Work environment and mental health status assessed by the general health questionnaire in female Japanese doctors

Mental Health Status before and during the COVID-19 Pandemic in Patients First Visiting a Psychosomatic Internal Medicine Clinic in Tokyo, Japan

The coronavirus disease (COVID-19) pandemic has aggravated anxiety and depression worldwide, particularly in patients with chronic illnesses and mental disorders. Using validated questionnaires, in this paper, we examine the psychological effects of the pandemic in Japan in detail. The General Mental Health Scale (GHQ), the State–Trait Anxiety Inventory (STAI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess mental health, state and trait anxiety, and depression, respectively. The survey was completed during the patients’ first visits to the clinic of Psychosomatic Internal Medicine from November 2018 to April 2021. The Mann–Whitney U test was used to compare data from 226 participants before and during the COVID-19 pandemic. The GHQ total, GHQ subscales of “social dysfunction” and “anxiety and dysphoria”, and state anxiety scores were significantly higher during than before the pandemic. The GHQ total, some GHQ subscales, and state anxiety scores were significantly higher among male than female participants during the pandemic. The GHQ total, some GHQ subscales, CES-D, and state anxiety scores in those aged 10–39 years were significantly higher. Thus, the COVID-19 pandemic may have caused mental health changes in many individuals based on their gender, age, and with time.

Depressive symptoms among primary healthcare workers during the novel SARS-CoV-2 coronavirus pandemic in the Muscat governorate

BACKGROUND

With the unprecedented spread of the novel SARS-CoV-2 coronavirus, primary healthcare workers (PHCWs) are having to shoulder the increasing weight of this ongoing pandemic.

AIMS

This study explored the rate and covariates of depressive symptoms among PHCWs in the Muscat governorate.

METHODS

A cross-sectional online survey was conducted from 10 May to 10 June 2020 among PHCWs working in all primary healthcares across the Muscat governorate. Data on sociodemographic and risk factors of having at least one underlying physical health condition, a psychiatric history, family history of psychiatric disorders, and direct involvement with COVID-19 positive patients were sought. The Patient Health Questionnaire (PHQ-9) was then used to solicit the presence of depressive symptoms. Those with a cutoff point ≥10 were considered as showing depressive symptoms. Logistic regression was used to determine risk factors associated with depressive symptoms in PHCWs after adjusting for all sociodemographic factors.

FINDINGS

A total of 432 (72%) out of 600 PHCWs with an average age of 39.2 years (SD = 7.8 years) ranging between 25.0 and 75.0 years responded to the survey. There were more females (n = 281, 65.3%) than males, and more than 45% (n = 195) of them were physicians. Additionally, more than 78% (n = 338) had been in contact with COVID-19 patients. There was a significant association between different age groups and profession (P < .001), having at least one underlying physical health condition (P = 0.001) and depressive symptom status (P = 0.038). A total of 78 out of the 423 subjects (18.1%) were considered to have depressive symptoms. After adjusting for all factors, the logistic regression model showed that an age of 34 years or below (OR = 2.079, P = 0.021) and having at least one underlying physical health condition (OR = 2.216, P = 0.007) were factors contributing significantly to depressive symptoms among the PHCWs.

Psychological distress and associated factors among Japanese nursery school and kindergarten teachers: a cross-sectional study

The understaffing of nursery schools and kindergartens and the increasing workload of childcare workers are becoming significant issues in Japan. In this study, a cross-sectional survey was conducted to investigate the stress experienced by childcare workers and its antecedents. We distributed 2,640 questionnaires to childcare workers in Miyagi prefecture, obtaining a response rate of 51.9% (n=1,370). Finally, 1,210 valid questionnaires were used in the analysis. As a stress indicator, psychological distress was measured with the Kessler Screening Scale for Psychological Distress (K6). The mean K6 score was 7.0 (SD=5.4), and the prevalence of psychological distress (K6 score ≥5) was 60.0%. Considering work-related factors, the mean scores were as follows: supervisor support 11.8 (2.6), coworker support 12.1 (2.0), work engagement 3.2 (1.2), and effort-reward ratio 0.93 (0.53). A multivariate logistic regression analysis with adjustment for possible confounders revealed that increased psychological distress was associated with higher effort-reward ratio, lower support from supervisors and coworkers, lower work engagement, and insufficient sleep. These results suggest that elevated psychological distress is strongly associated with effort-reward imbalance, while high work engagement in childcare workers helped to reduce their distress.

