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Iserson KV. From magical thinking to suicide: Understanding emergency physicians' psychological struggle. Am J Emerg Med 2024; 78:37-41. [PMID: 38183885 DOI: 10.1016/j.ajem.2024.01.001] [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: 12/05/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking-in this case, the belief that perfection is possible despite evidence to the contrary-leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.
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Affiliation(s)
- Kenneth V Iserson
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, United States of America
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Wang J, Zhao S, Tong X, Wang M, Wang Y. Work-family conflict among primary health workers during the COVID-19 pandemic: Its mediating role in the relationship between workload and job burnout. J Clin Nurs 2024. [PMID: 38284495 DOI: 10.1111/jocn.17035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/21/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS AND OBJECTIVES This study explores the situation of workload, work-family conflict and job burnout among primary health workers in China in the context of COVID-19 and identifies the mediating effect of work-family conflict between workload and job burnout. BACKGROUND Since the breakout of the COVID-19 pandemic, primary health workers have been working on the frontline of the epidemic and may experience increasing workload, work-family conflict and job burnout. It is important to focus on the issue of how to alleviate job burnout of primary health workers. DESIGN A cross-sectional study (STROBE) was used. METHODS Data were collected from 785 primary health workers in China. Multiple regression analysis was used to examine the mediating effect of work-family conflict between workload and job burnout. RESULTS 18.7%, 10.4% and 39.5% of respondents had high job burnout in the dimensions of emotional exhaustion, depersonalization and personal accomplishment, respectively. 34.6% of the respondents had high or very high workload, and 12.8% of the respondents had high or very high work-family conflict. Results of multiple regression analysis indicated that work-family conflict mediated the relationship between workload and job burnout. Workload (β = .163, CI = .207-.549) and work-family conflict (β = .211, CI = .311-.640) positively influenced job burnout, and workload (β = .428, CI = .375-.508) positively influenced work-family conflict. CONCLUSION The study indicated that primary health workers experienced a high level of job burnout, especially in the personal accomplishment dimension. Furthermore, this study verified the mediating effect of work-family conflict between workload and job burnout. RELEVANCE TO CLINICAL PRACTICE Some interventions for alleviating workload, work-family conflict and job burnout should be taken, including workplace assistance programmes, family-friendly policies and a well-integrated healthcare system. NO PATIENT OR PUBLIC CONTRIBUTION This study does not involve patient or public contribution in any part. IMPACT STATEMENT Nurses and other primary health workers are health gatekeepers of residents and play a vital role in the healthcare system. Due to the breakout of COVID-19, they have taken more work and are more vulnerable to work overload, work-family conflict and the consequent job burnout. Some interventions should be taken to effectively alleviate their job burnout and improve their health and performance.
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Affiliation(s)
- Jianyun Wang
- School of Public Administration, Shandong Normal University, Jinan, Shandong, China
| | - Shichao Zhao
- School of Public Administration, Shandong Normal University, Jinan, Shandong, China
| | - Xiyang Tong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Minghui Wang
- School of Public Administration, Northwest University, Xi'an, Shaanxi, China
| | - Yiying Wang
- School of Political Science and Public Administration, Shandong University, Qingdao, Shandong, China
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Oh DJ, Shin YC, Oh KS, Shin DW, Jeon SW, Cho SJ. Examining the links between burnout and suicidal ideation in diverse occupations. Front Public Health 2023; 11:1243920. [PMID: 37744483 PMCID: PMC10513409 DOI: 10.3389/fpubh.2023.1243920] [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: 06/21/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction It is uncertain whether burnout is associated with suicidal ideation among workers not in health care services. The aim of this study was to identify how burnout and suicidal ideation are linked among employees in various occupations and whether depression affects this link. Methods This cross-sectional study collected data from 12,083 participants aged 19-65 years from 25 companies and public institutions who underwent workplace mental health screening. Burnout and depression were assessed using both the Oldenburg Burnout Inventory and the Center for Epidemiologic Studies Depression Scale. Suicidal ideation was assessed by a self-rated questionnaire from the Korea National Health and Nutrition Examination Survey. Results Exhaustion but not the cynicism dimension of burnout was associated with increased odds of suicidal ideation after adjustment for depression and other covariates (odds ratio [OR] = 1.47, 95% CI = 1.26-1.72). The association of exhaustion with suicidal ideation was significant in both depressed (OR = 1.36, 95% CI = 1.14-1.61) and not depressed (OR = 1.77, 95% CI = 1.13-2.76) participants. In exhausted participants, insufficient job control, an unfavorable occupational climate, low educational level, and depression were associated with increased odds of suicidal ideation. Conclusion Exhaustion is linked with risk of suicidal ideation in employees not in health care service, regardless of depression status. Exhausted employees, particularly those having poor job resources, should be recognized as an at-risk group.
