Barriers to mental health care: Terminology of burnout and depression

Workplace burnout and clinical depression may co-exist in some physicians and other clinicians, but they are different issues that require different diagnoses and interventions. Daniel Saddawi-Konefka, MD, MBA, and Christine Yu Moutier, MD, are co-authors with Jesse M. Ehrenfeld, MD, MPH, of the special communication, “Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” published in JAMA. Here they discuss the terminology and distinctions involving burnout, depression and suicide risk.

Medical Economics: In that special communication, you wrote that critically differentiating burnout from diagnosable mental health conditions is essential for appropriately addressing physician mental health. Can you discuss that distinction and why appropriate recognition is so important?

Christine Yu Moutier, MD: I've devoted my life and my career now to suicide prevention, so of course, I'm coming at this through the lens of the issues that elevate risk for suicide, and the things that we can do about that. And the biggest concern I would say that I have around any conflating between burnout, which is its own serious issue and experience, and clinical depression, is that there has been, I think, a sort of — well, they can co occur first of all, and there is some overlap in the symptoms and the experience. But when burnout is more normalized and acceptable to talk about, then we might miss the opportunity to actually have treatment that could make a huge difference for the person's life, and actually could be life-saving. So there is data now that is a little bit more clear and helps us to understand that amongst, for example, in a UCSD study that I was a part of, amongst a sample of more than 2,000 health workers, it included more than just physicians, but health workers overall, about 52% met screening criteria for burnout, and about 48% met criteria for depression, and that there was quite a bit of overlap, 33% had both, again, by screening criteria. But what was the most important, kind of compelling finding is that it was only the health workers who had the depression, whether or not burnout was present alongside it or not, who were at greater risk for suicidal ideation and other risk factors for suicide, like hopelessness and very dire, extreme emotional states, anxiety and desperation. So burnout had been discussed in some parts of the literature as a risk factor for suicide, and it could be for some, it could be along their path of risk. But on its own, is probably not strong enough that I would consider it a strong risk factor for suicide. So, again, the most important thing being that recognizing a treatable health condition that's potentially life threatening is an essential thing to do and to not get that conflated with burnout.

Daniel Saddawi-Konefka, MD, MBA:I'll add just a quick thing, just in talking with my residents, other physicians, these days, it's almost as though burnout hasn't come to mean burnout. Any form of distress is just called burnout — oh, I'm feeling a little burnt out. And really what they mean to be saying is that they're feeling distressed. And to Dr Moutier’s point, if we call all of it burnout, well, burnout requires organizational and systemic solutions, whereas mental health conditions, the treatment’s individual, it's psychotherapy and medications at times. And so if everything gets relegated to, all forms of distress are just called burnout, then we have physicians who are foregoing or delaying really critical therapies that could not only help prevent suicide, but dramatically improve their quality of life.