Workplace Violence in Chinese Hospitals: The Effects of Healthcare Disturbance on the Psychological Well-Being of Chinese Healthcare Workers

Healthcare disturbance is a form of workplace violence against healthcare workers perpetrated by patients, their relatives, and gangs hired by them. It is a prevalent phenomenon in China, where evidence suggests that it impacts on the job satisfaction of healthcare workers. This study aims to examine the relationship between healthcare disturbance, surface acting as a response to emotional labour, and depressive symptoms in Chinese healthcare workers. The study adopted a cross-sectional design and used an online survey methodology. Data were collected from 418 doctors and nurses from one hospital in China. The results showed that frequency of healthcare disturbance was positively related to surface acting and depressive symptoms, respectively; surface acting was also positively related to depression, while deep acting showed no effect on symptoms of depression. Furthermore, surface acting in response to emotional labour mediated the relationship between healthcare disturbance and depressive symptoms. The results highlight the importance of preventing healthcare disturbance and of training healthcare staff in strategies for managing emotional demands in reducing depressive symptoms in Chinese healthcare staff.

Gender Differences in Demographic and Clinical Features of Physicians Admitted to a Program for Medical Professionals with Mental Disorders

OBJECTIVE

To examine the demographic and clinical differences between men and women admitted to a Physicians' Health Programme (PHP).

METHOD

Retrospective chart review of 778 medical records of physicians admitted to the Barcelona PHP from February 1, 1998 until December 31, 2015.

RESULTS

Women admitted to the Barcelona PHP were younger than men, were more likely to be self-referred and to be admitted for a non-addictive mental disorder. Prevalence of unipolar affective disorders (60.1 vs. 37.6%), adjustment disorders (62.4 vs. 37.6%), and obsessive-compulsive disorder (61.1 vs. 38.9%) was significantly higher among women, whereas prevalence of alcohol use disorders was lower (32.7 vs. 67.3%). Nevertheless, both groups were similar with regard to medical specialty, working status, length of their first treatment episode, and presence of hospitalization during that episode. After multivariate analysis, age, type of referral, and main diagnosis (addictive disorders vs. other mental disorders) discriminated the differences between groups.

CONCLUSION

Women physicians seem to be more prone to voluntarily ask for help from PHPs and are more likely to suffer from mood and anxiety disorders compared to men. However, mental disorders' severity may be similar in both groups. More studies are needed to clarify the gender factors related to this behavior.

Effects of work burden, job strain and support on depressive symptoms and burnout among Japanese physicians

OBJECTIVES

Days off, on call, night duty, working hours and job stress can affect physicians' mental health, and support from supervisors and co-workers may have a buffering effect. This study elucidates whether job strain and job factors affect physicians' mental health, and whether support from supervisors and co-workers has a protective effect on their mental health.

MATERIAL AND METHODS

The subjects included 494 physicians. The Brief Job Stress Questionnaire (BJSQ) was used to evaluate job demand, job control and support. High job strain was defined as a combination of high job demand and low job control. Depressive symptoms were assessed using the Patient Health Questionnaire-9. The Maslach Burnout Inventory-General Survey was used to evaluate burnout. Possible confounder adjusted logistic regression analyses were performed to obtain odds ratios for depressive symptoms and burnout.

RESULTS

As per the analysis, high job strain had significantly higher odds ratios, and support from co-workers had significant protective odds ratios for depressive symptoms. High job strain and having only 2-4 days off per month (compared to > 8 days off per month) had significantly higher odds ratios, and support from co-workers had significant protective odds ratios for burnout.

