Santé mentale des médecins libéraux français pendant la deuxième vague de COVID 19

La pandémie de COVID-19 a créé une crise sanitaire mondiale ayant entraîné une souffrance psychologique du personnel soignant notamment les médecins hospitaliers. Nous avons montré que les niveaux de souffrance psychologiques étaient aussi élevés parmi les médecins libéraux. Aucune étude n’a à ce jour comparé les médecins généralistes avec les médecins de l’ensemble des autres spécialités libérales pendant la pandémie en France. Cette étude visait à comparer la souffrance psychologique en termes de burn-out, d’anxiété, de symptômes dépressifs et d’insomnie entre les médecins généralistes et les médecins libéraux de toutes les autres spécialités en France durant la deuxième vague épidémique. Il s’agissait d’une étude transversale nationale en ligne adressée aux médecins libéraux utilisateurs de Doctolib. Nous avons utilisé le Copenhagen Burnout Inventory, l’Hospital and Anxiety Depression Scale, l’Insomnia Severity Index, afin d’évaluer burn-out, symptômes anxieux et dépressifs et insomnie. Nous avons évalué l’association entre la pandémie COVID-19, le travail et l’état psychologique. La période d’inclusion était du 1er au 30 novembre 2020 pendant le deuxième confinement. L’étude a été menée selon les critères STROBE. Au total, 1992 médecins ont répondu dont 957 généralistes. Parmi les médecins répondants, 79,4 % souffraient de détresse psychologique. Les médecins généralistes rapportaient davantage de stress lié au COVID-19 (OR = 1,43 IC95 [1,16 ; 1,77]) et à leur travail (O = 1,50 ; IC95 [1,23–1,81]) et souffraient plus de burn-out que les médecins d’autres spécialités (OR = 1,33 IC95 [1,09 ; 1,63]). Ils consommaient également davantage de psychotropes (OR = 1,38 ; IC95 [1,05–1,81]). Les médecins libéraux déclaraient un niveau élevé de détresse psychologique durant la pandémie COVID-19. Les médecins généralistes souffraient de davantage de stress lié à la pandémie et à leur travail en comparaison aux médecins d’autres spécialités. The 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians’ burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave. We conducted an online survey of private practitioners registered on Doctolib® (n = 32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of > 50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that “the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout”. Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations. 1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P < 0.001). GPs had a higher prevalence of burnout (OR = 1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR = 1.50 CI95 [1.23;1.81]) or COVID-19-related (OR = 1.43 CI95 [1.16;1.77]). Our study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves.