Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study

BACKGROUND

Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up.

METHODS

The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms.

RESULTS

There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle.

CONCLUSIONS

The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.

Finding neural correlates of depersonalisation/derealisation disorder via explainable CNN-based analysis guided by clinical assessment scores

Mental health disorders are typically diagnosed based on subjective reports (e.g., through questionnaires) followed by clinical interviews to evaluate the self-reported symptoms. Therefore, considering the interconnected nature of psychiatric disorders, their accurate diagnosis is a real challenge without indicators of underlying physiological dysfunction. Depersonalisation/derealisation disorder (DPD) is an example of dissociative disorder affecting 1-2 % of the population. DPD is characterised mainly by persistent disembodiment, detachment from surroundings, and feelings of emotional numbness, which can significantly impact patients' quality of life. The underlying neural correlates of DPD have been investigated for years to understand and help with a more accurate and in-time diagnosis of the disorder. However, in terms of EEG studies, which hold great importance due to their convenient and inexpensive nature, the literature has often been based on hypotheses proposed by experts in the field, which require prior knowledge of the disorder. In addition, participants' labelling in research experiments is often derived from the outcome of the Cambridge Depersonalisation Scale (CDS), a subjective assessment to quantify the level of depersonalisation/derealisation, the threshold and reliability of which might be challenged. As a result, we aimed to propose a novel end-to-end EEG processing pipeline based on deep neural networks for DPD biomarker discovery, which requires no prior handcrafted labelled data. Alternatively, it can assimilate knowledge from clinical outcomes like CDS as well as data-driven patterns that differentiate individual brain responses. In addition, the structure of the proposed model targets the uncertainty in CDS scores by using them as prior information only to guide the unsupervised learning task in a multi-task learning scenario. A comprehensive evaluation has been done to confirm the significance of the proposed deep structure, including new ways of network visualisation to investigate spectral, spatial, and temporal information derived in the learning process. We argued that the proposed EEG analytics could also be applied to investigate other psychological and mental disorders currently indicated on the basis of clinical assessment scores. The code to reproduce the results presented in this paper is openly accessible at https://github.com/AbbasSalami/DPD_Analysis.

Burnout and Psychological Vulnerability in First Responders: Monitoring Depersonalization and Phobic Anxiety during the COVID-19 Pandemic

Background: It is common knowledge that first responders are among the helping professionals most at risk of burnout and psychological vulnerability. During the COVID-19 pandemic, their mental health has been subjected to various risk factors. Methods: Data on socio-demographic characteristics, the Maslach Burnout Inventory (MBI) and psychological vulnerability (SCL-90-R) were obtained from 228 subjects (55.3% female; M age = 45.23, SD = 13.14) grouped on the basis of their actual involvement during the emergency phases (82% First Responders and 18% Second Responders). Results: First responders exceeded the MBI clinical cut-off, while SRs did not (χ² ≥ 0.5); specifically, EE = 89.8%, DP = 85.8%, and PA = 82.1%. The FR group showed a higher mean in the global severity index (GSI = 49.37) than did the SRs (=43.95), and the FR group exceeded the clinical cut-off in the SCL-90-R scales of SOM (51.06), ANX (52.40), and PHOB (53.60), while the SF group did so only for the PHOB scale (50.41). The MBI dimensions correlated significantly (p = 0.05) with all investigated clinical scales of the SCL-90-R. Conclusions: Emergency situations expose first responders to specific risk factors related to work performance and relational aspects, which contribute to increased psychological vulnerability and burnout.

Burden and Protection: Heterogeneous Effects of Occupational and Operational Stressors on Burnout Dimensions Among Firefighters

OBJECTIVE

To investigate the association between occupational stressors and Burnout dimensions among Brazilian firefighters.

METHOD

A cross-sectional study about firefighters (n = 237) was developed in Fortaleza, Northeast of Brazil. Logistic regression analysis was applied to investigate the association between high strain (high demand and low job control), low social support, high operational exposure, and Burnout dimensions (emotional exhaustion, depersonalization, and low personal accomplishment).

RESULTS

High strain was associated to emotional exhaustion (odds ratio [OR] = 11.65; 95% confidence interval [CI]: 3.92 to 34.60) and depersonalization (OR = 5.43; 95% CI: 2.03 to 14.58). Low social support was associated to emotional exhaustion (OR = 2.86; 95% CI: 1.24 to 6.60) and low personal accomplishment (OR = 2.59; 95% CI: 1.36 to 4.93). High operational exposure did not increase the odds of emotional exhaustion and depersonalization and decreased the odds of low personal accomplishment (OR = 0.31; 95% CI: 0.10 to 0.94).

CONCLUSION

The study highlights the heterogeneous effects that operational and organisational stressors have on each dimension of Burnout.

Prevalence of burnout in medical students in China: A meta-analysis of observational studies

ABSTRACT

This meta-analysis aimed to estimate the prevalence of burnout among medical students in China.A systematic search from the following electronic databases: China National Knowledge Infrastructure, Wangfang database, VIP database, Chinese biomedical literature database, PubMed, Embase, Web of Science, and Google Scholar was independently conducted by 2 reviewers from inception to September 2019. The data were analyzed using stata software Version 11. Heterogeneity was assessed using I2 tests, and publication bias was evaluated using funnel plots and Egger's test. The source of heterogeneity among subgroups was determined by subgroup analysis of different parameters.A total of 48 articles with a sample size of 29,020 met the inclusion criteria. The aggregate prevalence of learning burnout was 45.9% (95% confidence interval [CI] = 38.1%-53.8%). The prevalence rate of high emotional exhaustion was 37.5% (95% CI: 21.4%-53.7%). The percentage was 44.0% (95% CI: 29.2%-58.8%) for low personal accomplishment. The prevalence rate was 36.0% (95% CI: 23.0%-48.9%) in depersonalization dimension. In the subgroup analysis by specialty, the prevalence of burnout was 30.3% (95% CI: 28.6%-32.0%) for clinical medicine and 43.8% (95% CI: 41.8%-45.8%) for other medical specialties. The total prevalence of burnout between men and women was 46.4% (95% CI: 44.8%-47.9%) and 46.6% (95% CI: 45.5%-47.6%), respectively. The prevalence of burnout with Rong Lian's scale was 43.7% (42.1%-45.2%), and that with the other scales was 51.4% (50.4%-52.4%). The prevalence rates were 62.9% (61.3%-64.6%), 58.7% (56.3%-61.1%), 46.5% (42.9%-50.2%), and 56.0% (51.6%-60.4%) from Grades 1 to 4, respectively. There was a statistically significant difference among the different grades (P = .000).Our findings suggest a high prevalence of burnout among medical students. Society, universities, and families should take appropriate measures and allot more care to prevent burnout among medical students.