CONCLUSIONS

High job strain was related to depressive symptoms and burnout, and support from co-workers had a buffering effect on depressive symptoms and burnout. An inadequate number of days off was related to burnout. Assessment of job strain may be a good tool to measure physicians' mental health, and a sufficient number of days off may be needed to prevent burnout.

Psychological distress in the workforce: a multilevel and longitudinal analysis of the case of regulated occupations in Canada

Background

This study uses a multidimensional theoretical model to evaluate the role of regulated occupations and working conditions in explaining psychological distress.

Methods

Various multilevel regression analyses were conducted on longitudinal data for which measures repeated over time (n₁ = 36,166) were nested in individuals (n₂ = 7007).

Results

Results showed that when we controlled for working conditions, family situation, the social network outside the workplace, and personal characteristics, the level of psychological distress was significantly lower among professional workers in regulated occupations than among professionals not in regulated occupations. Among the working conditions studied, skill utilisation, psychological demands, and job insecurity were positively associated with psychological distress levels, whereas social support in the workplace was inversely related to distress. Finally, our results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce.

Conclusions

These results support our hypothesis that working in regulated occupations exerts a direct effect on mental health. These results also make clear the importance of developing new tools for measuring psychological distress among upper-level professional workers. Such tools will be much better suited to the realities characterising today's knowledge-based economies.

European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence

OBJECTIVE

To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians.

DESIGN

A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria.

SETTING

Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included.

PARTICIPANTS

The total number of participants was 14 338.

PRIMARY AND SECONDARY OUTCOME MEASURES

Health effects classified under the International Classification of Diseases (ICD-10).

RESULTS

Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified.

CONCLUSIONS

LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or 'dose-response' relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors.

Measuring the effects of Zen training on quality of life and mental health among Japanese monk trainees: a cross-sectional study

OBJECTIVE

Previous studies have reported that the practice of meditation can have beneficial physiologic and mental effects. Therefore, Zen trainees who regularly practice meditation might have high quality-of-life scores and high levels of general mental health; however, no previous study has tested these relationships. This article reports on a study that examined how rigorous professional training affected the International Quality of Life (QOL) Assessment Short Form-36 (SF-36) and General Health Questionnaire-28 (GHQ-28) scores of Zen trainees in Japanese monasteries.

DESIGN

This was a single-center questionnaire-based study.

SETTINGS/LOCATION

The study was conducted in Rinzai Zen monasteries. SUBJECT INTERVENTIONS: Anonymous and confidential surveys containing the SF-36 and GHQ-28 were distributed by mail, and 256 questionnaires were collected from Rinzai Zen monasteries.

OUTCOME MEASURES

One hundred ninety-eight complete questionnaires were collected and the participants were divided according to their training length: group I (<1 year), group II (1-3 years), and group III (≥3 years). One-way analysis of variance and Tukey test for multiple comparison were conducted on normally distributed data, and the Kruskal-Wallis test was performed on non-normally distributed data.

RESULTS

The SF-36 seven subscale scores (physical functioning, role-physical, body pain, general health, vitality, role-emotional, and mental health) of the longer-length training group were significantly higher compared to other groups. The SF-36 MCS (mental component summary) score among the groups were significantly different, and the scores of group III were significantly higher compared to the scores of group I. Furthermore, the GHQ-28 total and subscales (somatization, anxiety, social dysfunction, and depression) scores of longer-length training were significantly lower (better).

CONCLUSIONS

These findings suggest that Zen professional training, including inward-attention practices, improves the QOL and general mental health of trainees, even in a tough and distressing environment. However, detailed qualitative and longitudinal studies are required to fully assess these effects.

A survey of anxiety and depression symptoms among primary-care physicians in China

OBJECTIVE

Anxiety and depression disorder are the most prevalent mental health problems. However, few studies are available pertaining to these problems among Chinese doctors, especially the assessment of the anxiety and depression symptoms among primary-care providers. The aim of this study was to assess the anxiety and depression symptoms among Chinese primary-care physicians and their associated factors.

