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du Prel JB, Koscec Bjelajac A, Franić Z, Henftling L, Brborović H, Schernhammer E, McElvenny DM, Merisalu E, Pranjic N, Guseva Canu I, Godderis L. The Relationship Between Work-Related Stress and Depression: A Scoping Review. Public Health Rev 2024; 45:1606968. [PMID: 38751606 PMCID: PMC11094281 DOI: 10.3389/phrs.2024.1606968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Work-related stress is highly prevalent. Recent systematic reviews concluded on a significant association between common work-related stress measures and depression. Our scoping review aims to explore whether work-related psychosocial stress is generally associated with depression or depressiveness, the extent and methodology of the primary research undertaken on this topic and to elucidate inconsistencies or gaps in knowledge. Methods We searched for literature in Pubmed, PsycInfo and Web of Science including full reports in seven languages published between 1999 and 2022 and applied the PRISMA statement for scoping reviews criteria. Results Of 463 primarily identified articles, 125 were retained after abstract and full-text screening. The majority report significant associations between work-related stress and depression. Cross-sectional studies are most prevalent. Sufficient evidence exists only for job strain and effort-reward imbalance. Most studies are from Asia, North America and Europe. The health sector is the most studied. Several research gaps such as the lack of interventional studies were identified. Conclusion The consistency of most studies on the significant association between work-related stress and depression is remarkable. More studies are needed to improve evidence and to close research gaps.
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Affiliation(s)
- Jean-Baptist du Prel
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, Germany
| | | | - Zrinka Franić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Lorena Henftling
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, Germany
| | - Hana Brborović
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Damien M. McElvenny
- Research Group, Institute of Occupational Medicine, Edinburgh, United Kingdom
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, United Kingdom
| | - Eda Merisalu
- Estonian University of Life Sciences, Tartu, Estonia
| | - Nurka Pranjic
- Department of Occupational Medicine, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Irina Guseva Canu
- Department of Occupational and Environmental Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Lode Godderis
- Department of Primary Care and Public Health, University of Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
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Tao Y, Cheng Z, Wang C, Liu T, Yan M, Huang X, Jian S, Sun L, Chen Z. Perceived stress and psychological disorders in healthcare professionals: a multiple chain mediating model of effort-reward imbalance and resilience. Front Public Health 2023; 11:1320411. [PMID: 38155891 PMCID: PMC10753578 DOI: 10.3389/fpubh.2023.1320411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023] Open
Abstract
Background Healthcare professionals have shown more psychological disorders such as anxiety and depression due to the nature of work, which can cause job burnout, decrease the quality of medical services, and even endanger medical safety. The aim of the study is to explore the serial multiple mediating role of effort- reward imbalance and resilience between perceived stress and psychological disorders among healthcare professionals. Methods A cross-sectional study was conducted in China from February to April 2023. A total of 2098 healthcare professionals at a tertiary general hospital was investigated by the following self-reported questionnaires: Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), The Effort-Reward Imbalance (ERI), Healthcare professionals Resilience Scale (MSRS). Results Anxiety and depression are interrelated (r = 0.362, p < 0.01), and they were positively related to perceived stress (r = 0.640/0.607, p < 0.01) and ERI (r = 0.422/0.383, p < 0.01), and negatively related to resilience (r = -0.343/-0.320, p < 0.01). After controlling demographic factors, the variance in anxiety and depression was explained by perceived stress was 37.7 and 35.0%. Bootstrap analyses examining the pathway of perceived stress-ERI-resilience-anxiety revealed significant direct effects [B = 0.560, 95%CI (0.528, 0.591)], as well as indirect effects mediated independently by ERI [B = 0.045, 95%CI (0.029, 0.060)], resilience [B = 0.031, 95%CI (0.017, 0.047)], or a combination of both [B = 0.004, 95%CI (0.002, 0.007)]. Similarly, in the path of perceived stress-ERI-resilience-anxiety-depression, significant direct effects were found [B = -0.310, 95%CI(0.265, 0.351)], along with indirect effects mediated individually by ERI [B = 0.033, 95%CI(0.013, 0.052)], resilience [B = 0.014, 95%CI (0.001, 0.028)], and anxiety [B = 0.218, 95%CI (0.190, 0.246)], or by both or three together (B = 0.032). Conclusion This study proved the hypothesis that ERI and resilience played a mediating role in perceived stress and psychological disorders, revealed the potential mechanism of anxiety in stress and depression, and proposed a solution for perceived stress to psychological distress, which can provide a basis for the intervention of healthcare professionals in the face of mental health crisis.
