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Burnout is a psychological syndrome consisting of emotional exhaustion, cynicism, & decreased professional efficacy (Nagasaki et al., 2022). It is not uncommon for residents to experience burnout at least once throughout their program. Therefore, it is vital for residents to pay attention to potential signs of burnout within themselves and others.

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Ana's mood and energy is much lower than normal. She is beginning to experience symptoms that resemble what she felt when she had originally been diagnosed with clinical depression as a teeneager. She feels helpless and trapped- causing her to even question why she entered the medical field in the first place.

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The Patient Health Questionnaire is a self-administered health diagnostic instrument for common mental disorders. The PHQ-9 is a depression module, in which an individual is scored on each of the nine diagnostic criteria for major depression (Williams, 2014).

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Based on the information provided in the case study, Ana would likely be diagnosed with a more serious leaning moderately severe depression. This is because of the following sections certainly being scored in the gray section of the questionnaire (2-3 points each).

Section 2- Feeling down, depressed, or hopeless

Ana is worried because she was briefly diagnosed with clinical depression as a teenager, and her symptoms are beginning to resemble what she felt like back then. Additionally, she is feeling completely trapped and wonders why she went into the medical field in the first place, she would do anything at this point to escape it.

Section 4- Feeling tired or having little energy

Ana's mood has become low, her energy level has dropped, and she is having difficulty getting out of bed in the morning.

Section 6- Feeling bad about yourself- or that you are a failure or have let yourself or your family down

She is feeling overwhelmed and increasingly hopeless about life and, in spite of her many past successes, she is starting to regard herself as a complete failure.

Section 7/8- Trouble concentrating on things/ Moving or speaking slowly that other people have noticed

When a patient was admitted to the hospital, Ana did not do a thorough job of asking about family history. If a colleague had not thought about the possibility and suggested the requisite testing, the patient's life may have been in danger. Ana feels that she did not spend enough time talking to the patient and that if she was doing her normal amount of reading, that she would have been better prepared.

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Four Common SDOHs Associated with Burnout in Residency

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Four Common SDOHs Associated with Burnout in Residency

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1) Straining work/ sleep schedule

Occupational work schedules can make or break an individual's health. This SDOH can play a largely stressful role in an individual's lifestyle and potentially cause additional health risks. With such a busy schedule, Ana is finding herself feeling overwhelmed, tired, and overall helpless. She does not have the time to take care of her own health let alone the time to travel and see her sick mother.

2) Limited/ Lack of Social Interaction

Working long hours also ties into this SDOH. Neglecting the social aspect of one's life can be stressful and potentially even a missed opportunity to improve self-efficacy. Ana's minimal amount of interaction with friends and family is not helping her confidence; she does not want to discuss her situation with he family because she does not want to disappoint them and is afraid to tell anyone in the program because she knows that they will regard her as "weak".

3) Stressful Occupational Environment

Working in a hospital, as described above, requires individuals to endure long hours, leaving little time for themselves. Working in a hospital setting makes the long hours even more stressful and can take a toll on the body quickly. Ana must work with multiple patients daily, each of which are real people with lives in which her decisions can affect greatly or potentially become life-or-death situations.

4) Health History

Though this SDOH varies from person to person, health issues can be significantly heightened or brought back to the surface when working in such a stressful work environment. It is important that Ana pays attention to her previous diagnosis of clinical depression as the symptoms seem to be arising once again.

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Intervention to Improve Ana's Physical and Mental Health 

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Intervention to Improve Ana's Physical and Mental Health 

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Intervention is certainly needed for Ana. She is experiencing extreme lows at the moment and is lacking energy and motivation to continue her journey. Studies show that individuals in the medical field who incorporated mindfulness techniques had significant positive effects on stress, anxiety, and/or depression. However, these studies were typically comprised of interventions that included 8 weekly 1- to 2.5-hour sessions led by a mindfulness-trained instructor followed by at least 9 hours of practice at home. Although effective, mindfulness-based interventions are usually time-intensive and require clinicians to attend lengthy sessions followed by several hours of practice that may be difficult to arrange with their schedules. An additional technique Ana may try is Stress Management and Resiliency Training, comprised of a brief 90-minute session that focuses on attention and interpretation therapy that aims to decrease stress and increase resiliency along with the use of deep breathing techniques, which was found to lessen physician anxiety (Melnyk et al. , 2020).