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Affiliation(s)
- Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Chul Shin
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Jeon
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Joon Cho
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Padmanabhanunni A, Pretorius TB. Teacher Burnout in the Time of COVID-19: Antecedents and Psychological Consequences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4204. [PMID: 36901219 PMCID: PMC10002371 DOI: 10.3390/ijerph20054204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
The important, frontline role of teachers during the COVID-19 pandemic has often gone unrecognized, and attention to their mental health and well-being is often only the focus of scholarly research. The unprecedented challenges that teachers faced during the COVID-19 pandemic and the stresses and strains associated with it have severely impacted their psychological well-being. This study examined the predictors and the psychological consequences of burnout. Participants (N = 355) were schoolteachers in South Africa who completed the Perceived Vulnerability to Disease Questionnaire, the Fear of COVID-19 Scale, the Role Orientation Questionnaire, the Maslach Burnout Inventory, the Centre for Epidemiological Depression Scale, the Beck Hopelessness Scale, the Satisfaction with Life Scale, and the trait scale of the State-Trait Anxiety Inventory. The results of a multiple regression showed that fear of COVID-19, role ambiguity, and role conflict were significant predictors of emotional exhaustion and depersonalization, while perceived infectability and role ambiguity significantly predicted personal accomplishment. Gender and age also predicted emotional exhaustion and depersonalization, respectively, and age was also a significant predictor of personal accomplishment. Generally, the dimensions of burnout were significant predictors of indices of psychological well-being-namely, depression, hopelessness, anxiety, and life satisfaction-with the exception of the association between depersonalization and life satisfaction. Our results suggest that intervention efforts to reduce burnout need to provide teachers with adequate job resources to buffer against the demands and stressors associated with their work.
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McCammon LC, Gillen P, Kernohan WG. Explaining and addressing the limitations in usefulness of available estimated prevalence figures relating to burnout in family doctors: Evidence from a systematic scoping literature review. J Psychiatr Res 2023; 158:261-272. [PMID: 36621182 DOI: 10.1016/j.jpsychires.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/06/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
Burnout in family doctors (FDs) affects their well-being, patient care, and healthcare organizations, and is considered common worldwide. However, its measurement has been so inconsistent that whether the widely divergent prevalence figures can be meaningfully interpreted has been questioned. Our aim was to go further than previous systematic reviews to explore the meaning contribution and usefulness of FD-burnout prevalence estimates. Worldwide literature was systematically reviewed using Levac's scoping framework, with 249 papers undergoing full-text review. Of 176 studies measuring burnout, 78% used the Maslach Burnout Inventory (MBI), which measures burnout as now defined by the World Health Organization. We, therefore, concentrated on the MBI. Its burnout measurement was markedly inconsistent, with prevalence estimates ranging from 2.8% to 85.7%. Researchers made prevalence claims relating to burnout severity and implied diagnoses based on participants' MBI scores, even though the MBI has not been validated as a clinical or diagnostic tool. Except when comparisons were possible between certain studies, prevalence figures provided limited meaning and added little to the understanding of burnout in FDs. Our review revealed a lack of research-supported meaningful information about the prevalence of FD burnout and that care is required to avoid drawing unsubstantiated conclusions from prevalence results. This paper's overall purpose is to propose how obtaining meaningful prevalence estimates can begin, which are recognized as key to developing improved prevention policies and interventions. Researchers must adopt a consistent means to measure burnout, use the MBI as its authors intended, and explore making progress through quantitative and qualitative collaboration.
