{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:29:33Z","timestamp":1787747373864,"version":"build-2784847793"},"reference-count":44,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/501100013374","name":"NIHR School for Primary Care Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,1,2]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This paper provides an in-depth account of general practitioners\u2019 (GPs) experiences of living and working with mental illness and distress, as part of a wider study reporting the barriers and facilitators to help-seeking for mental illness and burn-out, and sources of stress\/distress for GP participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative study using in-depth interviews with 47 GP participants. The interviews were audio recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face to face or over the telephone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings report GP participants\u2019 in-depth experiences of distress and mental illness with many recollecting their distressing experiences and significant psychological and physical symptoms relating to chronic stress, anxiety, depression and\/or burn-out, and a quarter articulating thoughts of suicide. Many talked about their shame, humiliation and embarrassment at their perceived inability to cope with the stresses of their job and\/or their symptoms of mental illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings paint a concerning picture of the situation affecting primary care doctors, with participants\u2019 accounts suggesting there is a considerable degree of mental ill health and reduced well-being among GPs. The solutions are complex and lie in prevention and provision. There needs to be greater recognition of the components and cumulative effect of occupational stressors for doctors, such as the increasing workload and the clinical and emotional demands of the job, as well as the need for a culture shift within medicine to more supportive and compassionate work environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018620","type":"journal-article","created":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T13:09:54Z","timestamp":1525352994000},"page":"e018620","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["\u2018Treading water but drowning slowly\u2019: what are GPs\u2019 experiences of living and working with mental illness and distress in England? A qualitative study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8774-5344","authenticated-orcid":false,"given":"Ruth","family":"Riley","sequence":"first","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Spiers","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn A","family":"Chew-Graham","sequence":"additional","affiliation":[{"name":"Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K","family":"Taylor","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail A","family":"Thornton","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Buszewicz","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,5,3]]},"reference":[{"key":"2025120518485805000_8.5.e018620.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.5.633"},{"key":"2025120518485805000_8.5.e018620.2","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0b013e31829da074"},{"key":"2025120518485805000_8.5.e018620.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2011-000274","article-title":"Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice","volume":"2","author":"Orton","year":"2012","journal-title":"BMJ Open"},{"key":"2025120518485805000_8.5.e018620.4","doi-asserted-by":"publisher","DOI":"10.3109\/09638237.2010.541300"},{"key":"2025120518485805000_8.5.e018620.5","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X681661"},{"key":"2025120518485805000_8.5.e018620.6","doi-asserted-by":"publisher","DOI":"10.1136\/jech.55.5.296"},{"key":"2025120518485805000_8.5.e018620.7","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.149.4.475"},{"key":"2025120518485805000_8.5.e018620.8","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.161.12.2295"},{"key":"2025120518485805000_8.5.e018620.9","unstructured":"GMC. Doctors who commit suicide while under GMC fitness to practise investigation. 2015."},{"key":"2025120518485805000_8.5.e018620.10","doi-asserted-by":"publisher","DOI":"10.3109\/09638237.2011.556168"},{"key":"2025120518485805000_8.5.e018620.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001776","article-title":"Shame! self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study","volume":"2","author":"Henderson","year":"2012","journal-title":"BMJ Open"},{"key":"2025120518485805000_8.5.e018620.12","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqw024"},{"key":"2025120518485805000_8.5.e018620.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7315.728"},{"key":"2025120518485805000_8.5.e018620.14","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X692573"},{"key":"2025120518485805000_8.5.e018620.15","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X692561"},{"key":"2025120518485805000_8.5.e018620.16","unstructured":"Department of Health. Mental health and ill health in doctors. London: Department of Health, 2008."},{"key":"2025120518485805000_8.5.e018620.17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.genhosppsych.2016.09.004","article-title":"\"I would never want to have a mental health diagnosis on my record\": a survey of female physicians on mental health diagnosis, treatment, and reporting","volume":"43","author":"Gold","year":"2016","journal-title":"Gen Hosp Psychiatry"},{"key":"2025120518485805000_8.5.e018620.18","unstructured":"Baird B , Charles A , Honeyman M , et al . \u00a0Understanding pressures in general practice. London: King\u2019s Fund, 2016."