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Affiliation(s)
- Yuanling Tao
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhen Cheng
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chenxi Wang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Ting Liu
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Mi Yan
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiaohong Huang
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shasha Jian
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Li Sun
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zongtao Chen
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
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Denis MA, Iwaz J, Dumetier F, Poyard-Berger G, Vézina M. Screening for psychosocial risks among physicians in a pediatric hospital. Arch Pediatr 2023; 30:530-536. [PMID: 37777348 DOI: 10.1016/j.arcped.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/14/2023] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
Over the past decades, productivity practices at hospital resulted in staff overload and burnout. Prompted by physicians' complaints, this study assessed the level of psychosocial risk among senior pediatricians in a university hospital. The survey used the checklist of Quebec's National Institute of Public Health that comprises two six-indicator parts: "Context" and "Key Components" of the Organization. The psychosocial risk level was evaluated by a physician-psychologist duo during interviews of homogeneous groups of workers. The indicators were scored, tabulated, and discussed. The survey led to a substantial qualitative and quantitative clarification of physicians' working conditions, claims, and needs. Regarding Context, the staff reported mainly: (a) cumbersome organization and norms vs. limited human resources (lack of stability, incentives, and promotions); (b) absenteeism and presenteeism; (c) reluctance to seek care or advice for fear of discredit; (d) presence of verbal violence; (e) self-imposed harsh returns-to-work; (f) work-life conflicts and difficult mental disconnection from work. Regarding the Key Components, the staff reported mainly: (a) work overload (physical, mental, psychological, and relational/social), continuous stress, and perceived exhaustion; (b) low job satisfaction and insufficient recognition; (c) inconstant support by their superiors; (d) poor job relationships and colleagues' support; (e) occasional participation and lack of real autonomy and/or strategy sharing. The survey succeeded in underlining concerning issues that required the immediate attention of occupational physicians and managers. It proved the method feasible and valuable in the medical context despite a high diversity of staff functions and degrees.
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Affiliation(s)
- Marie-Agnès Denis
- Université de Lyon, Lyon, France; Université Claude Bernard, Lyon 1, Villeurbanne, France; Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement, UMRESTTE, UMR_9405 (Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux, IFSTTAR; Université Eiffel; Université Lyon 1), Bron, France; Service de médecine et santé au travail, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.
| | - Jean Iwaz
- Université de Lyon, Lyon, France; Université Claude Bernard, Lyon 1, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Fabienne Dumetier
- Service de médecine et santé au travail, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | | | - Michel Vézina
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec, Montréal, Canada
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Heming M, Siegrist J, Erschens R, Genrich M, Hander NR, Junne F, Küllenberg JK, Müller A, Worringer B, Angerer P. Managers perception of hospital employees' effort-reward imbalance. J Occup Med Toxicol 2023; 18:8. [PMID: 37280659 DOI: 10.1186/s12995-023-00376-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Hospitals are frequently associated with poor working conditions that can lead to work stress and increase the risk for reduced employee well-being. Managers can shape and improve working conditions and thereby, the health of their teams. Thus, as a prerequisite, managers need to be aware of their employees' stress levels. This study had two objectives: At first, it aimed to test the criterion validity of the Effort-Reward Imbalance (ERI) questionnaire measuring psychosocial workload in hospital employees. Secondly, mean scales of the ERI questionnaire filled in by employees were compared with mean scales of an adapted ERI questionnaire, in which managers assessed working conditions of their employees. METHODS Managers (n = 141) from three hospitals located in Germany assessed working conditions of their employees with an adapted external, other-oriented questionnaire. Employees (n = 197) of the mentioned hospitals completed the short version of the ERI questionnaire to assess their working conditions. Confirmatory factor analyses (CFA) were applied to test factorial validity, using the ERI scales for the two study groups. Criterion validity was assessed with multiple linear regression analysis of associations between ERI scales and well-being among employees. RESULTS The questionnaires demonstrated acceptable psychometric properties in terms of internal consistency of scales, although some indices of model fit resulting from CFA were of borderline significance. Concerning the first objective, effort, reward, and the ratio of effort-reward imbalance were significantly associated with well-being of employees. With regard to the second objective, first tentative findings showed that managers' ratings of their employees' effort at work was quite accurate, whereas their reward was overestimated. CONCLUSIONS With its documented criterion validity the ERI questionnaire can be used as a screening tool of workload among hospital employees. Moreover, in the context of work-related health promotion, managers' perceptions of their employees' workload deserve increased attention as first findings point to some discrepancies between their perceptions and those provided by employees.
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Affiliation(s)
- Meike Heming
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Johannes Siegrist
- Institute of Medical Sociology, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, University of Tuebingen, 72076, Tuebingen, Baden-Wuerttemberg, Germany
| | - Melanie Genrich
- Institute of Psychology, Work and Organisational Psychology, University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Nicole R Hander
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert- Einstein-Allee 23, 89081, Ulm, Germany
| | - Florian Junne
- University Clinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Janna K Küllenberg
- Institute for Medical Psychology, Centre for Psychosocial Medicine, University Heidelberg, University Hospital Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
- Institute for Research and Development of Collaborative Processes, FHNW School of Applied Psychology, Riggenbachstrasse 16, Olten, 4600, Switzerland
| | - Andreas Müller
- Institute of Psychology, Work and Organisational Psychology, University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Britta Worringer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Slavich GM, Roos LG, Mengelkoch S, Webb CA, Shattuck EC, Moriarity DP, Alley JC. Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychol Rev 2023; 17:5-59. [PMID: 36718584 PMCID: PMC10161928 DOI: 10.1080/17437199.2023.2171900] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
Classic theories of stress and health are largely based on assumptions regarding how different psychosocial stressors influence biological processes that, in turn, affect human health and behavior. Although theoretically rich, this work has yielded little consensus and led to numerous conceptual, measurement, and reproducibility issues. Social Safety Theory aims to address these issues by using the primary goal and regulatory logic of the human brain and immune system as the basis for specifying the social-environmental situations to which these systems should respond most strongly to maximize reproductive success and survival. This analysis gave rise to the integrated, multi-level formulation described herein, which transforms thinking about stress biology and provides a biologically based, evolutionary account for how and why experiences of social safety and social threat are strongly related to health, well-being, aging, and longevity. In doing so, the theory advances a testable framework for investigating the biopsychosocial roots of health disparities as well as how health-relevant biopsychosocial processes crystalize over time and how perceptions of the social environment interact with childhood microbial environment, birth cohort, culture, air pollution, genetics, sleep, diet, personality, and self-harm to affect health. The theory also highlights several interventions for reducing social threat and promoting resilience.
