Depression and Depressive Symptoms in Physicians Prior to the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Shan Dhaliwal^1,2,3Deena Fremont¹Wenshan Li^1,2Daniel Myran^1,4Marco Solmi^1,5Peter Tanuseputro⁶Janet Wilson⁷Manish M Sood^1*

• ¹Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
• ²School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
• ³ICES, Ottawa, Canada
• ⁴Department of Family Medicine, University of Ottawa, Ottawa, Canada
• ⁵Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Canada
• ⁶Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ⁷Faculty of Medicine, University of Ottawa, Ottawa, Canada

Background: Mental health disorders, such as depression, can significantly impact a physician's well-being and the quality of care they provide. We conducted a systematic review and meta-analysis to identify risk factors and to estimate the prevalence of depression and depressive symptoms in physicians prior to the COVID-19 pandemic. Methods: PRISMA 2020-compliant systematic review and meta-analyses, searching EMBASE, APA PsycINFO and Medline databases from January 2002-March 2020 (pre-COVID-19). Risk of bias was assessed using a modified Newcastle-Ottawa Scale for cohort and cross-sectional studies. We included studies of physicians where depression/depressive symptoms were measured by either a validated questionnaire or clinical diagnosis. The primary and secondary outcomes measures included assessing the prevalence of depression/depressive symptoms, and whether depression differed by pertinent risk factors (study design, sex, specialty, training stage) in the literature prior to the COVID-19 pandemic. Results: Forty-two studies from 14 countries involving 27,284 physicians (7,293 with depression or depressive symptoms) were included. The pooled prevalence estimate was 34.2% (95% CI: 26.4-43.0%), with substantial heterogeneity identified across studies (I2 = 98%). Most studies were cross-sectional surveys (n=28) and cohort studies (n=14). A total of 13 different assessment methods were used. We found no statistically significant difference in depression between male and female physicians (OR: 0.78, 95% CI: 0.46, 131), and a slightly increased rates in residents compared to staff physicians [pooled estimates of 36% (95% CI: 26-47%) and 29% (95% CI: 13-53%)]. Finally, 25 studies were deemed "High" risk of bias, while the remaining 17 were "Low" risk. Conclusions: In this review examining depression and depressive symptoms among physicians, we report a pooled estimate of 34% prior to the COVID-19 pandemic. Due to the high degree of heterogeneity in study design and limited examination of key risk factors, limited conclusions can be made regarding the true prevalence across the physicians, and how best to target interventions. Systematic Review Registration: PROSPERO ID CRD42021232814