Mental illness and suicide among physicians

Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades

OBJECTIVE

To examine the relative risk of suicide among healthcare professionals compared to other occupations and examine changes in suicide rates over time.

METHODS

Suicide cases were identified using the National Coronial Information System and were included if they were recorded as a death by intentional self-harm between 2001 and 2017 and were by an employed adult aged 20-69 with a known occupation at the time of death. Suicide methods were reported descriptively. Workforce data at the population level was extracted from the Australian Bureau of Statistics 2011 Census. Age-standardised suicide rates per 100,000 person-years for each of the four occupational groups were calculated using direct standardisation and using the Australian Bureau of Statistics population-level data from the 2011 Census. Negative binomial regression was used to estimate suicide risk by healthcare employment status and profession, to investigate differences by sex and to examine trends in suicide rates over time, using rate ratios and 95% confidence intervals.

RESULTS

Healthcare professionals were at increased risk of suicide compared to other occupations (rate ratio = 1.30, 95% confidence interval = [1.19, 1.42], p < 0.001), controlling for age, sex and year of death. Nurses and midwives were identified as being at significantly increased risk of suicide (rate ratio = 1.95, 95% confidence interval = [1.73, 2.19], p < 0.001). Suicide rates among female medical practitioners increased substantially over time (p = 0.01).

CONCLUSION

Health professionals are at significantly increased risk of suicide, though the relative risk of different groups is changing over time. There has been a substantial increase in the risk of suicide among female medical practitioners with rates of suicide in this group more than doubling over the last two decades. Findings highlight the need for targeted suicide prevention initiatives for healthcare professionals.

The association between self-treatment and mental health among Swedish physicians

BACKGROUND

Despite a high prevalence of mental health problems among physicians, the rate of help-seeking behaviour is low. Instead, physicians tend to self-treat. This can have a negative impact on individual physicians and society.

AIMS

The aim was to explore the relationship between self-rated depression, the use of psychotropic medication, and the extent of self-treatment across gender and hierarchical position among Swedish physicians. In addition, the aim was to investigate whether social support can buffer against self-treatment.

METHODS

This study draws on data from the Longitudinal Occupational Health for Health Care in Sweden 2021 study, comprising a representative sample of physicians. Descriptive statistics and logistic regressions were carried out.

RESULTS

The present study showed that approximately 60% of the physicians using narcotic or non-narcotic psychotropic medication were self-prescribing. Male and more senior physicians self-treated to a greater extent. Physicians without depression were self-treating to a greater extent than those with depression. Those who used non-narcotic psychotropic medication intermittently were more likely to self-treat than those who used these medications regularly. The frequency of use was insignificant in relation to self-treatment with narcotic psychotropic medication. No buffering effect from social support at work was found.

CONCLUSIONS

Self-treatment was common among physicians in Sweden, particularly among those who reported mild or no symptoms of depression. This may have negative long-term effects on an individual level and for Swedish health care at large.

Common mental disorder and suicidality among doctors: differences by specialty

BACKGROUND

Common mental disorders (CMDs) and suicidal ideation (SI) are prevalent among doctors, yet limited evidence exists investigating the relationship of specialty area to these outcomes.

AIMS

This study aimed to determine the prevalence of likely CMD and SI among doctors and to investigate whether likelihood of these outcomes varied by area of medical specialty.

METHODS

A secondary analysis of a representative national survey of 12,252 Australian doctors was conducted. Demographic and work-related variables, SI and CMD (GHQ-28), were assessed among doctors (n = 7037; 57%) working in a range of specialty areas. Logistic regression was used to examine the association between specialty and mental health outcomes in unadjusted and adjusted models.

RESULTS

Almost one-quarter of doctors (n = 1560; 23%) reported symptom levels indicating likely CMD whilst 9% (n = 667) reported SI in the last year. Doctors in surgery (adjusted odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.54-0.97, P = 0.03) were at significantly lower risk of CMD than General Practitioners (GPs), whilst doctors in anaesthetics (adjusted OR = 1.45; 95% CI 1.09-1.93, P = 0.01) and paediatrics (adjusted OR = 1.88; 95% CI 1.02-3.47, P = 0.04) were at significantly higher risk of experiencing SI compared to GPs after accounting for confounders.

CONCLUSIONS

Results demonstrated that doctors in Australia working in certain specialties, specifically anaesthetics and paediatrics, were at significantly greater risk of suicidal ideation compared to GPs after accounting for confounders. Interventions to address CMD and SI among doctors in all specialties remain urgently needed.

