Associations and Differences Between Occupational Burnout and Depression in Large Studies of U.S. Physicians

PURPOSE: To evaluate the correlation between occupational burnout and depression, frequency with which they coexist, how often one condition may be present in the absence of the other, and their association with suicidal ideation. METHOD: The authors conducted a secondary analysis of cross-sectional national surveys of practicing US physicians (conducted October 19, 2023-March 3, 2024) and residents/fellows ("trainees"; conducted November 30, 2023, to January 2, 2024). They measured correlation between emotional exhaustion (EE) and depersonalization (DP) scores using the Maslach Burnout Inventory and depression T-scores using the National Institutes of Health Patient Reported Outcomes Measurement Information System Depression scale. RESULTS: A total of 5,993 practicing physicians and 2,676 trainees were included in the analysis. The pooled R2 value between EE and depression scores for physicians and trainees was 0.42 (P < .001) and between DP and depression scores was 0.28 (P < .001). Among the 4,087 practicing physicians with normal depression scores, 1,201 (29.4%) had high EE and/or high DP. Among the 1,601 trainees with normal depression scores, 485 (30.3%) had high EE and/or high DP. On multivariable logistic regression adjusting for age, gender, relationship status, and work hours, each 1-point increase in depression T-score was associated with 15% higher odds of suicidal ideation among practicing physicians (OR 1.15; 95% CI: 1.13-1.17; P < .001) and trainees (OR 1.15, 95% CI: 1.13-1.17; P < .001). No statistically significant association between EE or DP scores and suicidal ideation was observed. CONCLUSIONS: Occupational burnout and depression are correlated but distinct constructs with distinct outcomes. Less than half the variation in burnout is explained by depression (and vice versa). Population health approaches to improve physician well-being should address both conditions. Organizational efforts should go beyond providing support for individuals experiencing distress and also address the work environment factors that contribute to it.