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Cognitive, Affective, and Somatic Symptoms of Depression as it Relates to Ana's Living/ Working Conditions

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Cognitive, Affective, and Somatic Symptoms of Depression as it Relates to Ana's Living/ Working Conditions

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Cognitive Symptoms-

Cognitive deficits
can occur before, during, or after a depressive
episode. Repeated episodes of depression may increase
vulnerability to further cognitive deficits, leading to a
“kindling” effect, secondary only to that of
repeated insults. Studies have shown that most patients with depression report significant cognitive symptoms,
including deficits in executive function (problem
solving, decision-making, and judgment), memory,
and attention to their daily activities. In addition,
more than 30% of depressed patients who have
responded to therapeutic management for depression
have reported residual problems, including
inattentiveness, apathy, forgetfulness, word-finding
difficulty, and mental slowness (Richardson & Adams 2018).

Affective Symptoms- Stressor exposure is often operationalized as the frequency of stressors reported, whereas affective reactivity to daily stressors is often assessed as the difference in negative or positive affect on stressor days versus non-stressor days. Affective reactivity to daily stressors is a person-level measure of how well an individual copes with stressors. Affective reactivity to daily stress is associated with multiple negative health outcomes (Apsely et al. 2023).

Somatic Symptoms-

Somatic symptoms are a core part of major depressive disorder. Other somatic complaints (e.g.,
pain and gastrointestinal symptoms) often accompany
depression. These complaints are related to worse
functioning and inordinate. People may also
present with somatic symptoms as their primary
complaint in primary care settings. Moreover,
somatic symptoms may be better predictors of longitudinal mortality and response to psychotropic treatment than affective symptoms (Tse et al. 2018).

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Nagasaki, K., Seo, E., Maeno, T., & Kobayashi, H. (2022). Diagnostic accuracy of the Single‐item Measure of Burnout (Japanese version) for identifying medical resident burnout. Journal of General and Family Medicine, 23(4), 241–247. https://doi.org/10.1002/jgf2.535

Denning, M., Goh, E. T., Tan, B., Kanneganti, A., Almonte, M., Scott, A., Martin, G., Clarke, J., Sounderajah, V., Markar, S., Przybylowicz, J., Chan, Y. H., Sia, C.-H., Chua, Y. X., Sim, K., Lim, L., Tan, L., Tan, M., Sharma, V., … Kinross, J. (2021). Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. PloS One, 16(4), e0238666–e0238666. https://doi.org/10.1371/journal.pone.0238666

Williams, N. (2014). PHQ-9. Occupational Medicine (Oxford), 64(2), 139–140. https://doi.org/10.1093/occmed/kqt154

Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. American Journal of Health Promotion, 34(8), 929–941. https://doi.org/10.1177/0890117120920451

Richardson, Luann, Adams, Susie (2018). Cognitive Deficits in Patients With Depression,The Journal for Nurse Practitioners, Volume 14, Issue 6, 2018, Pages 437-443.e3, ISSN 1555-4155,

https://doi.org/10.1016/j.nurpra.2018.03.006.

(https://www.sciencedirect.com/science/article/pii/S1555415518302848)

Tse, Pui San, González, David Andres, Jenkins, Sharon Rae (2018). Validating the Structure of the Depression and Somatic Symptoms Scale, Psychosomatics, Volume 59, Issue 3, 2018, Pages 277-282, ISSN 0033-3182, https://doi.org/10.1016/j.psym.2017.11.002.

(https://www.sciencedirect.com/science/article/pii/S0033318217302220)

Apsley, Abner & Lee, Sun Ah & Bhat, Aarti & Rush, Jonathan & Almeida, David & Cole, Steven & Shalev, Idan. (2023). Affective reactivity to daily stressors and immune cell gene expression in the MIDUS study. Brain, Behavior, and Immunity. 115. 10.1016/j.bbi.2023.09.025.

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Case Study of Ana: A Second-Year Resident

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Case Study of Ana: A Second-Year Resident

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Ana, a second-year resident, is currently dealing with a large number of stressors; causing her to feel a significant amount of burnout.