Latent Profiles of Burnout, Self-Esteem and Depressive Symptomatology among Teachers

Burnout is a reality in the teaching profession. Specifically, teaching staff usually have higher burnout rates. The present study aims to analyze the different burnout profiles and to verify if there were differences between burnout profiles in depressive symptomatology and in the self-esteem of the teachers at school. The total number of participants was 210 teachers from 30 to 65 years. The first scale was the Maslach burnout inventory, the second scale was the Self-Rating depression scale and the third scale was the Rosenberg Self-Esteem Scale . The latent class analysis identified three burnout profiles: the first group with a high level of emotional exhaustion, low personal accomplishment and depersonalization (high burnout); the second group with low emotional exhaustion, low depersonalization and high personal accomplishment (low burnout) and the third group with low depersonalization, low emotional exhaustion and low personal accomplishment (moderate burnout). The results revealed that there were differences in depressive symptomatology (group 1 obtained higher scores than group 2 and group 3) and self-esteem (group 2 obtained higher scores than group 1). The psychological balance and health of teachers depend on preventing the factors that have been associated with this syndrome.

High rate of burnout among residents under standardized residency training in a tertiary teaching hospital of middle China: Results from a cross-sectional survey

Burnout has been commonly observed in health care workers. Though research has been conducted involving burnout among doctors in China, few studies have focused on residents during standardized residency training (SRT). The professional status of the residents during SRT remains largely unclear. The present study was conducted in order to clarify the prevalence and potential risk factors of burnout in residents during SRT.An electronic questionnaire comprised 2 parts. The first part was designed to collect some basic characteristic information. Maslach Burnout Inventory-Human Services Survey was included in the second part.As many as 71.05% residents had at least 1 scale of burnout. Emotional exhaustion (EE) was found in 55.6% residents, depersonalization (DP) in 29.7% and reduced personal accomplishment (RPA) in 41.6%. Being older than 27, senior SRT year, working time more than 60 hours per week and poor sleeping quality was independently associated with at least on scale of burnout. Being unable to receive timely supervisor support significantly increased the probability of DP and EE. Not having friends at work or feeling cared for by the hospital were independently related to all 3 symptoms of burnout as well as overall burnout.Burnout rate is high in residents under SRT from middle part of China. Organizational, professional, and social support was demonstrated critical by the potential roles in protecting against burnout. Residents with burnout were prone to considering turnover. Strategies for managing burnout related factors among residents should be focused in future studies.

Factors related to burnout in resident physicians in Japan

OBJECTIVES

We explore the prevalence and characteristics of burnout among Japanese resident physicians and identifies factors associated with burnout.

METHODS

A cross-sectional study was conducted three times between April 2017 and March 2018 at a Japanese teaching hospital. Resident physicians were invited to answer an online survey that included existing valid instruments related to burnout, depression, and empathy. Demographic, background, occupational, and socioeconomic data were also collected. Participants were prompted to report the average daily work hours and the specialty they wish to pursue.

RESULTS

Overall, 39/76 (51%), 27/76 (36%), and 21/76 (28%) resident physicians responded to surveys in April 2017, October 2017, and March 2018, respectively. The percentages of participants with burnout for surveys in April 2017, October 2017, and March 2018 were 7/39 (18%), 6/27 (22%), and 7/21 (33.3%). Emotional exhaustion (EE) was the only burnout component strongly correlated with the severity of depression (r = .615, p < .001; r = .706, p < .001; r = .601, p < .01). EE and depersonalization (DP) had no significant correlation with average daily working hours (β = .156, p = .343 for EE; β = .061, p = .711 for DP).

CONCLUSIONS

The results suggest that capping working hours alone may not be effective in reducing burnout in Japanese resident physicians. Medical educators might need to consider not only working hours but also individual job quality and satisfaction to address burnout. Future studies may need to incorporate qualitative methods to explore the characteristics of burnout.

Prevalence of burnout among German general practitioners: Comparison of physicians working in solo and group practices

Background

Studies from general practitioner (GP) populations from various European countries show a high prevalence of burnout, yet data from Germany are scarce and there are no data comparing GPs from solo versus group practices.

Methods

This cross-sectional survey addressed all GPs from a German network of family medicine practices comprising 185 practices. Participants were asked to fill in a self-administered questionnaire addressing socio-demographic and job-related characteristics. The German version of the Maslach Burnout Inventory was used to measure the dimensions emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each participant was categorized as having high EE, high DP and low PA following pre-defined cut-offs.

Results

A total of 214 GPs from 129 practices participated: 65.9% male, 24.8% solo practice. Of all GPs, 34.1% (n = 73) scored high for EE, 29.0% (n = 62) high for DP, 21.5% (n = 46) low for PA and 7.5% (n = 16) for all three dimensions. A higher risk for EE was found among female physicians, those unsatisfied with their job, those using few stress-regulating measures regularly and those reporting bad work-life balance. Burnout prevalence was higher in GPs in group than in solo practices (37.9% vs. 28.8% had high EE, 33.1% vs. 18.9% had high DP and 22.8% vs. 18.9% had low PA). A significantly higher prevalence of burnout symptoms was found in group practice employees compared to group practice owners.

