Doctors with symptoms of depression are nearly twice as likely to report making clinical errors compared with peers who have no depression, a meta-analysis suggests.

The association appears to be bidirectional, with findings also indicating that medical mistakes can lead to depression in the accountable practitioners, the researchers say.

Their meta-analysis of 11 studies, including more than 20,500 doctors — mostly trainees and mostly in the US — shows that practitioners with a positive screen for depression are almost twice as likely to self-report errors relative to doctors without symptoms.

As many of the studies were longitudinal, the researchers were able to show that symptoms of depression at one point in time were associated with future medical errors, although the relative risk was about 60% rather than double.