One in ten young cancer docs depressed

In a survey of 401 oncology registrars, 102 scored above the threshold for possible psychiatric morbidity and more than one in ten showed clinically important levels of depression.

The main reasons cited include being over-stretched, keeping up-to-date with knowledge, fear of making mistakes, talking with distressed relatives, and poor senior support and team relations.

Professor Chris Todd and his team at the University's School of Nursing, Midwifery and Social Work and Christie Hospital, Manchester, publish their findings in 'Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars' in the Royal College of Physicians journal Clinical Medicine this month.

Professor Todd says: "It is clear that specialist registrars training in cancer and palliative care are experiencing high levels of stress.

"A number of contributing factors have been identified and should be addressed. It would seem to be a dreadful waste of the current 200,000 invested in training to specialist registrar level to put them under such stress that they are unable to treat patients effectively, themselves experience psychological suffering perhaps requiring healthcare, increased sickness absence or even leave the profession prematurely."

The team surveyed all the palliative medicine, medical oncology and clinical oncology registrars in the country - 63% of the UK's cancer specialist registrars replied- with a questionnaire and a test for short-term changes in mental health.

They found 102 with levels of psychological distress, 44 had scores indicating depression and 15 expressed suicidal ideas.

The main reasons cited by the respondents were being over-stretched at times, keeping up-to-date with knowledge, fear of making mistakes, talking to distressed relatives, the effect of long working hours on personal/family life and conflict between work and family commitment. These were especially pertinent for medical oncology registrars.

Other reasons, which were more important to palliative care registrars, were making the right decision as a team, feeling under-utilised, low prestige of speciality and difficult relations with nursing staff.

Clinical oncology registrars also reported a lack of senior support/supervision. Better support and supervision for all these specialists could alleviate stress.

Professor Todd says: "The items with the highest scores appear to relate to the very issues in clinical practice one might expect these doctors to be concerned about, being competent in the face of conflicting demands on time.

"On the other hand, we were surprised to find issues relating to team working were rated more highly by palliative care registrars, as palliative care is a specialty which espouses the team approach. This may imply that palliative care teams are not functioning as well as previously believed."

The study also found that the effect of stress on personal/family life was the dominant predictor of depression, which tallied with studies of other specialties.

He adds: "Many doctors in various specialties experience high levels of stress during their working lives and are more at risk of depression, alcoholism and suicide than the general population. They also report that it can affect their performance. Cancer clinicians are exposed to high risk of poor mental health and other work has shown that their psychiatric morbidity has increased markedly over recent years. We carried out this study as little is known of oncology registrars' stress levels and what can be done to help at an earlier stage.

"As well as addressing working hours and workload, there needs to be a change in culture to enable these registrars to identify, work through and discuss difficulties without a fear of it adversely affecting career prospects.

"Helpful strategies might include mentorship from a different team or specialty, review of appraisal so that positive as well as negative aspects of work are discussed, encouraging regular peer meetings where registrars may discuss any group issues, or team debriefs where patient- or team-related issues can be aired. In addition senior doctors need to be aware of the impact they have on the working lives of their juniors and be as supportive as possible."