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Affiliation(s)
- George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lydia G. Roos
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Christian A. Webb
- McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric C. Shattuck
- Institute for Health Disparities Research and Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel P. Moriarity
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jenna C. Alley
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Beschoner P, Jerg-Bretzke L, Braun M, Schönfeldt-Lecuona C, Rottler E, Brück A, Steiner L, Kempf MJ, von Wietersheim J. [Mobbing Among Hospital Physicians]. DAS GESUNDHEITSWESEN 2022; 84:1094-1100. [PMID: 34905784 DOI: 10.1055/a-1581-7896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health. METHODS Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used. RESULTS Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found. CONCLUSION Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived.
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Affiliation(s)
- Petra Beschoner
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Lucia Jerg-Bretzke
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Maxi Braun
- Artemed Kliniken GmbH und Co KG, Psychosomatische Klinik Kloster Dießen, Diessen, Deutschland
| | | | - Edit Rottler
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Aniela Brück
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Laurenz Steiner
- Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | | | - Jörn von Wietersheim
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
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7
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Meta-analysis of effort–reward imbalance prevalence among physicians. Int Arch Occup Environ Health 2022; 95:559-571. [DOI: 10.1007/s00420-021-01784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022]
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8
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Alcaraz-Mor R, Urcun A, Vigouroux A, Boyer L, Villa A, Lehucher-Michel MP. Contraintes psychosociales et organisationnelles : analyse qualitative auprès de 52 médecins hospitaliers. ARCH MAL PROF ENVIRO 2021. [DOI: 10.1016/j.admp.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Beschoner P, von Wietersheim J, Jarczok MN, Braun M, Schönfeldt-Lecuona C, Jerg-Bretzke L, Steiner L. Changes in Working Conditions and Mental Health Among Intensive Care Physicians Across a Decade. Front Psychiatry 2020; 11:145. [PMID: 32296349 PMCID: PMC7136524 DOI: 10.3389/fpsyt.2020.00145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background: International studies have shown that among physicians working in intensive care, a relatively high level of work load, an elevated risk of developing burnout and reduced mental health are frequent. The implementation of a legislative intervention in Germany with the goal to reduce the working hours of physicians, offered an opportunity to investigate the potential influence of occupational conditions on stress and mental health. The present study investigates working conditions, occupational stress and burnout risk in two samples of German Intensive Care Physicians in 2006 and 2016. The aim was to assess how occupational and private stress factors influenced burnout and Effort-Reward-Imbalance indices over this time-period. Methods: Intensive care physicians were surveyed during the annual conference of their profession in two cross-sectional studies (10-year gap). Data on demographic (occupational, family), medical history, and mental health (burnout and Effort-Reward-Imbalance) were assessed by paper pencil questionnaires. Results: In total, N = 2,085 physicians participated (2006: N = 1,403, 2016: N = 695), with N = 1,840 (2006 = 1,248; 2016 = 592) eligible for propensity score matching comparison. In general, more working hours per week and working days on weekends were associated with an increased effort/reward imbalance and higher burnout scores. From 2006 to 2016, reductions in working hours per week and days worked on weekends were accompanied by improvements in occupational stress (Effort-Reward-Imbalance) and by trend in mental health indices (burnout) after matching for differences in working conditions. Conclusions: The study presents the changes concerning occupational stress factors and mental wellbeing in physicians working in intensive care in 2016 as compared to 2006. These findings may promote the implementation of preventive strategies in the vocational context to protect health and productivity of physicians, especially intensive care physicians.
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Affiliation(s)
- Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Marc N Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Maxi Braun
- Clinic of Psychosomatics Kloster Dießen, Dießen am Ammersee, Germany
| | | | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Laurenz Steiner
- III. Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
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Pereira-Lima K, Gupta RR, Guille C, Sen S. Residency Program Factors Associated With Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:869-875. [PMID: 30570500 PMCID: PMC6538448 DOI: 10.1097/acm.0000000000002567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the associations between program-level variables such as organizational structure, workload, and learning environment and residents' development of depressive symptoms during internship. METHOD Between 2012 and 2015, 1,276 internal medicine interns from 54 U.S. residency programs completed the Patient Health Questionnaire-9 (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionnaire and average weekly work hours. The authors gathered program structural variables from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA online) and program research rankings from Doximity. Associations between program-level variables and change in depressive symptoms were determined using stepwise linear regression modeling. RESULTS Mean program PHQ-9 scores increased from 2.3 at baseline to 5.9 during internship (mean difference 3.6; SD 1.4; P < .001), with the mean increase ranging from -0.3 to 8.8 (interquartile range 1.1) among included programs. In multivariable models, faculty feedback (β = -0.37; 95% CI: -0.62, -0.12; P = .005), learning experience in inpatient rotations (β = -0.28; 95% CI: -0.54, -0.02; P = .030), work hours (β = 0.34; 95% CI: 0.13, 0.56; P = .002), and research ranking position (β = -0.25; 95% CI: -0.47, -0.03; P = .036) were associated with change in depressive symptoms. CONCLUSIONS Poor faculty feedback and inpatient learning experience, long work hours, and high institutional research rankings were associated with increased depressive symptoms among internal medicine interns. These factors may be potential targets for interventions to improve wellness and mental health among these professionals.
