Being a healthcare professional can be a uniquely rewarding calling. However, the demands of training and practice can lead to chronic distress and serious psychological, interpersonal, and personal health burdens. Although higher burnout, depression, and suicide rates have been reported in healthcare professionals, only a minority receive treatment. Concerns regarding confidentiality, stigma, potential career implications, and cost and time constraints are cited as key barriers. Web-based and mobile applications have been shown to mitigate stress, burnout, depression, and suicidal ideation among several populations and may circumvent these barriers. Here, we reviewed published data on such resources and selected a small sample that readily can be used by healthcare providers.
We searched PubMed for articles evaluating stress, burnout, depression, and suicide prevention or intervention for healthcare students or providers and identified five categories of programs with significant effectiveness: Cognitive Behavioral Therapy (online), meditation, mindfulness, breathing, and relaxation techniques. Using these categories, we searched for Web-based (through Google and beacon.anu.edu.au—a wellness resource website) and mobile applications (Apple and mobile.va.gov/appstore) for stress, burnout, depression, and suicide prevention and identified 36 resources to further evaluate based on relevance, applicability to healthcare providers (confidentiality, convenience, and cost), and the strength of findings supporting their effectiveness.
We selected seven resources under five general categories designed to foster wellness and reduce burnout, depression, and suicide risk among healthcare workers: breathing (Breath2Relax), meditation (Headspace, guided meditation audios), Web-based Cognitive Behavioral Therapy (MoodGYM, Stress Gym), and suicide prevention apps (Stay Alive, Virtual Hope Box).
This list serves as a starting point to enhance coping with stressors as a healthcare student or professional in order to help mitigate burnout, depression, and suicidality. The next steps include adapting digital health strategies to specifically fit the needs of healthcare providers, with the ultimate goal of facilitating in-person care when warranted.
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West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294–300. https://doi.org/10.1001/jama.2009.1389.
Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care. 2004;42(2 Suppl):II57–66. https://doi.org/10.1097/01.mlr.0000109126.50398.5a.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13. https://doi.org/10.1016/j.mayocp.2015.08.023.
Iacovides A, Fountoulakis KN, Kaprinis S, Kaprinis G. The relationship between job stress, burnout and clinical depression. J Affect Disord. 2003;75(3):209–21. https://doi.org/10.1016/S0165-0327(02)00101-5.
Prosser D, Johnson S, Kuipers E, Szmukler G, Bebbington P, Thornicroft G. Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction. J Psychosom Res. 1997;43(1):51–9. https://doi.org/10.1016/S0022-3999(97)00086-X.
Gartlehner G, Gaynes BN, Forneris C, Lohr KN. Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression. Ann Intern Med. 2016;165(6):454. https://doi.org/10.7326/L16-0209.
Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med. 2002;77(9):918–21. https://doi.org/10.1097/00001888-200209000-00024.
Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289(23):3161–6.
Kuhn CM, Flanagan EM. Self-care as a professional imperative: physician burnout, depression, and suicide. Can J Anaesth. 2017;64(2):158–68. https://doi.org/10.1007/s12630-016-0781-0.
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443–51. https://doi.org/10.1097/ACM.0000000000000134.
Martinez S, Tal I, Norcross W, Newton IG, Downs N, Seay K, et al. Alcohol use in an academic medical school environment: a UC San Diego Healer Education Assessment and Referral (HEAR) report. Ann Clin Psychiatry. 2016;28(2):85–94.
Ey S, Moffit M, Kinzie JM, Brunett PH. Feasibility of a comprehensive wellness and suicide prevention program: a decade of caring for physicians in training and practice. J Grad Med Educ. 2016;8(5):747–53. https://doi.org/10.4300/JGME-D-16-00034.1.
Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med. 2016;91(9):1200–4. https://doi.org/10.1097/ACM.0000000000001297.
Zisook S, Young I, Doran N, Downs N, Hadley A, Kirby B, et al. Suicidal ideation among students and physicians at a US medical school: a Healer Education, Assessment and Referral (HEAR) program report. OMEGA J Death Dying. 2016;74(1):35–61. https://doi.org/10.1177/0030222815598045.
Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87(3):320–6. https://doi.org/10.1097/ACM.0b013e31824451ad.
Downs N, Feng W, Kirby B, McGuire T, Moutier C, Norcross W, et al. Listening to depression and suicide risk in medical students: the Healer Education Assessment and Referral (HEAR) program. Acad Psychiatry. 2014;38(5):547–53. https://doi.org/10.1007/s40596-014-0115-x.
Slavin SJ, Chibnall JT. Finding the why, changing the how: improving the mental health of medical students, residents, and physicians. Acad Med. 2016;91(9):1194–6. https://doi.org/10.1097/ACM.0000000000001226.
Brooks E Preventing physician distress and suicide. In: Steps forward. American Medical Association. 2017. https://www.stepsforward.org/modules/preventing-physician-suicide. Accessed July 24, 2017.
Young G Background: what is wellbeing and resilience and why focus on it? In: AAMC leadership forum: creating a culture of wellbeing and resilience in academic medicine. Association of American Medical Colleges 2015. https://www.aamc.org/download/462612/data/wellbeingpresentations.pdf. Accessed July 24, 2017.
