Any frequent flyer understands this concept: in the event of an emergency, first put on your own mask. Then help others. The principle is that it’s impossible to care for others unless and until your own essential needs are first met. Yet, increasingly, psychiatric professionals are failing to prioritize their own “masks” of stress management and self-care. This has led to an increased prevalence of burnout among psychiatric professionals, according to findings of a study published in the American Journal of Psychiatry.
While acknowledging that burnout can be difficult to define, for the purposes of this review, the study authors regarded burnout as, “Emotional exhaustion, depersonalization, and decreased personal efficacy…[it] conceptualizes burnout as a response of individuals to a stressful workplace.”
Researchers invited 2084 North American psychiatrists to participate in an online survey, complete the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire-9 (PHQ-9), and submit personal demographic information as well as information about their individual practices.
The psychiatrists who participated in the survey were found to display significant rates of burnout and depression. Suicidal ideation did not appear to be a major concern, but the study authors still concluded that work must be done to develop effective interventions to reduce the high rates of burnout and depression.
Driving Factors Behind Psychiatrists Experiencing Burnout
The initial survey of psychiatric professionals was conducted in 2017, well before the onset of the coronavirus disease 2019 (COVID-19) pandemic. At the time of the survey, the authors identified several key factors responsible for psychiatrists experiencing burnout. They also found that older professionals, particularly women and African American practitioners, were disproportionately affected by burnout. Pre-existing depression also played a contributing role.
Practice setting was an important variable. Burnout was found to be more prevalent among those offering in-patient care and among those working in a government setting. A perceived lack of control over their schedules also increased the likelihood for psychiatrists experiencing burnout.
Ilana Rosenberg, PhD, a clinical psychologist practicing in Scarsdale, New York, notes this last factor has become more prevalent since the start of the pandemic.
“COVID is so stressful,” she says, “that mental health issues are exacerbated. Patients are more needy of their practitioner, and patients who were waiting and pushing through on their own are now seeking help. This has led to increased demands on caregivers’ time and energy, especially for psychiatrists, who deal with people facing more acute issues.”
In the face of this unprecedented need, many psychiatrists feel no choice but to work overtime. Dr Rosenberg says, “The summer is usually a slower time, but now it’s not. This means there is less time for self-care, something that’s really important for mental health practitioners. If you have too many patients in one day or week, it doesn’t leave enough time for you to go to your own doctor’s appointments or to complete the tasks you need to take care of, adding to your mental load.”
Identifying Crucial Interventions
Dr Rosenberg concludes that psychiatrists must self-reflect on their mental health. “If you’re sleeping more or less, if you’re more irritable or crying a lot, or if you’re dreading going to work and spending lots of time worrying about your patients or your ability to handle your case load, you have to take care of yourself first.”
She recommends joining a support network of peers or mentors — individuals with whom psychiatrists can seek consultations or simply commiserate. Dr Rosenberg believes this is an effective burnout intervention because, “even if [your peer or mentor] doesn’t have a solution, it can be helpful to share the load.” She also advocates continuing education, which she says “helps because it keeps you professionally excited and can also teach you new ways to help your patients, which can take stress off of practitioners.”
Dr Rosenberg noted that traditional self-care practices should be considered obligatory. “Schedule down time between patients each day. Try to get outside in the fresh air. And take enough vacation — I usually recommend one week per quarter.”
Dr Rosenberg’s observations are similar to those acknowledged in the American Journal of Psychiatry study referenced earlier. The authors noted that “Potentially important individual and workplace factors include work-home balance, such as family status and caregiver burden for family members, a sense of belonging to the physician community, efficiency of the workplace, ease of use of electronic health records, perception of response to medical errors, and other psychiatry-specific factors (e.g., out-of-network practice).”
They also acknowledge the lack of sufficient data regarding the effectiveness of widely accepted intervention practices. Most of the community’s discussions regarding burnout interventions rely on self-reporting from at-risk psychiatrists and mental health professionals. The authors note, “To our knowledge, there are no data on the effect of interventions for burnout among psychiatrists, except for one study of an intervention in several psychiatry residency training programs focused on building resilience among individuals.”
In light of this knowledge gap, the study authors conclude with a recommendation for a better way forward in the psychiatric community. “In addition to individually targeted interventions, there needs to be a greater focus on health care system-level interventions, as burnout is fundamentally an organizational problem that affects individuals… Systematic qualitative data would allow for a more nuanced analysis of some of the phenomena associated with burnout and depression.”
Summers RF, Gorrindo T, Hwang S, Aggarwal R, Guille C. Well-being, burnout, and depression among North American psychiatrists: the state of our profession [published online July 14, 2020]. Am J Psychiatry. doi:10.1176/appi.ajp.2020.19090901