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Affiliation(s)
- Karina Pereira-Lima
- K. Pereira-Lima is a research scholar, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, and PhD candidate, Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. R.R. Gupta is an MD candidate, University of Michigan Medical School, Ann Arbor, Michigan. C. Guille is assistant professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. S. Sen is research associate professor, Molecular and Behavioral Neuroscience Institute, and associate professor, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
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Pougnet R, Pougnet L, Dewitte JD, Jousset D, Loddé B. Vécu au travail des internes de médecine : étude qualitative. ARCH MAL PROF ENVIRO 2019. [DOI: 10.1016/j.admp.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Siegrist J, Wahrendorf M, Goldberg M, Zins M, Hoven H. Is effort-reward imbalance at work associated with different domains of health functioning? Baseline results from the French CONSTANCES study. Int Arch Occup Environ Health 2018; 92:467-480. [PMID: 30406331 DOI: 10.1007/s00420-018-1374-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/28/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite its importance a comprehensive assessment of health functioning has rarely been included in epidemiological investigations of work-related health outcomes. In this study, we analyzed associations of a health-adverse psychosocial work environment with a comprehensive set of subjective and objective measures of health functioning that cover the three domains of affective, cognitive, and physical functioning. METHODS Baseline data from the French CONSTANCES cohort study were used with a sample of 24,327 employed men and women aged 45-60. Psychosocial work environment was measured by the short version of the effort-reward imbalance (ERI) questionnaire. Measures of health functioning were depressive symptoms, semantic fluency, verbal memory, walking speed, standing balance and lung function. RESULTS First, we replicated main psychometric properties of the ERI questionnaire in the French cohort. Second, ERI scales revealed consistent associations with depressive symptoms, but less consistent links to cognitive and physical function. Among men, we observed an association of stressful work with reduced lung function. CONCLUSIONS This study demonstrated consistent associations of stressful work in terms of effort-reward imbalance with affective functioning in a large sample of male and female employees. Relationships with physical functioning were less consistent and restricted to men, and cognitive functioning was only marginally associated with stressful work. We also established the psychometric properties of the French short version of the ERI questionnaire, thus offering a tool for guiding and harmonizing further research in this field.
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Affiliation(s)
- Johannes Siegrist
- Senior Professorship on Work Stress Research, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Marcel Goldberg
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM UMS 11, Paris, France
- Paris Descartes University, Paris, France
| | - Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study. Eur J Emerg Med 2018; 25:191-198. [PMID: 27879536 DOI: 10.1097/mej.0000000000000434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine. METHODS In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months. RESULTS The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction. CONCLUSION The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.
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Barrech A, Riedel N, Li J, Herr RM, Mörtl K, Angerer P, Gündel H. The long-term impact of a change in Effort-Reward imbalance on mental health-results from the prospective MAN-GO study. Eur J Public Health 2018; 27:1021-1026. [PMID: 29186459 DOI: 10.1093/eurpub/ckx068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Little is yet known on the long-term effects of stress management interventions (SMIs) in the workplace. The aim this study was to prospectively examine the effect of an improvement of psychosocial working conditions measured by the Effort-Reward (E-R) Imbalance model within 2 years following an SMI, and mental health 7 years later. Methods The study sample consisted of 97 male industrial workers from southern Germany. Data were collected pre- and post-intervention in 2006 (T1) and 2008 (T2), respectively, as well as in 2015 (T3). Change scores were computed by subtracting T1 from T3 values. The associations between E-R ratio at T1, T2 and the change score, respectively, with depression and anxiety 7 years later were estimated by means of linear regression analysis. Analyses were adjusted for baseline levels of the exposure and outcome variables, socio-demographic-, health- and work-related covariates. Results Within-person comparisons revealed a significant reduction (i.e. improvement) in E-R ratio post-intervention (-0.103, SD 0.24, P = 0.000). This improvement in the E-R ratio was significantly associated with lower anxiety (β = 0.358, P = 0.001) and depression (β = 0.246, P = 0.031) scores in the fully adjusted models. The association between change scores and mental health were slightly stronger than associations with absolute values at T1 and T2. Conclusions An improvement in E-R ratio following an SMI, was significantly associated with lower anxiety and depression 7 years later. These results strongly support the importance of improving psychosocial working conditions in order to protect the mental health of employees in the long-run.
