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Küppers L, Göbel J, Aretz B, Rieger MA, Weltermann B. Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study. Healthcare (Basel) 2024; 12:479. [PMID: 38391854 PMCID: PMC10888352 DOI: 10.3390/healthcare12040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. METHODS This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. RESULTS Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation. CONCLUSION In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.
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Affiliation(s)
- Lucas Küppers
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Benjamin Aretz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Xu Y, Deng J, Tan W, Yang W, Deng H. Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study. BMJ Open 2023; 13:e068333. [PMID: 38035743 PMCID: PMC10689386 DOI: 10.1136/bmjopen-2022-068333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies. DESIGN We conducted a cross-sectional online self-report survey. SETTING The survey was conducted in Chongqing, China from July to August 2022. PARTICIPANTS Data were collected from 2145 GPs, with an effective response rate of 91.0%. PRIMARY AND SECONDARY OUTCOME MEASURES The main evaluation indicators were stress (Cohen's Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being. RESULTS Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work-life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05). CONCLUSION This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.
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Affiliation(s)
- Yang Xu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - JingZhi Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhao Tan
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen Yang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huisheng Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhang J, Xu L, Qin W, Xu A. Association between occupational stress and subclinical depression in Chinese primary healthcare workers. Front Psychiatry 2023; 14:1238603. [PMID: 38025466 PMCID: PMC10661949 DOI: 10.3389/fpsyt.2023.1238603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Wellbeing of healthcare workers is crucial for the effective functioning of primary health systems. This study aimed to examine the association between occupational stress and subclinical depression among primary healthcare workers, and to establish the foundation for future preventive strategies. Methods A cross-sectional study was conducted in Tai'an City, Shandong Province, China. Data were collected from 832 medical staff in primary health institutions using a structured self-administered questionnaire. The participants completed the Challenge and Hindrance-Related Self-Reported Stress (C-HSS) Scale and Patient Health Questionnaire-9. Multivariable logistic regression analysis was conducted to explore the relationship between occupational stress and subclinical depression among primary healthcare workers. Results The prevalence of subclinical depression among primary healthcare workers was 11.66%. Participants with subclinical depression have a significant higher level of occupational stress (including challenge-stress and hindrance-stress). Regression analysis result indicated that higher level of occupational stress was significantly associated with more severe subclinical depression, and the risk of subclinical depression remained after adjusting other covariates (OR = 4.57, 95%CI, 3.14-6.63). The association between challenge-stress and subclinical depression was not statistically significant when controlling for hindrance-stress. Subgroup analysis showed that male healthcare workers who perceived higher level of challenge stress were more likely to develop subclinical depression than female healthcare workers. Conclusion The level of subclinical depression among Chinese primary healthcare workers was high, and occupational stress especially hindrance stress may contribute to subclinical depression. Findings were also robust in subgroup analysis after adjusting for other covariates. These findings emphasize the importance of occupational stress psychosocial interventions to decrease the risk of developing depression among the primary healthcare workers.
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Affiliation(s)
- Jiao Zhang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenzhe Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Aijun Xu
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
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Chen D, Ni Y, Lu J, Wang Y, Qi Q, Zhai H. Examining the impact of perceived stress, anxiety, and resilience on depression among medical staff after COVID-19 quarantine: a chain mediation analysis. Front Public Health 2023; 11:1250623. [PMID: 37799150 PMCID: PMC10549932 DOI: 10.3389/fpubh.2023.1250623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction The COVID-19 pandemic and subsequent quarantine measures have led to a significant impact on mental health worldwide. Medical staff, in particular, have been exposed to high levels of stress due to their frontline work during the crisis. However, there is still limited research on the psychological mechanism among medical staff after quarantine. Methods In this cross-sectional observational study, 150 medical staff from Shanghai YangZhi Rehabilitation Hospital, Shanghai, China, were enrolled in October 2022. SPSS 26.0 and PROCESS 4.0 model 6 were used to analyze the chain mediating effect of perceived stress, anxiety, resilience and depression among medical staff after quarantine. Anxiety and depression were compared during and after the quarantine. All scales have high validity and reliability in a Chinese population. Results Our findings revealed a positive correlation between perceived stress and anxiety (r = 0.60, p < 0.001) and depression (r = 0.60, p < 0.001) levels among medical staff. Conversely, resilience was found to have a negative correlation with perceived stress (r = -0.67, p < 0.001), anxiety (r = -0.57, p < 0.001) and depression (r = -0.61, p < 0.001). The score of depression during the quarantine was higher than the score after the quarantine, but the p-value is only marginally significant (p = 0.067). The score of anxiety during the quarantine was significantly higher than the score after the quarantine (p < 0.05). Moreover, the chain mediation model suggested that anxiety and resilience could mediate the association between perceived stress and depression among medical staff following quarantine. Specifically, perceived stress had no direct effect on depression (β = 0.025, t = 0.548, p = 0.59) but positively predicted anxiety (β = 0.381, t = 8.817, p < 0.001) and resilience (β = -1.302, t = -6.781, p < 0.001), which influenced depression levels indirectly through multiple pathways. The three indirect paths: the mediating role of anxiety, the mediating role of resilience, and the chain mediating role of both anxiety and resilience. Discussion This study emphasizes the importance of psychological interventions aimed at protecting medical staff's psychological resilience and promoting coping mechanisms to manage stress during and after crises such as the COVID-19 pandemic. Additionally, our findings suggest that both anxiety and resilience play critical roles in mitigating the detrimental effects of perceived stress on mental health and further highlight the need for continued research to better understand the complex interplay of these factors.
