A study of new doctors found that stress increases depression risk.
Working 90 or more hours a week increased depressive symptom scores three times higher than working 40 to 45 hours.
Compared to those working less hours, more people who worked a lot had scores high enough to qualify for a diagnosis of moderate to severe depression, which requires therapy.
The University of Michigan researchers employed advanced statistical methods to simulate a randomised clinical trial, taking into account many other characteristics in the doctors’ personal and professional life.
They discovered a “dose response” effect between hours worked and depressive symptoms, with an average symptom increase of 1.8 points on a standard scale for 40 to 45-hour workers and 5.2 points for 90-hour workers. Working long hours is the biggest stressor for doctors, they say.
Michigan Medicine, U-academic M’s medical facility, published their findings from 11 years of data on almost 17,000 first-year medical residents in the New England Journal of Medicine. Newly graduated doctors trained at hundreds of US facilities.
Intern Health Study data from the Michigan Neuroscience Institute and Eisenberg Family Depression Center. New medical school graduates are recruited each year to document their depressed symptoms, work hours, sleep, and more during their intern year of residency.
The National Academy of Medicine and the Association of American Medical Colleges are addressing the high prevalence of depression among physicians, physicians-in-training, and other health care professionals. The interns in the survey reported a wide range of previous-week work hours, but the most common were 65–80 hours.
The Accreditation Council for Graduate Medical Education, which sets national residency programme standards, limits residents’ work weeks to 80 hours, however that can be averaged across four weeks and there are exceptions. ACGME limits residents’ shift length and consecutive days worked. These constraints have had conflicting effects on resident health and patient safety.
The authors conclude that residents should work fewer hours each week.
This analysis strongly implies that reducing the average number of work hours would minimise interns’ depressive symptoms and the number who develop diagnosable depression. “Working fewer hours helps you cope with job stress and frustration.
In cases where a real randomised trial is not possible, the new study uses a simulated clinical trial. Studying medical interns is great for simulating a clinical trial because most start at the same time of year and have different work schedules defined by their schools.
Fang, Y., et al. (2022) Work Hours and Depression in U.S. First-Year Physicians. New England Journal of Medicine. doi.org/10.1056/NEJMc2210365.