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Affiliation(s)
- Amira Barrech
- Centre for Health and Society, Institute of Occupational Medicine and Social Medicine, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Natalie Riedel
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
| | - Jian Li
- Centre for Health and Society, Institute of Occupational Medicine and Social Medicine, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Raphael M Herr
- Centre for Health and Society, Institute of Occupational Medicine and Social Medicine, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Kathrin Mörtl
- Department of Psychotherapy Science, Sigmund Freud Private University, Vienna, Austria
| | - Peter Angerer
- Centre for Health and Society, Institute of Occupational Medicine and Social Medicine, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
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Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany. Int Arch Occup Environ Health 2018; 91:643-654. [PMID: 29691658 DOI: 10.1007/s00420-018-1309-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though. METHODS We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort-reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses. RESULTS The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one's current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22). CONCLUSIONS Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.
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Wege N, Li J, Siegrist J. Are there gender differences in associations of effort–reward imbalance at work with self-reported doctor-diagnosed depression? Prospective evidence from the German Socio-Economic Panel. Int Arch Occup Environ Health 2018; 91:435-443. [DOI: 10.1007/s00420-018-1293-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022]
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Arnetz BB, Lewalski P, Arnetz J, Breejen K, Przyklenk K. Examining self-reported and biological stress and near misses among Emergency Medicine residents: a single-centre cross-sectional assessment in the USA. BMJ Open 2017; 7:e016479. [PMID: 28814584 PMCID: PMC5629729 DOI: 10.1136/bmjopen-2017-016479] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents. DESIGN Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses. SETTING The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA. PARTICIPANTS Residents in Emergency Medicine volunteered to participate. The sample consisted of 32 residents, with complete data on 28 subjects. Residents' supervising physicians assessed the clinical performance of each resident. PRIMARY AND SECONDARY OUTCOME MEASURES Participants' preshift and postshift stress, biological stress (salivary cortisol, plasma interleukin-6, tumour necrosis factor-alpha (TNF-α) and high-sensitivity C-reactive protein), residents' and supervisors' reports of near misses, number of critically ill and patients with trauma seen during the shift. RESULTS Residents' self-reported stress increased from an average preshift level of 2.79 of 10 (SD 1.81) to a postshift level of 5.82 (2.13) (p<0.001). Residents cared for an average of 2.32 (1.52) critically ill patients and 0.68 (1.06) patients with trauma. Residents reported a total of 7 near misses, compared with 11 reported by the supervising physicians. After controlling for baseline work-related exhaustion, residents that cared for more patients with trauma and had higher levels of TNF-α reported a higher frequency of near misses (R2=0.72; p=0.001). Residents' preshift ratings of how stressful they expected the shift to be were related to the supervising physicians' ratings of residents' near misses during the shift. CONCLUSION Residents' own ratings of near misses were associated with residents' TNF-α, a biomarker of systemic inflammation and the number of patients with trauma seen during the shift. In contrast, supervisor reports on residents' near misses were related only to the residents' preshift expectations of how stressful the shift would be.
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Affiliation(s)
- Bengt B Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Philip Lewalski
- Department of Emergency Medicine, Wayne State University School of Medicine, Michigan, USA
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karen Breejen
- Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA
| | - Karin Przyklenk
- Department of Emergency Medicine, Wayne State University School of Medicine, Michigan, USA
- Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Herr RM, Barrech A, Gündel H, Lang J, Quinete NS, Angerer P, Li J. Effects of psychosocial work characteristics on hair cortisol - findings from a post-trial study. Stress 2017; 20:363-370. [PMID: 28595512 DOI: 10.1080/10253890.2017.1340452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Prolonged work stress, as indicated by the effort-reward imbalance (ERI) model, jeopardizes health. Cortisol represents a candidate mechanism connecting stress to ill health. However, previous findings appear inconclusive, and recommendations were made to assess work stress at multiple time points and also to investigate ERI (sub-)components. This study therefore examines the effects of two single time points, as well as the mean and change scores between time points of ERI and its components on hair cortisol concentration (HCC), a long-term cortisol measurement. Participants were 66 male factory workers (age: 40.68 ± 6.74 years; HCC: 9.00 ± 7.11 pg/mg), who were followed up after a stress management intervention (2006-2008). In 2008 (T1) and 2015 (T2), participants completed a 23-item ERI questionnaire, assessing effort, the three reward components (esteem, job security, job promotion) and over-commitment. In 2015, participants also provided a 3-cm hair segment close to the scalp for HCC analysis, as well as information on relevant confounders (i.e. medication intake, age, work characteristics, socioeconomic and lifestyle factors, number of stressful life events). Linear regressions revealed hardly any cross-sectional or longitudinal effect of ERI and its components on HCC. Only the change scores between T1 and T2 of job security were negatively associated with lower HCC in unadjusted (β = -.320; p = .009) and adjusted (β = -.288; p = .044) models. In this study, only a decrease of perceived job security over time was significantly associated with higher HCC, and other predictors were not related to this outcome. Especially after correction for multiple testing, this study revealed just a weak association of different psychosocial work measurements with HCC. Lay summary This study showed that an increase in perceived job insecurity is correlated with higher levels of the stress hormone cortisol. The higher levels of cortisol might represent a biological explanation for the negative health effects of job insecurity. The association was, however, relatively low, and more and more voices are questioning whether cortisol in hair is a reliable marker for perceived work stress.
