Unravelling the Relationship between Physician Burnout and Depression

Dear Editor: We thank Dr. Schonfeld and colleagues for their letter responding to our survey regarding burnout symptoms among Canadian psychiatry residents. Their correspondence raises the issue of the connection between burnout and depression, noting that our survey did not consider whether residents who indicated burnout symptoms may have indeed been depressed. We agree that clarifying the relationship between burnout and depression is important. Although a large body of research has established a link between these constructs, it is premature to conclude that burnout and depression are one and the same. Clinical depression is marked by considerable heterogeneity and is optimally assessed using interviews by trained clinicians. Unfortunately, these issues have been inadequately accounted for in burnout research. As Schonfeld and colleagues note in a recent review, this prevents definitive conclusions regarding the overlap between burnout and depression. Alarming rates of depressive symptoms have been reported among residents of various medical specialties. Further research is needed to tease apart the relationship between training-related burnout and other potential depressogenic factors. Our survey was not designed to accomplish this. Rather, we sought to investigate the incidence of emotional exhaustion—a prominent burnout symptom—among psychiatry trainees in Canadian residency programs. While we do not know whether the residents who endorsed burnout symptoms were struggling with clinical depression, our findings may nevertheless provide some stimulus for further work—including research using more comprehensive assessment methods. If unaddressed, burnout may progress to depression. Hopefully, residents’ use of personal psychotherapy—along with other resources—can mitigate this unfortunate trajectory. Whether linked with depression or not, burnout among residents is a significant concern. We thus reiterate our call for attention to this matter on the part of psychiatric educators, administrators, and residents—and we join Schonfeld and colleagues in arguing for further research in this area.