Personality traits predict job stress, depression and anxiety among junior physicians

Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations

PURPOSE

Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students.

METHOD

A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models.

RESULTS

Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness ( β = 10.27 [95% confidence interval {CI}, 7.40-13.13; P < .001] and β = 3.42 [95% CI, 0.98-5.85; P = .006], respectively) and lower openness ( β = -4.95; 95% CI, -7.40 to -2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological ( P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological ( β = -5.66; 95% CI, -10.83 to -0.50; P = .03) and physiological stress reduction ( β = -0.002; 95% CI, -0.003 to -0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction ( β = -7.87; 95% CI, -13.05 to -2.68; P = .003).

CONCLUSIONS

Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.

Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019

AIMS

There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians.

METHODS

We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019.

RESULTS

Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress.

CONCLUSIONS

The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.

Work-related factors and the risk of common mental disorder 1 year later: A prospective cohort study among junior doctors

OBJECTIVE

This study investigated the relationship between work-related factors at baseline and the risk of common mental disorder at 12 month follow-up among a cohort of junior doctors.

METHOD

The data comprised the junior doctor respondents from two annual waves of the 'Medicine in Australia: Balancing Employment and Life' (MABEL) survey, a national longitudinal cohort of Australian doctors. Individual and work-related risk factors were assessed at baseline and the mental health outcome of caseness of common mental disorder (CMD) was assessed using the 6-item Kessler Psychological Distress Scale at 12-month follow-up. Unadjusted and adjusted logistic regressions were conducted to estimate the association between each baseline variable and the likelihood of CMD caseness at follow-up 1 year later.

RESULTS

Among 383 junior doctors, 24 (6%) had CMD 1 year later. Five work-related baseline variables were significantly associated with a higher likelihood of CMD 1 year later in adjusted models; lack of social support in work location (odds ratios (OR) = 6.11; 95% confidence intervals (CI) = [2.52, 14.81]), work-life imbalance (OR = 4.50; 95% CI = [1.31, 15.46]), poor peer support network in the workplace (OR = 2.61; 95% CI = [1.08, 6.27]), perceptions of patient expectations (OR = 2.46; 95% CI = [1.06, 5.71]) and total weekly work hours (OR 1.04; 95% CI = [1.01, 1.07]; p = 0.002)in models adjusting for gender.

CONCLUSION

These results identify key modifiable work-related factors that are associated with junior doctors' future mental health. Our findings suggest the need for a greater focus upon interpersonal factors and work-life balance in multi-level interventions while continuing to address workplace and system-level factors to prevent future mental disorder in junior doctors.

Role of stressful life events and personality traits on the prevalence of wish to die among French physicians

Background

Suicide rates are higher among physicians than in the general population. We aimed to investigate the role of stressful life events (related or not to work conditions) and personality traits on wish to die, a proxy measure of suicidal ideation.

Methods

This cross-sectional study took place in France from March 2018 to September 2018. Physicians completed an online questionnaire. A multiple logistic regression model estimated factors associated with wish to die. Moderated moderation models were used to assess the effect of personality traits on the relationship between stressful events and wish to die.

Results

1,020 physicians completed the questionnaire. Most (75%) had endorsed a work-related stressful event and one in six (15.9%) endorsed a wish to die the year before. Wish to die was associated with burnout (OR = 2.65, 95%CI = 1.82-3.88) and work-related stressful events (OR = 2.18, 95%CI = 1.24-3.85) including interpersonal conflicts, harassment and work-overload. Emotional stability was the only personality trait associated with wish to die in the logistic regression (OR = 0.69, 95%CI = 0.59-0.82). In moderation models, we observed a significant interaction involving three personality traits-emotional stability, extraversion, and agreeableness-along with gender, influencing the impact of stressful events on the wish to die.

Limitations

Our study is limited by the impossibility to control for risk factors associated with suicide like psychiatric comorbidities.

Conclusion

Work-related stressful events significantly contribute to the manifestation of a wish to die among physicians. The impact of stressful events on the wish to die is moderated by factors such as gender and personality traits, including emotional stability and extraversion. These results are overall consistent with prior studies concerning the risk of burnout and suicide among physicians.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Illness Anxiety Disorder and Distress among Female Medical and Nursing Students

Objective

This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics.

Methods

Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales.

Results

Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students.

Conclusion

The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.

Distribution of Psychological Instability Among Surgeons

BACKGROUND

High emotional instability (i.e., neuroticism) is associated with poor mental health. Conversely, traumatic experiences may increase neuroticism. Stressful experiences such as complications are common in the surgical profession, with neurosurgeons being particularly affected. We compared the personality trait neuroticism between physicians in a prospective cross-sectional study.

METHODS

We used an online survey using the Ten-Item Personality Inventory, an internationally validated measure of the 5-factor model of personality dimensions. It was distributed to board-certified physicians, residents, and medical students in several European countries and Canada (n = 5148). Multivariate linear regression was used to model differences between surgeons, nonsurgeons, and specialties with occasional surgical interventions with respect to neuroticism, adjusting for sex, age, age squared, and their interactions, then testing equality of parameters of adjusted predictions separately and jointly using Wald tests.

RESULTS

With an expected variability within disciplines, average levels of neuroticism are lower in surgeons than nonsurgeons, especially in the first part of their career. However, the course of neuroticism across age follows a quadratic pattern, that is, an increase after the initial decrease. The acceleration of neuroticism with age is specifically significant in surgeons. Levels of neuroticism are lowest towards mid-career, but exhibit a strong secondary increase towards the end of the surgeon's career. This pattern seems driven by neurosurgeons.

CONCLUSIONS

Despite initially lower levels of neuroticism, surgeons suffer a stronger increase of neuroticism together with age. Because, beyond well-being, neuroticism influences professional performance and health care systems costs, explanatory studies are mandatory to enlighten causes of this burden.

Sex-specific role of alexithymia in associations between parental bonding and mental health: A moderated mediation model

OBJECTIVE

This study aimed to explore the role of alexithymia and potential sex differences in the associations between perceived parental bonding and mental health.

METHODS

The sample consists of 2421 parents from the FinnBrain Birth Cohort Study who completed the parental bonding instrument, the Toronto alexithymia scale, the Edinburgh postnatal depression scale, and the anxiety subscale of the symptom checklist-90. Moderated mediation analyses were conducted to examine the possible mediating role of alexithymia and moderating role of sex in the associations between parental bonding and depressive/anxiety symptoms.

