Pandemic and Mental Health

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A healthcare worker sitting dejectedly

Physicians are at a crisis point. Even before COVID-19, we saw an alarming increase in the number of doctors experiencing burnout, loss of connection, or even moral exhaustion with their work. The pandemic has only exacerbated this frustration and fatigue. CPSO recognizes the extraordinary pressures inherent in the practice of medicine, as well as the threat physician burnout poses to patient care. The pandemic has caused chaos and misery, but it also began normalizing conversations about physician mental health. As the regulator, we need to be a part of this crucial conversation. We hope this series of articles conveys our support for physicians and encourages those who need help to seek it out. Also in this series: Reclaiming Herself and Reaching Out for Help.

The first year of the pandemic saw a significant increase in the number of Ontario doctors seeking help for mental health issues or problematic substance use.

A study published in the Journal JAMA Network Open found that during 2020, physicians had 27 percent more visits for mental health and substance disorders when compared to 2019. The relative increase was significantly greater in physicians without a prior mental health or substance use issue.

Surveys of physicians during the COVID-19 pandemic have found increased rates of depression, anxiety and burnout. However, because many surveys have low response rates, and capture only a single point in time, it is “unclear how reflective they are of physician mental health overall,” said lead author Dr. Daniel Myran, a family physician, public health and preventive medicine specialist, and postdoctoral fellow at the University of Ottawa Department of Family Medicine and The Ottawa Hospital. “To help understand how COVID-19 has been impacting physician mental health we looked at changes over time in health care visits by physicians.”

Dr. Myran and his colleagues linked anonymized data from 34,000 practising physicians in Ontario to the health administrative databases at ICES. They looked at all in-person and virtual care outpatient visits to a psychiatrist or primary care physician that were coded as related to mental health or substance use.

The study’s findings suggest the pandemic has placed a considerable strain on the mental health of physicians.

“We found a large increase in mental health visits by physicians during the first year of the COVID-19 pandemic, which raises real concerns about worsening physician mental health,” said Dr. Myran. “We found that more physicians were accessing mental health services during the pandemic, and that physicians who accessed services did so more often.”

There were no significant differences in increases of mental health visits between men and women, older and younger physicians, urban or rural physicians, or between physicians who cared directly for patients with COVID-19 in the emergency department or admitted to hospital and those who did not.

“We were surprised to see no change in mental health visits by physicians who provided direct care to COVID-19 patients in hospital, as in other studies they reported greater mental health impacts,” said co-senior author Dr. Manish Sood, a physician-scientist and Jindal Research Chair for the Prevention of Kidney Disease at The Ottawa Hospital, and associate professor at the University of Ottawa.

“Going forward, mental health interventions for physicians should focus both on stressors specific to COVID-19 as well as pre-pandemic factors”

“We did notice that this group of physicians, which included individuals in critical care, emergency medicine and internal medicine, already had lower rates of mental health visits pre-pandemic. This could mean they have greater resilience, more reluctance to seek care, or have work schedules that are a barrier to seeking care. However, it’s important to note that our study looked only at the first year of the pandemic, and the situation has changed since, particularly with the Omicron variant putting incredible pressure on the health care system.”

The researchers note that the expansion of virtual care options during the pandemic may have played a role in increased mental health visits by physicians.

“There is a lot of stigma in the medical profession when it comes to mental health and accessing services,” said co-senior author Dr. Peter Tanuseputro, a physician-scientist at The Ottawa Hospital, ICES and the Bruyère Research Institute and assistant professor at the University of Ottawa Department of Medicine. “It’s possible that virtual appointments reduced some of these barriers because they fit more easily into a physician’s schedule and were less visible to their colleagues.”

“While the pandemic may have exacerbated physician mental health concerns, our study suggests that many of these concerns predate the pandemic,” said Dr. Myran. “Going forward, mental health interventions for physicians should focus both on stressors specific to COVID-19 as well as pre-pandemic factors, many of which may require system-level changes and reinvestment in the health care system.”

This study was funded by ICES, the Canadian Institutes for Health Research, the Canadian Medical Association and the Academic Medical Organization of Southwestern Ontario. Data sources include ICES and the Canadian Institute for Health Information. This was the first published study from HELP MD, a novel data-driven research initiative to better understand and improve physician health and wellness, funded by the Canadian Medical Association.