METHODS

A cross-sectional study was conducted among 451 primary-care physicians in Shanghai China (effective response rate was 79.8%). There were 177 male physicians and 274 female physicians with average age of 37.8 (SD +/- 11.1) years. Questionnaire pertaining to depression disorder was indicated by the Zung Self-Rating Depression Scale (SDS) and anxiety disorder was indicated by the Zung Self-Rating Anxiety Scale (SAS).

RESULTS

The average SAS and SDS standard scores of the primary-care physicians were 41.1 +/- 11.5 and 46.5 +/- 11.8 respectively. Both of the scale scores were higher than those of Chinese national norms (P both < 0.001). SDS standard score > or = 53 and SAS standard score > or = 50 were regarded as screening-positive criteria. SAS and SDS screening positive rates of primary-care physicians were 18.0% and 31.7% respectively. In addition, married/cohabited and divorced/widowed physicians aged over 30 years with educational background of junior college had higher risks of anxiety and depression disorders.

CONCLUSIONS

Chinese primary-care physicians were at considerably high risk of anxiety and depression disorders, which was worthy of attention during healthcare system reform in China.

Somatic and mental morbidity of young female physicians. Does emotional exhaustion constitute the missing link?

Introduction: The high prevalence of morbidity among female physicians in Hungary is well documented, however, little is known about the prevalence of that in certain age groups. Aims: To assess the prevalence of somatic and psychiatric morbidity in two age cohorts (Cohort 1: age 24–43 and Cohort 2: age 44–76) of female physicians and to explore the relationship between morbidity and potential risk factors including work-related stressors. Methods: Representative, cross-sectional, quantitative survey among representative samples of female physicians (N = 408). Results: Physicians in Cohort 1 reported more frequent night shift rotation, less leisure time, and fewer days off compared to physicians in Cohort 2. Physicians in Cohort 1 were less satisfied with their work, workplace, reported less support from their colleagues, and received lower salary compared to physicians in Cohort 2. Physicians in Cohort 1 scored significantly higher on the emotional exhaustion and the personal accomplishment scales MBI as compared to Cohort 2 physicians. In Cohort 1 emotional exhaustion and personal accomplishment were associated with high depression scores and frequent suicidal ideation. Conclusions: The role of emotional exhaustion is decisive of young physicians’ well-being. Future research should focus on understanding the psycho-social, individual, organizational, and societal correlates of the high prevalence of morbidity among young female physicians in Hungary. Orv. Hetil., 2013, 154, 20–27.

Validation and normalization of the General Health Questionnaire 30 in parents with primary school children in China

OBJECTIVES

Parenting can be a stressful experience. Higher levels of parenting stress are predictive of parents' negative appraisal of children's behavior, the use of physical discipline, and poor child outcomes across a variety of domains. Assessment of parenting depression is needed in China. This study aims to standardize the Chinese version of the General Health Questionnaire (GHQ-30) for parents of primary school children.

METHOD

Stratified randomly selected parents of primary school children were selected from the cities of Nanjing and Shenyang in China. The Chinese version of the General Health Questionnaire 30 was administered to 7615 parents of primary school students aged between 8 and 12 years. A high response rate was achieved, with 6672 parents (88%) responding to the survey.

RESULTS

Exploratory factor analysis with a 5-factor solution showed that 5 factors were extracted from the scale, namely, depression, anxiety, inadequate coping, social dysfunctioning, and sleep disturbance. The 5-factor structures were confirmed by using confirmatory factor analysis (CFA). Overall, the 5-factor structure had a high level of reliability for each individual dimension. Confirmatory factor analysis showed that the 5-factor structure abstracted from this study had a good model fit.

CONCLUSIONS

The 5-factor structure derived from the present sample of parents, with good model fit in the CFA analysis, suggests that a 5-factor solution can be used to assess parent psychopathological symptoms in mainland Chinese parents of primary school children.

Menstrual disorders and their influence on low back pain among Japanese nurses

An increasing body of evidence now suggests that menstrual disorders may influence the development of Low Back Pain (LBP) among women of reproductive age. To investigate this issue in Japan, we conducted a large cross-sectional survey of female nurses from a university teaching hospital during 2008. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI: 1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, our study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.