Psychological stress among hospital doctors caring for HIV patients in the late nineties

Mental Illness and Work-Related Limitations in Healthcare Workers: A Preliminary Retrospective Study

This retrospective observational study investigated hospital staff requests for job fitness visits, addressed to occupational medicine. Specific objectives were to analyze: (1) health workers’ requests, sociodemographic characteristics, psychiatric diagnoses, assigned doctor’s fit notes, and (orthopedic, psychiatric) limitations; (2) associations between psychiatric diagnoses, sociodemographic (sex, age), and work-related (job, department) characteristics; (3) associations between the same psychiatric diagnoses/orthopedic limitations, fit notes, and/or psychiatric limitations. Data of St. Orsola-Malpighi Polyclinic health workers (N = 149; F = 73.8%; mean age = 48 ± 9.6 years), visited by both the occupational medicine physician and psychiatrist (January 2016−May 2019), were analyzed. 83.2% of the sample presented with at least one psychiatric diagnosis, including mood (47%), anxiety (13.4%), and anxious-depressive (10.7%) disorders. Significant differences between psychiatric diagnoses according to sex and fit notes (both p < 0.01) have been found, whereas no significant associations based on age and work-related characteristics have been observed. Analysis of frequencies of participants with the same psychiatric diagnosis (orthopedic limitation being equal), according to doctor’s fit notes and psychiatric work limitations, showed a high heterogeneity of assignments. The current occupational medicine procedure for fit notes/job limitations assignments does not allow taking into consideration clinical factors possibly associated with more specific assignments. To standardize the procedure and translate the psychiatrist’s clinical judgment into practice, further studies to test the usefulness of clinimetrics, which might represent a reliable approach in considering different fit notes and job limitations, are needed.

Effects of Job Burnout and Emotional Labor on Objective Structured Clinical Examination Performance Among Interns and Residents in Taiwan

Medical education faces challenges concerning job burnout and emotional labor among junior physicians, which poses a potential threat to the quality of medical care. Although studies have investigated job burnout and emotional labor among physicians, empirical research on the association between job burnout, emotional labor, and clinical performance is lacking. This study investigated the effects of job burnout and emotional labor on clinical performance by using the objective structured clinical examination (OSCE) scores of interns and residents. Specifically, this cross-sectional study utilized the Maslach Burnout Inventory and the Emotional Labor Questionnaire as measurement instruments. A total of 225 interns and residents in central Taiwan answered structured questionnaires before beginning their OSCE. The major statistical analysis method employed was logistic regression. After adjustment for covariates, first-year residents were less likely than other residents to obtain high OSCE scores. The odds of high OSCE performance among interns and residents with high interaction component scores in emotional labor were significantly higher than those with low interaction scores. A high score in the interaction dimension of emotional labor was associated with strong clinical performance. The findings suggest that interventions which motivate positive attitudes and increase interpersonal interaction skills among physicians should receive higher priority.

Burnout and psychological distress among nurses in a Nigerian tertiary health institution

BACKGROUND

The role of nurses in the health care delivery system cannot be overemphasized. Nurses are needed at all levels of healthcare and the profession requires a lot of dedication, time and energy with regards to patient management and service delivery. This time investment and dedication to duty is likely to lead to burnout and psychological distress among the nurses.

OBJECTIVE

This study assesses the prevalence of burnout and psychological distress among nurses working in Nigerian tertiary health institution.

METHOD

The Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) were used to assess 210 nurses working in this health institution for symptoms of burnout and psychological distress.

RESULTS

High levels of burnout were identified in 42.9% of the respondents in the area of emotional exhaustion, 47.6% in the area of depersonalization and 53.8% in the area of reduced personal accomplishment, while 44.1% scored positive in the GHQ-12 indicating presence of psychological distress.

CONCLUSION

Prevalence of burnout and psychological distress is high among nurses.

