Practice Management

Doctors should focus on things under their control to cope with psychological distress during the COVID-19 pandemic BY TAMMY WORTH

Former First Lady Michelle Obama broke the internet when she recently announced she had been suffering low-grade depression because of the pandemic and national upheaval. Her declaration appeared to resonate with people across the country suffering from physical illness, isolation, and income and job losses.

A recent study published in JAMA Network Open found that 3 times more Americans are suffering from depression during the COVID-19 pandemic compared with before. Front-line workers have not been sheltered from this challenge, as borne out by high-profile physician suicides in COVID-19 hotspots.

“We are all adapting to a situation where we don’t know what’s coming down the line,” said Carol Bernstein, MD, vice chair for faculty development at Montefiore Medical Center in New York City.

Burnout or Depression? Burnout is a common malady among physicians as a result of working long hours and dissatisfaction stemming from having less time to spend with individual patients. But with many physicians working fewer hours now, mental health challenges they are dealing with may look more like depression. How can one tell the difference?

Burnout, Dr Bernstein explained, tends to be more transient and is related to work situations. Symptoms can be emotional exhaustion, depersonalization and lack of effectiveness on the job.

“If someone is saying they feel down and disconnected and angry and irritable, but when they get away from work those symptoms go away, that is more indicative of burnout than depression,” she said.

It can be a bit more difficult to detangle those kinds of emotions during a pandemic when there are so many more stressors. But burnout is typically related to system issues in the workplace.

Classic symptoms of depression, however, are feelings of sadness, hopelessness, and loss of sleep or too much sleep. Symptoms tend to come on over a period of time and can stick around longer.

If more serious symptoms arise, like dramatic changes in sleep or appetite, suicidal ideation, and not enjoying things that usually are pleasurable, it is important to seek help from a mental health professional, Dr Bernstein said. This can also be true if symptoms are milder but persist for weeks or months at a time.

Debriefings Held A few weeks after the pandemic hit, SBH Health System in the Bronx, New York, began providing debriefings — therapy-like sessions for all departments of the hospital — by psychiatrists and psychologists in its department of psychiatry. The fact that everyone was going through the same kinds of strug- © TIM PLATT / GETTY IMAGES gles made it easier for people to talk in Exercising and getting healthy amounts of sleep may help ease distress, an expert says. those early days, said Lizica Troneci, MD, chair and residency program “It’s taboo to say we are struggling, Whether struggling with burnout or director in the department. and it’s a particular problem in medi- depression, it is important to focus on

“It was more acceptable to have cine,” she said. “A lot of what people the things that are under one’s control, debriefings and to talk about the feelings are feeling right now is normal in these Dr Bernstein said. Physicians should and experiences we have had, which, circumstances and normalizing it will try to do things they enjoy. Dr Troneci looking back, is different than discuss- help people feel better.” recommends such routine activities ing burnout we had experienced before,” as eating well, exercising, and getting Dr Troneci said. “The COVID-19 Get Together With Staff healthy amounts of sleep. experience brought us together because When talking about work issues, everyone had fears and anxiety, and Dr Bernstein recommends trying not Take One Day at a Time there was less stigma and more open- to focus too much on how awful things It is also important to remember to take one day at a time. “People don’t do that well, and doctors especially don’t,”

‘Isolation only contributes to feelings of loss and Dr Bernstein said. “We are always focused on the future. We have to take depression, so acknowledging and talking about one day at a time because we don’t stressors can help people get through tough times.’ know what’s coming, and eventually this will get under control.” Dr Bernstein equates moving forward now with the airline changes ness associated with talking about this.” are because that can be dishearten- after the events of 9/11. At first, she

This kind of assistance for physicians ing. Instead, she suggests having what said, it was a hassle to abide with the is extremely important, according to she calls an appreciative inquiry. Staff new encumbrances that went along Dr Bernstein. Isolation only contrib- members get together and focus on with flying, but eventually people got utes to feelings of loss and depression, what is working well and how they can used to them. so acknowledging and talking about do more of that. “It’s important to maintain in your stressors can help people get through “If you spend all of your time saying, head that this is a time-limited thing tough times, she said. The more promi- ‘It’s awful and I can’t do this or that,’ it and maintaining hope for the future is nent the people are who talk about feel- can perpetuate,” she said. “There is a important,” she said. ■ ing burned out or depressed, the easier delicate balance between sharing misit is for everyone to acknowledge and ery and looking at how you can proac- Tammy Worth is a freelance medical discuss their feelings, Dr Bernstein said. tively address things together.” journalist based in Blue Springs, MO.