Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa

Anxiety and depression in surgeons: A systematic review

INTRODUCTION

The unique pressures of a surgical career put surgeons at particular risk of mental health conditions, including anxiety and depression. Surgeons have previously been shown to have a high prevalence of psychological distress. This study aimed to systematically review the prevalence of anxiety and depression amongst surgeons, and to identify factors that can modify the risk of anxiety and depression in surgeons.

METHODS

A 10-year systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines to identify citations related to the keywords "anxiety" OR "depression" AND "surgeon" in PubMed/Medline and ScienceDirect databases. Inclusion and exclusion criteria were applied to produce a final list of citations.

RESULTS

Thirty-one citations were included with a total of 11,399 participants. The median percentage of anxiety in surgeons was 20 with a range of 54.6%. While the median percentage of depression was 24 with a range of 59%. Risk factors associated with a higher risk of anxiety and depression include female gender, younger age, concurrent burnout, and occupational concerns regarding the COVID-19 pandemic. Protective factors include institutional support and a sense of social belonging.

CONCLUSIONS

There was a high prevalence of anxiety and depression amongst surgeons over the past decade. It is imperative to develop strategies to mitigate the effect of anxiety and depression in surgeons.

Russian Physicians Burnout during the COVID-19 Pandemic: A Cross-Sectional Survey Study

Objective: To study burnout of Russian physicians in the conditions of COVID-19 pandemic and how their work with coronavirus-infected patients influenced it. According to a three-factor model of burnout developed by Maslach and Jackson, this syndrome includes emotional exhaustion, depersonalization, and reduction of personal accomplishment.Design: A cross-sectional survey study.Setting: Large medical practice.Participants: Physicians of different specialties.Methods: Data collection was conducted from June 23 to July 12, 2020. We developed a Google form including a questionnaire and psychological inventories and placed it in a medical portal. Maslach Burnout Inventory - Human Services Survey for Medical Personnel was used to study burnout; the Hospital Anxiety and Depression Scale was used to determine anxiety and depression.Results: Of all the physicians who took part in the study (N = 599), 31.2 % worked with coronavirus-infected patients. Of the medical personnel who treated COVID-19 patients, 63.6% noted increased workload during the pandemic. Compared to other physicians, they more often had a high degree of emotional exhaustion (43.3 % vs 33.0 %, φ* = 2.404, P ≤ 0.01) and depersonalization (41.7 % vs 34, 0%, φ* = 1.803, P ≤ 0.05). An overwhelming majority of physicians, without any dependence on work with infected patients, had an absence of anxiety and depression. The identified interrelations between the symptoms of burnout, anxiety, depression; age and career stage in medical personnel were identical, except for weak correlations between age and emotional exhaustion (rs = -0.097, P ≤ 0.05), as well as career stage and personal accomplishment (rs = 0.102, P ≤ 0.05) in those physicians who worked with COVID-19 patients. The structure of burnout was identical in all physicians and did not depend on interaction with the infected patients.Conclusion: Public health authorities should reduce the workload on physicians involved in treating infected patients against the backdrop of the pandemic. Psychotherapeutic measures focused on preventing burnout should reduce its number among physicians interacting with patients infected with the coronavirus.

Undergraduate Surgical Education: a Global Perspective

Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.