Occupational stressors, but not work hours, linked to physician depression

Regardless of the number of hours worked, occupational stress among physicians who are highly committed to their jobs may be associated with depression, a cross-sectional Japanese study suggests.

The study, published online March 7 in Occupational Medicine, examined the association between occupational variables and depression based on responses to self-administered questionnaires completed by 795 alumni (534 men, 172 women) of a Japanese medical school. The questionnaires assessed hours worked during the previous week, occupational stress evaluated by the effort-reward imbalance model (effort-reward ratio [ERR]), social support, and depression as measured by the Center for Epidemiologic Studies Depression Scale.

The odds ratio (OR) for depression in those who worked more than 70 hours per week was 1.8 compared with those who worked fewer than 54 hours per week, adjusted for basic attributes. Adjusted ORs in the upper tertile of ERR compared with the lower ERR tertile were 0.6 in those who worked fewer than 54 hours per week, 8.5 in those who worked 55 to 70 hours per week, and 9.9 among those who worked more than 70 hours weekly.

Stratification of participants by working hours and occupational stress (ERR) showed that adjusted ORs of depression tended to be higher in the groups with a higher ERR, but found no association between working hours and depression. The authors conclude that “occupational stressors peculiar to physicians cannot be simply measured using the number of working hours alone, while the psychological burden of physicians can be evaluated by considering the density of working hours and the work contents.”

They note that “the management of occupational stress causing an effort-reward imbalance, rather than limiting the working hours (which is an effective patient safety measure), might be an important countermeasure against depression among physicians.”

In addition, the study also found a significant association between depression and overcommitment, a measure of attitudes and behavior patterns that indicate a high level of commitment to one’s job. Elevated overcommitment, marked by a strong desire for appreciation and a tendency to think about the job after leaving work, “creates a dichotomy in effort that cannot be compensated by actual reward,” the researchers note.