How Workplace Challenges Affect the Risk of Substance Use Disorders in a Health Care Environment

Health care environments have historically faced stressful situations that place those working in those environments at risk for substance use disorders. Over the past several years, the rates of burnout, workplace violence, diverse population stigmatization, and mental health concerns (including suicide) during the Covid-19 pandemic have increased, further challenging and contributing to development of negative coping skills, including use of substances to reduce the side effects and emotions from work. This article introduces the problem of substance use disorders, pathophysiology, and how the challenges contribute to the development of turning to substances to cope.

Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey

BACKGROUND

Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems.

OBJECTIVE

The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties.

DESIGN AND PARTICIPANTS

A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used.

RESULTS

An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day.

CONCLUSIONS

Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.

Underrecognition and un-dertreatment of stress-related psychiatric disorders in physicians: Determinants, challenges, and the impact of the COVID-19 pandemic

Medical practitioners’ duties are highly stressful and performed in a particularly challenging and competitive work environment. Stress and burnout among physicians have emerged as a worldwide public health problem in recent years. A high level of distress and burnout can lead to clinically significant behavioral health problems, such as stress-related psychiatric disorders. Mounting evidence shows that physicians have higher risks of insomnia, anxiety, and depression than the general population, especially during the coronavirus disease 2019 pandemic. However, the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated. In this mini-review, we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among phy-sicians and their healthcare-seeking behaviors. We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.

Acknowledging the risk of suicidal ideation, depression, and anxiety in PAs

ABSTRACT

The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.

The comparative mental health of Australian doctors before and during COVID-19: A population-based approach

OBJECTIVE

Occupational surveys of doctors consistently show higher rates of depression and anxiety than reported in general population surveys, findings replicated in all other occupational groups, suggesting potential selection bias. We evaluated the comparative mental health of different occupations in Australia from the same sampling frame over the past 6 years and assessed whether COVID-19 differentially affected different occupational groups.

METHODS

We analysed six annual data waves (2015-2020) from the nationally representative 'Household, Income, and Labour Dynamics in Australia' study. Mental health (Mental Health Inventory-5 from the 36-Item Short Form Survey) and life satisfaction scores of doctors over this period were compared with five other professions and all other employees. Regression models were adjusted for age, gender, income and work hours. Two-way analysis of variance examined the comparative changes in mental health among occupations between 2019 and after exposure to the COVID-19 pandemic in late 2020.

RESULTS

The sample of 15,174 employed respondents included 106 doctors. The 5-year mean mental health score for doctors (M = 78.7; SD = 13.1) was significantly higher than that for teachers (M = 75.6; SD = 14.9), nurses and midwives (M = 76.6; SD = 15.9), lawyers (M = 74.2; SD = 16.1), accountants (M = 74.2; SD = 16.5) and all other employed respondents (M = 73.1, SD = 16.7) (p < 0.001). Cognitive wellbeing comparisons were similar. There were no significant changes in professionals' mental health over this period except for an improvement in engineers and a decline for teachers. From 2019 to 2020, all occupations suffered mental health declines without any significant inter-occupational differences.

CONCLUSION

Australian doctors identified from a population-based sample rather than occupational surveys reported better levels of mental health and greater life satisfaction than most professions prior to COVID-19 without experiencing the worsening seen in the general employed population over the past 5 years. From 2020, there was a mental health decline in all of the employed population, not disproportionately affecting doctors. Although over-representing Australian trained general practitioners, the results from both this sample and other tentative findings challenge the discourse in medical advocacy, but need more formal comparative studies to confirm.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study

Background

Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion.

Methods

A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL.

Results

Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = −0.027, 95% CI = −0.079 to −0.003) and frequency of eating breakfast (β = −0.041, 95%CI = −0.079 to −0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL.

