The effects of organisational-level interventions on symptoms of depression and anxiety in medical doctors – A Systematic Review

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ABSTRACT

  • 1Mahanjana, SK,
  • 2Pitso, LA ,
  • 3Ledibane, TD ,
  • 4Razwiedani, L ,
  • 5Ncube, MV ,
  • 6Hajison, P
  • 1Community Medicine, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria
  • 2Community Medicine, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria
  • 3Community Medicine, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria
  • 4Community Medicine, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria
  • 5Health Policy & Research, South African Medical Association, Pretoria, South Africa
  • 6Department of Paediatric and Child Health, School of Medicine, University of Pretoria

Background

Medical doctors face considerably greater rates of depression and anxiety than the general population, driven by workplace stressors. Organisational-level interventions may effectively address these challenges by tackling root causes. This systematic review aimed to assess the effects of organisational-level interventions on symptoms of anxiety and depression in medical doctors and evaluate the strength of evidence supporting their effectiveness.

Method

This review followed the PRISMA 2020 guidelines. A two-stage literature search was conducted using PubMed, EMBASE, PsycINFO, Scopus, and Web of Science between 2014 and 2024, complemented by citation chaining. Peer-reviewed studies in English assessing organisational-level interventions targeting depression and anxiety among medical doctors were included. Two independent reviewers conducted eligibility screening, data extraction, and quality assessment. The methodological quality of the studies was assessed using the Quality Assessment Tool for Quantitative Studies (QATQS), and data synthesis included both narrative and quantitative analyses. The primary outcomes were measured using validated tools.

Result

The 16 studies identified from the inclusion criteria were mainly conducted in hospitals, involving a total of 4227 study participants. Most of the studies (14 out of 16) were conducted in high-income countries, with 70.6% of participants being specialists. Fourteen studies were rated as having strong or moderate methodological quality. Five intervention categories were identified: mental health surveillance and monitoring, training and development, relational/team dynamics, flexible work/scheduling, and job/task modifications. Fewer than half (seven) of the studies reported statistically significant improvements in at least one primary outcome (symptoms of depression or anxiety). There was an insufficient level of evidence for all the intervention categories.

Conclusion

Organisational-level interventions, particularly training and development, show potential in reducing depression and anxiety symptoms among medical doctors. However, the evidence remains inconsistent, with limited research in low-income and primary care settings. Further research is essential to address knowledge gaps and inform effective, evidence-based strategies that support the mental wellbeing of medical professionals.
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PRESENTING AUTHOR

Dr. Siphesihle Mahanjana, MBChB; PG Dip PH; FCPHM Candidate

Public Health Medicine Registrar, Sefako Makgatho Health Sciences University

Dr Siphesihle Mahanjana is a senior Public Health Medicine Registrar at Sefako Makgatho Health Sciences University. She holds an MBChB degree and a Postgraduate Diploma in Public Health. She has an interest in the social determinants of health, health policy, as well as non-communicable diseases with a particular focus on mental health. She has worked on a number of projects related to mental health in Gauteng and nationally addressing mental health care challenges for both patients and healthcare workers alike. This is all with the hope of seeing true transformation in the way mental health is perceived and managed within our context. She is passionate about quality healthcare services and continues to advocate for such services in all spheres of work.
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