The relationship between working conditions and self-rated health among medical doctors: evidence from seven waves of the Medicine In Australia Balancing Employment and Life (Mabel) survey

Incorporating gendered analysis and flexibility in heavy work investment studies: a systematic literature review

Introduction

Significant impacts of heavy work investment on employee well-being and organizational performance have prompted its increasing importance as a research topic. The findings about good or evil of these repercussions are nonetheless inconclusive. The intersection of Heavy Work Investment construct with gender has not been explicitly addressed by previous literature review and research. Besides, the relevance of flexibility for women, as one of the key factors for successful work-family balance management, still remains to be analyzed.

Methods

A literature review on Heavy Work Investment was conducted using the SPAR-4-SLR protocol, wherein 83 articles were selected from a pool of 208 previously identified works. Bibliometric and content analysis techniques were employed, including co-word analysis, to evaluate research production, impact, and trends in the gender perspective within Heavy Work Investment.

Results

As a result, a strategic diagram illustrates thematic topics, providing a clear understanding of the field's structure and evolution. Six thematic groups were identified, around work-family conflict as the central theme.

Discussion

The explicit consideration of a gender perspective in literature involves nuanced differences regarding the conclusions of studies with a broader focus. First, the emerging prominence of studies on China and Japan becomes clear with gender as the specific focus of the review, aiming to clarify the experiences women face in more traditional societies with a more decisive division of roles. Second, there is a shift in interest regarding the analysis of Job Demands and Job Resources. Despite the apparent decline in interest in the former, the focus in gender literature clearly shifts toward the side of Job Resources, showing potential for the future. It could be understood that in a context of talent war and employee retention efforts, priority is given to better understanding of facilitating individual and organizational factors for work-life balance, especially for women. Future research areas are identified, including gender differences in organizational support and the impact of flexible work on the work-life balance, providing valuable insights for academia, practitioners, and organizations. The need for more comprehensive cross-cultural and gender research is also made clear.

Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades

OBJECTIVE

To examine the relative risk of suicide among healthcare professionals compared to other occupations and examine changes in suicide rates over time.

METHODS

Suicide cases were identified using the National Coronial Information System and were included if they were recorded as a death by intentional self-harm between 2001 and 2017 and were by an employed adult aged 20-69 with a known occupation at the time of death. Suicide methods were reported descriptively. Workforce data at the population level was extracted from the Australian Bureau of Statistics 2011 Census. Age-standardised suicide rates per 100,000 person-years for each of the four occupational groups were calculated using direct standardisation and using the Australian Bureau of Statistics population-level data from the 2011 Census. Negative binomial regression was used to estimate suicide risk by healthcare employment status and profession, to investigate differences by sex and to examine trends in suicide rates over time, using rate ratios and 95% confidence intervals.

RESULTS

Healthcare professionals were at increased risk of suicide compared to other occupations (rate ratio = 1.30, 95% confidence interval = [1.19, 1.42], p < 0.001), controlling for age, sex and year of death. Nurses and midwives were identified as being at significantly increased risk of suicide (rate ratio = 1.95, 95% confidence interval = [1.73, 2.19], p < 0.001). Suicide rates among female medical practitioners increased substantially over time (p = 0.01).

CONCLUSION

Health professionals are at significantly increased risk of suicide, though the relative risk of different groups is changing over time. There has been a substantial increase in the risk of suicide among female medical practitioners with rates of suicide in this group more than doubling over the last two decades. Findings highlight the need for targeted suicide prevention initiatives for healthcare professionals.

Moral injury and suicidal ideation among health professionals: The role of mental health

BACKGROUND

The prolonged COVID-19 pandemic has burdened health professionals mentally and physically. This study aims to explore the relationship between moral injury (MI) and suicidal ideation (SI), and the role of mental health conditions in this relationship.

METHODS

Three-wave repeated online cross-sectional study with a total of 10,388 health professionals were conducted in different stages (2020-2022) of the COVID-19 pandemic in mainland China. Participants completed the Chinese version of the Moral Injury Symptoms Scale-Health Professional, Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 coupled with a blanket of scales.