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Affiliation(s)
- Raphael M Herr
- a Institute of Occupational, Social and Environmental Medicine , Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf , Düsseldorf , Germany
- b Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany
| | - Amira Barrech
- a Institute of Occupational, Social and Environmental Medicine , Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf , Düsseldorf , Germany
- c Department of Psychosomatic Medicine , University of Ulm , Ulm , Germany
| | - Harald Gündel
- c Department of Psychosomatic Medicine , University of Ulm , Ulm , Germany
| | - Jessica Lang
- d Institute of Occupational and Social Medicine , RWTH Aachen University , Aachen , Germany
| | - Natalia Soares Quinete
- d Institute of Occupational and Social Medicine , RWTH Aachen University , Aachen , Germany
| | - Peter Angerer
- a Institute of Occupational, Social and Environmental Medicine , Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf , Düsseldorf , Germany
| | - Jian Li
- a Institute of Occupational, Social and Environmental Medicine , Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf , Düsseldorf , Germany
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Ndjaboue R, Brisson C, Talbot D, Vézina M. Chronic exposure to adverse psychosocial work factors and high psychological distress among white-collar workers: A 5-year prospective study. J Psychosom Res 2017; 94:56-63. [PMID: 28183403 DOI: 10.1016/j.jpsychores.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/13/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prospective studies which evaluated whether the effects of chronic exposure to psychosocial work factors on mental health persisted over time are scarce. For the first time, this study evaluated: 1) the effect of chronic exposure to effort-reward imbalance over 5years on the prevalence of high psychological distress among men and women, and 2) the persistence of this effect over time. METHODS Overall, 1747 white-collar workers from three public organizations participated in a prospective study. Psychological distress and effort-reward imbalance were measured using validated questionnaires at baseline, and at 3- and 5-year follow-ups. Prevalence ratios (PRs) of high psychological distress were estimated using log-binomial regression according to baseline and repeated exposure. RESULTS Compared to unexposed workers, those with repeated exposure to effort-reward imbalance had a higher prevalence of high psychological distress. Workers exposed only at some time-points also had a higher prevalence. The deleterious effect of repeated exposure observed at the 3-year follow-up persisted at the 5-year follow-up among women (PR=2.48 95% confidence interval (CI) 1.97-3.11) and men (PR=1.91 95% CI 1.20-3.04). These effects were greater than those found using a single baseline measurement. CONCLUSION The current study supported a deleterious effect of repeated exposure to effort-reward imbalance on psychological distress, and a lack of adaptation to these effects over time among men and women. Since psychological distress may later lead to severe mental problems, current results highlight the need to consider exposure to these adverse work factors in primary and secondary preventions aimed at reducing mental health problems at work.
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Affiliation(s)
- Ruth Ndjaboue
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada.
| | - Chantal Brisson
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada
| | - Denis Talbot
- Centre de Recherche du CHU de Québec- Université Laval, Quebec, Canada
| | - Michel Vézina
- Institut National de Santé Publique du Québec, Canada
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Mache S, Vitzthum K, Hauschild I, Groneberg D. A pilot study evaluation of psychosocial competency training for junior physicians working in oncology and hematology. Psychooncology 2017; 26:1894-1900. [PMID: 28219121 DOI: 10.1002/pon.4403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND This pilot and feasibility study evaluated a work-related self-care competency training in oncology and hematology medicine for junior physicians working in oncology and hematology medicine. METHODS A pilot study was conducted with 80 physicians working in oncology and hematology hospital departments in Germany. Physicians were distributed to either the intervention group receiving competency training or a comparison group. The intervention took place in groups over a period of 12 weeks. Training content included work-related self-care strategies, problem-solving techniques solution-focused counselling. The outcomes studied were changes in work-related stress, emotional exhaustion, emotion regulation, and job satisfaction. Follow-up assessments were arranged after 12 weeks (T1), after 24 weeks (T2), and after 36 weeks (T3). RESULTS Intervention group reached a decrease in perceived job stress and emotional exhaustion. Self-perceived improvements were also obvious regarding enhanced emotion regulation skills. Future oncologists valued the intervention with high scores for training design, content, received outcome, and overall training satisfaction. CONCLUSIONS This study provided first indications that an innovative self-care competency training might be a supportive approach for junior physicians starting work in oncology and hematology. However, replication studies are needed to verify the results in the medical working context.
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Affiliation(s)
- Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt, Germany
| | | | - Inka Hauschild
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt, Germany
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Abstract
BACKGROUND Psychosocial factors have been shown to predict a poor disease course in patients with inflammatory bowel disease (IBD), but whether this applies to job stress is currently unknown. We assessed the prevalence of job stress and its correlates in a large cohort of patients with IBD. METHODS We included all adult, professionally active patients enrolled between 2006 and 2015 in the Swiss IBD Cohort. Job stress was measured through the self-report effort-reward imbalance ratio and overcommitment (OC) to work questionnaires. We used multiple linear regressions to assess association with sociodemographic, lifestyle, psychosocial, and disease-related factors. RESULTS Altogether 1656 patients completed the questionnaires (905 Crohn's disease and 751 ulcerative colitis/IBD unclassified). Only 91 (5.7%) of patients had an effort-reward imbalance ratio >1. Effort-reward imbalance and OC scores were higher in full-time versus part-time employees (coef = 0.050, P = 0.002; coef = 0.906, P < 0.001) and among those absent from the workplace in the previous 3 months (coef = 0.049, P = 0.010; coef = 1.062, P < 0.001). Higher OC scores were associated with sex (women vs. men: coef = 0.568, P = 0.014), being in a relationship (coef = 0.805, P = 0.001), higher level of occupation (director vs. trainee: coef = 1.447, P < 0.001), and extraintestinal manifestations (coef = 0.623, P = 0.005). Patients hospitalized in the previous 12 months had lower OC scores (coef = 0.560, P = 0.038). CONCLUSIONS The average level of job stress seems to be remarkably low in patients with IBD from Switzerland. The clinician should turn attention especially to women, full-time employees with a high level of education, and patients with extraintestinal manifestations to identify those with the most vulnerability to suffer from job stress.