RESULTS

Alexithymia was found to be a potential mediator and sex be a moderator in the relations between perceived dysfunctional parental bonding and the psychological symptoms. Specifically, dysfunctional paternal bonding, especially paternal overprotection, had stronger indirect effects (via alexithymia) on the psychological symptoms in males.

CONCLUSIONS

This study indicates the importance of alexithymia in the parenting-related mental health impacts and highlights the significance of paternal bonding for the development of alexithymia and mental health problems in male populations. The findings improve the limited understanding of sex-related parental factors for alexithymia and mental health problems. Future studies in longitudinal designs are warranted to clarify the causal process of the mediation.

The prevalence and factors associated with anxiety symptoms among resident physicians in Oman: a cross-sectional study

Background

Anxiety disorders are a significant factor associated with physician burnout and poor patient care, reported to have a significant frequency among the youth in the Middle East. However, to date, no study has explored the prevalence of anxiety among resident physicians in the Arabian Gulf country of Oman. This cross-sectional study, conducted among a random sample of residents affiliated with the Oman Medical Specialty Board, aimed to examine the frequency and factors associated with anxiety symptoms among them. Participants were asked to complete the General Anxiety Disorder Assessment (GAD-7) to assess anxiety, as well as a socio-demographic questionnaire.

Results

In a total of 251 residents, the prevalence of anxiety was 14.7% (GAD-7 cut-off score ≥ 10). More than 60% of the respondents were female (68.9%). The age breakdown ranged from 25 to 30 years old (66.5%) and the majority were married (64.9%). More than 70% of respondents attended at least 5 shifts in their weekly schedule and received at least 5 on-call shifts from the hospital per week. Logistic regression showed that residents with chronic disease were 2.5 times (95% CI 1.36–4.72, p = 0.003) more likely to have anxiety than those without them. Those residents who did not exercise were 2.1 times (95% CI 1.04–4.46, p = 0.038) more likely to have anxiety than those who exercise often or regularly. Residents who received 6 or more on-calls from the hospital were 2.6 times (95% CI 1.35–5.25, p = 0.005) more likely to have anxiety than those who received 5 or fewer on-calls in a month.

Conclusions

The factors seemingly responsible for anxiety symptoms in this sample of resident physicians are those that are typically associated with poor work-life balance and unhealthy lifestyles. Pending further scrutiny, these results could be used to lay the groundwork for the identification of those who will require more protracted help during their training in Oman and in other culturally similar Middle Eastern countries.

Moderating role of observing the five precepts of Buddhism on neuroticism, perceived stress, and depressive symptoms

PURPOSE

Evidence has shown that the Five precepts significantly affect the relationship between attachment and resilience; however, little is known whether observing the Five Precepts would help reduce depressive symptoms among those who experience risks. The aim of this study was to examine the moderating role of the Five Precepts in the mediation model relationship among neuroticism, perceived stress, and depression.

PATIENTS AND METHODS

The study employed a cross-sectional survey design and data were collected from the end of 2019 to September 2022 in Thailand. In all, 644 general participants completed questionnaires on the Neuroticism Inventory (NI), the 10-item Perceived Stress Scale (PSS), Depression Subscale, and the Five-Precept Subscale of the Inner Strength-based Inventory (SBI-PP). Mediation and moderation analyses with 5000 bootstrapping methods were used.

RESULTS

Among all, 74.2% were female, and the mean age totalled 28.28 years (SD = 10.6). SBI-PP was shown to have a moderation effect on the relationship between NI, PSS and depressive symptoms. The moderating effect between SBI-PP and PSS was significant, whereas SBI-PP and NI was not. The index of moderated mediation from the Five Precepts was significant (b = -0.019 (95%CI -0.029, -0.009)). The moderated mediation model increased the percent variance explaining depressive symptoms to 47.6%, compared with 32.6% from the mediation model alone.

CONCLUSION

Observing the Five Precepts offers evidence that it buffers the effect of perceived stress on depression. People with high levels of observing the Five Precepts are less likely to develop depressive symptoms. Implications as well as possible future research are discussed.

The Association between COVID-19 Pandemic and the Quality of Life of Medical Students in Silesian Voivodeship, Poland

(1) Background: Since the COVID-19 pandemic spread rapidly in 2020, medical universities have been affected by a particular crisis. Due to the increased risk of SARS CoV-2 transmission, the authorities of medical faculties all over the world, including Poland, started to minimize direct contact between students. The objective of the paper is to identify and assess determinants of the quality of life among medical students in Poland before and during the COVID-19 pandemic. (2) Methods: We analyzed data obtained in a cross-sectional study performed among three groups of students tested in three consecutive research periods: period before the COVID-19 pandemic, the COVID-19 pandemic lockdown period and the COVID-19 pandemic period following lockdown. (3) Results: The total number of participants was 1098. We identified that the research period before the COVID-19 pandemic was the risk factor for lower quality of life in terms of the somatic and environmental domains. It was also confirmed that determinants such as poor financial situation, low frequency of physical activity and bad self-declared health status harmed the QoL scores in all domains. (4) Conclusions: The obtained results confirmed that better financial situation, higher physical activity and better self-declared health status were statistically significant factors improving the quality of life of first-year medical students in Poland. The findings of our study also showed that the declared somatic and environmental domains of QoL among medical students were better during the COVID-19 pandemic period. Our observations confirmed that the immediate implementation of e-learning could protect against the deterioration of mental health and quality of life in first-year medical students during possible future epidemic crises.

Burnout phenomenon: neurophysiological factors, clinical features, and aspects of management

Burnout syndrome is a distinct “occupational phenomenon” rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the severity of symptoms in burnout syndrome. Persistent burnout is a cause of reduced quality of life and is associated with increased risk of sleep impairment and with several medical disorders including mild cognitive impairment, diabetes, and cardiovascular disease.

Active coping strategies promoting mental resilience and adaptive behavior, stress-reducing activities, improving work conditions, and reducing exposure to work stressors together may alleviate the distress of burnout and should be introduced early in the clinical course of burnout syndrome. The purpose of this review was to explain this complex and puzzling phenomenon and to describe burnout management.