RESULTS

The prevalence of SI and MI among health professionals was 9.8 % and 40.2 %, respectively. The prevalence risk of SI was lower in wave 2 (OR = 0.64, 95 % CI: 0.54-0.77) and wave 3 (OR = 0.71, 95 % CI: 0.60-0.84) when compared with wave 1. MI (OR = 4.66, 95 % CI: 3.99-5.43), medical error (OR = 1.15, 95 % CI: 1.00-1.32), workplace violence (OR = 1.13, 95 % CI: 0.97-1.32), depression (OR = 94.08, 95 % CI: 63.37-139.69), anxiety (OR = 25.54, 95 % CI: 21.22-30.74), PTSD (OR = 24.51, 95 % CI: 19.01-31.60) were associated with a higher risk of SI. The mediation model revealed that depressive, anxiety, and PTSD symptoms explained 90.6 % of the total variance in the relationship between MI and SI.

CONCLUSIONS

The risk of SI has reduced among health professionals since the first peak of the COVID-19 pandemic in China. MI may contribute to prevalent SI, and mental health conditions, especially depressive symptoms, play a significant role as mediators.

LIMITATIONS

Cross-sectional design precludes the investigation of casual relationships. The nonrandom sampling method limits the generalization.

Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners

BACKGROUND

Locus of control (LoC) is a social cognition, that relates to the level of self-control that people have over their personal environment that influences their life. In this context, LoC is frequently associated with work-related behavioral outcomes, ranging from job attitudes, career behaviors, stress, and burnout.

OBJECTIVE

To investigate the association between LoC, and work-related behavioral factors, socio-cultural factors, and personal factors among Australian General Practitioners (GPs).

METHODS

This study utilized data from the 2010 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Locus of control (LoC) was measured by a 7-point Likert scale based on Pearlin-Schooler Mastery/Self-efficacy 7-item Scale. Higher score indicated lower internal LoC. Multivariate linear regression model was performed to determine the independent predictors of LoC.

RESULTS

Of 3,664 GP participants, LoC did not differ by gender. Poor/fair self-rated health, working in urban location, running a stressful practice, poor balance of professional and personal commitments, poor support network, financial circumstances after retirement, and perception of unrealistic expectation by patients were significant predictors for a lower Internal LoC in a multivariate linear regression model. Adjusted R² explained 22.4% of variation in predicting the LoC in our models.

CONCLUSIONS

LoC of Australian GPs is negatively affected by poor work-life balance, inadequate support, and unrealistic patient expectation. These work-place specific factors could be targeted by interventions to improve GPs wellbeing.

Occupational Stress and Personality in Medical Doctors from Romania

Occupational stress amongst doctors has been intensively studied as doctors are exposed to several stress factors daily. The purpose of this study was to investigate if there are associations between personality dimensions and the factors that generate stress at work. We conducted a cross-sectional study of 280 medical doctors from Romania between February 2021 and September 2021 who were evaluated using the DECAS and ASSET Scales. Our results showed that the agreeableness and emotional stability dimensions of personality, according to the Big Five model, were statistically associated with work relationships (A p < 0.0001; ES p = 0.0005), work-life balance (A p = 0.008; ES p = 0.01), overload (A p = 0.01; ES p = 0.001), job security (A p < 0.0001; ES p = 0.002), job control (A p = 0.001; ES p = 0.009), resources and communication (A p = 0.0002; ES p < 0.0001), and job conditions (A p = 0.005; ES p = 0.03). The conscientiousness dimension was statistically associated with job control (p = 0.02). Doctors from different specialties experienced stress differently, with psychiatrists and doctors from preclinical specialties reporting the lowest levels of stress. Internists and surgeons reported higher levels of stress. This study showed that the dimensions of agreeableness and emotional stability were both associated with variables indicative of the level of stress felt at work.