Conclusion

These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Academic Neurology and the COVID-19 Pandemic: Resilience, Hope, and Solutions

The SARS-CoV-2 (COVID-19) viral pandemic dramatically affected human health, health care delivery, health care workers, and health care research worldwide. The field of academic neurology was no exception. In this 2022 Presidential Plenary, we discuss the challenges faced by neurologists and neuroscientists professionally and personally. We review the threats posed by the pandemic to neuroscience research activities, materials, productivity, and funding. We then discuss the impact of the pandemic on clinical trials for neurologic diseases. Restrictions to patient enrolment due to limited in-person access to laboratory testing, imaging, and study visits led to delay in both clinical trial enrolment and study completion but also to innovative new means to engage clinical trial participants remotely and to strategies to critically appraise the frequency and design of trial-related patient evaluations. Clinical care was also challenged by initial pandemic prioritization of urgent visit and inpatient care and the rapid pivot to telehealth for most other neurology care encounters. Front-line neurology care teams faced their fears of infection, with the first few months of the pandemic being characterized by uncertainty, inconsistent national health care strategies, limited personal protective equipment, and an alarming rate of human illness and death caused by COVID-19. The personal and societal toll of the pandemic is incalculable. Across research and clinical neurology providers, women and particularly those with young families juggled the impossible balance of career and family care as schools closed and children required home-based education. Shining through this dark time are lessons that should shape a brighter future for our field. We are resilient, and the advances in neuroscience and neurology care continue to advance improved neurologic outcomes. The National Institutes of Health devised multiple support strategies for researchers to help bridge the pandemic. Telehealth, clinical trial designs that are more participant-centric with remote monitoring, and flexible work schedules are strategies to rebalance overworked lives and improve our engagement with our patients. As we re-emerge, we have the chance to reframe our field.

Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists

BACKGROUND

Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited.

OBJECTIVES

The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life.

METHODS

The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC.

RESULTS

Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation.

CONCLUSIONS

More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.

Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial

BACKGROUND

Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority.

OBJECTIVE

This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version.

METHODS

This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs.

RESULTS

The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed.

CONCLUSIONS

This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/32992.

LGBTQ+ Identity and Ophthalmologist Burnout

PURPOSE

To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort.

METHODS

An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling.

RESULTS

A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239).

CONCLUSIONS

LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study

BACKGROUND

Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings.

OBJECTIVE

This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students.

METHODS

This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes.

RESULTS

Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills.

CONCLUSIONS

This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field.

The Association of Experienced Long Working Hours and Depression, Anxiety, and Suicidal Ideation Among Chinese Medical Residents During the COVID-19 Pandemic: A Multi-Center Cross-Sectional Study

Background

Long working hours are common among medical residents and may increase the risk of mental disorders. We aimed to investigate the association between experienced long working hours and depression, anxiety, and suicidal ideation among Chinese medical residents during the COVID-19 pandemic.

Methods

This study was conducted in September 2022; 1343 residents from three center in Northeastern China were included in the final analysis (effective response rate: 87.61%). The data were collected from participants via online self-administered questionnaires. Depression and anxiety were measured by the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) scale, respectively. Adjusted odds ratios and 95% confidence intervals were determined after adjusting for potential confounders by binary unconditional logistic regression.

Results

The effective response rate was 87.61%. Among the 1343 participants, 12.88% (173), 9.90% (133), and 9.68% (130) had experienced major depression, major anxiety, and suicidal ideation, respectively. We found that longer weekly worktime increased the risk of major depression, particularly in those who worked for more than 60 hours per week (≥ 61 hours vs ≤ 40 hours, OR=1.87, P for trend = 0.003). However, this trend was not observed for either major anxiety or suicidal ideation (P for trend > 0.05 for both).

Conclusion

This study revealed that there was a considerable incidence of poor mental health among medical residents; furthermore, the longer weekly worktime was associated with a higher risk of major depression, especially for those who worked more than 60 hours per week, but this association was not observed in either major anxiety or suicidal ideation. This may help policymakers to develop targeted interventions.

Supporting the future of medicine: Student mental health services in medical school

Background

Mental health issues are common among United States medical students, and the AAMC has established recommendations for student mental health services provided by medical schools. Few studies directly compare mental health services at medical schools across the United States and, to our knowledge, none analyze how well schools adhere to the established AAMC recommendations.

Objective

To determine whether mental health services at United States medical schools adhere to established guidelines.

Methods

From October 2021 to March 2022, we obtained student handbooks and policy manuals from 77% of the accredited LCME United States medical schools. The AAMC guidelines were operationalized and placed into a rubric format. Each set of handbooks was independently scored against this rubric. A total of 120 handbooks were scored and the results were compiled.

Results

Rates of comprehensive adherence were very low, with only 13.3% of schools displaying adherence to the full set of AAMC guidelines. Partial adherence was higher, with 46.7% of schools meeting at least one of three guidelines. Portions of guidelines whose requirements reflected a standard for LCME accreditation displayed a higher rate of adherence.