Role of neuroticism and perceived stress on quality of life among patients with dry eye disease

This hospital-based, cross-sectional observational study aimed to examine whether neuroticism has an impact on stress that is related to dry eye disease (DED) and quality of life (QOL). One hundred participants who had DED completed the Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire, a 5-level EQ-5D (EQ-5D-5L), Neuroticism Inventory (NI), and 10-Item Perceived Stress Scale (PSS). Hierarchical linear regression was applied to determine the predictive effect of the independent variables. Participants' mean age was 50.91 ± 14.3 years, and females totalled 89.0%. Hierarchical linear regression analysis showed that DESQ-Ocular symptoms were the strongest predictor for QOL either assessed by DEQS or EQ-5D, and its effect was lessened when perceived stress and neuroticism were added to the model. The final model explained up to 30-39% variance of the QOL, compared with 13-32% by DESQ-Ocular symptoms alone. QOL of the patients with DED, is not only related to eye symptoms but perceived stress. Moreover, neuroticism was a strong predictor contributing to the QOL among patients with DED. The study showed a significant association between perceived stress, neuroticism and the QOL of patients with DED. Personality has some impact on both subjective dry eye symptoms and impact on daily life, along with the general health-related QOL.

Stress and Burnout in EFL Teachers: The Mediator Role of Self-Efficacy

Within the class environment, particularly in the language learning setting, stress is considered to be the most common mental condition educators experience in their work, and due to the effect of stress on teachers, burnout similarly occurs because English as a foreign language (EFL) teachers periodically experience affective trauma while participating and engaging in their careers. To solve the problem, one must consider teacher self-efficacy, a significant construct that can mitigate the probability of burnout by preventing the occurrence of stress at work that also plays a key role in enhancing positive upshots. To emphasize the impact of teachers' stress and burnout on the one hand and the mediator role of teachers' efficacy, on the other hand, this mini-review attempted to study the issue. Finally, some scholastic recommendations are pinpointed.

Association between intimate partner psychological violence and psychological distress among nurses: The role of personality traits and social support

AIM

This study proposes investigating the risk and protective factors of intimate partner (IP) psychological violence and psychological distress to better promote psychological wellbeing for nurses and health outcomes for patients.

DESIGN

A cross-sectional study.

METHOD

This cross-sectional study was carried out chiefly in Guangdong, Hunan, and Shaanxi provinces, in the east, central, and west of the Chinese economic areas, respectively. It was conducted in October 2021 using convenience sampling. A total of 843 nurses were eligible for the final analysis. Single-factor linear regression models were used to identify potential factors associated with IP psychological violence and psychological distress. In addition, the structural equation model was used to explore the role of personality traits and social support in the association between IP psychological violence and psychological distress.

RESULTS

The predictors for the score of IP psychological violence among nurses were participants' married status, contact frequency with a partner, perceived past-year psychological and physical violence experience, the alcohol consumption of partners, and personality traits and social support of partners. Moreover, the alcohol consumption of participants, the past-year experience of IP psychological violence, the score of psychological violence, personality traits, social support, and the personality traits of partners were associated factors affecting the psychological distress of nurses. In the structural model, the personality trait of partners had a direct pathway to psychological violence and social support. The results demonstrated that psychological violence significantly increased psychological distress.

CONCLUSION

Personality traits and social support are essential factors influencing the relationship between IP psychological violence and psychological distress.

IMPACT

The findings of this study emphasize the possibility and importance of identification and intervention for reducing IP psychological violence based on personality traits and social support.

Role of Equanimity on the Mediation Model of Neuroticism, Perceived Stress and Depressive Symptoms

Background: Equanimity is widely and commonly practiced, but few have investigated the concept in clinical research. While the mediation model of neuroticism, perceived stress and depression have been demonstrated, it remains unclear whether equanimity mediates the relationship of these variables in parallel, serial or moderated mediation models. This study aimed to investigate the role of equanimity among those models. Methods: In all, 644 general participants (74.2% female, mean age = 28.28 (SD = 10.6)) provided data on the 10-item Perceived Stress Scale (PSS), the Neuroticism Inventory (NI), depression subscale of the Core Symptom Index, and the equanimity subscale of the inner Strength-based Inventory. Mediation and moderation analyses with the 5000 bootstrapping method were applied. Results: Equanimity was shown to moderate the relationship between NI/PSS and depressive symptom. Statistical evaluation supported all parallel, serial and moderated mediation models. Equanimity as a moderator provided a higher amount of percent variance explained by depressive symptoms than parallel and serial mediation models. Conclusions: Results suggest that the effect of perceived stress and neuroticism on depression can be mitigated by increasing levels of equanimity. The results demonstrated one potential benefit from practicing equanimity; enabling its extension to mental health problems could constitute an interesting focus for future research.

Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway

IMPORTANCE

Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians.

OBJECTIVE

To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020.

EXPOSURES

Medical career during 20 years in Norway.

MAIN OUTCOMES AND MEASURES

WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures.

RESULTS

At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (β = -1.06; 95% CI, -1.31 to -0.09; P < .001) and acts of violence (β = -1.13; 95% CI, -1.73 to -0.53; P < .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40; P < .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99; P = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58; P = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71; P < .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84; P = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97; P = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23; P < .001). There were no interactions with gender or cohort in the significant associated factors.

CONCLUSIONS AND RELEVANCE

Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.

Personality Profiles and Personal Factors Associated with Psychological Distress in Chinese Nurses

BACKGROUND

A high prevalence of psychological distress is observed in nurses due to multiple occupational stressors. Personality traits and personal factors are important factors that lead to psychological distress. The personality profile reflects a combination of personality traits; however, the relationship between personality profiles and personal factors that affect psychological distress among nurses has not been defined.

METHODS

This cross-sectional study was conducted in November 2020 in China. Convenience and snowball sampling were used to recruit participants. Latent profile analysis was used to identify personality profiles of nurses based on the big-five personality traits. Single-factor analysis and multivariate logistic regression were used to determine the factors affecting psychological distress. The structural equation model was used to verify the hypothetical model linking personality profiles, self-efficacy, psychological resilience, and coping style with psychological distress.

RESULTS

A total of 953 Chinese nurses (934 female) with a mean (S.D.) age of 32.8 (8.6) years were recruited. Personality profiles identified were negative, normative, and positive. A personality profile may predict psychological distress directly and indirectly through self-efficacy, psychological resilience, and coping style.

LIMITATIONS

No complex sampling limits the representativeness of Chinese nurses. External factors affecting psychological distress were not investigated.

CONCLUSION

Nurses with anegative personality profile had a higher prevalence of psychological distress. This study establishes the importance of personality profile assessment to identify nurses at higher risk of psychological distress. It suggests that interventions should be based on self-efficacy, psychological resilience, and coping style as potential management strategies.