Medical negligence claims and the health and life satisfaction of Australian doctors: a prospective cohort analysis of the MABEL survey

OBJECTIVE

To assess the association between medical negligence claims and doctors' self-rated health and life satisfaction.

DESIGN

Prospective cohort study.

PARTICIPANTS

Registered doctors practising in Australia who participated in waves 4 to 11 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey between 2011 and 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-rated health and self-rated life satisfaction.

RESULTS

Of the 15 105 doctors in the study, 885 reported being named in a medical negligence claim. Fixed-effects linear regression analysis showed that both self-rated health and self-rated life satisfaction declined for all doctors over the course of the MABEL survey, with no association between wave and being sued. However, being sued was not associated with any additional declines in self-rated health (coef.=-0.02, 95% CI -0.06 to 0.02, p=0.39) or self-rated life satisfaction (coef.=-0.01, 95% CI -0.08 to 0.07, p=0.91) after controlling for a range of job factors. Instead, we found that working conditions and job satisfaction were the strongest predictors of self-rated health and self-rated life satisfaction in sued doctors. In analyses restricted to doctors who were sued, we observed no changes in self-rated health (p=0.99) or self-rated life satisfaction (p=0.59) in the years immediately following a claim.

CONCLUSIONS

In contrast to prior overseas cross-sectional survey studies, we show that medical negligence claims do not adversely affect the well-being of doctors in Australia when adjusting for time trends and previously established covariates. This may be because: (1) prior studies failed to adequately address issues of causation and confounding; or (2) legal processes governing medical negligence claims in Australia cause less distress compared with those in other jurisdictions. Our findings suggest that the interaction between medical negligence claims and poor doctors' health is more complex than revealed through previous studies.

Associations of within-individual changes in working conditions, health behaviour and BMI with work ability and self-rated health: a fixed effects analysis among Dutch workers

OBJECTIVES

This study assessed the associations of (1) within-individual improvements and (2) within-individual deteriorations in working conditions, health behaviour and body mass index (BMI) with changes in work ability and self-rated health among workers.

DESIGN

Prospective cohort study.

SETTING

The Netherlands.

PARTICIPANTS

Persons in paid employment, aged 45-64 years, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) between 2010 and 2017, and improved or deteriorated at least once with respect to working conditions (psychological and emotional job demands, autonomy, social support, physical workload), health behaviour (moderate and vigorous physical activity, smoking status), or BMI between any of two consecutive measurements during the 7-year follow-up.

PRIMARY AND SECONDARY OUTCOME MEASURES

Changes in self-reported work ability on a scale from 0 to 10 (1st item of the work ability index) and self-rated health on a scale from 1 to 5 (SF-12).

RESULTS

Of the 21 856 STREAM participants, ultimately 14 159 workers were included in the fixed effects analyses on improvements (N=14 045) and deteriorations (N=14 066). Workers with deteriorated working conditions decreased in work ability (β's: -0.21 (95% CI: -0.25 to -0.18) to -0.28 (95% CI: -0.33 to -0.24)) and health (β's: -0.07 (95% CI: -0.09 to -0.06) to -0.10 (95% CI: -0.12 to -0.08)), whereas improvements were to a lesser extent associated with increased work ability (β's: 0.06 (95% CI: 0.02 to 0.09) to 0.11 (95% CI: 0.06 to 0.16)) and health (β's: 0.02 (95% CI: 0.00 to 0.03) to 0.04 (95% CI: 0.02 to 0.06)). Workers with increased BMI or decreased physical activity reduced in work ability and health. Likewise, decreased BMI or increased vigorous physical activity was associated with improved health. An increase in moderate or vigorous physical activity was modestly associated with a reduced work ability. Quitting smoking was associated with reduced work ability and health.

CONCLUSIONS

Compared with improvements, preventing deteriorations in working conditions, health behaviour and BMI, might be more beneficial for work ability and workers' health.

'The hardest job I've ever done': a qualitative exploration of the factors affecting junior doctors' mental health and well-being during medical training in Australia

Background

Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training.

