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Study: Stressed Out Surgical Residents At High Risk For Substance Abuse

SAN FRANCISCO (KCBS) -- Burnout among surgical residents greatly increases the risk of high anxiety, depression, substance abuse and thoughts of suicide, according to a UCSF study released Thursday.

The study, published in the Journal of the American College of Surgeons, found that 70 percent of the 566 surgical residents who answered the research team's questionnaire said they had or were experiencing burnout driven by emotional exhaustion, "depersonalization" and doubts about their effectiveness at work.

The research team, headed by Dr. Carter Lebares, assistant professor in the UCSF Department of Surgery, found that 68.95 percent of the respondents experienced high burnout, comprised of emotional exhaustion and depersonalization, which can manifest as feeling detached from patients or becoming more cynical in general.

Moderate to severe depressive symptoms were identified in 20 percent of the residents, approximately twice as high as in the general age-matched population. Suicidal thoughts were present in 11 percent of the residents, more than three times higher than in the general population.

"Surgical trainees live in a culture where high stress is normative, but excessive stress must be addressed," said Lebares, noting that 53 percent of residents scored positive for high perceived stress."

"Although stress is initially stimulating, there is a tipping point when demand outstrips resources and stress becomes overwhelming," she continued. "In the absence of adequate coping skills, overwhelming stress that lasts for years has been associated with mood disorders and physiologic deterioration that can lead to disruption of neuro-endocrine regulation and exacerbation of atherosclerosis."

Close to half the residents – 49 percent – misused alcohol, more than five times the prevalence of misuse found in the general population. Alcohol abuse or dependence was found in 33 percent of the residents, twice as prevalent as in practicing surgeons.

Among female residents, who comprised 51 percent of the respondents, alcohol misuse and abuse was reported by 58 percent of the responders.

The study did find that emotional exhaustion, high stress and anxiety -- which peaked in the third year of residency -- appeared to decline markedly during the later years.

"Excessive stress and burnout are already well-known problems in health care workers," said Elissa Epel, a professor in the UCSF Department of Psychiatry and senior author of the study. "Here we identify what looks like a particularly high-risk group, surgery residents, whose stress levels during their training years are making them highly vulnerable to poor mental health."

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