Conclusion

The low rates of adherence across medical schools, as measured by handbooks and Policies & Procedures manuals, represents an opportunity to improve the mental health services within United States allopathic schools. An increase in adherence could be a step towards improving the mental health of United States medical students.

The Pandemic Effect on Faculty Attrition at a School of Medicine

Mentors at Academic Health Centers (AHC) are challenged by mentee attrition, with one in five physicians reporting an intent to leave in 2020. AHCs struggle with physician replacement costs, which are exorbitant. Data-driven efforts to mitigate attrition during the pandemic require an understanding of reasons to leave. This study compares characteristics of exiting faculty at the University of New Mexico School of Medicine (UNM SOM) two years before to two years after April 1, 2020. Demographic and reason to leave variables from exit interviews of 168 faculty that left UNM SOM between April 2018-to-March 2020 and 151 faculty that left between April 2020-to-March 2022 were compared. Exiting faculty were stratified into those resigning vs. retiring. Distributions of each variable were analyzed for statistically significant differences using a chi-square or Fisher's 2-sided exact test. The pandemic was associated with an approximately three-fold higher proportion of retirement contributing to total attrition than before (25.8% vs. 8.9%; p<0.001). Among those who resigned, the pandemic was associated with a higher proportion of physicians than before (84.3% vs. 72.8%; p=0.03). Hispanic faculty may be more likely to resign during the pandemic than before (p=0.06). Those who resigned during the pandemic may be significantly less likely to cite "inadequate adherence to FTE" or a "challenging work environment" (p= 0.048 and 0.053 respectively) but more likely to cite personal family matters (p=0.06) as reasons to leave than before the pandemic. The increased proportion of retirees during the pandemic presents challenges for AHCs by exacerbating the current shortage of mentors while providing leadership opportunities for those retained. Mentors need to be aware of the top reasons for faculty leaving (which have not materially changed during the pandemic): challenging work environment, personal/family matters, inadequate work-life balance, greater career opportunities, and inadequate salary.

Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review

IMPORTANCE

Problematic alcohol use in physicians poses a serious concern to physicians' health and their ability to provide care. Understanding the extent and characteristics of physicians with problematic alcohol use will help inform interventions.

OBJECTIVE

To estimate the extent of problematic alcohol use in physicians and how it differs by physician sex, age, medical specialty, and career stage (eg, residency vs practicing physician).

EVIDENCE REVIEW

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review, searching Medline, Embase, and PsychInfo from January 2006 to March 2020. Search terms included Medical Subject Headings terms and keywords related to physicians as the population and problematic alcohol use as the primary outcome. The quality of studies was assessed using the Newcastle-Ottawa Scale. We included articles where problematic alcohol use was measured by a validated tool (ie, Alcohol Use Disorders Identification Test [AUDIT], AUDIT Version C [AUDIT-C], or CAGE [Cut down, Annoyed, Guilty, and Eye-opener] questionnaire) in practicing physicians (ie, residents, fellows, or staff physicians).

FINDINGS

Thirty-one studies involving 51 680 participants in 17 countries published between January 2006 and March 2020 were included. All study designs were cross-sectional, self-reported surveys. Problematic alcohol use varied widely regardless of measurement method (0 to 34% with AUDIT; 9% to 35% with AUDIT-C; 4% to 22% with CAGE). Reported problematic alcohol use increased over time from 16.3% in 2006 to 2010 to 26.8% in 2017 to 2020. The extent of problematic use by sex was examined in 19 studies, by age in 12 studies, by specialty in 7 studies, and by career stage in 5 studies. Seven of 19 studies (37%) identified that problematic alcohol use was more common in males than females. Based on the wide heterogeneity of methods for included studies, limited conclusions can be made on how problematic alcohol use varies based on physician age, sex, specialty, and career stage.

CONCLUSIONS AND RELEVANCE

Studies about problematic alcohol use in physicians demonstrate a high degree of heterogeneity in terms of methods of measurement, definitions for problematic alcohol use, and cohorts assessed. Most studies are primarily self-reported, precluding the ability to determine the true prevalence among the profession. Few studies provide relevant comparisons to aid in identifying key risk groups for targeted interventions.

The psychological distress and suicide-related ideation in hospital workers during the COVID-19 pandemic: Second results from repeated cross-sectional surveys

The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic’s beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic’s beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers’ mental health.