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Affiliation(s)
- Leonard C McCammon
- Ulster University, School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, York Street, Belfast, Co. Antrim, Northern Ireland, BT15 1ED, UK.
| | - Patricia Gillen
- Ulster University, School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, York Street, Belfast, Co. Antrim, Northern Ireland, BT15 1ED, UK; Southern Health and Social Care Trust, Gilford, Co. Armagh, Northern Ireland, BT63 5JX, UK
| | - W George Kernohan
- Ulster University, School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, York Street, Belfast, Co. Antrim, Northern Ireland, BT15 1ED, UK
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Malik H, Annabi CA. The impact of mindfulness practice on physician burnout: A scoping review. Front Psychol 2022; 13:956651. [PMID: 36204751 PMCID: PMC9530040 DOI: 10.3389/fpsyg.2022.956651] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Physician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians. Methodology A scoping review was conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review. Results 31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice. Conclusion Mindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation.
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Affiliation(s)
- Hani Malik
- Department of Family Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Manama, Bahrain
- *Correspondence: Hani Malik,
| | - Carrie Amani Annabi
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland-Dubai, Dubai, United Arab Emirates
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Prevalence of Burnout among General Practitioners: A Systematic Review and Meta-Analysis. Br J Gen Pract 2021; 72:e316-e324. [PMID: 34990391 DOI: 10.3399/bjgp.2021.0441] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background Burnout is a work-related syndrome documented to have negative consequences for general practitioners (GPs) and their patients. Our objective was to conduct a systematic review and meta-analysis of the literature to provide an estimate of how widespread this phenomenon is. AIM To review the existing literature concerning studies published up to December, 2020, on the prevalence of burnout amongst GPs in general practice, to determine GP burnout estimates worldwide. DESIGN AND SETTING Systematic literature search and meta-analysis. METHOD Searches of CINAHL Plus, Embase, MEDLINE, PsycINFO, and Scopus were conducted to identify published peer-reviewed quantitative empirical studies in English up to December, 2020, that have used the Maslach Burnout Inventory-Human Services Survey to establish the prevalence of burnout in practising GPs (i.e., excluding GPs in training). A random-effects model was employed. RESULTS Wide-ranging prevalence estimates (6% to 32%) for 22,177 GPs across 29 countries were reported for 60 studies included in this review. Mean burnout estimates were as follows: 16.43 (EE); 6.74 (DEP); and 29.28 (PA). Subgroup and meta-analyses documented that country-specific factors may be important determinants of the variation in GP burnout estimates. Moderate overall burnout cut-offs were found to be determinants of the variation in moderate overall burnout estimates. CONCLUSION Moderate to high GP burnout exist worldwide. However, substantial variations in how burnout is characterised and operationalised resulted in considerable heterogeneity in GP burnout prevalence estimates. This highlights the challenge of developing a uniform approach, and the importance of considering the GP's work context, to better characterise burnout.
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Salvado M, Marques DL, Pires IM, Silva NM. Mindfulness-Based Interventions to Reduce Burnout in Primary Healthcare Professionals: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9101342. [PMID: 34683022 PMCID: PMC8544467 DOI: 10.3390/healthcare9101342] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/23/2023] Open
Abstract
Mindfulness-based interventions (MBIs) are reported by experimental studies as practical approaches to reduce burnout in primary healthcare professionals (PHCP). However, to date, no research has synthesized the evidence to determine the overall effects of MBIs for reducing burnout in PHCP. We conducted a systematic review and meta-analysis to analyze the effects of MBIs to reduce burnout in PHCP. We searched articles in the PubMed/MEDLINE, Web of Science, Cochrane, and Scopus databases from inception to September 2021 using MeSH terms: "mindfulness", "burnout", and "primary healthcare". Two reviewers extracted the data and assessed the risk of bias. We used a random-effects meta-analysis to calculate the standardized mean differences (SMD) and mean differences (MD) with 95% confidence intervals (CI) of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) domains of burnout. Of 61 records, ten were included (n = 417). Overall, the studies were rated as having a high risk of bias and limited quality evidence. MBIs significantly reduced EE (SMD = -0.54, 95%CI: -0.72 to -0.36; MD = -5.89, 95%CI: -7.72 to -4.05), DP (SMD = -0.34, 95%CI: -0.52 to -0.17; MD = -1.96, 95%CI: -2.96 to -0.95), and significantly increased PA (SMD = 0.34, 95%CI: 0.17 to 0.52; MD = 2.05, 95%CI: 1.04 to 3.06). Although further high-quality research is needed, our findings support the implementation of MBIs for reducing burnout in PHCP.