Conclusion

Burnout prevalence was higher among physicians in group practices compared to solo practices. In group practices, employed, young, female and part-time working physicians showed a higher burnout risk.

Professional burnout among medical students: Systematic literature review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students.

METHODS

The review was performed according to the PRISMA guidelines. Databases were systematically searched for peer-reviewed articles, reporting burnout among medical students published between 2000 and 2017. The meta-analysis was conducted on the available data on burnout rates in medical students measured with the Maslach Burnout Inventory (MBI-HSS).

RESULTS

Fifty-eight out of 3006 studies were found eligible for inclusion. Twelve of these studies met the criteria for meta-analysis. Weighted mean values for the three sub-dimensions of the MBI-HSS were M = 22.93 (SD = 10.25) for Emotional Exhaustion, M = 8.88 (SD = 5.64) for Depersonalization, and M = 35.11 (SD = 8.03) for Personal Accomplishment. Prevalence rates for professional burnout ranged from 7.0% to 75.2%, depending on country-specific factors, applied instruments, cutoff-criteria for burnout symptomatology.

CONCLUSION

This review underlines the burden of burnout among medical students. Future research should explicitly focus on specific context factors and student group under investigation. Such efforts are necessary to control for context-dependent confounders in research on medical students' mental health impairment to enable more meaningful comparisons and adequate prevention strategies.

Burnout syndrome among medical residents: A systematic review and meta-analysis

BACKGROUND

Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).

OBJECTIVE

To estimate burnout among different medical residency specialties.

METHODS

A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included.

RESULTS

4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%.

CONCLUSION

The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties.

PROSPERO REGISTRATION

CRD42018090270.

The Correlation of Stress in Residency With Future Stress and Burnout: A 10-Year Prospective Cohort Study

BACKGROUND

Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout.

OBJECTIVE

We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout.

METHODS

A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003-2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice.

RESULTS

From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P < .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028).

CONCLUSIONS

We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.

Gender, Marital Status, and Children as Risk Factors for Burnout in Nurses: A Meta-Analytic Study

The correlation between the burnout syndrome and sociodemographic variables in nursing professionals has been widely studied though research results are contradictory. The aim of this study was to assess the impact of gender, marital status, and children on the dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and personal accomplishment) in nursing professionals, as measured with the Maslach Burnout Inventory. The search was performed in May 2018 in the next databases: CINAHL, CUIDEN, Dialnet, Psicodoc, ProQuest Platform, OVID Platform, and Scopus with the search equation ("Maslach Burnout Inventory" OR "MBI") AND "nurs*", without using any search restriction. The sample was n = 78 studies: 57 studies for gender; 32 for marital status; 13 for having children. A statistically significant relation between depersonalization and gender (r = 0.078), marital status (r = 0.047), and children (r = 0.053) was found. A significant relation was also found between emotional exhaustion and children (r = 0.048). The results showed that being male, being single or divorced, and not having children were related to the highest levels of burnout in nurses. Moreover, these relations could be accentuated by the influence of moderator variables (age, seniority, job satisfaction, etc.), which, in combination with the previously mentioned significant relations, should be evaluated in the design burnout risk profiles for nursing professionals.

Prevalence of Burnout Among Physicians: A Systematic Review

Importance

Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.

Objective

To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.

Data Extraction and Synthesis

Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.

Main Outcomes and Measures

Point or period prevalence of burnout assessed by questionnaire.

Results

Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.

Conclusions and Relevance

In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.

Resident Preferences for Program Director Role in Wellness Management

BACKGROUND

Burnout and depression are prevalent among resident physicians, though the supportive role of the program director (PD) is not well defined.

OBJECTIVE

To understand the residents' view of the residency program director's role in assessing and promoting resident wellness.

METHODS

A single institution survey of all house staff was conducted in 2017. Rates of burnout and depression were identified via the 2-item Maslach Burnout Inventory (MBI) and the Patient Health Questionaire-2 (PHQ-2), respectively. Residents then qualified their preferences for various assistance services and for the role of their program directors in assisting them.

RESULTS

One-hundred sixty-one of 202 (79.7%) residents completed the survey. The rate of depression was 28%. Rates of emotional exhaustion and depersonalization (2-item MBI) were 44 and 62%, respectively. Only 4% of respondents had used the Employee Assistance Program (EAP) in the prior 12 months. Eighty-two percent of residents were in favor of PDs inquiring about wellness regardless of their job performance and only 1% of residents stated the PD should not inquire about wellness at all. Thirty-three percent of residents reported that they would be likely to contact EAP on their own if they felt unwell. Significantly more residents (62%) reported being more likely to contact EAP if recommended by their PD (33 vs 62%, p < 0.001%). Important perceived barriers to seeking assistance were lack of time (65%), lack of knowledge of how to contact EAP (41%), and concerns about appearing weak (35%).

CONCLUSIONS

Despite a high prevalence of burnout and depression, residents are unlikely to seek help on their own. Program directors have an important role in assessing and promoting the wellness of their residents. The majority of residents wants their PD to inquire about wellness and may be more likely to seek and receive help if recommended and facilitated by their PD.

The burnout phenomenon among student radiographers: a single centre experience

OBJECTIVES

Burnout syndrome is a condition that may occur not only for staff in human service sectors/jobs, involving intensive interactions with others, but also people that are engaged in activities psychologically similar to work, such as students. Radiographers in training suffer double stress, first linked to the status of being a university student and secondly as early career workers who have relations with the public of the health system. Aim of our study was to investigate the prevalence and levels of burnout syndrome among radiographers in training in an University Hospital.

METHODS

In order to gain a better understanding of nature of the burnout syndrome a modified version of Maslach's questionnaire (investigating three areas: emotional exhaustion, depersonalization and reduced personal accomplishment), was administered to two groups selected from a cohort of radiographers University students (from the 1st and 3rd year of course).

RESULTS

62/62 questionnaires were completed, returned and analysed. The research outcomes highlighted a clear difference between group I and group II in relation to one of the three areas of the Maslach's model: "depersonalization" (p<0.001). Moreover, the third year students group presented a significantly higher risk to develop burnout. On the other hand, the third area examined, the reduced personal accomplishment domain, was surprisingly high even among first-year students.