An impact model to understand and improve work-life balance in early-career researchers in radiation oncology

Purpose

The COVID-19 pandemic had a substantial effect on mental health and work productivity of early-career researchers working in Radiation Oncology (RO). However, the underlying mechanisms of these effects are unclear. The aim of the current qualitative study was therefore to achieve a better understanding of how these effects arose and could be managed in the future.

Methods

This study was conducted jointly by RO and qualitative health researchers. Data was collected in four online Focus Groups with 6-11 RO researchers (total N = 31) working in Europe. The transcripts were analysed through a qualitative cross-impact analysis.

Results

Causal relations were identified between seventeen variables that depict the impact of disrupted working conditions. Mental health and work productivity were indeed the most important affected variables, but relations between variables towards these impacts were complex. Relations could either be positive or negative and direct or indirect, leading to a cascade of interrelated events which are highly personal and could change over time. We developed the model 'impact of disrupted working conditions' depicting the identified variables and their relations, to allow more individual assessment and personalised solutions.

Conclusion

The impacts of disrupted working conditions on RO researchers varied due to the complexity of interrelated variables. Consequently, collective actions are not sufficient, and a more personal approach is needed. Our impact model is recommended to help guide conversations and reflections with the aim of improving work/life balance. The participants showed high levels of personal responsibility towards their own mental health and work productivity. Although being an individual issue, a collective responsibility in developing such approaches is key due to the dependency on organizational variables.

Psychiatric Symptoms and Frequency of Eating out among Commuters in Beijing: A Bidirectional Association?

Background: Mental illness places as a distant first in global burdens, exceeding both cardiovascular and circulatory diseases, in terms of the years lived with the disability. The emergence of the new and burgeoning area of “Nutrition Psychiatry” offers promise in improving mental health with diet. Mental health and well-being are critical to commuters but rarely recieve the attention they need. This study aimed to examine the bidirectional relationship between the frequency of eating out and depression, anxiety, and stress symptoms in a sample of Beijing commuters. Methods: A total of 3337 commuters (mean (SD) age, 38.78 (10.41); 74.74% males) from the cohort study CHCN-BTH were included. The psychiatric symptoms were evaluated using a 21-item self-reported depression–anxiety–stress scale (DASS-21). A Cochran–Armitage trend chi-square test, restricted cubic spline, multiple logistic regression, multinomial logit models, and E-values were performed to estimate the associations between eating out and psychiatric symptoms in both directions. Results: A daily rate of eating out more than 50% had a higher risk for depression (OR, 95% CI: 1.68, 1.184–2.393), anxiety (1.73, 1.259–2.369), and stress (1.99, 1.191–3.329) than the individuals eating at home. A higher frequency of eating out for lunch was significantly associated with an increased risk of depression (1.78, 1.28–2.46), anxiety (1.67, 1.26–2.23), and stress (2.05, 1.31–3.22). Similar results were found when eating out for dinner with increased risks for depression 2.20 (1.59, 3.06), anxiety 1.91 (1.42, 2.59), and stress 2.61 (1.68, 4.05). There is limited evidence supporting the effects of psychiatric symptoms on the frequency of eating out in the reverse analyses. Conclusions: The frequency of eating out is positively associated with an increased risk of psychiatric symptoms, especially when eating out for lunch and dinner. People eating at home have the lowest risk of suffering psychiatric symptoms, followed by those eating in the workplace canteen. Eating at home should be considered for future recommendations for the prevention of psychiatric symptoms.

The global prevalence of burnout among general practitioners: a systematic review and meta-analysis

BACKGROUND

Burnout among general practitioners (GPs) has attracted the attention of more and more researchers. An adequate understanding the prevalence and related factors of burnout to prevent and reduce burnout is necessary. This study systematically measured the global prevalence of burnout among GPs.

METHODS

Eligible original studies were identified from the PubMed, Ovid Embase, Ovid Medline (R), and Web of science databases. We searched the full-time period available for each database, up to 30 September 2021. The adjusted prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study-level characteristics were estimated via subgroup analyses and meta-regression.

RESULTS

A total of 16 cross-sectional studies with 7,595 participants were included. The pooled burnout rate showed 37%, 28%, and 26% of general GPs suffer from high emotional exhaustion (EE), high depersonalization (DP), and low personal exhaustion (PA), respectively. Groups comparisons found that high EE, high DP, and low PA rate data obtained from 2001 to 2009, high DP rate data obtained from Europe, low PA rate data obtained from high-quality studies had much higher rates.