Maladaptive Schemata und berufliche Gratifikationskrisen bei ÄrztInnen und PsychotherapeutInnen

Hintergrund

Laut Studienlage leiden ÄrztInnen häufig an Arbeitsstress und Burn-out. Gründe dafür liegen v. a. in den Arbeitsbedingungen. Daneben spielen „intrinsische“ Faktoren eine Rolle. Frühe maladaptive Schemata (MS) können als Marker für intrinsische Belastungen dienen. Ein Schema umfasst dauerhafte, ungünstige Muster von Gefühlen, Gedanken und Erinnerungen, die das Verhalten in einer konkreten Situation steuern. Der Beitrag soll eine systematische Übersicht über die internationale Studienlage zu Gratifikationskrisen und MS bei ÄrztInnen/PsychotherapeutInnen (PT) geben.

Material und Methoden

Systematische Literaturrecherche von 2000 bis 2020 in PubMed, Psyndex und Google Scholar. Eine Registrierung erfolgte bei OSF-Registries (osf.io/jxhga/). Suchbegriffe waren: „schema“, „maladaptive schema“, kombiniert mit „physician“, „psychiatrist“, „psychotherapist“, „psychologist“, als weitere Suche verknüpft mit „effort reward (imbalance)“ bzw. „effort-reward (imbalance)“.

Ergebnisse

In der ersten Suche wurden 906 Publikationen, in der zweiten 1088 Veröffentlichungen gefunden. Durch Filtern von Duplikaten, Screening von Abstracts und Inhalten dezimierte sich die Zahl auf 2 Publikationen. Mithilfe vor- und rückwärts gerichteter Suche wurden 5 weitere Arbeiten und damit insgesamt 7 relevante Publikationen identifiziert.

Schlussfolgerung

Bislang gibt es wenige Untersuchungen, die sich mit MS im Zusammenhang mit beruflichem Stress und mentaler Gesundheit bei ÄrztInnen/PT beschäftigen. Insbesondere das vielschichtige Konzept der Schemata erscheint aussagekräftiger als eher eindimensionale Persönlichkeitszüge. Intrinsische Faktoren haben eine große Bedeutung, wenn es um die Entwicklung von Präventions- und Hilfsmaßnahmen für belastete ÄrztInnen/PT geht.

Circadian Typology and Personality Dimensions of Croatian Students of Health-Related University Majors

The aim of this study was to determine the relationship between circadian preferences and personality dimensions among 712 students of three different majors from the Faculty of Medicine, Osijek: medical students (MD), nursing students (RN) and medical laboratory diagnostics students (MLD). For the measurement of personality dimensions, the IPIP50 Big-Five questionnaire was used. The circadian preference of students was assessed using the reduced morningness-eveningness questionnaire (rMEQ). Several significant results were observed and there was a significant difference in circadian preference among the three tested groups, with RN students scoring highest on the morningness scale and MLD students scoring the lowest. RN students scored significantly higher on agreeableness and conscientiousness than the other two groups. On the other hand, MD students scored higher on intellect than the MLD students. MLD students scored the lowest on emotional stability scales. Morning type students had higher conscientiousness and emotional stability scores. These results imply that circadian preference and personality traits are crucial elements of medical professionals' wellbeing. With this paper, we would like to raise awareness about common personality traits and adherence to certain circadian orientations in medical professionals as a motivation to introduce a more flexible view towards strict time and task divisions in everyday practice.

Racialized Experiences of Black Nursing Professionals and Certified Nursing Assistants in Long-Term Care Settings

Introduction. This study explores the ways in which racism-related stress affects the well-being and career trajectories of Black nursing professionals and certified nursing assistants and their strategies for coping with such stress. Method. Semistructured interviews were conducted to explore racism-related stress and coping strategies. Data were analyzed using content analysis. Results. Findings illuminate how Black nursing professionals and certified nursing assistants experience both subtle and explicit racism in the workplace from a variety of actors, including patients, peers, and supervisors. Coping strategies included consultation with personal support systems, such as friends outside of work or family members. Participants described barriers to advancement, including disparate educational and mentoring experiences, and a lack of policies or standards to address racial bias and discrimination in their work settings. Discussion. Facilitating diversity in nursing and supporting nursing professionals of color requires multipronged approaches that include collaborations between education systems and employers.

The role of perceived stress and cognitive function on the relationship between neuroticism and depression among the elderly: a structural equation model approach

BACKGROUND

Depression comprises common psychological problems, and has been strongly related to neuroticism and perceived stress. While neuroticism has been shown to have a direct effect on depression, it also has an indirect effect via perceived stress. Among the elderly, cognitive function produces influences that should not be overlooked when investigating depression. This study aimed to determine the role of mediating effects of perceived stress as well as cognitive function on neuroticism and depression among elderly patients.

METHODS

This research constituted a secondary analysis, with data collected during the pre-operative period of 429 elderly individuals undergoing elective, noncardiac surgery. The evaluation included the Perceived Stress Scale, the Neuroticism Inventory, the Montreal Cognitive Assessment, and the Geriatric Depression Scale. Structural equation modeling was used to investigate the hypothesized model.

RESULTS

Neuroticism exhibited a significant indirect effect on perceived stress via depression and cognition (β = 0.162, 95% CI 0.026, 0.322, p = .002). Neuroticism initially had a direct effect on depression (β = 0.766, 95% CI 0.675, 0.843 p = 0.003); thereafter, it was reduced after covariates were added (β = 0.557, 95% CI 0.432, 0.668 p = 0.002). Based on this model, the total variance explained by this model was 67%, and the model showed an acceptable fit with the data.

CONCLUSIONS

Both perceived stress and cognitive function partially mediated the effect of neuroticism on depression, with perceived stress exhibiting a greater effect.

TRIAL REGISTRATION

The study protocol has been registered at Clinicaltrials.gov under registered number: NCT02131181.

High levels of depression and anxiety among Croatian medical and nursing students and the correlation between subjective happiness and personality traits

High levels of stress, anxiety, and depression are commonly reported among medical students. The aim of this study was to determine the levels of depressive and anxiety symptoms among medical and nursing students at the University of Osijek, Croatia and their relation to subjective happiness and personality traits. This cross-sectional study included a total of 562 students. To assess the levels of depression and anxiety, the PHQ-9 (The Patient Health Questionnaire), GAD-7 (Generalized Anxiety Disorder), SHS (Subjective Happiness Scale), and IPIP Big-5 questionnaires were used. A very high prevalence of both anxiety (54.5%) and depressive (60.2%) symptoms was found among medical and nursing students. Subjective happiness most strongly correlated with emotional stability and extraversion, also emotional stability correlated negatively with anxiety and depression. Nursing students scored higher on subjective happiness and in the domain of conscientiousness, but lower on depression. The differences in depression and anxiety could not be attributed to personality traits. Although the reported symptoms were mostly mild in intensity, we believe that this represents a significant public mental health concern. Appropriate measures should be taken to motivate students to seek help for their symptoms and to increase the availability of mental health services for students.

Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors

BACKGROUND

Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction.

METHODS

Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction.

RESULTS

Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work-home stress (β = - 0.20, 95% confidence interval [CI] = - 0.25 to - 0.16, p < 0.001), perceived job demands (β = - 0.10, CI = - 0.15 to - 0.05, p < 0.001), and colleague support (β = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction.

CONCLUSIONS

Work-home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors' work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.

The Validity of Daily Self-Assessed Perceived Stress Measured Using Smartphones in Healthy Individuals: Cohort Study

Background

Smartphones may offer a new and easy tool to assess stress, but the validity has never been investigated.

Objective

This study aimed to investigate (1) the validity of smartphone-based self-assessed stress compared with Cohen Perceived Stress Scale (PSS) and (2) whether smartphone-based self-assessed stress correlates with neuroticism (Eysenck Personality Questionnaire-Neuroticism, EPQ-N), psychosocial functioning (Functioning Assessment Short Test, FAST), and prior stressful life events (Kendler Questionnaire for Stressful Life Events, SLE).

Methods

A cohort of 40 healthy blood donors with no history of personal or first-generation family history of psychiatric illness and who used an Android smartphone were instructed to self-assess their stress level daily (on a scale from 0 to 2; beta values reflect this scale) for 4 months. At baseline, participants were assessed with the FAST rater-blinded and filled out the EPQ, the PSS, and the SLE. The PSS assessment was repeated after 4 months.

Results

In linear mixed-effect regression and linear regression models, there were statistically significant positive correlations between self-assessed stress and the PSS (beta=.0167; 95% CI 0.0070-0.0026; P=.001), the EPQ-N (beta=.0174; 95% CI 0.0023-0.0325; P=.02), and the FAST (beta=.0329; 95% CI 0.0036-0.0622; P=.03). No correlation was found between smartphone-based self-assessed stress and the SLE.

Conclusions

Daily smartphone-based self-assessed stress seems to be a valid measure of perceived stress. Our study contains a modest sample of 40 healthy participants and adds knowledge to a new but growing field of research. Smartphone-based self-assessed stress is a promising tool for measuring stress in real time in future studies of stress and stress-related behavior.

Depressive symptoms and associated factors in medical interns at a tertiary hospital

BACKGROUND

It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa.

OBJECTIVES

This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape.

METHOD

The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2).

RESULTS

Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out'.

CONCLUSION

Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.

Is Student Stress Related to Personality or Learning Environment in a Physician Assistant Program?

PURPOSE

The purpose of this research was to study the impact of students' personalities and 2 different learning environments-lecture-based learning (LBL) and problem-based learning (PBL)-on the stress perceived by 5 cohorts of physician assistant (PA) students.

METHODS

Students rated their stress related to family obligations, financial concerns, schoolwork, relocation, and overall stress on 6 occasions over the course of the 2-year program. Personalities of students were assessed using the California Psychological Inventory 7 months into the program. Students' expectations and observations of their learning environments were measured using the PA School Learning Environment Survey at the beginning and end of the didactic year.

RESULTS

Personalities of LBL and PBL students were very similar, but LBL students who scored higher on the Independence concept were less stressed about their schoolwork. The LBL students, in general, were more discontented with their learning environment, but this finding was not related to higher schoolwork-related stress. In contrast, PBL students' personalities were not related to stress, and PBL students also rated some dimensions of their learning environment higher than they had expected. However, those PBL students who rated the PBL environment less favorably also reported higher schoolwork-related stress.

CONCLUSIONS

High stress perceived by LBL students was related to some personality concepts but not to the students' learning environment, despite their overall disappointment with that environment. The PBL students were more stressed by schoolwork, although their stress was not related to personality. Problem-based learning students, except for those most highly stressed, tended to rate their learning environment more favorably.

General self-efficacy modifies the effect of stress on burnout in nurses with different personality types

Background

Burnout is a health problem in nurses. Individuals with a certain personality are more susceptible to job-related burnout. General self-efficacy (GSE) is an important predictor of job-related burnout. The relationships between general self-efficacy, job-related burnout and different personality types are still not clear. This study aims to analyze the relationships of job-related burnout, stress, general self-efficacy and personality types, as well as their interactions in job-related burnout.

Method

A cross-sectional survey of 860 nurses was conducted between June and July 2015 in China. We measured their job-related burnout using the scale of the Maslach Occupational Burnout Scale, and personality, stress, and GSE. Machine learning of generalized linear model were performed.

Results

Maslach Burnout Inventory (MBI) professional efficacy was significantly associated with gender, marital status, age, job title and length of service. A machine learning algorithm showed that stress was the most important factor in job-related burnout, followed by GSE, personality type (introvert unstable), and job title. Individuals with low GSE and either introversion or unstable (high neuroticism) personality seemed to have stronger burnout when they faced stress (regardless of stress intensity) compared to others.

Conclusion

Stress, GSE and introvert unstable personality are the top three factors of job-related burnout. GSE moderates the effect of stress on burnout in nurses with extroversion or neuroticism personality. Reducing stress, increasing GSE, and more social support may alleviate job-related burnout in nurses. Nurses with introvert unstable personality should be given more social support in reducing stress and enhancing their GSE.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3478-y) contains supplementary material, which is available to authorized users.

Self-diagnosed depression in the Norwegian general population - associations with neuroticism, extraversion, optimism, and general self-efficacy

BACKGROUND

Multi-item rating scales for depression informs about the level of depression, but does not allow individuals to state by self-evaluation whether they feel depressed or not. The insider perspective on depression is rarely assessed. This study investigated the prevalence of self-diagnosed depression in the Norwegian general population, and associations with sociodemographic and psychological factors.

METHODS

As part of a national survey, the General Self-Efficacy Scale, the Life Orientation Test-Revised, a short version of the Eysenck Personality Questionnaire and a one-item measure of self-diagnosed depression was administered to 5.500 persons in the general Norwegian population. Of the 4961 eligible participants ≥ 18 years of age, 1.787 (response rate 36%) participated in the survey, and 1.684 of these had valid scores on the relevant scales. The associations between sociodemographic factors and self-diagnosed depression were examined using univariate and multivariate logistic regression analyses.

RESULTS

One hundred and thirty-six participants (8.1%) reported depression during the preceding month. When adjusting for sociodemographic and psychological variables, higher age (OR = 0.82), being in work (OR = 0.57), and higher levels of general self-efficacy (OR = 0.67) and optimism (OR = 0.52) were associated with lower risk of self-diagnosed depression, whereas higher levels of neuroticism (OR = 1.97) was associated with higher risk.

