doctors who work more than 55 hours a week are at a greater risk of developing mental health problems and experiencing suicidal ideation, according to Australian-first research led by the Black Dog Institute and the University of NSW.

Published in The BMJ the results reveal a link between long working hours and poorer mental health amongst doctors-in-training, highlighting the need for workplace improvements to help protect their health and wellbeing.

The findings come as the issue of junior doctor suicide and burnout remain in the public spotlight, amidst greater scrutiny of their work and training conditions.

“Long working hours have been par for the course in the culture of medical training for decades, and we’re now starting to understand the human cost behind these excessive workloads,” said co-author Associate Professor Samuel Harvey, Chief Psychiatrist at the Black Dog Institute.

“Pressure on junior doctors to ‘earn their stripes’ by taking on long work hours has always been common, but what we now know is that this can have profound mental health impacts, with concerning implications for both the individual doctors and our broader health system," he said.

The study examined the Beyond Blue National Mental Health Survey (2013) comprising questionnaire data from more than 12,250 Australian doctors, the largest and most recent national figures on mental health outcomes in doctors available.

Assessing the survey’s responses from 2,706 full-time graduate medical trainees in various specialties, researchers identified the number of junior doctors who met the criteria for common mental disorder (CMD), such as depression and anxiety, as well as those who reported experiencing suicidal ideation in the last 12 months.

Once a junior doctor worked more than 55 hours each week, their chance of CMD and suicidal ideation doubled, compared to doctors-in-training who worked fewer hours (between 40-44 hours per week). This association remained regardless of age, gender, level of training, location, marital status and whether they were trained overseas or locally.

“It's an extraordinary finding given that it's not at all uncommon for junior doctors to be working those hours," Assoc. Professor Harvey said.

A quarter (25.3%) of junior doctors in the research sample from 2013 worked more than 55 hours per week, suggesting a considerable proportion of this workforce may be at significant risk of poor mental health and suicidality. The latest Australian Medical Association (AMA) survey of doctors’ working hours from 2016 shows that this pattern is ongoing.

Researchers warn that simply restricting junior doctor working hours without any changes to staff numbers or work planning may be ineffective, as this could increase workloads within shifts or lead to more unpaid or unrostered overtime.

The Australian Medical Association (AMA) Council of Doctors In Training chairperson Dr Tessa Kennedy said it was important to note it was not just the number of hours worked that could impact on junior doctor health, and factors including the pattern of work and the work environment played a part.

"If you’re in a well-supported environment and your boss has got your back, all those things can offset some of the difficulties [of working long hours]," she said, but added addressing work hours was a "really tangible place to start".

However, she said restricting the number of hours doctors could work was a simplistic solution. She said ensuring there were sufficient breaks between shifts and on-call periods and making sure doctors were being paid for overtime would be more effective.

"I think it’s important that we address not just rostered hours but also un-rostered hours," she said.

“Ideally, the optimal solution would include increasing the efficiency of the work environment to reduce the workload of junior doctors, implementing kinder rostering and work practices as well as ensuring adequate staffing to reduce total hours per junior doctor”, the authors note.

“While working hours are a key contributor to junior doctors’ overall wellbeing, their complex working environments mean this measure shouldn’t be considered in isolation,” said lead author Katherine Petrie from the Workplace Mental Health Research Program at UNSW and the Black Dog Institute.

“Further research should take account of other factors like fatigue, sleep deprivation, conflicts between work and home life, organisational-level workplace stressors as well as broader regulatory practices," she said.