Practice The Competent Novice

How to handle stress and look after your mental health

BMJ 2009; 338 doi: (Published 27 April 2009) Cite this as: BMJ 2009;338:b1368
  1. Amy Iversen, clinical lecturer1,
  2. Bruno Rushforth, general practice specialty registrar2,
  3. Kirsty Forrest, consultant anaesthetist3
  1. 1Department of Psychological Medicine, Institute of Psychiatry, London SE5 9RJ
  2. 2Dewsbury and District Hospital, Dewsbury WF13 4HS
  3. 3Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds LS1 3EX
  1. Correspondence to: A Iversen a.iversen{at}

    Junior doctors can take action to avoid stress and depression associated with their workload. This article explains how, and gives advice on who to seek help from if the need arises

    Key points

    • Stress is common among junior doctors

    • A proportion of stressed doctors will develop mental health problems

    • Factors that contribute to stress can be identified and modified

    • Many confidential and free sources of help are available for doctors

    Twenty years ago Firth-Cozens reported that among doctors in their first year of graduating 50% were estimated to have emotional disturbance and 28% fulfilled criteria for depression.1 Since then, working hours have decreased, and the way that doctors are trained and managed has changed substantially. Despite this, the proportion of doctors experiencing psychological distress has remained constant, at about 28%, compared with about 18% in the general working population.2 3 For junior doctors, 79% of those caught up in the recent problems of MTAS (the UK medical training application service, an online system for the selection of junior doctors) scored above the threshold for psychological distress and 21% had significant distress.4 Psychiatric morbidity and burnout among hospital specialists in the UK are also increasing, rising between 1994 and 2002 from 27% to 32% and from 32% to 41% respectively.5 The four fictitious case scenario boxes illustrate a typical experience of a junior doctor becoming increasingly stressed.


    Stress is a controversial term but is broadly understood to result from an “imbalance between demands and resources” or occurring when “pressure exceeds one’s perceived ability to cope.”6 Although stress is not unique to medicine, commentators have suggested that the following combination of factors may contribute to stress in doctors: excessive workload7; dealing with patients’ suffering and one’s own mistakes or fear of them; and lack of professional support …

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