Optimising strategies to address mental ill-health in doctors and medical students: ‘Care Under Pressure’ realist review and implementation guidance.

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Abstract

BACKGROUND: Mental ill-health in health professionals, including doctors, is a global and growing concern. The existing literature on interventions that offer support, advice and/or treatment to sick doctors has not yet been synthesised in a way that considers the complexity and heterogeneity of the interventions, and the many dimensions of the problem. We (1) reviewed interventions to tackle doctors’ and medical students’ mental ill-health and its impacts on the clinical workforce and patient care-drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives-and (2) produced recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.

METHODS: Realist literature review consistent with the RAMESES quality and reporting standards. Sources for inclusion were identified through bibliographic database searches supplemented by purposive searches-resulting also from engagement with stakeholders. Data were extracted from included articles and subjected to realist analysis to identify (i) mechanisms causing mental ill-health in doctors and medical students and relevant contexts or circumstances when these mechanisms were likely to be ‘triggered’ and (ii) ‘guiding principles’ and features underpinning the interventions and recommendations discussed mostly in policy document, reviews and commentaries.

RESULTS: One hundred seventy-nine records were included. Most were from the USA (45%) and were published since 2009 (74%). The analysis showed that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote wellbeing. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors and medical students needed to have confidence in an intervention for the intervention to be effective.

CONCLUSIONS: Successful interventions to tackle doctors’ and students’ mental ill-health are likely to be multidimensional and multilevel and involve multiple stakeholders. Evaluating and improving existing interventions is likely to be more effective than developing new ones. Our evidence synthesis provides a basis on which to do this.

Citation

Relevant Evidence Summaries

The evidence was reviewed and included in the following summaries: 

What works to reduce burnout and vicarious trauma among refugee service providers?

There is strong evidence for a variety of strategies to reduce vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout among helping professionals. A strong body of evidence has developed in the past twenty years on reducing stress reactions among a variety of professional helpers in a wide range of settings and professions. Strategies to […]

About this study

AGE: Adults

DIRECTION OF EVIDENCE: Positive impact

FULL TEXT AVAILABILITY: Free

GENDER: All

HOST COUNTRY: Multiple countries

HOST COUNTRY INCOME: High

INTERVENTION DURATION: Varies

INTERVENTION: Organizational strategies

OUTCOME AREA: Reduction of compassion fatigue, burnout, and secondary trauma

STRENGTH OF EVIDENCE: Strong

TYPE OF STUDY: Systematic review

YEAR PUBLISHED: 2020

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