Factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors

Louise M Nash, Michele G Daly, Patrick J Kelly, Elizabeth H van Ekert, Garry Walter, Merrilyn Walton, Simon M Willcock and Chris C Tennant
Med J Aust 2010; 193 (3): 161-166.


Objective: To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors.

Design, setting and participants: Cross-sectional postal survey of 2999 doctors (including all major specialty groups, trainees and general practitioners) insured with an Australian medical insurance company. The potential for psychiatric morbidity was measured by the General Health Questionnaire (GHQ), and the potential for hazardous alcohol use by the Alcohol Use Disorders Identification Test (AUDIT). The survey was conducted in 2007.

Main outcome measures: Demographic, work-related and personality factors associated with a GHQ score > 4 and an AUDIT score ≥ 8.

Results: Factors significantly associated with psychiatric morbidity in doctors were: having a current medicolegal matter, not taking a holiday in the previous year, working long hours, type of specialty, and having personality traits of neuroticism and introversion. Factors significantly associated with potentially hazardous alcohol use were being male, being Australian-trained, being between 40 and 49 years of age, having personality traits of neuroticism and extroversion, failing to meet Continuing Medical Education requirements, and being a solo practitioner.

Conclusions: The mental health of medical practitioners is crucial to the quality of care their patients receive. Doctors should reflect on their hours of work and need for holidays. Involvement with medicolegal processes, such as lawsuits, complaints and inquiries, is a stressful part of medical practice today. Doctors need to be educated about these processes and understand how the experience may affect their health, work and loved ones.

  • Louise M Nash1,2
  • Michele G Daly3
  • Patrick J Kelly4
  • Elizabeth H van Ekert5
  • Garry Walter2,6
  • Merrilyn Walton7
  • Simon M Willcock3
  • Chris C Tennant7

  • 1 New South Wales Institute of Psychiatry, Sydney, NSW.
  • 2 Discipline of Psychological Medicine, University of Sydney, Sydney, NSW.
  • 3 Academic General Practice Unit, Hornsby Ku-ring-gai Hospital, University of Sydney, Sydney, NSW.
  • 4 School of Public Health, University of Sydney, Sydney, NSW.
  • 5 MDA National, Sydney, NSW.
  • 6 Child and Adolescent Mental Health Services, Northern Sydney Central Coast Health, Sydney, NSW.
  • 7 University of Sydney, Sydney, NSW.


Our study was funded by a Northern Sydney Health research grant, the McGeorge Bequest (through the University of Sydney) and Avant Mutual Group Limited. The New South Wales Institute of Psychiatry provided a part-time research fellowship to Louise Nash from January to August 2008.

Competing interests:

Avant provided funding for a part-time research officer (Michele Daly) and mail-out of the questionnaire, as well as inhouse support for sample selection and comparison. Simon Willcock is an elected board member of Avant. Elizabeth van Ekert is a former employee of Avant.

