Working 90 or more hours a week was linked to a threefold increase in rates of depressive symptoms compared to people working 40 to 45 hours a week.
Longer work weeks were strongly associated with a higher increase in depressive symptoms in an “emulated” clinical trial, pushing some first-year medical residents into the range of moderate to severe depression.
According to a recent study by doctors, the more hours a person works a week in a demanding job, the more likely they are to develop depression.
Working 90 hours or more per week was associated with changes in depression symptom scores three times greater than the change in depression symptoms among people working 40 to 45 hours per week.
Also, compared to those who worked fewer hours, a greater proportion of those who worked long hours scored high enough to be diagnosed with moderate to severe depression, which is severe enough to require therapy.
The University of Michigan-based study team used advanced statistical methods to simulate a randomized clinical trial while taking into account several other factors in doctors’ personal and professional lives.
They found a “dose-response” effect between hours worked and depressive symptoms, with an average increase in symptoms of 1.8 points on a standard scale for those who worked 40-45 hours, reaching as high as 5, 2 points for those who worked more than 90 hours. They come to the conclusion that, of all the stresses that affect doctors, working long hours is a major factor in depression.
Write in the New England Journal of Medicine, the team at Michigan Medicine, UM’s academic medical center, reports the results of the study of 11 years of data on more than 17,000 first-year medical residents. Recently graduated doctors were in training at hundreds of hospitals across the United States.
The data comes from the Intern Health Study, based at the Michigan Neuroscience Institute and the Eisenberg Family Depression Center. Each year, the study recruits new medical graduates to participate in a year-long tracking of their depressive symptoms, work hours, sleep, etc., as they complete the first year of residency, also known as internship year.
The impact of high working hours
This study comes as major national organizations, such as the National Academy of Medicine and the Association of American Medical Colleges, attempt to address high rates of depression among physicians, physicians-in-training and other healthcare professionals. . Although interns in the study reported a wide range of working hours over the previous week, the most common levels of working hours were between 65 and 80 hours per week.
The Accreditation Council for Higher Medical Education, which sets national standards for residency programs, currently sets an 80-hour limit on resident workweeks, but this can be averaged over four weeks and there are possible exceptions. The ACGME also limits the length of a single shift and the number of consecutive days residents can work. Studies have shown mixed results on the impact of these limits on resident well-being and patient safety risks.
The authors say their findings indicate a clear need to further reduce the number of hours residents work each week on average.
“This analysis strongly suggests that reducing the average number of working hours would make a difference in the extent to which interns’ depressive symptoms increase over time and would reduce the number of people developing diagnosable depression,” says Amy Bohnert , Ph.D., the lead author of the study and a professor at UM Medical School. “The main thing is that people work fewer hours; you can handle stress or frustrations from your job more effectively when you have more time to recuperate.
Yu Fang, MSE, lead author of the study and a research specialist at the Michigan Neuroscience Institute, notes that the number of hours is important, but so are the training opportunities that come from time spent in hospitals and clinics. “It’s important to use time at work for supervised learning opportunities, not low-value clinical service tasks,” she says.
A population ripe for study
The new study uses a design called an emulated clinical trial, which simulates a randomized clinical trial in situations where it is not possible to conduct a true randomized trial. Since nearly all interns in the country start around the same time of year and are subject to varying work schedules defined by their programs, studying people going through this stage of medical training is ideal. to emulate a clinical trial.
This opportunity is what led Intern Health Study founder Srijan Sen, MD, Ph.D. to launch the research project in the first place: New doctors entering the most stressful year of their careers are a ideal group to study the role of many factors in the risk or onset of depression.
The authors suggest that parallel studies to this work on physicians should be conducted in other high-stress, high-hours jobs. “We would expect the negative effect of long working hours on physician mental health to be present in other professions,” the senator says.
The average age of the doctors in the study was 27, and just over half were women. One in five were trained in surgical disciplines and 18% belonged to racial or ethnic groups traditionally underrepresented in the medical profession.
Less than 1 in 20 met the criteria for moderate to severe depression at the start of the internship year. A total of 46% experienced a stressful life event, such as a death or birth in the family or marriage, during their internship year, and 37% said they had been involved in at least one medical error during of the year.
Analyzing the results, the researchers adjusted for gender, neuroticism, history of depression before the internship, early family environment, age, year the internship started, marital status, whether they had children, stressful life events and medical errors during the internship year.
Make a difference for today’s residents
“National clinician wellbeing initiatives have increasingly focused on the complex set of factors that affect clinician wellbeing, including the electronic health record, regulatory burden, resilience, workplace violence and culture,” says Sen, director of the EFDC and the Eisenberg Professor of Depression and Neuroscience. “I think this insistence has inadvertently led to the feeling that the problem is infinitely complicated and that it is hopeless to make any real progress. This article shows how the sole factor of working hours has an impact on depression and clinician well-being.
Sen is on the National Academy of Medicine’s Task Force on Navigating the Impacts of
” data-gt-translate-attributes=”[{” attribute=””>COVID-19 on Clinician Well-Being, part of a larger effort that recently issued a National Plan for Health Workforce Well-Being.
Bohnert notes that residency directors running training programs for new doctors could reduce work hours by prioritizing efforts that increase efficiency and decreases unnecessary work.
Fang also notes that the data from U.S. residents may apply to junior doctors, as they’re called, in other nations. The Intern Health Study now enrolls interns in China and Kenya as well.
Reference: “Work Hours and Depression in U.S. First-Year Physicians” by Yu Fang, M.S.E., Sara Lodi, Ph.D., Tasha M. Hughes, M.D., M.P.H., Elena Frank, Ph.D., Srijan Sen, M.D., Ph.D. and Amy S.B. Bohnert, Ph.D., 20 October 2022, New England Journal of Medicine.
DOI: 10.1056/NEJMc2210365
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