Clinician stress and patient-clinician communication in HIV care

BACKGROUND

Clinician stress is common, but few studies have examined its relationship with communication behaviors.

OBJECTIVE

To investigate associations between clinician stress and patient-clinician communication in primary HIV care.

DESIGN

Observational study.

PARTICIPANTS

Thirty-three primary HIV clinicians and 350 HIV-infected adult, English-speaking patients at three U.S. HIV specialty clinic sites.

MAIN MEASURES

Clinicians completed the Perceived Stress Scale, and we categorized scores in tertiles. Audio-recordings of patient-clinician encounters were coded using the Roter Interaction Analysis System. Patients rated the quality of their clinician's communication and overall quality of medical care. We used regression with generalized estimating equations to examine associations between clinician stress and communication outcomes, controlling for clinician gender, clinic site, and visit length.

KEY RESULTS

Among the 33 clinicians, 70 % were physicians, 64 % were women, 67 % were non-Hispanic white, and the mean stress score was 3.9 (SD 2.4, range 0-8). Among the 350 patients, 34 % were women, 55 % were African American, 23 % were non-Hispanic white, 16 % were Hispanic, and 30 % had been with their clinicians >5 years. Verbal dominance was higher for moderate-stress clinicians (ratio=1.93, p<0.01) and high-stress clinicians (ratio=1.76, p=0.01), compared with low-stress clinicians (ratio 1.45). More medical information was offered by moderate-stress clinicians (145.5 statements, p <0.01) and high-stress clinicians (125.9 statements, p=0.02), compared with low-stress clinicians (97.8 statements). High-stress clinicians offered less psychosocial information (17.1 vs. 19.3, p=0.02), and patients of high-stress clinicians rated their quality of care as excellent less frequently than patients of low-stress clinicians (49.5 % vs. 66.9 %, p<0.01). However, moderate-stress clinicians offered more partnering statements (27.7 vs. 18.2, p=0.04) and positive affect (3.88 vs. 3.78 score, p=0.02) than low-stress clinicians, and their patients' ratings did not differ.

CONCLUSIONS

Although higher stress was associated with verbal dominance and lower patient ratings, moderate stress was associated with some positive communication behaviors. Prospective mixed methods studies should examine the complex relationships across the continuum of clinician well-being and health communication.

Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices

PURPOSE

Burnout syndrome (BOS) has frequently been reported in healthcare workers, and precipitating factors include communication problems in the workplace and stress related to end-of-life situations. We evaluated the effect of an intensive communication strategy on BOS among caregivers working in intensive care (ICU).

METHODS

Longitudinal, monocentric, before-and-after, interventional study. BOS was evaluated using the Maslach Burnout Inventory (MBI) and depression using the Centre for Epidemiologic Studies Depression Scale (CES-D) in 2007 (period 1) and 2009 (period 2). Between periods, an intensive communication strategy on end-of-life practices was implemented, based on improved organisation, better communication, and regular staff meetings.

RESULTS

Among 62 caregivers in the ICU, 53 (85%) responded to both questionnaires in period 1 and 49 (79%) in period 2. We observed a significant difference between periods in all three components of the MBI (emotional exhaustion, p = 0.04; depersonalization p = 0.04; personal accomplishment, p = 0.01). MBI classified burnout as severe in 15 (28%) caregivers in period 1 versus 7 (14%) in period 2, p < 0.01, corresponding to a 50% risk reduction. Symptoms of depression as evaluated by the CES-D were present in 9 (17%) caregivers in period 1 versus 3 (6%) in period 2, p < 0.05, corresponding to a risk reduction of almost 60%.

CONCLUSION

The implementation of an active, intensive communication strategy regarding end-of-life care in the ICU was associated with a significant reduction in the rate of burnout syndrome and depression in a stable population of caregiving staff.

