The results of a recent meta-analysis published in JAMA Network Open suggest that physicians who screen positively for depression are at greater risk for medical errors, whether they are in training or practicing.

Medical errors are a serious public health problem. Estimates suggest that between 98,000 and 251,000 hospitalized patients die each year as the result of preventable adverse events, while many others are harmed. These errors cost the healthcare system billions of dollars every year, making the identification and rectification of potential causes of errors especially crucial.

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Karina Pereira-Lima, PhD, of the department of psychiatry, University of Michigan Medical School in Ann Arbor, and colleagues sought to determine the relative risk (RR) estimates for the associations between physician depression and perceived or observed medical errors. They conducted a systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science through December 2018 to identify peer-reviewed empirical studies that explored this complex issue.

The investigators identified 11 studies that included 21,517 physicians; 7 studies were longitudinal and involved 5595 physicians and 4 were cross-sectional with a combined study population of 15,922. Medical errors were observed in physicians with depression (RR, 1.95) although there was high heterogeneity across the studies (χ 2 = 49.91; P <.001; I2 = 82%; τ2 = .06).  Study design accounted for most of the heterogeneity, with lower RR estimates associated with medical errors in the longitudinal studies (RR, 1.62; χ2 = 5.77; P =.33; I2 = 13%; τ2 <.01) and higher RR estimates associated with medical errors in the cross-sectional studies (RR, 2.51; χ2 = 5.44; P =.14; I2 = 45%; τ2 <.01).

Of note, the RR for this association was bidirectional, with medical errors also showing an association with subsequent depressive symptoms over the following 3 months (RR 1.67; χ2 = 1.85; P =.60; I2 = 0%; τ2 = 0) in the meta-analysis of 4 longitudinal studies (n=4462).

The investigators attempted to identify possible sources of heterogeneity by examining study-level characteristics. Studies of surgical specialties and those conducted in the United States, but not any particular career level, yielded significantly higher RR estimates compared with their counterparts (RRs, 2.59 vs 1.79 and 2.10 vs 1.39, respectively).

Study limitations included the reliance on self-report measures of medical errors in 10 of the 11 studies. Additionally, the small number of studies for some subgroups may have biased the results and 9 of the 11 studies only included US physicians, which may make the results less generalizable to physicians in other countries. Furthermore, 8 of 11 studies included only training physicians in their assessment. However, the investigators did not find significant publication bias.

The study authors wrote, “Given that few physicians with depression seek treatment and that recent evidence has pointed to the lack of organizational interventions aimed at reducing physician depressive symptoms our findings underscore the need for institutional policies to remove barriers to the delivery of evidence-based treatment to physicians with depression.” They called for future research into the efficacy of interventions for reducing physician depressive symptoms in decreasing the number of medical errors.

Disclosure: Study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Pereira-Lima K, Mata DA, Loureiro SR, Cripp JA, Bolsoni LM, Sen S. Association between physician depressive symptoms and medical errors. A systematic review and meta-analysis. JAMA Network Open. 2019. doi:10.1001/jamanetworkopen.2019.16097