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Bernburg M, Baresi L, Groneberg D, Mache S. Does psychosocial competency training for junior physicians working in pediatric medicine improve individual skills and perceived job stress. Eur J Pediatr 2016; 175:1905-1912. [PMID: 27629780 DOI: 10.1007/s00431-016-2777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 08/17/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Pediatricians' job performance, work engagement, and job satisfaction are essential for both the individual physician and quality of care for their little patients and parents. Therefore, it is important to maintain or possibly augment pediatricians' individual and professional competencies. In this study, we developed and implemented a psychosocial competency training (PCT) teaching different psychosocial competencies and stress coping techniques. We investigated (1) the influence of the PCT on work-related characteristics: stress perception, work engagement, job satisfaction and (2) explored pediatricians' outcomes and satisfaction with PCT. Fifty-four junior physicians working in pediatric hospital departments participated in the training and were randomized in an intervention (n = 26) or a control group (n = 28). In the beginning, at follow-up 1 and 2, both groups answered a self-rated questionnaire on perceived training outcomes and work-related factors. The intervention group showed that their job satisfaction significantly increased while perceived stress scores decreased after taking part in the PCT. No substantial changes were observed with regard to pediatricians' work engagement. Participating physicians evaluated PCT with high scores for training design, content, received outcome, and overall satisfaction with the training. CONCLUSION Professional psychosocial competency training could improve junior pediatricians' professional skills, reduce stress perception, increase their job satisfaction, and psychosocial skills. In addition, this study indicates that the PCT is beneficial to be implemented as a group training program for junior pediatricians at work. What is Known: • Junior pediatricians often report experiencing high levels of job strain and little supervisory support. • High levels of job demands make pediatricians vulnerable for mental health problems and decreased work ability. What is New: • Development, implementation, and evaluation of a psychosocial competency training for junior pediatricians working in clinical settings • Psychosocial competency training has the potential to improve pediatricians' psychosocial skills and perceptions of perceived work-related stress and job satisfaction.
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Affiliation(s)
- Monika Bernburg
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Free University and Humboldt University, Thielallee 69-73, 14195, Berlin, Germany
| | - Lisa Baresi
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Free University and Humboldt University, Thielallee 69-73, 14195, Berlin, Germany
| | - David Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Stefanie Mache
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, 20459, Hamburg, Germany.
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The Association Between Effort-Reward Imbalance and Depressive Symptoms Is Modified by Selection, Optimization, and Compensation Strategy. J Occup Environ Med 2016; 57:1222-7. [PMID: 26539771 DOI: 10.1097/jom.0000000000000546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the main and interactive effects of effort-reward imbalance (ERI) and selection, optimization, and compensation (SOC) strategy on depressive symptoms among the working population in the City of Kumning, China. METHODS We assessed the separate and combined effects of low versus high ERI and good versus poor SOC strategy on depressive symptoms using multivariable logistic regression analyses in a population-based sample (N = 2457). RESULTS High ERI and poor SOC were significantly associated with depressive symptoms, respectively. In employees with both high ERI and poor SOC, the odds ratio was highly elevated as compared with the reference group (low ERI and good SOC). CONCLUSIONS If our findings are confirmed by prospective studies, health promotion programs in work settings might consider SOC as an integral part to mitigate the adverse mental health effects of ERI.
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Loerbroks A, Weigl M, Li J, Angerer P. Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health 2016; 16:342. [PMID: 27090211 PMCID: PMC4835931 DOI: 10.1186/s12889-016-3016-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
Background Work stress may impair physicians’ ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians’ poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care. Methods We used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians’ perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians’ mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses. Results Both an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians’ depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care. Conclusions Our study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians’ depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Jian Li
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Associations of psychosocial working conditions and working time characteristics with somatic complaints in German resident physicians. Int Arch Occup Environ Health 2015; 89:583-92. [PMID: 26542379 DOI: 10.1007/s00420-015-1096-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Somatic complaints (SC) are highly prevalent in working populations and cause suffering and extensive health-care utilization. Adverse psychosocial working conditions as conceptualized in the Job Demand-Control-Support Model (JDC-S) and adverse working time characteristics (WTC) are potential risk factors. This combination is particularly common in hospital physicians. This study examines associations of JDC-S and WTC with SC in resident physicians from Germany. METHODS A cross-sectional study was conducted among 405 physicians at the end of residency training. SC were measured using the Giessen Subjective Complaints List (GBB-24) containing the sub-categories exhaustion, gastrointestinal, musculoskeletal, and cardiovascular complaints. Data on working conditions were collected by a self-report method for work analysis in hospitals (TAA-KH-S) and by questions on WTC (i.e., working hours). Multivariable stepwise regression analyses were applied. RESULTS Workload showed the most pronounced relationship with all sub-categories of SC except gastrointestinal complaints. Job autonomy was not significantly related to any SC sub-category. Social support at work was inversely associated with all SC sub-categories except for cardiovascular complaints. Free weekends were associated with reduced SC except for exhaustion. Shift work was related to an increased SC total score and musculoskeletal complaints. Working hours showed no association with SC. CONCLUSION In resident physicians, high workload and shift work are associated with increased SC, while social support at work and free weekends are associated with decreased SC. These insights may inform the development of preventive measures to improve the health of this professional group. Prospective studies are needed though to corroborate our findings.