CONCLUSIONS

The research outcomes seem to suggest that the presence of emotional burnout, or risk of burnout, among third year students is statistically significant, compared to the first year students, being a significant aspect to investigate further in this class of students. It is also assumed that the high degree of "past failures, feeling of self failure" observed among all student, is related to a feeling of poor efficacy and poor self worth that appear to grow from the beginning of the course. This topic needs further investigation in the light of the result of this study.

Emotional Wellness of Current Musculoskeletal Radiology Fellows

RATIONALE AND OBJECTIVES

Burnout is a psychological syndrome composed of emotional exhaustion, depersonalization, and sense of lack of personal accomplishment, as a result of prolonged occupational stress. The purpose of our study was to determine the prevalence of burnout among current musculoskeletal radiology fellows and to explore causes of emotional stress.

MATERIALS AND METHODS

A 24-item survey was constructed on SurveyMonkey using the Maslach Burnout Inventory. We identified 82 musculoskeletal radiology fellowship programs. We recruited subjects indirectly through the program director or equivalent.

RESULTS

Fifty-eight respondents (48 male, 10 female) identified themselves as current musculoskeletal radiology fellows and completed the survey. Comparison of the weighted subscale means in our data to the Maslach normative subscale thresholds for medical occupations indicates that musculoskeletal radiology fellows report relatively high levels of burnout with regard to lack of personal accomplishment and depersonalization, whereas emotional exhaustion levels in our sample are within the average range reported by Maslach. Although male musculoskeletal radiology fellows experience relatively high levels in two of the three dimensions of burnout (depersonalization and personal accomplishment), female musculoskeletal radiology fellows experience relatively high burnout across all three dimensions. Job market-related stress and the effort required providing care for dependents significantly affect personal accomplishment. Conversely, imbalances in the work-life relationship and feelings of powerlessness are significantly associated with depersonalization and emotional exhaustion.

CONCLUSIONS

Musculoskeletal radiology fellows report relatively high levels of burnout. Because the consequences of burnout can be severe, early identification and appropriate intervention should be a priority.

Burnout in the Plastic Surgeon: Implications and Interventions

A career as a plastic surgeon is both rewarding and challenging. The road to becoming a surgeon is a long arduous endeavor and can bring significant challenges not only to the surgeon but their family. A study by the American College of Surgeons (ACS) suggested that over 40% of surgeons experience burnout and a recent survey of American Society of Plastic Surgeons (ASPS) showed that more than one-fourth of plastic surgeons have signs of professional burnout. Burnout is a state of physical and mental exhaustion. The three main components of burnout are emotional exhaustion, depersonalization, and reduced personal accomplishment. Exhaustion occurs as a result of emotional demands. Depersonalization refers to a cynical, negative or a detached response to patient care. The reduced accomplishment refers to a belief that one can no longer work effectively. There has been a recent explosion in the literature characterizing burnout within the surgical profession. Reports of burnout, burnout victims, and burnout syndrome are filling the medical literature, books, blogs, and social media across all different specialties. Burnout in a plastic surgeon has negative and potentially fatal repercussions to the surgeon, their family, their patients, their staff, colleagues, coworkers, and their organization. To date, there are a limited number of publications addressing burnout in the plastic surgery community. The goals of this paper are to review the symptoms of burnout, its effect on plastic surgeons, and discuss potential solutions for burnout prevention and physician wellness.

Impostor syndrome and burnout among American medical students: a pilot study

OBJECTIVES

To describe levels of burnout and impostor syndrome (IS) in medical students, and to recognize demographic differences in those experiencing burnout and IS.

METHODS

Anonymous survey administered online in 2014 that included demographic data, the Maslach Burnout Inventory and an IS screening questionnaire. Main outcome measures were level of burnout, and presence or absence of imposter syndrome. The presence of IS and burnout components were analyzed across age, gender, race, year of training, intention to pursue fellowship training, and greater than one year of work experience outside of medicine using chi-squared tests. The association between burnout and IS was also compared using chi-squared tests.

RESULTS

One hundred and thirty-eight students completed the questionnaire. Female gender was significantly associated with IS (χ²₍₃₎=10.6, p=0.004) with more than double the percentage of females displaying IS than their male counterparts (49.4% of females versus 23.7% of males). IS was significantly associated with the burnout components of exhaustion (χ² ₍₂₎=5.9, p=0.045), cynicism (χ²₍₂₎=9.4, p=0.004), emotional exhaustion (χ²₍₂₎=8.0, p=0.018), and depersonalization (χ² ₍₂₎=10.3, p=0.006). The fourth year of medical school was significantly associated with IS (χ²₍₃₎=10.5, p=0.015).

CONCLUSIONS

Almost a quarter of male medical students and nearly half of female students experience IS and IS was found to be significantly associated with burnout indices. Given the high psychological morbidity of these conditions, this association cannot be ignored. It behooves us to reconsider facets of medical education (i.e. shame-based learning and overall teaching style) and optimize the medical learning environment.

Prevalence and implications of Truman symptoms in subjects at ultra high risk for psychosis

Preliminary qualitative research has suggested that patients with early stages of psychosis and those at Ultra High Risk (UHR) may experience "Truman symptoms" (TS). This study is an exploratory investigation of TS in a sample of 26 UHR subjects and 14 matched controls (HC) recruited from three prodromal and early intervention clinics and its relation with clinical features, depersonalization and basic self-disturbances. The UHR were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS), Social and Occupational Functioning Assessment Scale (SOFAS), the Positive and Negative Syndrome Scale (PANSS), the Cambridge Depersonalization Scale (CDS) and the Examination of Anomalous Self Experiences (EASE) checklist. In our sample, TS were specific (TS absent in HC) and highly prevalent (50%) in UHR subjects. We found a significant difference in EASE total scores across HC, UHR with TS and without TS but post-hoc analyses showed similar scores in the two latter groups. The presence of TS in our UHR sample was associated with significant higher PANSS general psychopathology but with non-significant difference in the CAARMS, CDS and SOFAS scores. This study of TS in UHR subjects suggested that they might be prevalent and specific of this population.