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Affiliation(s)
- Mafalda Salvado
- Centro de Saúde Dr. Gorjão Henriques, Unidade de Saúde Familiar Cidade do Lis, 2410-272 Leiria, Portugal;
- Correspondence:
| | - Diogo Luís Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal;
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal;
- Escola de Ciências e Tecnologias, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal
| | - Nádia Mendes Silva
- Centro de Saúde Dr. Gorjão Henriques, Unidade de Saúde Familiar Cidade do Lis, 2410-272 Leiria, Portugal;
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Irizar P, Puddephatt JA, Gage SH, Fallon V, Goodwin L. The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression. Drug Alcohol Depend 2021; 226:108858. [PMID: 34214883 DOI: 10.1016/j.drugalcdep.2021.108858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates. METHOD Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers. RESULTS 1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance. CONCLUSIONS Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom.
| | - Jo-Anne Puddephatt
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
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Cost Borne by the Counselor: Comparing Burnout Between Dialectical Behavior Therapy (DBT) Counselors and Non‐DBT Counselors. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Inderbinen M, Schaefer K, Schneeberger A, Gaab J, Garcia Nuñez D. Relationship of Internalized Transnegativity and Protective Factors With Depression, Anxiety, Non-suicidal Self-Injury and Suicidal Tendency in Trans Populations: A Systematic Review. Front Psychiatry 2021; 12:636513. [PMID: 34093262 PMCID: PMC8172993 DOI: 10.3389/fpsyt.2021.636513] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Discrimination heavily impacts the lives of trans populations and causes adverse mental health outcomes. As stated by the Gender Minority Stress Model self-stigmatization could play an important role in this process. The aim of this systematic review is to investigate whether there is a positive association between self-stigmatization and mental health and to identify mediation factors. Studies which quantitatively investigated the association between internalized transnegativity and selected mental health outcomes (depression, anxiety, non-suicidal self-injury, suicidal tendency) in self-identified trans populations were included. Comprehensive search of 5 large databases in June 2020 and the following screening and selection procedure, performed by two researchers separately, identified 14 studies which met criteria. The relationship to be studied was reported with correlation and/or mediation analysis of cross-sectional data. IT was directly positively associated with depression, anxiety and suicidal tendency in most of the reviewed studies. Data indicates links between self-stigmatization and other general mental health stressors such as rumination and thwarted belongingness. Community connectedness showed to be the strongest protective factor for mental health impairments. These results should be considered in transition counseling. More research is needed to better understand the underlying mechanisms of the GMSM and to address unsolved operationalization and measurement issues.
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Affiliation(s)
- Marc Inderbinen
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Kristin Schaefer
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | | | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - David Garcia Nuñez
- Center for Gender Variance, Basel University Hospital, University of Basel, Basel, Switzerland
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Mental health among clinicians: what do we know and what can we do? Int Urogynecol J 2021; 32:1055-1059. [PMID: 33938962 PMCID: PMC8091150 DOI: 10.1007/s00192-021-04805-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
Mental health and mental health disorders among clinicians remain a taboo, despite increasing evidence showing the direct impact on medical teams and patient care. This editorial is aimed at increasing awareness of mental issues amongst healthcare professionals, identifying perceived barriers to seeking help, and suggesting ways in which to seek help. Mental health disorders, including anxiety and depression, are prevalent from medical school, leading to increased burnout and suicide risks at later stages of a clinician’s career. There is often a reluctance to seek help, particularly amongst the surgical specialties, caused by self-criticism, lack of convenient access and the potential negative impact on medical licensure. This editorial has been written in loving memory of our colleague, friend and board member Dr. Nikolaus Veit-Rubin, who sadly passed away at the beginning of the year. It is written in the hope of highlighting the importance of maintaining mental wellbeing amongst the medical team, supporting help-seeking behaviour and changing attitudes toward mental health disorders amongst clinicians.
