Systematic review and meta-analysis results published in JAMA Network Open suggest that physicians with positive screening for depressive symptoms were at higher risk for making medical errors.
Researchers searched Embase, ERIC, PubMed, PsycINFO, Scopus, Web of Science from database inception through 2018 for cross-sectional and longitudinal studies describing an association between physician depressive symptoms and medical errors. Studies that did not use a validated measure of depression were excluded. Cohort characteristics and relative risk (RR) estimates were extracted from each study by 2 independent reviewers. Methodologic quality was assessed using the Cochrane Library guidelines. Overall RR estimates were calculated by pooling study-specific estimates using a random-effects model to account for between-study heterogeneity.
Overall, 11 studies involving 21,517 physicians were included: 7 longitudinal studies (n=5595) and 4 cross-sectional studies (n=15,922). The RR for medical errors was 1.95 (95% CI, 1.63-2.23) among physicians with positive screening for depression. However, greater between-study heterogeneity was observed for this measure (P <.001). Study design contributed most strongly to heterogeneity in RR values; a greater pooled RR for medical errors was observed in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84) compared with cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83). Of the 7 longitudinal studies, 4 also reported on medical errors associated with depressive symptoms in the next 3 months. A meta-analysis of these 4 studies indicated that the RR for subsequent depressive symptoms was 1.67 (95% CI, 1.48-1.87) among physicians who had experienced medical errors. As such, the association between depressive symptoms and medical errors was bidirectional. Physicians in a surgical specialty had significantly higher RRs compared with physicians in non-surgical specialties (2.59 [95% CI, 2.10-3.16] vs 1.79 [95% CI, 1.46-3.16]). Differences in RR were also observed across depression screening instruments, with higher values observed among physicians screened with the Harvard National Depression Screening Day Scale and the 2-item Primary Care Evaluation of Mental Disorders questionnaire.
These data suggest that physicians with depression may have a higher risk of making medical errors. However, the researchers noted that the majority of studies gathered data on self-reported medical errors rather than objective measures, which may have introduced bias. They conclude that further study is necessary to expand on these findings and to investigate the potential efficacy of depression interventions for medical error reduction.
Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures
Pereira-Lima K, Mata DA, Loureiro SR, Crippa JA, Bolsoni LM, Sen S. Association between physician depressive symptoms and medical errors: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(11):e1916097.