Exhausted, stressed and burned out
There is a significant burden of psychological distress, burnout and mental health issues among Australian dental practitioners, with a need for awareness, education and support.
This week we published the second paper in our series on mental health in Australian dental practitioners, this one focusing on mental health, psychological distress and burnout. It follows our research highlighting the high rates of suicidal ideation amongst dental practitioners.
Around 1 in 10 dental practitioners reported either a current diagnosis of depression or anxiety disorder, with nearly 1 in 4 having a history of depression or anxiety disorder. Approximately 1 in 4 dental practitioners were found to have moderate-severe psychological distress, 60% reported psychiatric morbidity and 1 in 4 had symptoms consistent with burnout. These are rates that are generally much higher than then general Australian population or comparable studies of Australian doctors, suggesting that there is something unique about dental practitioners and the practice of dentistry contributing to this burden of mental health issues.
Both the literature and personal experience tells us that dentistry is a stressful profession, with time and scheduling pressures, constantly striving for perfection, fear of litigation, demanding and unrealistic patient expectations and particularly meeting aesthetic needs, anxious patients, professional isolation, business pressures, staffing problems, regulatory demands and negative public perceptions of dentists all contributory factors. Perfectionism also appears to play a role - noting that there is a distinction between striving for perfection and perfectionist concerns related to making an error, or the discrepancy between expectation and performance. We found that nearly 90% of dental practitioners reported being distinctly perfectionist.
Stress in dentistry is a constant battle – however I feel that many workplaces make this situation worse with the mistreatment of their staff, or unwillingness to comply with important changes such as infection control updates, or advertising policies. Contracted and employed dentists often have NO control over the way the practice is run, and cannot change things even when change is necessary. This causes huge amounts of stress on young dentists trying to do the right thing.
Female dentist, 31–40 years, NSW, Regional, Private practice.
Psychological distress is a significant factor associated with mental health issues such as depression, anxiety disorder and burnout. The consequences of poor mental health in dental practitioners may be reflected in poor patient outcomes, poor practitioner wellbeing and the possibility of people leaving the profession.
Resilience
There is a strong focus on resilience and resilience training in workplaces as one mechanism to deal with high rates of burnout and mental ill-health, and there is certainly some evidence that resilience is a potential protective factor. Our research indicated that younger practitioners reported lower levels of resilience that older practitioners which might be a factor in the rates of mental health issues in younger practitioners. Low resilience was associated with higher rates of depression, anxiety disorder, psychological distress and burnout. However, burnout and mental ill-health is still present in dental practitioners with high levels of resilience.
There is a risk that focusing on resilience training shifts the burden of mental health to being an individual problem by suggesting that healthcare workers are to blame for their burnout, rather than seeking to address poor working conditions and unreasonable expectations placed on practitioners by external forces in the workplace. It is therefore important that strategies to address burnout and mental health have a broader focus on the causal factors, rather than focus on individual resilience.
Coping Behaviours
Of particular concern was some of the maladaptive behaviours that some practitioners engaged in as a potential coping mechanism to manage stress. Approximately one in six reported potentially hazardous or risky consumption of alcohol and 13.2% reported illicit substance use over the past 6 months. There were higher rates of risky or hazardous alcohol consumption in males, older practitioners and those working in regional or rural locations. Males and younger practitioners reported higher rates of illicit substance use, with lower rates in those who worked fewer clinical hours.
Mental Health and Mandatory Notifications
One of the barriers to seeking care for mental health issues is fears about mandatory reporting to health practitioner registration authorities and the potential to have restrictions placed on the ability to practice. However mandatory reporting guidelines only require a treating health practitioner to make a report for significant health impairment which places the public at-risk of substantial harm. Mandatory notification is not required in cases where there are effective strategies in place to manage an illness, which emphasizes the need for practitioners to seek professional care for mental health conditions. In contrast to practitioner perceptions, there are relatively few mandatory notifications in Australia.
These are often difficult conversations, but it is important that we continue to talk about these issues in order to reduce the stigma associated with mental health and ensure that practitioners are supported to seek appropriate care.
There are plenty of confidential services that are available to provide help and support – please make sure that if you are experiencing any issues of anxiety, depression, burnout or thoughts of suicide that you seek professional help:
Lifeline – 13 11 14
Dental Practitioner Support - 1800 377 700
Beyond Blue – 1300 224 636