Method

Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach.

Results

Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being.

Conclusion

The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07381-5.

Relationship between medical students' negative perceptions of colleagues' work-life and burn-out during clerkships: a longitudinal observational cohort study

OBJECTIVE

Because work and educational environments are closely related and can affect each other, this study examined whether medical students' negative perceptions of their colleagues' work-life balance (NWLB) during their clinical rotations would be related to burn-out in clerkships and investigated the effect of students' gender on this relationship.

DESIGN

A longitudinal, prospective 2-year cohort study conducted between September 2013 and April 2015.

SETTING

Medical students from a university school of medicine in Taiwan.

PARTICIPANTS

One voluntary cohort of undergraduate medical students in clerkships was invited to participate. Among 190 medical students recruited in September 2013, a total of 124 students provided written informed consent. Participants were free to decide whether to complete each survey; therefore, varying numbers of responses were obtained during the study period. Those who responded to our survey for more than 6 months were included in our analyses. Overall, 2128 responses from 94 medical students were analysed, with each student providing an average of 23 responses for 2 years.

PRIMARY OUTCOME MEASURE

Burn-out was measured using the Professional Quality of Life Scale.

RESULTS

Our study found that a strong NWLB was related to high burn-out levels among medical students during their clerkships (p<0.001). However, the gender of the student had no effect on this relationship (p>0.05). In addition, our study indicated that medical students living with a companion had decreased burn-out levels than did those living alone during their clerkships.

CONCLUSIONS

The significance of policies promoting employee work-life balance should be emphasised because of the potential for social contagion effects on medical students. Clerkship trainees might be vulnerable to such negative contagion effects during the transition to their early clinical workplace training and may, therefore, require advanced socialisation and mentoring.

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participant's profile regarding self-rated health: a multiple correspondence analysis

BACKGROUND

Self-rated health (SRH) - one of the most common health indicators used to verify health conditions - can be influenced by several types of socioeconomic conditions, thereby reflecting health inequalities. This study aimed to evaluate the participant profiles regarding the association between self-rated health and social and occupational characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

Cross-sectional design, including 11,305 individuals. Self-rated health was categorized as good, fair, and poor. The relationship between socio-demographic, psychosocial work environment, health-related variables, and self-rated health was analyzed by multiple correspondence analysis (stratified by age: up to 49 years old and 50 years old or more).

RESULTS

For both age strata, group composition was influenced by socioeconomic conditions. Poor SRH was related to lower socioeconomic conditions, being women, black self-declared race/ethnicity, being non-married/non-united, low decision authority, low skill discretion, and obesity.

CONCLUSION

To promote health, interventions should focus on reducing existing socioeconomic, race, and gender inequalities in Brazil.

Mental illness and suicide among physicians

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.

Workplace stress, common mental disorder and suicidal ideation in junior doctors

BACKGROUND

Doctors-in-training report elevated rates of mental disorders and high levels of stress. Whilst a number of work-related sources of stress have been identified in the medical profession, it remains unclear as to the relative importance of workplace stressors for mental ill-health in junior doctors.

AIMS

To examine workplace stressors reported by junior doctors and identify variables associated with adverse mental health outcomes.

METHODS

Cross-sectional analysis of national 2013 survey of Australian doctors focussing on junior medical officers (N = 3053; 24.9% of total sample). Primary outcomes were caseness of common mental disorder (CMD) and suicidal ideation in the past year.

RESULTS

Perceived level of conflict between study/career and family/personal responsibility (OR = 3.76, 95% CI: 2.61-5.43; P < 0.01) and sleep deprivation (OR = 2.19, 95% CI: 1.46-3.28; P < 0.01) were significantly associated with CMD, while perceived level of conflict between study/career and family/personal responsibility (OR = 3.13, 95% CI: 1.78-5.50; P < 0.01) and bullying (OR = 2.92, 95% CI: 1.42-6.03; P < 0.01) were most strongly associated with suicidal ideation in adjusted models.