No variability across centers in adherence and response to HAART in French hospitals: results from the ANRS-EN12-VESPA study

OBJECTIVE

Because a centre effect can sometimes exist in HIV treatment, we sought to measure the heterogeneity of French hospital departments delivering HIV care and to test the presence of such an effect on adherence and response to highly active antiretroviral therapy.

METHODS

The ANRS-EN12-VESPA study is a nationally representative 2-stage cross-sectional survey conducted in France in 2003 and covering 102 hospital departments providing HIV care. Each department described its HIV care activities and care provision. Analyses of adherence and 4 indicators of treatment outcome were restricted to the 699 patients diagnosed from 1996 onwards and treated with highly active antiretroviral therapy for at least 6 months. The variability between departments was assessed with random-effect models for binary outcomes.

RESULTS

The departments delivering HIV care proved to be somewhat heterogeneous in numerous respects, including their size and their onsite provision of consultancies and other services, and the characteristics of their patient population. Mean observed adherence was 63.3%, and the means of the different treatment failure indicators ranged from 6.1% to 59.8%. The departments showed some variability for these outcomes, but no significant centre effect was detected.

CONCLUSIONS

Despite the heterogeneity of the specific types of medical services offered by the hospitals providing HIV care, the nationwide treatment results seem homogeneous. This homogeneity could be attributed to the widespread and consistent application of therapeutic guidelines, which are regularly updated by consensus.

[Effect of psychosocial work environment and job satisfaction on burnout syndrome among specialist physicians]

OBJECTIVES

To describe the prevalence of burnout syndrome according to medical specialty and to examine the impact of work psychosocial risk factors, job satisfaction and professional characteristics on burnout syndrome among specialist physicians throughout Spain.

METHODS

A cross-sectional survey was carried out among 1,021 Spanish physicians. The outcome variables were the 3 dimensions of burnout syndrome: emotional exhaustion, depersonalization, and personal accomplishment. The explanatory variables were work psychosocial risk factors and job satisfaction evaluated by a stress scale specifically designed for physicians. Adjusted odds ratios and their 95% confidence intervals were calculated by logistic regression.

RESULTS

The probability of high emotional exhaustion and depersonalization were greater in physicians exposed to a high level of contact with suffering and death and to a negative impact of work on home life. The probability of high emotional exhaustion was greater among physicians with a high work overload. The risk of low personal accomplishment was higher among physicians with low professional satisfaction and those without training activities. Dissatisfaction with relationships with patients and relatives had a negative effect on the 3 dimensions of burnout.

CONCLUSIONS

Psychosocial work environment and job satisfaction have a negative effect on burnout syndrome, especially on emotional exhaustion and depersonalization.

Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists

BACKGROUND

Studies have shown that physicians are subject to high stress levels that can lead to mental health problems. Ophthalmologists are facing particularly high pressures because of shortages in their number and lack of resources. This study describes the state of mental health of Quebec's ophthalmologists and identifies certain elements of their work environment and personal lives that may contribute to problems.

METHODS

This cross-sectional study uses self-report questionnaires, including validated instruments, as well as instruments created for the study. A total of 133 out of 266 Quebec's ophthalmologists participated in the study.

RESULTS

More than 35% of ophthalmologists reported high levels of burnout and psychological distress. The 5 main occupational stressors were growth in demand for services (49.2%), shortage of ophthalmologists (48.1%), amount of work to be done (45.4%), budgetary pressures (44.6%), and repeated training of new work teams (41.9%). Self-acceleration is the defensive strategy used most often to deal with work overload. Nearly half (47.4%) reported having problems reconciling work and personal life. The mean scores indicate that ophthalmologists received little recognition from administration.

INTERPRETATION

Work overload and systemic organizational deficiencies are burdening ophthalmologists in Quebec. They constantly work harder to preserve their professional ideals, but they receive little recognition from the administration. The levels of distress observed in this context point to the need for the authorities to take action to improve practice conditions. The situation is urgent because population aging has already begun to cause a sharp increase in demand, and younger physicians appear to be suffering most from work overload and burnout.

