Association Between Physician Depressive Symptoms and Medical Errors
Authors: Karina Pereira-Lima, Douglas A. Mata, Sonia R. Loureiro, José A. Crippa, Lívia M. Bolsoni, Srijan Sen
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature. <h3>Objective</h3> To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors. <h3>Data Sources</h3> A systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science was performed from database inception to December 31, 2018. <h3>Study Selection</h3> Peer-reviewed empirical studies that reported on a valid measure of physician depressive symptoms associated with perceived or observed medical errors were included. No language restrictions were applied. <h3>Data Extraction and Synthesis</h3> Study characteristics and RR estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. <h3>Main Outcomes and Measures</h3> Relative risk estimates for the associations between physician depressive symptoms and medical errors. <h3>Results</h3> In total, 11 studies involving 21 517 physicians were included. Data were extracted from 7 longitudinal studies (64%; with 5595 individuals) and 4 cross-sectional studies (36%; with 15 922 individuals). The overall RR for medical errors among physicians with a positive screening for depression was 1.95 (95% CI, 1.63-2.33), with high heterogeneity across the studies (χ<sup>2</sup> = 49.91;<i>P</i> &lt; .001;<i>I</i><sup>2</sup> = 82%; τ<sup>2</sup> = 0.06). Among the variables assessed, study design explained the most heterogeneity across studies, with lower RR estimates associated with medical errors in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84; χ<sup>2</sup> = 5.77;<i>P</i> = .33;<i>I</i><sup>2</sup> = 13%; τ<sup>2</sup> &lt; 0.01) and higher RR estimates in cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83; χ<sup>2</sup> = 5.44;<i>P</i> = .14;<i>I</i><sup>2</sup> = 45%; τ<sup>2</sup> &lt; 0.01). Similar to the results for the meta-analysis of physician depressive symptoms associated with subsequent medical errors, the meta-analysis of 4 longitudinal studies (involving 4462 individuals) found that medical errors associated with subsequent depressive symptoms had a pooled RR of 1.67 (95% CI, 1.48-1.87; χ<sup>2</sup> = 1.85;<i>P</i> = .60;<i>I</i><sup>2</sup> = 0%; τ<sup>2</sup> = 0), suggesting that the association between physician depressive symptoms and medical errors is bidirectional. <h3>Conclusions and Relevance</h3> Results of this study suggest that physicians with a positive screening for depressive symptoms are at higher risk for medical errors. Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could play a role in mitigating medical errors and thus improving physician well-being and patient care.