CONCLUSION

This study identifies modifiable workplace variables that are influential in junior doctors' mental health, and in doing so, provides meaningful evidence-informed targets for future interventions to prevent suicide and mental disorder in this population.

Medical Doctors and Dementia: A Longitudinal Study

OBJECTIVE

To examine the association between being a medical doctor (MD) and the risk of incident dementia.

DESIGN

Cohort study.

SETTING

Olmsted County, Minnesota.

PARTICIPANTS

A total of 3460 participants (including 104 MDs), aged 70 years or older, of the population-based Mayo Clinic Study of Aging.

MEASUREMENTS

Participants were randomly selected from the community and had comprehensive cognitive evaluations at baseline and approximately every 15 months to assess for diagnosis of dementia. For participants who withdrew from the follow-up, dementia diagnosis was also assessed using information available in their medical record. The associations were examined using Cox proportional hazards models, adjusting for sex, education, and apolipoprotein E ε4, using age as the time scale.

RESULTS

MDs were older (vs "general population"), and most were males (93.3%). MDs without dementia at baseline did not have a significantly different risk for incident dementia (hazard ratio = 1.12; 95% confidence interval = 0.69-1.82; P = .64) compared to the general population.

CONCLUSIONS

Although the study includes a small number of older, mainly male, MDs, it provides a preliminary insight on cognitive health later in life in MDs, while most previous studies examine the health of younger MDs. Larger longitudinal studies are needed to examine these associations and investigate if associations are modified by sex. J Am Geriatr Soc 68:1250-1255, 2020.

Influence of changing working conditions on exit from paid employment among workers with a chronic disease

Objectives

To investigate the relation between changes in working conditions and exit from paid employment among workers with a chronic disease.

Methods

Six waves from the longitudinal Study on Transitions in Employment, Ability and Motivation (2010–2016), enriched with tax-based employment information from Statistics Netherlands (2011–2017), were available for 4820 chronically ill workers aged 45–63 years (mean 55.3 years, SD 5.1). A change in working conditions (physical workload, psychological job demands, job autonomy, emotional job demands and social support) was defined as an increase or decrease between two consecutive waves of at least one SD. Discrete-time survival models with repeated measurements were used to estimate the relative risk (RR) of a change in working conditions on exiting paid employment in the following year compared with no change and consecutive favourable working conditions.

Results

A favourable change in physical workload lowered the risk to exit paid employment (RR 0.46, 95% CI 0.22 to 0.94). An adverse change in psychosocial working conditions, especially a decrease in social support (RR 2.07, 95% CI 1.52 to 2.81), increased the likelihood to exit paid employment. In contrast, a favourable change in psychological job demands increased the risk to exit paid employment (RR 1.57, 95% CI 1.09 to 2.24). Multiple adverse changes increased the risk to exit paid employment up to six times (RR 6.06, 95% CI 2.83 to 12.98).

Conclusions

Changes in working conditions among workers with chronic diseases influence exit from paid employment. Ensuring that working conditions can be adapted to the needs of workers with a chronic disease may help to extend working life.

Workplace violence and health in human service industries: a systematic review of prospective and longitudinal studies

OBJECTIVES

To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.

METHODS

The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type: prospective or longitudinal in articles published 1990-August 2019. Quality assessment was performed based on a modified version of the Cochrane's 'Tool to Assess Risk of Bias in Cohort Studies'.

RESULTS

After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.

CONCLUSION

There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.

Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey

OBJECTIVE

Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia.

DESIGN AND PARTICIPANTS

A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded.

OUTCOME MEASURES

Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia.

RESULTS

JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week.

CONCLUSIONS

Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.

Challenges faced by acute care surgeons in China

The aim of this article is to describe briefly about Chinese ACS surgeons' work status. It is an undeniable fact that the analysis of ED and ACS resources shows negative tendencies and high work overload, resulting in low patient safety and quality of care. And, there was a substantial shortage of surgeons in the subspecialty. So, a set of strategic measures and state policies should be prioritized.