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Affiliation(s)
| | | | | | | | - Qi Qi
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hua Zhai
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Pan Y, Pikhart H, Bobak M, Pikhartova J. Labour-Market Characteristics and Self-Rated Health: Evidence from the China Health and Retirement Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4748. [PMID: 36981656 PMCID: PMC10048592 DOI: 10.3390/ijerph20064748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
In the face of labour-force ageing, understanding labour-market characteristics and the health status of middle-aged and older workers is important for sustainable social and economic development. Self-rated health (SRH) is a widely-used instrument to detect health problems and predict mortality. This study investigated labour-market characteristics that may have an impact on the SRH among Chinese middle-aged and older workers, using data from the national baseline wave of the China Health and Retirement Longitudinal Study. The analytical sample included 3864 individuals who at the time held at least one non-agricultural job. Fourteen labour-market characteristics were clearly defined and investigated. Multiple logistic regression models of the associations of each labour-market characteristic with SRH were estimated. Seven labour-market characteristics were associated with higher odds of poor SRH when controlled for age and sex. Employment status and earned income remained significantly associated with poor SRH, when controlling for all the sociodemographic factors and health behaviours. Doing unpaid work in family businesses is associated with 2.07 (95% CI, 1.51-2.84) times probability of poor SRH, compared with employed individuals. Compared with more affluent individuals (highest quintile of earned income), people in the fourth and fifth quintiles had 1.92 (95% CI, 1.29-2.86) times and 2.72 (95% CI, 1.83-4.02) times higher chance, respectively, of poor SRH. In addition, residence type and region were important confounders. Measures improving adverse working conditions should be taken to prevent future risk of impaired health among the Chinese middle-aged and older workforce.
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Zhu D, Wang J, Zhao Y, Yang L, Gao J, Chang X, Li S, Zheng Y. The Status of Occupational Stress and Its Influence on the Health of Medical Staff in Lanzhou, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10808. [PMID: 36078517 PMCID: PMC9518311 DOI: 10.3390/ijerph191710808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to understand the status quo of occupational stress and its impact on the health of medical staff and provide a theoretical basis for relieving occupational stress and improving the health status of medical staff. The occupational stress and health status of medical staff in 14 hospitals in Lanzhou were studied using a general questionnaire, Effort-Reward Imbalance questionnaire, and Self-Rated Health Measurement Scale. A total of 2169 participants were included in the analysis, and 59.4% of the medical staff experienced occupational stress. The results of the occupational stress survey showed that the prevalence of occupational stress among medical staff aged 40-50, with a master's degree or above, senior professional title, working for 10-20 years, and working more than 48 h per week was higher than in the other groups. The health survey results showed that, compared with other groups, the scores of physical, mental, and social health were lower in medical staff with working years of 10-20 years and working hours of more than 48 h per week. The results show that working years and working hours per week affect not only the level of occupational stress but also physiological, psychological, and social health.
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Affiliation(s)
- Dongsheng Zhu
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Jinyu Wang
- School of Basic Medical Science, Lanzhou University, Lanzhou 730000, China
| | - Yurui Zhao
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Lu Yang
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Jinxia Gao
- Lanzhou Municipal Center for Disease Control, Lanzhou 730030, China
| | - Xuhong Chang
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Sheng Li
- Department of Public Health, The First People’s Hospital of Lanzhou, Lanzhou 730050, China
| | - Yanni Zheng
- Department of Public Health, The First People’s Hospital of Lanzhou, Lanzhou 730050, China
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