Mental ill-health in health professionals, including doctors, is a global and growing concern. The existing literature on interventions that offer support, advice and/or treatment to sick doctors has not yet been synthesised in a way that considers the complexity and heterogeneity of the interventions, and the many dimensions of the problem. We (1) reviewed interventions to tackle doctors’ and medical students’ mental ill-health and its impacts on the clinical workforce and patient care—drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives—and (2) produced recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Realist literature review consistent with the RAMESES quality and reporting standards. Sources for inclusion were identified through bibliographic database searches supplemented by purposive searches—resulting also from engagement with stakeholders. Data were extracted from included articles and subjected to realist analysis to identify (i) mechanisms causing mental ill-health in doctors and medical students and relevant contexts or circumstances when these mechanisms were likely to be ‘triggered’ and (ii) ‘guiding principles’ and features underpinning the interventions and recommendations discussed mostly in policy document, reviews and commentaries. One hundred seventy-nine records were included. Most were from the USA (45%) and were published since 2009 (74%). The analysis showed that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote wellbeing. Interventions creating a people-focussed working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors and medical students needed to have confidence in an intervention for the intervention to be effective. Successful interventions to tackle doctors’ and students’ mental ill-health are likely to be multidimensional and multilevel and involve multiple stakeholders. Evaluating and improving existing interventions is likely to be more effective than developing new ones. Our evidence synthesis provides a basis on which to do this. PROSPERO CRD42017069870. Research project webpage http://sites.exeter.ac.uk/cup/

中文翻译：

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优化解决医生和医学生精神疾病的策略：“压力下的护理”现实主义审查和实施指南。

包括医生在内的卫生专业人员中的心理健康问题已成为全球关注的焦点，并且日益受到关注。现有的关于为生病的医生提供支持，建议和/或治疗的干预措施的文献尚未以考虑干预措施的复杂性和异质性以及问题的许多方面的方式进行综合。我们（1）回顾了针对医生和医科学生的心理疾病及其对临床工作人员和患者护理的影响的干预措施-借鉴了各种文献资料，并反复地从不同的利益相关方角度进行了讨论-（2）提出了支持性建议制定，实施，监测和评估情境相关战略，以解决精神疾病及其影响。现实主义文学评论与RAMESES质量和报告标准一致。通过书目数据库搜索，再加上有目的的搜索，也可以从与利益相关者的参与中获得信息，从而确定包容的来源。从收录的文章中提取数据，并进行现实主义分析，以确定（i）可能导致医生和医学生精神疾病的机制以及可能触发这些机制的相关环境或情况，以及（ii）“指导原则”以及主要在政策文件，评论和评论中讨论的干预措施和建议的基础。包括一百七十九条记录。大部分来自美国（45％），自2009年以来发表（74％）。分析表明，当医生感到孤立无助或无法完成工作以及担心寻求帮助的影响时，他们更容易出现精神疾病。健康的员工对于出色的患者护理至关重要。强调人际关系和归属感的干预更有可能促进幸福感。干预措施创造了以人为本的工作文化，在积极/消极的表现之间取得平衡，并承认医疗职业的积极/消极方面，使医生得以蓬勃发展。实施干预措施的方式似乎至关重要。医生和医学生需要对干预措施有信心，才能使干预措施有效。解决医生和学生精神疾病的成功干预措施可能是多层面和多层次的，涉及多个利益相关者。评估和改进现有的干预措施可能比开发新的干预措施更为有效。我们的证据综合提供了进行此操作的基础。PROSPERO CRD42017069870。研究项目网页http://sites.exeter.ac.uk/cup/