CONCLUSIONS

This study demonstrated the prevalence of burnout in the GPs and alert health managers to tailor their strategies to retain this community. Targeted initiatives are needed to provide adequate GPs' well-being and maintain primary health care.

Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION

Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions.

AIMS

To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment.

RESULTS

Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]).

DISCUSSION

Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

The psychological impact of COVID-19 pandemic on healthcare workers

Background

As unprecedented and prolonged crisis, healthcare workers (HCWs) are at high risk of developing psychological disorders. We investigated the psychological impact of COVID-19 pandemic on HCWs.

Methods

This cross-sectional study randomly recruited 439 HCWs in Hunan Cancer Hospital via a web-based sampling method from June 1st 2021 to March 31st 2022. Anxiety and depression levels were measured using Hospital Anxiety and Depression Scale (HADS). The Post Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) was used to assess the presence and severity of PTSD. Fear was measured by modified scale of SARS. Data were collected based on these questionnaires. Differences in fear, anxiety, depression and PTSD among HCWs with different clinical characteristics were analyzed using a multivariate analysis of variance. The Cronbach's alpha scores in our samples were calculated to evaluate the internal consistency of HADS, fear scale and PCL-5.

Results

The prevalence of anxiety, depression, and PTSD in HCWs was 15.7, 9.6, and 12.8%, respectively. Females and nurses were with higher fear level (P < 0.05) and higher PTSD levels (P < 0.05). Further analysis of female HCWs revealed that PTSD levels in the 35-59 years-old age group were higher than that in other groups; while married female HCWs were with increased fear than single HCWs. The internal consistency was good, with Cronbach's α = 0.88, 0.80 and 0.84 for HADS, fear scale, and PCL, respectively.

Conclusion

Gender, marital status, and age are related to different level of psychological disorders in HCWs. Clinical supportive care should be implemented for specific group of HCWs.

Determinants of well-being and their interconnections in Australian general practitioners: a qualitative study

OBJECTIVES

The well-being of doctors is recognised as a major priority in healthcare, yet there is little research on how general practitioners (GPs) keep well. We aimed to address this gap by applying a positive psychology lens, and exploring what determines GPs' well-being, as opposed to burnout and mental ill health, in Australia.

DESIGN

Semi-structured qualitative interviews. From March to September 2021, we interviewed GPs working in numerous settings, using snowball and purposive sampling to expand recruitment across Australia. 20 GPs participated individually via Zoom. A semi-structured interview-guide provided a framework to explore well-being from a personal, organisational and systemic perspective. Recordings were transcribed verbatim, and inductive thematic analysis was performed.

RESULTS

Eleven female and nine male GPs with diverse experience, from urban and rural settings were interviewed (mean 32 min). Determinants of well-being were underpinned by GPs' sense of identity. This was strongly influenced by GPs seeing themselves as a distinct but often undervalued profession working in small organisations within a broader health system. Both personal finances, and funding structures emerged as important moderators of the interconnections between these themes. Enablers of well-being were mainly identified at a personal and practice level, whereas systemic determinants were consistently seen as barriers to well-being. A complex balancing act between all determinants of well-being was evidenced.

CONCLUSIONS

GPs were able to identify targets for individual and practice level interventions to improve well-being, many of which have not been evaluated. However, few systemic aspects were suggested as being able to promote well-being, but rather seen as barriers, limiting how to develop systemic interventions to enhance well-being. Finances need to be a major consideration to prioritise, promote and support GP well-being, and a sustainable primary care workforce.

Professional help-seeking behaviour for mental health problems among veterinarians in Norway: a nationwide, cross-sectional study (The NORVET study)

Background

Veterinarians have a relatively high prevalence of mental health problems; however, research on professional help-seeking is limited. The main purpose of the present study was to investigate the prevalence of mental health problems and professional help-seeking behaviour for such problems, and the independent factors associated with help-seeking behaviour among veterinarians in Norway.

Method

This cross-sectional study included all veterinarians in Norway (response rate 75%, 70% women). Logistic regression was used to calculate odds ratios (OR) for professional help-seeking for mental health problems. Analyses were controlled for socio-demographic, individual (personality trait reality weakness, SCL-5, attitudes toward mental illness), and work-related factors (work field, job stress).