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Mache S, Danzer G, Klapp B, Groneberg DA. An Evaluation of a Multicomponent Mental Competency and Stress Management Training for Entrants in Surgery Medicine. JOURNAL OF SURGICAL EDUCATION 2015; 72:1102-1108. [PMID: 26232060 DOI: 10.1016/j.jsurg.2015.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Stress occurs in surgeons with a significantly higher prevalence than in the general population. At the same time, learning of coping techniques and improving personal skills how to handle the daily workload are not integral parts of the medical education or during adjustment to the job as a surgeon. In this pilot study, we developed a training course to teach different stress management and coping techniques and analyzed individual conditions of the surgeons before and after the course. METHODS In total, 68 junior surgeons in their first year at work participated in the training and were randomized in an intervention (n = 35) or a control group (n = 33). At the beginning and the end of the training, the intervention and the comparison group answered a standardized, validated questionnaire on job satisfaction, perceived stress, and personal skills (such as self-efficacy). RESULTS The surgeons showed a significant decline in perceived stress. Furthermore, they showed an improvement in self-reported resilience and self-efficacy. Job satisfaction increased at the same time. The comparison cohort of surgeons showed comparable scores for the specified outcome variables at the beginning but showed no progressive changes during time. CONCLUSIONS The study findings indicate that the training for junior surgeons in their first year at work is suitable to implement as a group training program. Moreover, the training provides statistically significant improvement in perceptions of distress and strengthens individual protective factors and job satisfaction.
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Affiliation(s)
- Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
| | - Gerhard Danzer
- Department of Medicine/Psychosomatics, Charité-Universitätsmedizin Berlin, Free University and Humboldt University, Berlin, Germany
| | - Burghard Klapp
- Department of Medicine/Psychosomatics, Charité-Universitätsmedizin Berlin, Free University and Humboldt University, Berlin, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
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Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians. Eur J Pediatr 2015; 174:1237-46. [PMID: 25846697 DOI: 10.1007/s00431-015-2529-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/09/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care. CONCLUSION Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care. WHAT IS KNOWN • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality. WHAT IS NEW • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians' work stress on mitigated care quality.
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Psychosocial work factors and first depressive episode: retrospective results from the French national SIP survey. Int Arch Occup Environ Health 2014; 88:835-47. [DOI: 10.1007/s00420-014-1013-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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Guo H, Yang W, Cao Y, Li J, Siegrist J. Effort-reward imbalance at school and depressive symptoms in Chinese adolescents: the role of family socioeconomic status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6085-98. [PMID: 24919130 PMCID: PMC4078567 DOI: 10.3390/ijerph110606085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/16/2014] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
Abstract
Depression is a major mental health problem during adolescence. This study, using a sample of Chinese adolescents, examined the separate and combined effects of perceived school-related stress and of family socioeconomic status (SES) on the prevalence of depressive symptoms. A total of 1774 Chinese students from Grades 7–12 were recruited into our questionnaire survey. School-related stress was measured by the Effort-Reward Imbalance Questionnaire-School Version, family SES was assessed by a standardized question, and depressive symptoms were evaluated by the Center for Epidemiological Studies Depression Scale for Children. Multivariate logistic regression was applied, adjusting for age, gender, grade, smoking, alcohol drinking and physical activity. It was found that high school-related stress and low family SES were associated with elevated odds of depressive symptoms, respectively. The effect of school-related stress was particularly strong in low SES group. In adolescents with both high stress at school and low SES, the odds ratio was 9.18 (95% confidence interval = 6.53–12.89) compared to the reference group (low stress at school and high SES). A significant synergistic interaction effect was observed (synergy index = 2.28, 95% confidence interval = 1.56–3.32). The findings indicated that perceived school-related stress, in terms of effort-reward imbalance, was related to depressive symptoms in this sample of Chinese adolescents. The strong interaction with family SES suggests that health promoting efforts in school settings should be targeted specifically at these socially deprived groups.
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Affiliation(s)
- Hongxiang Guo
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Wenjie Yang
- School of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Ying Cao
- First High School of Zhengzhou, Zhengzhou 450000, China.
| | - Jian Li
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstrasse 1, Düsseldorf 40225, Germany.
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Life-Science Centre, University of Düsseldorf, Düsseldorf 40225, Germany.
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