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Andela M. Work-related stressors and suicidal ideation: The mediating role of burnout. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2021. [DOI: 10.1080/15555240.2021.1897605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Marie Andela
- Department of Psychology, University of Franche-Comté, UFR SLHS, Besancon, France
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Menon NK, Shanafelt TD, Sinsky CA, Linzer M, Carlasare L, Brady KJS, Stillman MJ, Trockel MT. Association of Physician Burnout With Suicidal Ideation and Medical Errors. JAMA Netw Open 2020; 3:e2028780. [PMID: 33295977 PMCID: PMC7726631 DOI: 10.1001/jamanetworkopen.2020.28780] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. OBJECTIVE To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. MAIN OUTCOMES AND MEASURES The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. RESULTS Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.
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Affiliation(s)
- Nikitha K. Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christine A. Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Lindsey Carlasare
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Keri J. S. Brady
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | | | - Mickey T. Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Laurent A, Lheureux F, Genet M, Martin Delgado MC, Bocci MG, Prestifilippo A, Besch G, Capellier G. Scales Used to Measure Job Stressors in Intensive Care Units: Are They Relevant and Reliable? A Systematic Review. Front Psychol 2020; 11:245. [PMID: 32226400 PMCID: PMC7080865 DOI: 10.3389/fpsyg.2020.00245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/03/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Many studies have been conducted in intensive care units (ICUs) to identify the stress factors involved in the health of professionals and the quality and safety of care. The objectives are to identify the psychometric scales used in these studies to measure stressors and to assess their relevance and validity/reliability. Methods: All peer-reviewed full-text articles published in English between 1997 and 2016 and focusing on an empirical quantitative study of job stressors were identified through searches on seven databases and editorial portals. Results: From the 102 studies analyzed, we identified 59 different scales: 17 "all settings scales" (16 validated scales), 20 "healthcare settings scales" (13 validated scales), and 22 "ICU settings scales" (two validated scales). All these scales used measured stressors from at least one of the following eight broad categories: High job demands, Problematic relationships with other professionals, Lack of control over work situations and career, Lack of organizational resources, Problematic situations with users and relatives, Dealing with ethical- and moral-related situations, Risk management issues, and Disadvantages in comparison to other occupational situations. The "all settings scales" and "healthcare settings scales," the most often validated, did not measure, or only slightly measured, the stressors most specific to ICUs. Where these were taken into account, the authors were forced to develop their own tools or modify existing scales without testing the validity of the tool used. Conclusions: This review highlights the lack of a tool that meets both the criteria of validity and relevance with regard to the specificity of work in ICUs. Future research must focus on developing reliable/valid tools covering all types of relevant stressors to ensure the quality of the studies carried out in this field.
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Affiliation(s)
- Alexandra Laurent
- Le Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (Psy DREPI), University of Bourgogne Franche-Comté, Dijon, France
- La Maison des Sciences de l'Homme et de l'Environnement (MSHE) C. N. Ledoux, University of Bourgogne Franche-Comté, Besançon, France
| | - Florent Lheureux
- Laboratory of Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | - Magali Genet
- Laboratory of Psychology, University of Bourgogne Franche-Comté, Besançon, France
| | | | - Maria G. Bocci
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besançon, University of Bourgogne Franche-Comté, Besançon, France
| | - Gilles Capellier
- Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France
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16
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Clough BA, Ireland MJ, Leane S, March S. Stressors and protective factors among regional and metropolitan Australian medical doctors: A mixed methods investigation. J Clin Psychol 2020; 76:1362-1389. [PMID: 32048300 DOI: 10.1002/jclp.22940] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to compare stress, burnout, stressors, and protective factors among regional- and metropolitan-based Australian medical doctors. METHOD A mixed methods design was utilized with 252 Australian medical doctors completing an online questionnaire package. A subsample also completed qualitative interviews. RESULTS Stress was significantly higher among doctors compared with population norms. Over half of doctors reported burnout on one or more dimensions. The strongest unique predictors were being female, working late, and work-family conflict. Qualitatively, 12 stressors (e.g., training and competition, workload, and time management) and 9 protective subthemes (e.g., being well resourced, clinical interest) emerged across system-level, clinical environment-level, and individual factor and personal response themes. CONCLUSIONS Stress and burnout among doctors are alarmingly high and both system/organization-level (e.g., communication systems, workload, flexible work arrangements) and individual-level (e.g., fostering resilience/coping strategies) predictors are implicated by our results. These may be useful targets for future interventions.