Results

The prevalence of self-reported mental health problems in need of treatment was 30% (746/2494), significantly higher among women than men (36% vs. 15%). Fifty-four percent had sought professional help, women significantly more often (56%) than men (41%). Among veterinarians with serious suicidal thoughts, 50% (69/139) had sought help. Veterinarians most frequently related mental health problems to work problems (47%), women significantly more often (49%) than men (34%). Factors significantly associated with help-seeking were being female, OR = 2.11 (95% CI: 1.24–3.60), working with production animals, OR = 0.35 (0.13–0.98), public administration, OR = 2.27 (1.15–4.45), academia/research, OR = 4.78 (1.99–11.47) or ‘other’ fields, OR = 2.79 (1.23–6.32), and attitudes toward mental illness, OR = 1.32 (1.03–1.68).

Conclusions

Thirty percent of veterinarians in Norway reported mental health problems in need of treatment, and only half of them had sought professional help. A low degree of help-seeking was also seen among those with serious suicidal thoughts. Being female, positive attitudes toward treatment of mental illness, working in public administration, academia/research and ‘other’ field were associated with more help-seeking, while working in production animal practice was associated with less help-seeking. Interventions to increase help-seeking behaviour for mental health problems among veterinarians are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13710-y.

Burnout und Abhängigkeit bei ärztlichem Personal zeitlos und während der COVID-19-Pandemie am Beispiel der Chirurgie und Anästhesie

Hintergrund

Die COVID-19(„coronavirus disease 2019“)-Pandemie wirkt sich auf die psychische Gesundheit und das berufliche Verhalten von Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen aus und scheint einen Einfluss auf die Substanzabhängigkeit zu haben.

Fragestellung

Welche Gründe gibt es für das Auftreten einer Substanzabhängigkeit und einem Burnout bei Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen zeitlos und während der COVID-19-Pandemie und welche Verbesserungsmaßnahmen könnten im klinischen Alltag helfen?

Material und Methoden

Es wurde eine Literaturrecherche in Form einer systematischen Übersicht („systematic review“) zu Studien und Übersichtsarbeiten durchgeführt, die für das Thema relevant sind.

Ergebnisse

Im Laufe der Jahre hat sich gezeigt, dass Chirurgen bzw. Chirurginnen und Anästhesisten bzw. Anästhesistinnen aufgrund ihres direkten Zugangs zu Medikamenten in der Klinik und der arbeitsbezogenen Stressbelastung zur Drogenabhängigkeit neigen. Insbesondere Chirurgen und Chirurginnen und Anästhesisten und Anästhesistinnen schienen eine erhöhte Neigung zur Suchterkrankungen und ein erhöhtes Burnout-Risiko in der Pandemie vorzuweisen.

Schlussfolgerungen

Präventive Maßnahmen zugunsten besserer Arbeitsbedingungen in der Chirurgie und Anästhesie und eine bessere Drogenkontrolle (nicht nur wegen der Ausgabe, sondern auch wegen der richtigen Drogentests) sowie mehr Therapie- und Wiedereingliederungsprogramme unter psychiatrischer Begleitung und in Zusammenarbeit mit einem multidisziplinären Team sind sinnvoll.

Burnout Among School Teachers During the COVID-19 Pandemic in Jazan Region, Saudi Arabia

Background

Burnout is a syndrome that results from stressors in the work environment that have not been successfully managed. The prevalence of burnout among schoolteachers was always controversial. COVID-19 pandemic added more stressors to teachers since they had to change their working styles in response to the pandemic lockdowns or curfews. In Saudi Arabia, the prevalence and determinants of burnout among school teachers were not measured by any other group during the COVID-19 pandemic stressors.

Methods

A cross-sectional survey was conducted among 879 teachers in the Jazan region, Saudi Arabia, using the Maslach Burnout Inventory (MBI), during April 2021. Multistage cluster random sampling was used.

Results

The mean age of the participants was 41.4 (±6.9) years. Male teachers represented 52.6% of the participants while females represented 47.4%. Most teachers showed burnout symptoms (69.6%). Consequences of burnout were observed, such as using psychotropic medications (4.6%), absenteeism (45.6%), lack of job satisfaction (7.7%), and changing schools (15.8%). Using the MBI scale, most teachers showed medium or high emotional exhaustion (57.6%), low depersonalization (62.2%), and low personal accomplishment (51.4%).