Prevalence of burnout among Irish general practitioners: a cross-sectional study

BACKGROUND

Burnout constitutes a significant problem among physicians which impacts negatively upon both the doctor and their patients. Previous research has indicated that burnout is prevalent among primary care physicians in other European countries and North America. However, there is a paucity of research assessing burnout among Irish general practitioners and examining predictive factors.

AIMS

To report the findings of a survey of burnout among Irish general practitioners, and assess variables related to burnout in this population.

METHODS

An online, anonymous questionnaire was distributed to general practitioners working in the Republic of Ireland.

RESULTS

In total, 683 general practitioners (27.3 % of practising Irish general practitioners) completed the survey. Of these, 52.7 % reported high levels of emotional exhaustion, 31.6 % scored high on depersonalisation and 16.3 % presented with low levels of personal accomplishment. In total, 6.6 % presented with all three symptoms, fulfilling the criteria for burnout. Emotional exhaustion was higher among this sample than that reported in European and UK studies of burnout in general practitioners. Personal accomplishment was, however, higher in this sample than in other studies. Multiple regression analyses revealed that younger age, non-principal status role, and male gender were related to increased risk of burnout symptoms.

CONCLUSIONS

The symptoms of burnout appear prevalent among Irish general practitioners. This is likely to have a detrimental impact both upon the individual general practitioners and the patients that they serve. Research investigating the factors contributing to burnout in this population, and evaluating interventions to improve general practitioner well-being, is, therefore, essential.

Prevalence and correlates of depersonalization in students aged 12-18 years in Germany

BACKGROUND

Depersonalization (DP) involves unpleasant experiences of detachment from one's sense of self or unreality in the environment. DP may occur in a broad range of conditions, among healthy persons due to sleep loss, drug induced, secondary to anxiety disorders or primary in depersonalization disorder. Although DP has an early age of onset, little is known about the prevalence and correlates of DP among adolescents.

METHODS

Between January and June 2011, we conducted a questionnaire-based representative survey of pupils aged 12-18 years in the federal state Rhineland-Palatinate of Germany. The final sample comprised 3,809 pupils. We analyzed the prevalence of depersonalization and its correlates regarding sociodemographic characteristics, substance abuse, global mental distress and resilience factors.

RESULTS

One-third of the sample showed severe global mental distress, and 11.9 % were in the range of clinically significant depersonalization. Depersonalized students were less often living with both parents (67.3 vs. 75.7 %), came more often from an disadvantaged socioeconomic background, had a very severe level of global mental distress (comparable to psychiatric inpatients), were more often smoking and abusing cannabis and they suffered from specific impairments regarding social insecurity, global self-efficacy and active coping abilities.

CONCLUSIONS

Experiences of depersonalization were very common among adolescents and may indicate an increased risk for poor academic achievement and mental health in the long term. Prospective studies are needed to investigate the course and clinical relevance of depersonalization for the development of the adolescents.

Underlying construct of empathy, optimism, and burnout in medical students

OBJECTIVE

This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students.

METHODS

Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model.

RESULTS

Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization).

CONCLUSIONS

Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.

[Work ability, psycho-physical health, burnout, and age among nursery school and kindergarten teachers: a cross-sectional study]

INTRODUCTION

Although well-being and psychophysical health of nursery school and kindergarten teachers have important implications also on the health and well-being of their recipients, studies dedicated to these workers are quite rare, particularly in Italy.

AIM

The aim of the study was to observe psychophysical health conditions in a sample of nursery school and kindergarten teachers employed in the Education Services Division of the Municipality of Turin.

METHOD

The study was cross-sectional; 884 self-reporting questionnaires were distributed and 734 teachers (representing 53% of those employed at the Education Services of the Municipality of Turin) correctly filled out the questionnaire.

RESULTS

Respectively 53.4% and 50% of participants reported medium or high levels of emotional exhaustion and depersonalization, while 18.5% showed low levels of personal accomplishment. Responders reported moderate levels of work ability in 38.9% and poor levels in 5.6%. The majority of the respondents (98.7%) did not report depressive symptoms; 42.9% of the sample suffered moderate to severe limiting musculoskeletal pain. Age and profession were associated with emotional exhaustion, personal accomplishment, and musculoskeletal pain. However, work ability and depression were only associated with age. No associations were found with depersonalization.

CONCLUSIONS

The present study shows that health conditions of nursery school and kindergarten teachers were critical and that age contributed to the explanation of these conditions.

Empathy and burnout among physicians of different specialities

AIM

The aim of this study was to assess the level of empathy and burnout among physicians of different specialization, as well as to determine whether a correlation existed between the level of empathy and burnout.

MATERIALS AND METHOD

Seventy-one physicians took part in the study - 25 women (35.2%) and 46 men (age between 25 to 68 years). The physicians were either employed in hospitals, outpatient clinics or university departments in Krakow. The participants were asked to fill out a personal questionnaire, the Maslach Burnout Inventory (MBI) and the Emotional Empathy Scale (EES) as well as describe four chosen tables from the Thematic Apperception Test (TAT).

RESULTS

The average empathy score for the whole group was 14.3 (SD ± 6.4). The average levels of each of the burnout (according to MBI) elements for the whole group were 21.72 for emotional exhaustion, 9.62 for depersonalization and 29.07 for loss of personal accomplishment. For the whole group a negative correlation was noted between loss of personal accomplishment (according to MBI) and the level of empathy (according to EES) (r = -0.23, p <0.05). For the whole group negative correlations were noted between the level of emotional exhaustion, depersonalization and the total level of burnout (according to MBI) and the level of empathy (according to TAT) (r = -0.30, p <0.05; r = -0.39, p <0.01; p = -0.32, p <0.01 respectively).

