Optimising strategies to address mental ill-health in doctors and medical students: 'Care under Pressure' realist review and implementation guidance

Carrieri, Daniele; Mattick, Karen; Pearson, Mark; Papoutsi, Chrysanthi; Briscoe, Simon; Wong, Geoff; Jackson, Mark

Abstract

© 2020 The Author(s). Background: Mental ill-health in health professionals, including doctors, is a global and growing concern. The existing literature on interventions that offer support, advice and/or treatment to sick doctors has not yet been synthesised in a way that considers the complexity and heterogeneity of the interventions, and the many dimensions of the problem. We (1) reviewed interventions to tackle doctors' and medical students' mental ill-health and its impacts on the clinical workforce and patient care - drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives - and (2) produced recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Methods: Realist literature review consistent with the RAMESES quality and reporting standards. Sources for inclusion were identified through bibliographic database searches supplemented by purposive searches - resulting also from engagement with stakeholders. Data were extracted from included articles and subjected to realist analysis to identify (i) mechanisms causing mental ill-health in doctors and medical students and relevant contexts or circumstances when these mechanisms were likely to be 'triggered' and (ii) 'guiding principles' and features underpinning the interventions and recommendations discussed mostly in policy document, reviews and commentaries. Results: One hundred seventy-nine records were included. Most were from the USA (45%) and were published since 2009 (74%). The analysis showed that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote wellbeing. Interventions creating a people-focussed working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors and medical students needed to have confidence in an intervention for the intervention to be effective. Conclusions: Successful interventions to tackle doctors' and students' mental ill-health are likely to be multidimensional and multilevel and involve multiple stakeholders. Evaluating and improving existing interventions is likely to be more effective than developing new ones. Our evidence synthesis provides a basis on which to do this. Study registration: PROSPERO CRD42017069870. Research project webpage http://sites.exeter.ac.uk/cup/

Citation

Carrieri, D., Mattick, K., Pearson, M., Papoutsi, C., Briscoe, S., Wong, G., & Jackson, M. (2020). Optimising strategies to address mental ill-health in doctors and medical students: 'Care under Pressure' realist review and implementation guidance. BMC medicine, 18(1), Article 76. https://doi.org/10.1186/s12916-020-01532-x

• Journal Article Type: Review
• Acceptance Date: Feb 13, 2020
• Online Publication Date: Apr 8, 2020
• Publication Date: Apr 8, 2020
• Deposit Date: Apr 17, 2020
• Publicly Available Date: Apr 17, 2020
• Journal: BMC Medicine
• Electronic ISSN: 1741-7015
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 1
• Article Number: 76
• DOI: https://doi.org/10.1186/s12916-020-01532-x
• Keywords: General Medicine
• Public URL: https://hull-repository.worktribe.com/output/3497279
• Publisher URL: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01532-x
• Additional Information: Received: 11 October 2019; Accepted: 13 February 2020; First Online: 8 April 2020; : Secondary research. Ethical approval is not required.; : Not applicable.; : Geoff Wong is the Joint Deputy Chair of the National Institute for Health Research Health Technology Assessment Programme Prioritisation Committee Panel A (Out of hospital). Mark Pearson is a member of the NIHR Health Services & Delivery Research (HS&DR) Funding Committee. The other authors declare that they have no competing interests.