Conclusion

Most teachers showed symptoms of burnout during the COVID-19 pandemic. Being an expert and ability to adapt to technology during the COVID-19 pandemic proved to effectively reduce burnout symptoms. Increasing incentives, early detection, and improving the work environment is recommended to diminish burnout consequences.

The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic

Background

During the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic.

Methods

We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model.

Results

Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse.

Conclusions

We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.

Garcia-Ribera JM, Garrido A, Gil E, Gomez M, Gomez J, Pinto AG, Haro JM, Hernando M, Insigna MG, Iriberri M, Jimenez N, Jimenez X, Larrauri A, Leon F, Lopez-Fresneña N, Lopez C, Lopez-Atanes Juan Antonio Lopez-Rodriguez M, Lopez-Cortacans G, Marcos A, Martin J, Martin V, Martinez-Cortés M, Martinez-Martinez R, Martinez de Salazar AD, Martinez I, Marzola M, Mata N, Molina JM, de Dios Molina J, Molinero E, Mortier P, Muñoz C, Murru A, Olmedo J, Ortí RM, Padrós R, Pallejà M, Parra R, Pascual J, Pelayo JM, Pla R, Plana N, Aznar CP, Gomez BP, Zapata AP, Pijoan JI, Polentinos E, Puertolas B, Puig MT, Quílez A, Quintana MJ, Quiroga A, Rentero D, Rey C, Rius C, Rodriguez-Blazquez C, Rojas MJ, Romero Y, Rubio G, Rumayor M, Ruiz P, Saenz M, Sanchez J, Sanchez-Arcilla I, Sanz F, Serra C, Serra-Sutton V, Serrano M, Sola S, Solera S, Soto M, Tarrago A, Tolosa N, Vazquez M, Viciola M, Vieta E, Vilagut G, Yago S, Yañez J, Zapico Y, Zorita LM, Zorrilla I, Zurbano SL, Perez-Solá V. Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Preliminary investigation of Shift, a novel smartphone application to support junior doctors’ mental health and wellbeing: Examination of symptom progression, usability, and acceptability after one month of use (Preprint)

Background

Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues.

Objective

This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool.

Methods

Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle.

Results

A total of 222 female (n=156, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly.

Conclusions

Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.

Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial

BACKGROUND

Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches.

OBJECTIVE

This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated.

METHODS

In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants' identified PF training needs at each log-in or nonindividualized.

RESULTS

Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group.

CONCLUSIONS

The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/32992.

Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study

BACKGROUND

Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic.

METHODS

This cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

RESULTS

A total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1-2 and Specialty Trainee 1-2 grades.

CONCLUSIONS

These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons.

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico

BACKGROUND

Psychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support.

OBJECTIVE

The aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not.

METHODS

This was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey.

RESULTS

73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support.

CONCLUSION

Psychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health.

Compassion Fatigue and Satisfaction among Turkish Emergency Medicine Residents Using the Professional Quality of Life Scale

Introduction

Emergency medicine (EM) residents are at high risk for burnout syndrome. The professional quality of life scale (ProQOL) is a validated survey that measures compassion satisfaction (CS) and compassion fatigue, which is comprised of burnout and secondary traumatic stress (STS) scales. This study sought to evaluate CS and fatigue among Turkish EM residents using the ProQOL survey.

Methods

This was a cross-sectional study of Turkish EM residents who are part of the EM Residency Association of Turkey. The ProQOL survey version 5 was E-mailed in Turkish to all 150 EM residents. Participants were currently employed as EM residents. Demographics and satisfaction with quality of life were also collected.

Results

Eighty residents completed the survey. Almost half of the respondents were either very dissatisfied or dissatisfied with their overall quality of life. Turkish EM residents not only had moderate levels of CS (scoring 33.9 ± 7.9), but also suffered moderate burnout (27.0 ± 5.9) and STS (24.7 ± 5.3).

Conclusions

Turkish EM residents have moderate levels of CS and moderate levels of burnout and secondary traumatic stress.

'The hardest job I've ever done': a qualitative exploration of the factors affecting junior doctors' mental health and well-being during medical training in Australia

Background

Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training.

Method

Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach.

Results

Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being.

Conclusion

The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07381-5.

Identifying the Subtypes and Characteristics of Mental Workload Among Chinese Physicians in Outpatient Practice: A Latent Profile Analysis

Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload.

Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians.

Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype.

Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.

Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals

INTRODUCTION

Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP.

METHODS

The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire.

RESULTS

All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2.

CONCLUSION

Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.