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Affiliation(s)
- Bonnie A Clough
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Sheena Leane
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Sonja March
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Queensland, Australia
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17
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Bayani AA, Baghery H. Exploring the Influence of Self-Efficacy, School Context and Self-Esteem on Job Burnout of Iranian Muslim Teachers: A Path Model Approach. JOURNAL OF RELIGION AND HEALTH 2020; 59:154-162. [PMID: 30259394 DOI: 10.1007/s10943-018-0703-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study tested the influence of self-efficacy, school context and self-esteem on job burnout of Iranian Muslim teachers. Job burnout was taken to be composed of three components: emotional exhaustion, depersonalization and personal accomplishment. A sample of 212 secondary school teachers completed a packet of scales that measure self-efficacy, school context, self-esteem and job burnout. The relationships between the variables were examined via path analysis. Path analysis showed self-efficacy to have a significant direct negative effect on depersonalization (β = - 0.25, p < 0.01) and reduced personal accomplishment (β = - 0.31, p < 0.01). School context had a significant direct effect on emotional exhaustion (β = - 0.36, p < 0.01), depersonalization (β = - 0.23, p < 0.01) and reduced personal accomplishment (β = - 0.17, p < 0.01). Self-esteem had a significant direct effect on emotional exhaustion (β = - 0.36, p < 0.01), depersonalization (β = - 0.15, p < 0.01) and reduced personal accomplishment (β = - 0.26, p < 0.01). The proposed model explained 47% of total variance of "emotional exhaustion," 28% of "depersonalization" and 54% of "reduced personal accomplishment."
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Affiliation(s)
- Ali Asghar Bayani
- Department of Education and Psychology, Azadshahr Branch, Islamic Azad University, Azadshahr, Golestan Province, Islamic Republic of Iran.
| | - Hossine Baghery
- Department of Education and Psychology, Azadshahr Branch, Islamic Azad University, Azadshahr, Golestan Province, Islamic Republic of Iran
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Bugaj TJ, Valentini J, Miksch A, Schwill S. Work strain and burnout risk in postgraduate trainees in general practice: an overview. Postgrad Med 2019; 132:7-16. [PMID: 31570072 DOI: 10.1080/00325481.2019.1675361] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.
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Affiliation(s)
- T J Bugaj
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - J Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - A Miksch
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - S Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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19
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Williams ES, Rathert C, Buttigieg SC. The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature. Med Care Res Rev 2019; 77:371-386. [DOI: 10.1177/1077558719856787] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The well-being of the health care workforce has emerged as both a major concern and as a component of the “quadruple aim” to enable the “triple aim” of improving patient experiences, reducing costs, and improving population health. Physician burnout is problematic given its effects on physicians, patients, health care organizations, and society. Using conservation of resources theory as a frame, we conducted a systematic review of the empirical literature on the relationship of physician burnout with physician personal and professional outcomes that includes 43 articles. Nine outcomes were organized into three categories illustrating burnout as a dynamic loss spiral rather than a static end-state. Findings show that emotional exhaustion had the greatest impact with the outcomes explored, while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon, which unfolds over time. Future research and implications of these results are discussed.
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20
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Truchot D, Andela M. Burnout and hopelessness among farmers: The Farmers Stressors Inventory. Soc Psychiatry Psychiatr Epidemiol 2018; 53:859-867. [PMID: 29725701 DOI: 10.1007/s00127-018-1528-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Farming is a stressful occupation with a high rate of suicide. However, there have been relatively few studies that have examined the antecedents of stress and suicide in farmers. We also lack methodologically sound scales aimed at assessing the stressors faced by farmers. AIMS Therefore, the purposes of this study were to develop an instrument assessing the stressors met by farmers, The Farmers Stressors Inventory, and to test its factorial structure, internal consistency and criterion validity. METHODS First, based on the existing literature and interviews with farmers, we designed a scale containing 37 items. Then a sample of 2142 French farmers completed a questionnaire containing the 37 items along with two measures: The MBIGS that assesses burnout and the BHS that assesses hopelessness. RESULTS The statistical analyses (EFA and CFA) revealed eight factors in accordance with different aspects of farmers job stressors: workload and lack of time, incertitude toward the future and the financial market, agricultural legislation pressure, social and geographical isolation, financial worry, conflicts with associates or family members, family succession of the farm, and unpredictable interference with farm work. The internal consistency of the eight subscales was satisfactory. Correlation between these eight dimensions and burnout on the one side and hopelessness on the other side support the criterion-related validity of the scale.