CONCLUSIONS

The prevalence of self-diagnosed depression in the adult Norwegian population was higher for women than for men. Higher age, being in work and having higher levels of psychological resources appear to reduce the risk of self-diagnosed depression, whereas neuroticism increases the risk.

Self-perceived level of competitiveness, tension and dependency and depression risk in the SUN cohort

BACKGROUND

Emerging evidence suggests a possible etiologic role of certain personality traits (not necessary dysfunctional) in the risk of depression, but the longitudinal long-term available evidence is currently scarce. We longitudinally assessed whether 3 common personality traits (competitiveness, tension and dependency) were associated with the risk of depression after a maximum follow-up of 15 years.

METHODS

We assessed 15,604 university graduates free of depression at baseline through a self-administered questionnaire including personality traits. Simple, Likert-type, questions with 11 possible answers ranging from 0 to 10 were used at baseline to assess the 3 personality traits. We compared participants with high scores (7-10) versus those with low scores (0-4). New medical diagnoses of depression during follow-up were used as the outcome.

RESULTS

During a median follow-up of 10.1 y, we prospectively identified 902 new medical diagnoses of depression. The multivariable-adjusted hazard ratios (95% confidence intervals) for depression were 1.85 (1.52-2.24) for participants with higher baseline tension (7-10 versus 0 to 4), P-trend < 0.001; and 1.23 (1.06-1.44) for high versus low baseline dependence levels, P-trend = 0.004. Higher levels of competitiveness were marginally associated with lower risk of depression, with hazard ratio = 0.78 (0.61-1.01), P-trend = 0.105.

CONCLUSION

A simple scoring system of personality traits shows an independent association with the future occurrence of depression. This finding underscores, with now prospective evidence, the importance of personality traits in the aetiology of depression and can provide a clinically useful tool for gathering valid information about depression-related personality traits.

Exploring the relationships among personality traits, burnout dimensions and stigma in a sample of mental health professionals

A sample of mental health professionals (n = 215) from six Community Mental Health Services was examined using a short version of the Attribution Questionnaire-27, the Maslach Burnout Inventory and the Ten Items Personality Inventory to detect possible associations among stigma, burnout dimensions and personality traits. The role of demographic and professional variables was also explored. Perception of workplace safety resulted to significantly affect attitudes toward patients. The concern about being assaulted and a low level of Personal Accomplishment were both related to avoidant attitudes, while the presence of procedures for managing the violent patient was associated with a higher level of Personal Accomplishment. Conversely, Emotional Stability and Openness to new experiences were inversely correlated with burnout dimensions and avoidant attitudes, respectively. Overall, our study supports the view of a significant association among some dimensions of stigma, burnout and personality factors. In particular, avoidant attitudes toward patients may be influenced by Personal Accomplishment and Openness to new experiences.

Grit, anxiety, and stress in emergency physicians

INTRODUCTION

The personality traits of emergency physicians are infrequently studied, though interest in physician wellness is increasing. The objective of this study is to acquire pilot data about the amount of grit, anxiety, and stress in emergency physicians using established psychological survey instruments, and to examine their associations of each of these traits with each other.

METHODS

Thirty-six emergency medicine resident and attending physicians from an urban academic medical center consented for enrollment. Participants were administered the Duckworth 12-point Grit Scale, the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS), which measure grit, anxiousness, and perceived stress, respectively. These are the gold standard psychological instruments for each of their areas. We analyzed the results with descriptive statistics, Spearman correlations, and linear regression.

RESULTS

Nineteen residents and 17 attending physicians completed the surveys during the first quarter of a new academic year. The mean grit score was 3.7 (95% CI 3.5-3.8, SD: 0.56), the mean trait-anxiety score was 32.61 (95% CI 30.15-35.07, SD: 7.26), and the mean PSS score was 12.28 (95% CI 10.58-13.97, SD: 4.99). Only trait-anxiety and perceived stress were significantly correlated (Spearman's rho: 0.70, p<0.01).

CONCLUSIONS

In this pilot study at a single institution, emergency physicians demonstrated a range of grit, trait-anxiety, and perceived stress. Trait-anxiety and stress were strongly associated, and individuals who were more anxious reported more stress. Levels of grit were not associated with trait-anxiety. These psychological concepts should be studied further as they relate to the function and health of emergency medicine providers.

The Relationship between Job Demands and Employees' Counterproductive Work Behaviors: The Mediating Effect of Psychological Detachment and Job Anxiety

This study aims to explore the relation between job demands and counterproductive work behaviors (CWBs). A cross-sectional sample of 439 coal miners completed a self-report questionnaire that assessed their job demands, psychological detachment, job anxiety, and CWBs in a Chinese context. The conceptual model, based on the stressor-detachment model, was examined using structural equation modeling. The results suggest that psychological detachment mediates not only the relation between job demands and job anxiety but also that between job demands and CWBs. Furthermore, the relation between job demands and CWBs is sequentially mediated by psychological detachment and job anxiety. Our findings validate the effectiveness of the stressor-detachment model. Moreover, we demonstrate that the underlying mechanism of the relation between job demands and CWBs can be explained by psychological detachment and job anxiety.

Prevalence of illicit drug use among medical students in Northern Greece and association with smoking and alcohol use

AIM

The aim of this study was to estimate the prevalence of illicit drug use among medical students in Northern Greece, to identify the motivations for cannabis use and also to investigate the possible associations with smoking and alcohol misuse.

METHODS

A sample of undergraduate students completed an anonymous, self-administered, web-based survey assessing lifetime and past-year illicit substance use. To further evaluate the motivation to use, the responders were classified into three subtypes (self-medication, recreational, and mixed). The CAGE questionnaire and a question assessing binge drinking were also used. Illicit substance use was correlated with age, gender, study year, CAGE and binge drinking.

RESULTS

Five hundred and ninety-one undergraduate medical students completed the survey. The lifetime prevalence of illicit drug use was 24.7 %, while the most used drug was cannabis (22.2 %). The past-month prevalence of cannabis use was 8.1 %. Experimentation was the predominant reported motivation for its use, and the recreational subtype was the most prevalent. Binge drinking behavior was reported by 22.7 % of the sample, and the CAGE screening test was positive for 6.4 % of the students. Most students (80.4 %) characterized themselves as non-smokers. In the multivariate analysis, lifetime use of illicit drugs was significantly correlated with smoking and binge drinking. No associations were found with gender, age, study year or CAGE.