CONCLUSIONS

Concluding, medical specialists have a significantly higher level of empathy than surgeons and family physicians. It is imperative to remember that increasing depersonalization and emotional exhaustion can have a negative impact on empathy.

Deliberate self-harm behavior among Italian young adults: correlations with clinical and nonclinical dimensions of personality

This study aims to explore rates of deliberate self-harm (DSH) behaviors and their psychological and psychopathological correlates within a sample of nonclinical young adults (N = 365; 63% women; M age = 23 ± 4.06). Participants completed the Deliberate Self-Harm Inventory and other self-report questionnaires assessing clinical (borderline personality, dissociative, and depersonalization traits) and nonclinical (body perception, behavioral inhibition and activation, cognitive emotional regulation, and the Big Five traits) dimensions of their personality. The rate of DSH in the present sample was 39%, comparable to that found in previous studies of young adults in other countries. Further, consistent with past research, DSH was found to be associated with clinical dimensions of personality pathology, including borderline personality and dissociative symptoms. Finally, results revealed an association between DSH and nonclinical dimensions of personality, including the behavioral activation dimension of fun-seeking, more negative body perception and lower body protection, the use of more nonadaptive cognitive strategies for regulating emotions, higher levels of openness to experience, and lower levels of emotional stability. This pattern of results is consistent with those found for other impulsive behaviors and impulse control disorders.

[Job satisfaction, job burnout and their relationships with work'and patients' characteristics: a comparison between intensive care units (ICU) and not-intensive care units (not-ICU)]

INTRODUCTION

Health worker's population is espoused to high level of stress, and several studies highlight differences between intensive care units (ICU) and non-intensive care unit (non-ICU). Particular features of the job in ICU concern responsibilities for critically patients, highly advanced technology and need for quick decision.

AIMS

Aims of this study are: (1) to examine differences between ICU's and not-ICU's workers on several dimensions describing work environment and workers' health; (2) investigate which specific work conditions have a role in determining psychological work reactions in ICU's and not-ICU's workers.

METHOD

144 ICUs' and not-ICU's 114 workers employed in an Italian Hospital filled out a questionnaire concerning decision authority, autonomy, colleagues' and supervisors' support, physical and cognitive demands as antecedents; job satisfaction and job burnout (EE, DP) as consequences.

RESULTS

1) MANOVA highlighted how ICU workers reported significantly higher scores on depersonalization, job satisfaction, aggressive customers, while physical demands and proportionate customer expectations were significantly higher for not-ICU workers; (2) Six Multiple Linear Regressions were carried out. Those indicated decision authority, autonomy and supervisors' support as predictors of emotional exhaustions in ICU. In not-ICU only cognitive demands and colleagues' support are significant predictors. Depersonalization is predicted in ICU by colleagues' support. Predictors of job satisfaction both in ICU and not-ICU are: decision authority and colleagues support.

CONCLUSION

Current study highlighted several differences among ICU and non-ICU workers' referred to work environment and psychological reactions.

[Burnout syndrome among medical residents during the influenza A H1N1 sanitary contigency in Mexico]

OBJECTIVE

To measure the degree of stress among medical residents at a Third Level Hospital in Mexico City during the sanitary contingency caused by the AH1N1 influenza virus.

METHODS

A transversal descriptive study with a non-probabilistic sample of 99 medical residents with different fields of specialization related to respiratory medicine. Researchers applied the Maslach Burnout Inventory questionnaire to evaluate three dimensions: emotional fatigue, depersonalization, and personal fulfillment. The survey was self-administered and anonymous, and the study was conducted during the first AH1N1 influenza virus outbreak (April 23 to May 10, 2009). During that period, the hospital underwent a process of reorganization that included cancelling vacation periods for all medical residents and adjusting duty rosters.

RESULTS

The highest proportion of medical residents with burnout syndrome was those in their second year of specialization in the area of pneumology. Results also showed that medical residents under 30 years of age had a higher probability of presenting burnout syndrome. No significant differences were found regarding the residents’ place of origin.

Depressive phenomenology in regard to depersonalization level

BACKGROUND

It has been found that in patients suffering from unipolar depression, associated depersonalization symptomatology is more intense compared to healthy controls, and also that there is a positive correlation between depression and depersonalization. According to data that may be found in the literature, there is a relatively high prevalence of depersonalization symptomatology in unipolar depressions. Our study was aimed at finding whether the presence of depersonalization was related to a specific phenomenological expression of depressive symptomatology in unipolar depression.

SUBJECTS AND METHODS

The study included 84 subjects suffering from unipolar depression without psychotic features. Based on the Cambridge Depersonalization Scale (CDS) score, the subjects were divided into two groups - a group with associated depersonalization (CDS>or=70) (40 subjects) and a group with subsyndromal depersonalization (CDS<70) (44 subjects), the later one being treated as a control group. The groups were compared in regard to the intensity of depressive symptomatology, depressive symptoms frequency and the depressive symptoms duration. The General Socio-Demographic Questionnaire, the Cambridge Depersonalization Scale and The Patient Health Questionnaire - 9 were used.

RESULTS

The depressive patients with depersonalization had predominantly severe episodes, almost all patients had feelings of sadness, insomnia, and decrease of energetic potentials. The biggest difference between the groups, in terms of greater number of manifest symptoms in the patients with depersonalization, was for psychomotor disturbances (agitation or retardation), insomnia, decrease of energetic potentials and concentration. At the same time, 75% of the subjects with associated depersonalization had anhedonia, sadness/dysphoria, insomnia and decrease of energetic potentials continuously present. Unlike this group, the control group subjects experienced sadness, appetite problems, concentration and motor behavior changes almost half as frequently. Particularly significant were the differences regarding suicidal thoughts. It was shown that in the group with depersonalization there was a higher percentage of patients with suicidal thoughts, mostly continuously present, which represent a significant suicidal risk factor.

CONCLUSION

Unipolar depression, associated with depersonalization is more severe in its intensity .It has a bigger number of manifest symptoms which have a tendency to continuous duration. A special focus is on the negative impact on the occurrence and lasting presence of suicidal thoughts.

