Depressed residents make more drug errors

Researchers say these findings show residency programs need to focus on physicians' mental health and work conditions.

By Myrle Croasdale — Posted March 10, 2008

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Depressed medical residents make six times more medication errors than residents who are not depressed, according to a U.S. study published online Feb. 7 in the British Medical Journal.

"Depression is a significant problem for residents as well as for their patients," said lead study author Amy Fahrenkopf, MD, MPH. "The fact that it's a problem for both needs to be addressed."

The study looked at 123 pediatric residents at Children's Hospital Boston, Lucile Packard Children's Hospital in Palo Alto, Calif., and Children's National Medical Center in Washington, D.C. A medication error was defined as any error in the ordering, transcription or administration of a medication.

Participants wrote a total of 6,078 orders, and 45 medication errors were found. Depressed residents made 6.2 times more errors per month than residents who were not depressed. The study found that 20% of residents were depressed, while 74% were burned out.

Dr. Fahrenkopf said it made sense that depressed residents would make more errors, because depression causes problems with attention and reaction time. Half of the depressed residents were unaware of their mental illness, she said.

"Most people expect to be miserable during residency, and they often miss when they cross the line into illness," said Dr. Fahrenkopf, a pediatric hospitalist at Children's Hospital Boston.

Concerns about mental health

Christopher Landrigan, MD, MPH, the study's principal investigator, said that while the researchers were not the first to find a high incidence of depression among residents, the study is important because it clearly links depression with medical errors.

"This really should be a wake-up call for [resident] programs," Dr. Landrigan said. "They need to think seriously about the work conditions and mental health of their residents."

Data were collected as part of a larger duty-hours study measuring the effects of the Accreditation Council for Graduate Medical Education's 80-hour-per-week limits on residents' safety, health and educational experiences.

Other studies have found high rates of depression and burnout among residents, with rates ranging from 7% to 56% for depression and 41% to 76% for burnout.

Practicing physicians also are susceptible to mental illness, with studies over the past four decades documenting higher-than-average suicide rates among physicians, though their depression rates are comparable with those in the general population.

Theodore Sectish, MD, pediatric resident director at Children's Hospital Boston, said the study reinforces the need to humanize medical training, something his program is working into a new curriculum.

"Instead of focusing on depression and burnout, we're focusing on the whole experience of resident training," Dr. Sectish said. "We're trying to raise awareness that seeking help for mental health is not a weakness, but a strength."

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