CONCLUSION

Smoking and binge drinking were found to be risk factors for illicit drug use, whereas no association was found with gender, age, study year and CAGE. HIPPOKRATIA 2017, 21(1): 13-18.

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study

BACKGROUND

We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking.

METHODS

Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations.

RESULTS

Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness.

CONCLUSIONS

Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.

Burnout in the intensive care unit professionals: A systematic review

BACKGROUND

Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals.

METHODS

The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: "burnout" and "intensive care unit". Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting.

RESULTS

Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making.

CONCLUSIONS

The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information, suggesting that ICU professionals may suffer from a high level of burnout, potentially threatening patient care. Future work should address the effective management of the factors negatively affecting ICU professionals.

Job Stress and Related Factors Among Iranian Male Staff Using a Path Analysis Model

BACKGROUND

In recent years, job stress has been cited as a risk factor for some diseases.

OBJECTIVES

Given the importance of this subject, we established a new model for classifying job stress among Iranian male staff using path analysis.

MATERIALS AND METHODS

This cross-sectional study was done on male staff in Tehran, Iran, 2013. The participants in the study were selected using a proportional stratum sampling method. The tools used included nine questionnaires (1- HSE questionnaire; 2- GHQ questionnaire; 3- Beck depression inventory; 4- Framingham personality type; 5- Azad-Fesharaki's physical activity questionnaire; 6- Adult attachment style questionnaire; 7- Azad socioeconomic questionnaire; 8- Job satisfaction survey; and 9- demographic questionnaire).

RESULTS

A total of 575 individuals (all male) were recruited for the study. Their mean (±SD) age was 33.49 (±8.9) and their mean job experience was 12.79 (±8.98) years. The pathway of job stress among Iranian male staff showed an adequate model fit (RMSEA=0.021, GFI=0.99, AGFI=0.97, P=0.136). In addition, the total effect of variables like personality type (β=0.283), job satisfaction (β=0.287), and age (β=0.108) showed a positive relationship with job stress, while variables like general health (β=-0.151) and depression (β=-0.242) showed the reverse effect on job stress.

CONCLUSIONS

According to the results of this study, we can conclude that our suggested model is suited to explaining the pathways of stress among Iranian male staff.

Understanding and reducing work-related psychological distress in interns: a systematic review

The aim of this study was to collate and evaluate studies investigating either the factors influencing work-related psychological distress in postgraduate year one (PGY1) doctors or the strategies designed to reduce it. This is a systematic review conducted in May 2014. The data sources were key databases (MEDLINE, PsycINFO and Embase) and manual searches of reference lists for relevant studies published in the last 15 years. This study is an empirical research designed either to elucidate the factors influencing work-related psychological distress in PGY1 doctors, or examine the effects of an intervention designed to reduce it. Key information was extracted into an electronic data extraction form, which incorporated elements of Murphy's model of work stress factors. A total of 21 studies was included in the review; 16 studies had examined the factors influencing work-related psychological distress, four studies had investigated strategies to reduce it, and a single study addressed both. Analysis of the findings of each individual study through the conceptual framework provided by Murphy's model revealed a discrepancy between the factors influencing work-related psychological distress and the focus of strategies designed to reduce it. Factors such as career progression and a PGY1 doctor's role within the organisation were not addressed in the interventions identified. Significant sources of psychological distress in PGY1 doctors remain overlooked by current interventions. Strategies designed to prevent or reduce psychological distress should be broad-based and grounded in both the literature exploring salient factors and existing theories of work-related stress.

Stress and wellbeing of junior doctors in Australia: a comparison with American doctors and population norms

BACKGROUND

Stress in doctors adversely affects decision-making, memory, information-recall and attention, thereby negatively impacting upon the provision of safe and high quality patient care. As such, stress in doctors has been subject to increasing scientific scrutiny and has amassed greater public awareness in recent years. The aims of this study are to describe stress levels and the psychological wellbeing of current junior medical officers (JMOs), and to compare this to their predecessors, American surgical residents and population norms.

METHODS

Post graduate years 1 & 2 doctors at a single metropolitan tertiary referral center were surveyed in 2009 and 2014 using two reliable and validated psychometric questionnaires, the Short Form-36 (SF36) and Perceived Stress Scale-14 (PSS14), with additional questions pertaining to demographics and training. The results were compared with published data from American general surgical residents and Australian age-matched population norms.

RESULTS

Mean stress levels were lower in 2014 (23 ± 7.2) than in 2009 (27.2 ± 7.6) (p = 0.017). The mean PSS-14 score was lower than that of American surgical residents, both before (26.8 ± 7.3, p = 0.003) and after (26.7 ± 8.2, p = 0.004) implementation of the safe working hour policies but higher than societal controls (p < 0.0001). Whilst JMOs in 2014 reported better overall mental health compared to those in 2009 (p = 0.02), they were significantly worse than the general population (p = 0.009). Multivariate analysis showed that JMOs were more likely to have a high PSS-14 score or to have a low mental health score if they reported higher career anxiety (p < 0.05).

CONCLUSIONS

Doctors are still at risk despite an improvement in their stress levels and overall mental health. They are less likely to be stressed and to have better mental health if they have less career-related anxiety. This has implications for the medical education and training of our junior doctors.

Health-promoting factors in the freshman year of medical school: a longitudinal study

CONTEXT

The freshman year of medical school is a stressful period in the lives of future doctors. Resilience to this stress differs greatly, leading to different health outcomes. Less resilient students, whose health may deteriorate early in their education, are at greater risk for developing stress-related diseases. Early identification of individuals at risk and the provision of tailored health-promoting interventions might prevent this.

OBJECTIVES

This study was designed to investigate: (i) how the health of medical students develops over the freshman year, and (ii) whether certain protective factors can predict general and mental health status after 1 year of medical education.

METHODS

A prospective, longitudinal, observational study was conducted at one medical school. Self-rated general and mental health status before and after the freshman year were used as outcomes. In addition to socio-demographic variables and leisure activities, personality and study-related behaviour and experience were surveyed as potential predictors. Both descriptive techniques and logistic regression analyses were employed to identify predictors for general and mental health separately.

RESULTS

At baseline, 93% of medical students rated their general health and 88% rated their mental health as good. These frequencies declined over the first year to 76% and 84%, respectively. For general health, regular physical activity was the strongest predictor (odds ratio [OR] 4.58). Satisfaction with life (OR 1.18) and balance and mental stability (OR 1.20) emerged as positive predictors, and age (OR 0.85) and striving for perfection (OR 0.76) as negative predictors. Mental health status was predicted by emotional distancing (OR 1.25), experience of social support (OR 0.73), neuroticism (OR 0.89) and age (OR 0.85).

