Burnout and psychiatric morbidity in new medical graduates

Simon M Willcock, Michele G Daly, Christopher C Tennant and Benjamin J Allard
Med J Aust 2004; 181 (7): 357-360.


Objective: To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year.

Design: Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions.

Participants: All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented.

Outcome measures: Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory.

Results: The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period.

Conclusions: Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.

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  • Simon M Willcock1
  • Michele G Daly2
  • Christopher C Tennant3
  • Benjamin J Allard4

  • 1 Hornsby Hospital, Sydney, NSW.
  • 2 Royal North Shore Hospital, Sydney, NSW.
  • 3 Wollongong Hospital, Wollongong, NSW.



This study was supported by a grant from the National Health and Medical Research Council and approved by the Human Ethics Committee, Sydney University. We thank Professors Stewart Dunn, Geoffrey Berry and Associate Professor Jill Gordon for their advice at the onset of this study, the interns and the clinical training units of the participating hospitals in NSW and the Australian Capital Territory, and Tracey Bayliss for her data management skills.

  • 1. Girard DE, Sack RL, Reuler JB, et al. Survival of the medical internship. Forum Med 1980 Jul; 3: 460-463.
  • 2. Hsu K, Marshall V. Prevalence of depression and distress in a large sample of Canadian residents, interns and fellows. Am J Psychiatry 1987; 144: 1561-1566.
  • 3. Firth-Cozens J. Emotional distress in junior house officers. BMJ 1987; 295: 533-536.
  • 4. Baldwin PJ, Dodd M, Wrate RW. Young doctor’s health II — health and health behaviour. Soc Sci Med 1997; 45: 41-44.
  • 5. Shanafelt T, Bradley K, Wipf J, Back A. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002; 136: 358-367.
  • 6. Clark DC, Salazar-Gruesco E, Grabler P, Fawcett J. Predictors of depression during the first 6 months of internship. Am J Psychiatry 1984; 141: 1095-1098.
  • 7. Collier V, McCue JD, Markos A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med 2002; 136: 384-390.
  • 8. Maslach C, Jackson SE, Leiter M. Maslach burnout inventory manual. Palo Alto, Calif.: Consulting Psychologists Press, Inc, 1996.
  • 9. Firth-Cozens J. Depression in doctors. In: Robertson MM, Katona CLE, editors. Depression and physical illness. New York: John Wiley and Sons, 1997.
  • 10. Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Ed 2001; 35: 110-120.
  • 11. Schofield K, Saunders NA. Education and training in the early postgraduate years: the NSW experience. Ann Commun-Oriented Educ 1993; 6: 173-179.
  • 12. Australian Medical Association. AMA Safe Hours Project. National code of practice: hours of work, shiftwork and rostering for hospital doctors. Available at: (accessed Aug 2004).
  • 13. Goldberg DP. Manual of the General Health Questionnaire. London: NFER, 1978.
  • 14. Andrews G, Hall W, Teeson M, Henderson S. The mental health of Australians: national survey of mental health and wellbeing. Canberra: Mental Health Branch,Commonwealth Department of Health and Aged Care, 1999: 2, 29-30.
  • 15. Winefield HR, Goldney RD, Winefield AH, Tiggemann M. The General Health Questionnaire: reliability and validity for Australian youth. Aust N Z J Psychiatry 1989; 23: 53-58.
  • 16. Firth J. Levels and sources of stress in medical students. BMJ 1986; 292: 1177-1180.
  • 17. Wilkin D, Hallam L, Doggett M. Measures of need and outcome for primary health care. Oxford: Oxford University Press, 1994.
  • 18. Fairley M, Langeluddecke P, Tennant C. Psychological and physical morbidity in the aftermath of a cyclone. Psychol Med 1986; 16: 671-676.
  • 19. SPSS version 10.1 [computer program]. Chicago, Ill: SPSS Inc, 2001.
  • 20. Bruce CT, Sanger MM, Thomas PS, et al. Factors affecting female or male consultant stress in an Australian teaching hospital. Med J Aust 2003; 179: 174-175. <MJA full text>
  • 21. Newbury-Birch D, Kamali F. Psychological stress, anxiety, depression, job satisfaction, and personality characteristics in preregistration house officers. Postgrad Med J 2001; 77: 109-111.
  • 22. Romans-Clarkson SE, Walton VA, Herbison GP, Mullen PE. Validity of the GHQ-28 in New Zealand women. Aust N Z J Psychiatry 1989; 23: 187-196.
  • 23. Ziegler JL, Kanas N. Coping with stress during internship. In: Scott CD, Hawk J, editors. Heal thyself: the health of health care professionals. New York: Brunner/Mazel Publishers, 1986.
  • 24. Wessels DT Jnr. The etiology of job stress. In: Wessels DT Jnr, Kutscher AM, Seeland IB, et al, editors. Professional burnout in medicine and the helping professions. New York: Hawthorn Press Inc, 1989: 11-19.
  • 25. Firth-Cozens J, Moss F. Hours, sleep, teamwork and stress. BMJ 1998; 317: 1335-1336.
  • 26. Houston DM, Allt SK. Junior house officers one year on: changes in psychological distress and error making. Psychol Health Med 1999; 4: 281-287.
  • 27. Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995; 71: 1263-1269.
  • 28. Gabbe SG, Melville J, Mandel L. Burnout in chairs of obstetrics and gynecology: diagnosis, treatment and prevention. Am J Obstet Gynecol 2002; 186: 601-612.
  • 29. Guntupalli KK, Fromm RE. Burnout in the internist-intensivist. Intensive Care Med 1996; 22: 625-630.
  • 30. Doctors’ Mental Health Working Group. Report and recommendations. Sydney: Centre for Mental Health, NSW Health Department and NSW branch of the Australian Medical Association, 1997: 1-28.
  • 31. Houston DM, Allt SK. Psychological distress and error making among junior house officers. Br J Health Psychol 1997; 2: 141-151.
  • 32. O’Hagan J, Richards J. In sickness and in health. 2nd ed. Wellington (New Zealand) Doctors Health Advisory Service (DHAS), 1998: 1-9.


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