Burnout syndrome among critical care healthcare workers

PURPOSE OF REVIEW

Burnout syndrome is a psychological state resulting from prolonged exposure to job stressors. Because ICUs are characterized by a high level of work-related stress, a factor known to increase the risk of burnout syndrome, we sought to review the available literature on burnout syndrome in ICU healthcare workers.

RECENT FINDINGS

Based on most recent studies, severe burnout syndrome (as measured using the Maslach Burnout Inventory) is present in about 50% of critical care physicians and in one third of critical care nurses. Strikingly, determinants of burnout syndrome are different in the two groups of caregivers. Namely, intensivists who have severe burnout syndrome are those with a high number of working hours (number of night shifts and time from last vacation) but determinants of severe burnout syndrome in ICU-nurses are related to ICU organization and end-of-life-related characteristics. ICU conflicts, however, were independent predictors of severe burnout syndrome in both groups.

SUMMARY

Recent studies reported high levels of severe burnout syndrome in ICU healthcare workers and identified potential targets for preventive strategies such as ICU working groups, communication strategies during end-of-life care and prevention and management of ICU conflicts.

A study on burnout syndrome in healthcare providers to people living with HIV

Dedicating physical and psychological care to other people is a tiring activity, not only because of the responsibility but also, more importantly, because of the emotional aspects involved in this relationship, which lead to stress and, if this stress continues, to burnout syndrome. Some authors report that the demands of caring for HIV-positive people are greater than those for other types of patients, increasing the chances of burnout. This study aimed to investigate the occurrence of burnout in healthcare providers of HIV-positive patients in the state of Paraná, Brazil. Through the use of a questionnaire and the Maslach Burnout Inventory (MBI), 87 people were evaluated. The averages for the MBI were 19.07 for emotional exhaustion (EE), 4.18 for depersonalisation (DE) and 39.60 for personal accomplishment (PA). There were 26.4% of people with high scores on EE, 17.2% presenting elevated DE and 10.5% showing diminished PA in their work. It was observed that the majority of the carers were in this occupation for a short period of time (74.7% for less than five years), while 42.5% spent up to 20 hours per week in the activity. Among the healthcare providers, 63.2% were volunteers. The variables 'sex' and 'working time' have showed themselves as significant predictors for DE as well as 'age' for PA. Taking these characteristics into account, it can be seen that it is necessary to give some special attention to this group of workers, in order to enable them to access preventive and/or interventional measures.

Burnout syndrome in critical care nursing staff

RATIONALE

Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff.

OBJECTIVES

To identify determinants of BOS in critical care nurses.

METHODS

We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data.

MEASUREMENTS AND MAIN RESULTS

Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04).

CONCLUSION

One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.

[Burnout syndrome: prevalence and associated factors among workers in a district hospital]

AIM

Burnout syndrome refers to a kind of occupational stress that can have psychosomatic, behavioral, emotional, familial, and social repercussions; it can also cause absenteeism and loss of efficacy at work. The aim of this study was to determine the prevalence of burnout among staff in a district hospital, as well as the personal and working characteristics associated with the syndrome.

METHODS

A cross-sectional study was designed in which a representative random sample of 300 workers, stratified according to professional group, was given the Maslach Burnout Inventory to measure the degree of burnout. This questionnaire has three subscales: emotional exhaustion (EE), depersonalization (DP) and personal achievement (PA).

RESULTS

A high degree of burnout was found for EE in 13.9% of the staff interviewed, in 11.1% for DP and in 6.6% for PA. None of the interviewees had high scores for all three scales while 27% had a high level of burnout in at least one of the scales. In the multivariate analysis, professional category and sex were statistically significantly associated with a high level of burnout.

CONCLUSION

The prevalence of burnout in Mataró Hospital (Spain) is relatively low and depends mainly on sex and professional group.