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Affiliation(s)
- Didier Truchot
- Université of Bourgogne Franche-Comté, 30-32 rue Mégevand, 25030, Besançon Cedex, France.
| | - Marie Andela
- Université of Bourgogne Franche-Comté, 30-32 rue Mégevand, 25030, Besançon Cedex, France
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21
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Khan A, Teoh KRH, Islam S, Hassard J. Psychosocial work characteristics, burnout, psychological morbidity symptoms and early retirement intentions: a cross-sectional study of NHS consultants in the UK. BMJ Open 2018; 8:e018720. [PMID: 30037857 PMCID: PMC6059335 DOI: 10.1136/bmjopen-2017-018720] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objectives of this study are twofold. First, to examine the direct effect of psychosocial work characteristics (as measured by job autonomy and work-related pressure) in relation to self-reported psychological morbidity symptoms and early retirement intentions among a sample of hospital consultants in the National Health Service (NHS). Second, to investigate burnout as mediating variable (ie, indirect effect) of these postulated associations. DESIGN A cross-sectional observational study. PARTICIPANTS 593 NHS consultants (male=63.1%) from hospitals in England, Scotland and Wales. MEASURES Self-reported online questionnaires on work-related pressure and job autonomy (Job Demands-Resources Questionnaire); emotional exhaustion and depersonalisation (Maslach Burnout Inventory); depressive and anxiety symptoms (State Trait Personality Inventory) and a single-item on early retirement intention. RESULTS This study observed high prevalence rates across all adverse health measures: emotional exhaustion (38.7%), depersonalisation (20.7%), anxiety symptoms (43.1%) and depressive symptoms (36.1%). Multiple linear regressions examined the postulated direct and indirect effects. Job autonomy had significant negative direct effects on the frequency of NHS consultants' anxiety and depressive symptoms, and their intention to retire early. Both emotional exhaustion and depersonalisation mediated the relationships that work-related pressure (full mediation) and job autonomy (partial mediation) had with self-reported symptoms of psychological morbidities. Only emotional exhaustion mediated the relationships where early retirement intention was the outcome. In terms of sociodemographic factors, age and years' experience predicted both burnout dimensions and psychological morbidity. CONCLUSIONS This is the first study to observe job autonomy to be associated with the number of self-reported psychological morbidity symptoms and early retirement intentions in a sample of NHS consultants. Burnout dimensions mediated these relationships, indicating that interventions need to focus on enhancing working conditions and addressing burnout among NHS consultants before more severe symptoms of psychological morbidity are reported. This study has implications for NHS policy makers and senior leadership.
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Affiliation(s)
- Atir Khan
- Diabetes Centre, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, UK
| | - Kevin RH Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Saiful Islam
- Swansea Trials Unit, College of Medicine, Swansea University, Swansea, UK
| | - Juliet Hassard
- Centre for Organisational Health and Development, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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22
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La relation soignant–soigné dans la littérature académique : tendances générales, limites et perspectives futures. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Lemoine J, Roland-Lévy C, Zaghouani I, Deschamps F. Contribution d’une catégorisation des RPS à la prédiction du stress et du burnout (ou du mal-être au travail) des soignants. PSYCHOLOGIE DU TRAVAIL ET DES ORGANISATIONS 2017. [DOI: 10.1016/j.pto.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Wallace JE. Burnout, coping and suicidal ideation: An application and extension of the job demand-control-support model. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2017. [DOI: 10.1080/15555240.2017.1329628] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jean E. Wallace
- Department of Sociology, University of Calgary, Calgary, Canada
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25
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Pilgrim JL, Dorward R, Drummer OH. Drug-caused deaths in Australian medical practitioners and health-care professionals. Addiction 2017; 112:486-493. [PMID: 27866392 DOI: 10.1111/add.13619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent. DESIGN Retrospective cohort study. SETTING The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians). MEASURES χ2 tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm. FINDINGS Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI) = 42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI = 92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI = 33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ2(7) = 237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases. CONCLUSIONS Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.
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Affiliation(s)
- Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Rhyse Dorward
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.,Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
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