  • 1. Firth-Cozens J, Cording H, Ginsburg R. Can we select health professionals who provide safer care? Qual Saf Health Care 2003; 12 (1 Suppl): i16-i20.
  • 2. Willcock SM, Daly MG, Tennant C, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Med J Aust 2004; 181: 357-360. <MJA full text>
  • 3. Johnson W. Predisposition to emotional distress and psychiatric illness amongst doctors: the role of unconscious and experiential factors. Br J Med Psychol 1991; 64: 317-329.
  • 4. Tyssen R, Vaglum P. Mental health problems among young doctors: an updated review of prospective studies. Harv Rev Psychiatry 2002; 10: 154-165.
  • 5. Newbury-Birch D, Kamli F. Psychological stress, anxiety, depression, job satisfaction, and personality characteristics in preregistration house officers. Postgrad Med J 2001; 77: 109-111.
  • 6. Bruce CT, Sanger MM, Thomas PS, et al. Factors affecting female or male consultant stress in an Australian teaching hospital [letter]. Med J Aust 2003; 179: 174-175. <MJA full text>
  • 7. Schattner PL, Coman GJ. The stress of metropolitan general practice. Med J Aust 1998; 169: 133-137. <MJA full text>
  • 8. Hayasaka Y, Nakamura K, Yamamoto M, Sasaki S. Work environment and mental health status assessed by the general health questionnaire in female Japanese doctors. Ind Health 2007; 45: 781-786.
  • 9. Clarke D, Singh R. Life events, stress appraisals, and hospital doctors’ mental health. N Z Med J 2004; 117: U1121.
  • 10. Martin C, Wilson J, Fiebelman N, et al. Physicians’ psychological reactions to malpractice litigation. South Med J 1991; 84: 1300-1304.
  • 11. Cook R, Neff C. Attitudes of physicians in northern Ontario to medical malpractice litigation. Can Fam Physician 1994; 40: 689-698.
  • 12. Mello MM, Studdert DM, Desroches CM, et al. Caring for patients in a malpractice crisis: physician satisfaction and quality of care. Health Aff (Millwood) 2004; 23: 42-53.
  • 13. Goldberg R, Kuhn G, Andrew L, Thomas H. Coping with medical mistakes and errors in judgment. Ann Emerg Med 2002; 39: 287-292.
  • 14. Waterman AD, Garbutt J, Hazel E, et al. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf 2007; 33: 467-476.
  • 15. Zuger A. Dissatisfaction with medical practice. N Engl J Med 2004: 350; 69-75.
  • 16. Charles S, Pyskoty M, Nelson A. Physicians on trial — self reported reactions to malpractice trials. West J Med 1988; 148: 358-360.
  • 17. Newman MC. Emotional impact of mistakes on family physicians. Arch Fam Med 1996; 5: 71-75.
  • 18. Cunningham W. The immediate and long-term impact on New Zealand doctors who receive patient complaints. N Z Med J 2004; 117: 972.
  • 19. Nash L, Daly M, Johnson M, et al. Psychological morbidity in Australian doctors who have and have not experienced a medico-legal matter: a cross sectional survey. Aust N Z J Psychiatry 2007; 41: 917-925.
  • 20. Newbury-Birch DR, Walshaw D, Farhad K. Drink and drugs: from medical students to doctors. Drug Alcohol Depend 2001; 64: 265-270.
  • 21. Rosta J. Hazardous alcohol use among hospital doctors in Germany. Alcohol Alcohol 2008; 43: 198-203.
  • 22. Rosta J, Aasland O. Female surgeons’ alcohol use: a study of a national study of Norwegian doctors. Alcohol Alcohol 2005; 40: 436-440.
  • 23. Nash L, Kelly P, Daly M, et al. Australian doctors’ involvement in medicolegal matters: a cross-sectional self-report study. Med J Aust 2009; 191: 436-440. <MJA full text>
  • 24. Eysenck HJ, Eysenck SBG. Manual of the Eysenck Personality Scales (EPS Adult). London: Hodder and Stoughton, 1991.
  • 25. Goldberg DP. Manual of the General Health Questionnaire. Windsor: National Foundation for Educational Research, 1978.
  • 26. Saunders J, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcoholic consumption — II. Addiction 1993; 88: 791-804.
  • 27. Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley, 1989.
  • 28. Peisah C, Latif E, Wilhelm K, Williams B. Secrets to psychological success: why older doctors have lower psychological distress and burnout than younger doctors. Aging Ment Health 2009; 13: 300-307.
  • 29. Taylor A, Dal Grande E, Parsons J. Mental health status of South Australians: October 1997. Adelaide: Government of South Australia, 1997. (accessed Feb 2010).
  • 30. Ivis FJ, Adlaf EM, Rehm J. Incorporating the AUDIT into a general population telephone survey: a methodological experiment. Drug Alcohol Depend 2000; 60: 97-104.
  • 31. Fleming J. The epidemiology of alcohol use in Australian women: findings from a national survey of women’s drinking. Addiction 1996; 91: 1325-1334.
  • 32. Australian Institute of Health and Welfare. Medical labour force 2005. Canberra: AIHW, 2008. (AIHW Cat. No. HWL 41; National Health Labour Force Series No. 40.) (accessed Jun 2010).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.