Burnout, perceived stress, and depression among cardiology residents in Argentina

OBJECTIVE

Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes.

METHODS

The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory.

RESULTS

One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group.

CONCLUSION

Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.

Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms

This two-stage study was undertaken to assess the extent and nature of Critical Incident Stress (CIS) amongst frontline staff in a large ambulance service in Ireland. In Stage One, 63% (112/180) of participants completed a Screening Questionnaire and the GHQ-12. In Stage Two, 27 participants, who had experienced a critical incident (CI) during the previous year completed several measures to assess PTSD symptomatology, burnout, health-related Quality of Life, and dispositional optimism. Eighty-one per cent (80/94) of the Stage One group reported that their health had been affected by a CI; 42% (44/106) were identified as 'cases' on the GHQ-12. Stage Two results indicated that 12 participants had PTSD symptoms while this entire group showed moderate levels of emotional exhaustion and depersonalization, despite experiencing high levels of personal accomplishment and optimism. The findings suggest a high prevalence of CIS among ambulance personnel in Ireland and a significant impact on overall health and wellbeing. This has important implications for the effective management of CIS and suggests an important role for occupational health and organizational psychologists in providing routine support to ambulance service staff andpossibly other emergency services personnel.

[The burnout syndrome among doctors and nurses]

The burnout syndrome is a complex of symptoms which are related to psychological, behavioral and physiological man's functioning. Recently, the spread of a burnout syndrome significantly increases. As Polish examinations show it is a serious danger among nurses and doctors.

THE AIM OF THE STUDY

To estimate the presence and the level of the burnout syndrome intensity among nurses and doctors. The second aim was to confirm the connections between symptoms of a burnout syndrome and the internal locus of control. Material and methods. 55 doctors and 53 nurses who worked full-time in hospitals in tbdi and in Social Assistance House were examined. Questionnaire of burnout syndrome Ch. Maslach (MBI) and Questionnaire of Locus of control--I-E Scale W. Gliszczyńska were used.

RESULTS

Among doctors and nurses all three factors of burnout syndrome were presented: emotional exhaustion (WE), low level of personal satisfaction from work (ZA) and depersonalization (DP). Nurses in comparison to doctors have a higher level of the emotional exhaustion, a lower level of an involvement in work and a lower level of an internal locus of control.

CONCLUSIONS

Executed research supplied the proofs which confirmed a view that the burnout syndrome is most popular among nurses and doctors. Our results indicate that the burnout syndrome escalates among nurses in comparison to doctors and its influence of work functioning is essential.

[Depersonalization crisis: between acute anxiety and psychosis]

AIMS

The depersonalization is a clinical condition of frequent observation that occurs often in the late adolescence and among the young adults. This condition most of the time causes anguish justified from the gravity of the symptomatic perception, involving consequently a series of clinical problems, not last the answer that such condition generates in the observer: answer not only aware, that influences strongly the diagnostic interpretation and the therapeutic approach.

MATERIALS AND METHODS

We tried to investigate this clinical condition within a sample of 267 subjects, 120 of them examinated in our outpatients ambulatory of psychotherapy and 147 examinated in E.R. and in inpatients unit.

RESULTS

The percentage of patients with depersonalization, similarly to other studies, is quantitatively different in the two samples. However, what seems obvious is that if the differences for what concerns the frequency and the symptomatic intensity are rather marked, otherwise for what concerns the psychodinamic aspect the differences appears less sharp.

CONCLUSIONS

This observation puts in evidence, on the model of many international studies about the latent psychosis, that in psychiatry at the seriousness of the psychodynamic and prognostic aspects not always corresponds the seriousness of the symptomatic aspects.

Depersonalisation/derealisation symptoms and updating orientation in patients with vestibular disease

BACKGROUND

Patients with vestibular disease have an increased rate of reporting symptoms of depersonalisation/derealisation (DD) and similar symptoms can be provoked in healthy subjects during caloric vestibular stimulation.

OBJECTIVE

To assess the relationship between DD symptoms in patients with peripheral vestibular disease and their ability to update orientation in the environment.

METHODS

Sixty healthy subjects and 50 patients with peripheral vestibular disease completed a DD questionnaire (Cox and Swinson, 2002) and a General Health Questionnaire (GHQ)-12 (Goldberg and Williams, 1988). This was followed by a test of updating spatial orientation in which subjects were exposed to 10 manually driven whole body rotations of 45 degrees, 90 degrees or 135 degrees in a square room, which contained distinctive features on the walls, in such a way that the features and corners subtended 45 degrees with respect to the subject. After each rotation subjects reported which wall or corner they were facing. Estimation error was calculated by subtracting the reported rotation from the actual rotation.

RESULTS

DD scores were significantly higher in vestibular patients than in healthy subjects (p<0.05, t test). In patients, the lowest symptom scores and the lowest estimation errors were found in those with a unilateral canal paresis without balance symptoms whereas the highest scores and largest estimation errors were found in those with bilateral vestibular loss (p<0.05, ANOVA). Across all patients, DD scores were related to estimation errors (adjusted r2 = 0.25, p<0.05, ANCOVA).

CONCLUSIONS

Patients with peripheral vestibular disease have a deficit in the ability to update orientation on the environment and a high prevalence of DD symptoms, which may imply a high order effect of the vestibular impairment. Derealisation symptoms in vestibular disease may be a consequence of a sensory mismatch between disordered vestibular input and other sensory signals of orientation.

Observations on burnout in family medicine and psychiatry residents

OBJECTIVE

To investigate the relationship between burnout, work environment, and a variety of personal variables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians.

METHODS

Between 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction.

