It was not possible to calculate the response rate because it was not clear if all NHS trusts and Royal Colleges who agreed to invite doctors to take part in this research did send out the invitations, and to how many doctors.

Introduction

Distress suffered by doctors has significant consequences for patient care. A recent meta-analysis of 47 studies found that burned-out doctors were more likely to provide poor quality care because of reduced professionalism, and they were more likely to be associated with poor patient satisfaction and incidents that jeopardise patient safety.1 There is a high prevalence of distress among doctors in the UK, with a systematic review of 30 studies showing that 17%–52% of doctors have psychiatric morbidity,2 higher than the prevalence rate of 19% in the general population,3 and 31%–54% of doctors have a type of burnout called emotional exhaustion.2 Little is known, however, about whether occupational distress raises the risk of health problems (eg, insomnia, binge-drinking) that might compel doctors to be absent from work or take sick leave resulting in understaffing and a risk to patient safety.

Occupational distress can be described as a syndrome comprising burnout, depression, maladaptive coping strategies and other symptoms.4 The potential implications for risks to patient safety due to sickness-absence make it useful to investigate the impact of different types of occupational distress on the relative risk of: (a) behaviours that have an impact on doctors’ health such as alcohol/drug use and binge-eating; (b) health issues such as sleep disturbances and daily or weekly symptoms of ill health (eg, headaches or fatigue). This is the first study to examine such a broad spectrum of health consequences among doctors. The other innovation of the current study is that, whereas many previous studies have sampled US doctors5 or individual specialties such as oncology4 and surgery,6 this study sheds new light on the impact of occupational distress on health problems among doctors in the UK.

Does occupational distress increase the risk of doctors using alcohol or drugs? Workers experiencing occupational distress are more likely to regularly drink alcohol, binge-drink or use drugs as a method of coping.7 8 Doctors, on average, report equivalent or lower rates of alcohol abuse than the general population,9 but daily alcohol consumption or binge-drinking that does not meet the threshold for diagnosis of alcoholism is still problematic,10 11 and symptomatic of psychological distress. In the USA, 10% of doctors drink alcohol daily and 8% report severe alcohol or drug misuse or dependence at some point in their lives.5 Prescription drug abuse is particularly problematic because doctors are up to five times more likely to use prescription drugs than the general population due to easier access or familiarity with prescription drugs, for example, 24% of US doctors use benzodiazepine and 40% use minor opiates.5 There are many reasons why doctors use substances—not all of which are to do with being distressed—therefore research is needed to clarify the proportion of doctors who use alcohol/drugs as a way of coping with occupational distress. The coping function of alcohol/drug use among doctors, as with the general population, is plausible because alcohol and many drugs have psychoactive properties, for example, prescription drugs such as benzodiazepine and opiates; illicit drugs such as Lysergic Acid Diethylamide (LSD). Occupational distress is known to predict alcohol misuse in the general population,7 but little is known about whether, for example, doctors with high levels of burnout are at greater risk of using alcohol or drugs (including prescription or legally purchased drugs), and whether other types of occupational distress (eg, psychiatric morbidity, negative coping strategies) have similar effects. Little is also known about the impact of other job factors such as work experience on the risk of doctors engaging in substance use.

Does occupational distress increase the risk of doctors’ binge-eating? Like alcohol or drug use, binge-eating is more prevalent among workers experiencing occupational distress12 but, unlike substance use, little is known about binge-eating rates among doctors and risk factors. Binge-eating can be defined as eating a larger amount of food than most people eat in one sitting and finding oneself unable to control one’s eating.13 Binge-eating, like alcohol or drug use, is a common method of coping with psychological distress because eating offers an initial sense of comfort.14 15 The initial comfort is, however, followed by feelings of shame or guilt, thus exacerbating distress.15 This is one of the first studies to assess the prevalence of binge-eating among UK doctors and to offer insights into whether doctors who binge-eat experience unpleasant emotions after bingeing. This study will also offer new insights into the impact of different types of occupational distress (eg, work-life imbalance) which, together with analysing substance abuse by doctors, will reveal the consequences of occupational distress for doctors’ health-related behaviours.

Does occupational distress increase the risk of doctors having sleep disturbances? There have been calls for research into the connection between sleep problems and doctors’ health,16 but most previous studies have focused on sleep deprivation rather than sleep disturbances that have a psychological aetiology, for example, trouble falling/staying asleep due to worry. Sleep deprivation can be defined as the lack of the opportunity to sleep, or more simply as sleeping too few hours each day. Sleep deprivation is associated with depression,17 18 burnout,19 suicide risk18 and immunity or cardiovascular health problems20 among doctors but sleep deprivation in itself is not necessarily a sign of psychological distress. Doctors who work long shifts21 or lack block-scheduled shifts22 sleep too few hours because they have no choice. Therefore, rather than measuring sleep deprivation, this study measured types of sleep disturbance with a psychological aetiology such as trouble falling asleep, waking up prematurely because of worrying about work and insomnia. It is plausible that the risk of these types of sleep disturbance is higher among doctors suffering from work-life imbalance, psychiatric morbidity and other types of occupational distress. This study will evaluate whether UK doctors suffering from occupational distress have an increased risk of sleep disturbances.

Does occupational distress increase the risk of doctors presenting with ill health? There is some research about the physical health of doctors in some specialties (eg, oncology),4 but research is needed to assess whether occupational distress predicts the risk of doctors from various specialties suffering from daily or frequent headaches, gastrointestinal problems and other physical symptoms. Physical health has a complex range of causes (eg, health behaviours, genetics and infections), but people who are distressed are more susceptible to infections because psychological distress weakens the immune system.23 The important question, therefore, is the relative risk of ill health symptoms, comparing doctors with and without occupational distress. We recognise that the physical health of doctors is shaped by a complex range of factors—only one of which is occupational distress—because working in a clinical environment can pose some risk to physical health.24 This study is one of the first to shed light on the impact of occupational distress on ill health symptoms among UK doctors.