Physician well-being: resources. Accreditation Council for Graduate Medical Education. 2017. http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources. Accessed July 24, 2017.
Mental health awareness in osteopathic medical education. Association of Colleges of Osteopathic Medicine. 2017. http://www.aacom.org/become-a-doctor/mental-health-awareness-in-ome. Accessed July 31, 2017.
Physician and medical student depression and suicide prevention. American Foundation for Suicide Prevention. 2017. https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/. Accessed July 31, 2017.
Haskins J, Carson JG, Chang CH, Kirshnit C, Link DP, Navarra L, et al. The suicide prevention, depression awareness, and clinical engagement program for faculty and residents at the University of California, Davis Health system. Acad Psychiatry. 2016;40(1):23–9. https://doi.org/10.1007/s40596-015-0359-0.
West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174(4):527–33. https://doi.org/10.1001/jamainternmed.2013.14387.
Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the conversation from burnout to wellness: physician well-being in residency training programs. J Grad Med Educ. 2009;1(2):225–30. https://doi.org/10.4300/JGME-D-09-00026.1.
Gold KJ, Andrew LB, Goldman EB, Schwenk TL. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51–7. https://doi.org/10.1016/j.genhosppsych.2016.09.004.
Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35(1):45–9. https://doi.org/10.1016/j.genhosppsych.2012.08.005.
Howells A, Ivtzan I, Eiroa-Orosa FJ. Putting the ‘app’ in happiness: a randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. J Happiness Stud. 2016;17(1):163–85. https://doi.org/10.1007/s10902-014-9589-1.
Guille C, Zhao Z, Krystal J, Nichols B, Brady K, Sen S. Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: a randomized clinical trial. JAMA Psychiatry. 2015;72(12):1192–8. https://doi.org/10.1001/jamapsychiatry.2015.1880.
Bush NE, Smolenski DJ, Denneson LM, Williams HB, Thomas EK, Dobscha SK. A Virtual Hope Box: randomized controlled trial of a smartphone app for emotional regulation and coping with distress. Psychiatr Serv. 2016:appips201600283.
West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–81. https://doi.org/10.1016/S0140-6736(16)31279-X.
Heber E, Ebert DD, Lehr D, Cuijpers P, Berking M, Nobis S, et al. The benefit of web- and computer-based interventions for stress: a systematic review and meta-analysis. J Med Internet Res. 2017;19(2):e32. https://doi.org/10.2196/jmir.5774.
Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, et al. Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA Psychiatry. 2017;74(4):351–9. https://doi.org/10.1001/jamapsychiatry.2017.0044.
Andersson G, Carlbring P, Hadjistavropoulos HD. Internet-based cognitive behavior therapy. In: Hofmann SG, Asmundson GJ, editors. The science of cognitive behavioral therapy. London: Elsevier; 2017. p. 531–49. https://doi.org/10.1016/B978-0-12-803457-6.00021-0.
Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37(3):319–28. https://doi.org/10.1017/S0033291706008944.
App evaluation model. American Psychiatric Association. 2017. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model. Acessed 14 September 2017.
Luxton DD, Hansen RN, Stanfill K. Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis. J Telemed Telecare. 2014;20(8):431–5. https://doi.org/10.1177/1357633X14555616.
Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119–28. https://doi.org/10.2190/PM.43.2.b.
Chittaro L, Sioni R. Evaluating mobile apps for breathing training: the effectiveness of visualization. Comput Hum Behav. 2014;40:56–63. https://doi.org/10.1016/j.chb.2014.07.049.
Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: randomised controlled trial. BMJ. 2004;328(7434):265–0. https://doi.org/10.1136/bmj.37945.566632.EE.
O'Kearney R, Gibson M, Christensen H, Griffiths KM. Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial. Cogn Behav Ther. 2006;35(1):43–54. https://doi.org/10.1080/16506070500303456.
Williams A, Hagerty BM, Brasington SJ, Clem JB, Williams DA. Stress Gym: feasibility of deploying a Web-enhanced behavioral self-management program for stress in a military setting. Mil Med. 2010;175(7):487–93. https://doi.org/10.7205/MILMED-D-09-00216.
Griffiths KM, Mackinnon AJ, Crisp DA, Christensen H, Bennett K, Farrer L. The effectiveness of an online support group for members of the community with depression: a randomised controlled trial. PLoS One. 2012;7(12):e53244. https://doi.org/10.1371/journal.pone.0053244.
Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329–42. https://doi.org/10.1016/j.cpr.2012.02.004.
Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on Internet-based mental health interventions—a systematic review. Internet Interv. 2014;1(4):205–15. https://doi.org/10.1016/j.invent.2014.08.003.
This work was supported by the National Institute on Mental Health R25 grant MH071544 and the John A Majda, MD Memorial Fund.
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Pospos, S., Young, I.T., Downs, N. et al. Web-Based Tools and Mobile Applications To Mitigate Burnout, Depression, and Suicidality Among Healthcare Students and Professionals: a Systematic Review. Acad Psychiatry 42, 109–120 (2018). https://doi.org/10.1007/s40596-017-0868-0
- Suicide prevention
- Mobile applications
- Web applications