CONCLUSIONS

Self-rated general and mental health declined throughout the first year of medical education. Physical activity proved to be a strong predictor for the maintenance of good general health. This finding may represent a starting point for health-promoting interventions, such as the provision of time slots for physical activity.

Comparison of characteristics of anxiety sensitivity across career stages and its relationship with nursing stress among female nurses in Hunan, China

OBJECTIVES

This study aimed to investigate anxiety sensitivity (AS) in female Chinese nurses to better understand its characteristics and relationship with nursing stress based on the following hypotheses: (1) experienced nurses have higher AS than newly admitted nurses; and (2) specific nursing stresses are associated with AS after controlling general stress.

SETTING

The cross-sectional survey was conducted from May 2014 to June 2015 among female nurses at the provincial and primary care levels in Hunan Province, China.

PARTICIPANTS

Among 793 nurses who volunteered to participate, 745 returned and completed the questionnaires. Eligible participants are healthy female nurses aged 18-55 years and exempt from a history of psychiatric disorder or severe somatic disease and/or a family history of psychiatric disorder.

PRIMARY AND SECONDARY OUTCOME MEASURES

AS was assessed by the Anxiety Sensitivity Index-3 (ASI-3). Anxiety symptoms, general stress and nursing stress were measured by the Beck Anxiety Inventory (BAI), the Perceived Stress Scale (PSS-10) and the Nursing Stress Scale (NSS).

RESULTS

There were significant differences overall and in the three dimensions of AS across nurses of different career stages (all p<0.05). Middle and late career nurses had higher AS than early career nurses (all p<0.05), while no significant difference was found between middle and late career nurses. Conflict with physicians and heavy workload had a significant effect on all aspects of AS, whereas lack of support was related to cognitive AS (all p<0.05).

CONCLUSIONS

After years of exposure to stressful events during nursing, experienced female nurses may become more sensitive to anxiety. Middle career stage might be a critical period for psychological intervention targeting on AS. Hospital administrators should make efforts to reduce nurses' workload and improve their professional status. Meanwhile, more social support and appropriate psychological intervention would be beneficial to nurses with higher AS.

Self-concept and obsessive-compulsiveness as moderators of anxiety and depression: a Portuguese prospective study

Objective

Research shows a high prevalence of psychopathology among medical students. This study aims to assess the time trend of depression, anxiety, self-concept and obsessive-compulsiveness in medical students within the first year (short-run) and over the years (long-run) of medical school, and to measure if self-concept and obsessive-compulsiveness predict anxiety and depression trends.

Methods

At baseline, 183 freshman students that enrolled at FMUP in the 2002/03 academic year were recruited; from these, 71 (39%) participated in the short-run study and were assessed at the beginning and at the end of the first year and 151 (83%) participated in the long-run study (assessed in the first, third and fifth year). Participants answered three self-report questionnaires: the Hospital Anxiety Depression Scale (HADS), the Maudsley Obsessive-Compulsive Inventory (MOCI) and a self-concept scale.

Results

In the long-run, there was a negative linear trend with time for the MOCI score (B = -0.68, p < 0.001) and for the HADS anxiety score (B = -0.28, p < 0.001), a positive linear trend for self-concept (B = 1.37, p < 0.001) and no association with depression (B = -0.05). The short-run results were opposite given that anxiety, depression and obsessive-compulsiveness increased and no differences were found for self-concept.After adjusting for self-concept and obsessive-compulsiveness, there was no effect of time on anxiety but there was a negative interaction between self-concept and time on depression scores.

Conclusions

The effect of time on depression is moderated by a protective effect of self-concept, while obsessive-compulsiveness explained time trends on anxiety scores.It is important to understand and find the pathways of anxiety and depression to improve medical students' mental health.

Job Stress and Job Satisfaction among Health-Care Workers of Endoscopy Units in Korea

Background/Aims:

The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea.

Methods:

We performed a cross-sectional survey of health-care providers in the endoscopy units of three university-affiliated hospitals in Korea. We analyzed the job stress levels by using the Korean occupational stress scale, contributing factors, and job satisfaction.

Results:

Fifty-nine workers completed the self-administered questionnaires. The job stress scores for the endoscopy unit workers (46.39±7.81) were relatively lower compared to those of the national sample of Korean workers (51.23±8.83). Job stress differed across job positions, with nurses showing significantly higher levels of stress (48.92±7.97) compared to doctors (42.59±6.37). Job stress and job satisfaction were negatively correlated with each other (R²=0.340, p<0.001).

Conclusions:

An endoscopy unit is composed of a heterogeneous group of health-care professionals (i.e., nurses, fellows, and professors), and job stress and job satisfaction significantly differ according to job positions. Job demand, insufficient job control, and job insecurity are the most important stressors in the endoscopy unit.

Influence of clerks' personality on their burnout in the clinical workplace: a longitudinal observation

BACKGROUND

The clinical training of medical students in clerkship is crucial to their future practice in healthcare services. This study investigates burnout during a 2-year clerkship training period as well as the role of personality traits on burnout during training.

METHODS

Ninety-four clerks at a tertiary medical centre who provided at least 10 responses to a routine survey on clinical rotation were included in this study, which spanned September 2013 to April 2015. Web-based, validated, structured, self-administered questionnaires were used to evaluate the clerks' personalities at the beginning of the first clerkship year, and regular surveys were conducted to evaluate their burnout at each clinical specialty rotation throughout the 2-year clerkship period. Overall, 2230 responses were analysed, and linear mixed-effects models were used to examine the repeated measures of the clerks.

RESULTS

Our findings revealed that medical student burnout scores were lower in the second year than they were in the first year of clerkships. Using the Big Five personality factors, all of the propensities, namely extroversion, agreeableness, consciousness, emotional stability, and openness were related to different extents of burnout reduction in the first clerkship year (P < .05). However, only emotional stability and openness were related to clerks' reduced burnout in the second clerkship year. Furthermore, being female, older, and with accompanied living were more closely related to lower burnout compared with being male, younger, and living alone throughout the clerkship period.

CONCLUSIONS

The students in the first-year clerkship, particularly those with higher burnout levels, had tendencies in the Big Five personality characteristics, exhibiting higher levels of introversion, antagonism, lack of direction, neuroticism, and not open to new experiences. The students in the second-year clerkship who do not exhibit a high propensity for emotional stability and openness should be of particular concern. The findings can serve as a reference for clinical teachers and mentors to effectively prevent and reduce the burnout of medical students during clerkship training at clinical workplaces.