Medical residencies are one of the most stressful and emotionally taxing times for new physicians. But what toll does all that stress and sleep deprivation take on a person’s mental well-being? Researchers are using a popular wearable device to learn more about how stress and sleep affect depression — and how the workplace impacts physicians’ health. Their findings may show the long-term effects of stress on physicians throughout their careers as well.
Researchers at the University of Michigan have been studying physician residents for the past 12 years, and they have discovered clear links between depression and a host of expensive consequences, including lower-quality patient care, lost productivity, burnout and turnover.
“Physician depression has a high cost — one that’s measurable,” says the study’s lead investigator Srijan Sen, MD, PhD, professor of depression and neurosciences and an associate professor of psychiatry at the University of Michigan. “Depressed physicians commit medical errors at almost twice the rate of non-depressed ones. Depression also is clearly linked to attrition. But, if we can provide interventions to retain wellness and reduce work-family conflicts, we can change the system.”
Studying the students
The Intern Health Study, which now includes residents at nearly 60 training hospital sites nationwide, shows that depression rates are getting worse, especially among female physicians, who, as of 2018, now constitute the majority of U.S. medical school students for the first time in history. “Over the past 12 years, depression rates have been increasing by about five percent per year, and as the ratio of female physicians increases, work-family conflict is becoming a big driver,” Sen says.
For the first time, the longitudinal cohort study is using Fitbit wearable bracelets to gather real-time data and self-reporting from all physician participants as they work at their residencies. The smartphone-based app, developed specifically for the study, automatically tracks sleep quality and length, records activity levels and asks the wearer for input on daily mood levels. Algorithms estimate peak fatigue times based on changes in a person’s sleep schedule, length of awake time and other data.
“Now we can gather objective data in real-time, instead of subjective feedback — and that’s a really exciting direction,” Sen says. “For example, we've known for a long time there's a close connection between mood and sleep, but we didn't know that much about how much people slept or how it affected their mood the next day. We found there are really high-risk periods for getting depressed, even becoming suicidal. Being able to get at that fine-grained relationship between these variables wasn’t possible before these sorts of devices were around, and we can collect that data on a daily basis.”
The effects of changes in the sleep schedule aren’t the same across all residents, the study shows. Some residents experience significant mood changes when they work very long shifts compared to shorter ones, Sen explains. Others suffer most when they keep changing from days to nights and back again, preventing a stable sleep/wake cycle.
Among training physicians, depression disproportionately impacts women, especially during the first year of residency, notes a separate study published in JAMA Internal Medicine. Within the study group of 3,121 interns from the academic year 2015-2016, women experienced higher family-work conflict and higher attrition rates than their male counterparts. But, when work-family conflicts were proactively addressed, depressive disparity between the sexes decreased by 36 percent, the article notes.