},{"key":"2025120518485805000_8.5.e018620.19","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/S0140-6736(16)00620-6","article-title":"Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007\u201314","volume":"387","author":"Hobbs","year":"2016","journal-title":"The Lancet"},{"key":"2025120518485805000_8.5.e018620.20","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X683425"},{"key":"2025120518485805000_8.5.e018620.21","doi-asserted-by":"crossref","unstructured":"Firth-Cozens J . A perspective on stress and depression. In: Cox JK J , Hutchinson A , McAvoy P , eds. Understanding doctors\u2019 performance. Oxford: Radcliffe Publishing, 2006:22\u20135.","DOI":"10.1201\/9781846197062-2"},{"key":"2025120518485805000_8.5.e018620.22","doi-asserted-by":"crossref","unstructured":"Firth-Cozens JH J . A little too much, in how to survive in medicine: personally and professionally. Oxford: Wiley-Blackwell, 2010.","DOI":"10.1002\/9781444318432"},{"key":"2025120518485805000_8.5.e018620.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017361","article-title":"What are the sources of stress and distress for general practitioners working in England? A qualitative study","volume":"8","author":"Riley","year":"2018","journal-title":"BMJ Open"},{"key":"2025120518485805000_8.5.e018620.24","unstructured":"Hippisley-Cox J , Vinogradova Y . Trends in consultation rates in general practice 1995 to 2008: analysis of the QResearch database. London: NHS Information Centre, 2009."},{"key":"2025120518485805000_8.5.e018620.25","unstructured":"King\u2019s Fund. Improving the quality in General Practice. London: King\u2019s Fund, 2011."},{"key":"2025120518485805000_8.5.e018620.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2007.03.004"},{"key":"2025120518485805000_8.5.e018620.27","first-page":"175","article-title":"A study of self-care among Irish doctors","volume":"91","author":"Clarke","year":"1998","journal-title":"Ir Med J"},{"key":"2025120518485805000_8.5.e018620.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7379.22"},{"key":"2025120518485805000_8.5.e018620.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.07.016"},{"key":"2025120518485805000_8.5.e018620.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7099.34"},{"key":"2025120518485805000_8.5.e018620.31","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(84)90099-6"},{"key":"2025120518485805000_8.5.e018620.32","unstructured":"Smith JA . \u00a0Qualitative psychology: A practical guide to research methods. Washington, D.C: Sage, 2007."},{"key":"2025120518485805000_8.5.e018620.33","first-page":"1","article-title":"The constant comparative analysis method outside of grounded theory","volume":"18","author":"Fram","year":"2013","journal-title":"The Qualitative Report"},{"key":"2025120518485805000_8.5.e018620.34","doi-asserted-by":"publisher","DOI":"10.1002\/nur.4770180211"},{"key":"2025120518485805000_8.5.e018620.35","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X688861"},{"key":"2025120518485805000_8.5.e018620.36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.5116\/ijme.5274.f445","article-title":"A qualitative study of how doctors use impression management when they talk about stress in the UK","volume":"4","author":"Thompson","year":"2013","journal-title":"Int J Med Educ"},{"key":"2025120518485805000_8.5.e018620.37","doi-asserted-by":"crossref","unstructured":"W L , Hange D , Bj\u00f6rkelund C , et al . Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care--an observational study. BMC Fam Pract 2015;16.","DOI":"10.1186\/s12875-015-0252-7"},{"key":"2025120518485805000_8.5.e018620.38","unstructured":"\u00a0NHS GP Health Service. Secondary NHS GP Health Service 2017. https:\/\/www.england.nhs.uk\/gp\/gpfv\/workforce\/health-service\/"},{"key":"2025120518485805000_8.5.e018620.39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyg.2016.00600","article-title":"Exploring Environmental Factors in Nursing Workplaces That Promote Psychological Resilience: Constructing a Unified Theoretical Model","volume":"7","author":"Cusack","year":"2016","journal-title":"Front Psychol"},{"key":"2025120518485805000_8.5.e018620.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.01.014"},{"key":"2025120518485805000_8.5.e018620.41","first-page":"497","article-title":"Compassion fatigue and burnout: the role of Balint groups","volume":"34","author":"Benson","year":"2005","journal-title":"Aust Fam Physician"},{"key":"2025120518485805000_8.5.e018620.42","unstructured":"Gishen F , Gill D . \u00a0Introducing schwartz rounds at UCL Medical School. Secondary Introducing Schwartz rounds at UCL Medical School. https:\/\/uclmsnews.wordpress.com\/2014\/09\/29\/introducing-schwartz-rounds-at-ucl-medical-school\/ (accessed 15 Sep 2017)."},{"key":"2025120518485805000_8.5.e018620.43","unstructured":"RCGP. http:\/\/www.rcgp.org.uk\/membership\/about-rcgp-membership\/join-rcgp-newly-qualified-gps.aspx. accessed 24 Nov 2017"},{"key":"2025120518485805000_8.5.e018620.44","unstructured":"BMA. Are you concerned about a colleague? Secondary are you concerned about a colleague? https:\/\/www.bma.org.uk\/advice\/work-life-support\/your-wellbeing\/concerned-about-a-colleague (accessed 24 Nov 2017)."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-018620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:49:12Z","timestamp":1764989352000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-018620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,5,3]]},"published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1136\/bmjopen-2017-018620"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-018620","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5]]}}}