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Depressed Residents Make Medication Errors

A study of pediatric residents links medication errors to depression, but not to burnout.

Unfortunately, medication errors are frequent, and severe ones can affect morbidity and mortality. Most investigators into the issue have focused on system factors, such as scheduling that causes sleep deprivation and overwork. These researchers prospectively examined the relation between self-reported depression and "burnout" in residents and subsequent medical errors in two pediatric residency programs. Errors were confirmed by review of charts and medication orders and by formal hospital reports of errors.

Of eligible residents, 123 (50%) participated. Twenty-four (20%) had scores on a 10-item validated rating scale indicating probable clinical depression; of these residents, three (12%) were taking antidepressants and seven (29%) reported a history of depression. Ninety-two respondents (75%) reported burnout on a standard inventory.

The rate of medication error was six times greater in depressed residents than in nondepressed residents. Burnout did not alter the error rate. However, both depressed and burned-out residents reported that they thought they made more errors.

Comment: This preliminary study suggests that the mental health of physicians is a neglected factor affecting work performance. Medication errors may be both more common in pediatrics than in other specialties, because of the use of many off-label medications and nonstandardized dosing, and potentially more dangerous because of the age of the patients. The continuing stigma against mental illness may hinder young doctors from acknowledging their depression and seeking treatment. It is vital that training programs provide screening and outreach for this problem. The study’s low response rate and small sample are major limitations and argue for larger, prospective studies that involve all specialties and physicians at all levels of practice.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry March 17, 2008

Citation(s):

Fahrenkopf AM et al. Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ 2008 Mar 1; 336:488.

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