RESULTS

Female residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t=3.37, p=0.001). Parenting was associated with lower Depersonalization (t=3.98, p<0.001) and Emotional Exhaustion (t=2.59, p=0.011). Residents from the United States culture reported higher Depersonalization and Emotional Exhaustion (t=-3.64, p<0.001; t=-3.85, p<0.001). On the Work Environment Scale, residents from United States culture reported less Task Orientation and Control but higher Work Pressure (t=2.89, p=0.005; t=2.24, p=0.027; t=-2.79, p=0.006). Psychiatry residents reported less burnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t=2.49, p=0.014: t=2.05, p=0.042) and higher Physical Comfort on the Work Environment Scale (t=-2.60, p=0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t=3.41, p=0.001; t=2.38, p=0.019; t=2.27, p=0.025).

CONCLUSION

This study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout, the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.

[A meta-analysis of job burnout using the MBI scale]

BACKGROUND AND AIM

The aim of this study was to investigate the theoretical dimensionality of burnout measurement (MBI). The objective of the study was to check the working hypothesis according to which the subscales of the Maslach Burnout Inventory (MBI) such as "emotional exhaustion" and "cynicism" (depersonalization) were not correlated with that of "personal achievement" (professional efficacy). To do so, we performed a meta-analysis [Maslach and Jackson, The Maslach Burnout Inventory, 1981, 1986].

METHODS

The sample included 12,112 participants (sample size range from 100-3312 participants; estimated mean=448.59; standard deviation=648.51). Doctheses, Francis, Interscience, Kluweronline, Medline, PsycInfo, and ScienceDirect were searched to identify papers. Exploring references identified 83 publications (1998-2001). Two keywords were used: "Maslach Burnout Inventory" and "organizational stress". The criteria for this meta-analysis included: using the MBI "human services survey (HSS)" for professional care givers, "educators' survey (ES)" for professional educators, "general survey (GS)" for other workers).

RESULTS

About 58% of the population concerned professional caregivers, 13% professional educators, 11% social workers, and 18% correctional officers and other workers. In this meta-analysis, effect sizes should be reported with the number of studies and confidence intervals to test the consistency and reliability of the mean estimated (effect size). In this case, each correlation can be corrected. The meta-analysis can therefore be conducted on this corrected correlation. The aim will be to control any artefact and sampling error. Meta-analysis showed that the value of the corrected correlation is not always negative in the case of a relation between the dimension of "emotional exhaustion" and "personal achievement" (professional efficacy). In the case of the dimension "emotional exhaustion" and "cynicism" (depersonalization), we observed that the value of the corrected correlation studies and confidence intervals showed that this dimension was always correlated positively in the studies included. For the relationship between the value of corrected correlation studies and confidence intervals of the dimension of "cynicism" (depersonalization) and "personal achievement" (professional efficacy), the studies included showed that they were always correlated negatively. These results confirm the hypothesis studied.

CONCLUSION

The study revealed two points: (1) the homogeneity of the studies included concerning the fact that assessment of emotional exhaustion and cynicism (depersonalization) are always correlated positively; (2) the heterogeneity of the studies included concerning the fact that personal achievement is correlated with the other subscales of burnout (MBI). This study confirms the hypothesis.

Mental health and related factors among massage practitioners with visual impairment

The purpose of this study was to explore the mental health conditions and related factors among 155 visually impaired massage practitioners chosen from alumni lists of ten schools for the visually impaired in Japan. It was thought massage practitioners with visual impairment did not suffer burnout and depression because their mean scores indicated "no problem". However, their mean score for anxiety was high compared with previous studies. Gender and level of education showed no significant differences on anxiety and depression. Higher scores for anxiety and depression correlated inversely with age. Scores of depersonalization, anxiety, and depression were significantly higher and those of personal accomplishment lower for unmarried subjects compared to those who were married. Scores of emotional exhaustion, anxiety, and depression were significantly higher in persons who were able to read written text compared to those who read Braille only. Massage practitioners with visual impairment working at hospitals, medical clinics, and nursing homes revealed significantly higher daily client turnover, emotional exhaustion, and depersonalization compared to those who established their own massage clinics. It was thought that massage practitioners who were young and unmarried, had slight visual impairment, high client turnover, hectic relationships between clients, little autonomy at work, and worked at medical-related workplaces were prone to burnout. It is suggested that this group of massage practitioner requires periodic education about stress management techniques and more social support.

Prevalence of the burnout syndrome among Brazilian medical oncologists

INTRODUCTION

Burnout syndrome which is prevalent among oncologists is characterized by three aspects: emotional exhaustion, depersonalization and low personal accomplishment. The purpose was to evaluate prevalence of the burnout syndrome among Brazilian medical oncologists and the variables that correlate with its presence.

METHODS

A survey was conducted with members of the Brazilian Society of Medical Oncology (SBOC) who received three questionnaires (general, Maslach burnout questionnaire and an opinion survey) mailed to all 458 members.

RESULTS

Response rate was of 22.3%. According to the criteria proposed by Grunfeld, which consider burnout present when at least one of the aspects is severely abnormal, prevalence of this syndrome was 68.6% (95% confidence interval, CI: 58.68% to 77.45%). By multivariate analysis having a hobby/physical activity, a religious affiliation, older age, living with a companion and rating vacation time as sufficient were correlated significantly and independently with burnout syndrome.

CONCLUSIONS

The burnout syndrome is prevalent among Brazilian oncologists. Oncologists having sufficient personal and social resources to engage in a hobby, physical activity, have enough vacation time and religious activities are at lower risk of developing burnout.

Association between burnout and anger in oncology versus ophthalmology health care professionals

The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.

Gender differences in psychiatric symptoms related to suicidal ideation in Japanese patients with depression

Recent figures show that more than 30,000 people suicide each year in Japan, and that many of them are considered to suffer from depression. In addition, the suicide rate among Japanese women has been shown to be higher than in other countries. However, it is not clear whether the psychiatric symptoms leading to suicide differ by gender. The authors examined gender differences in psychiatric symptoms related to suicidal ideation (SI) in Japanese patients with depression. Study subjects were 199 new patients (66 men and 133 women) who were diagnosed with a major depressive disorder. SI and psychiatric symptoms were assessed by several psychological tests using questionnaires. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) with an adjustment for all relevant factors simultaneously. The stepwise method was also used for selecting variables. In univariate analysis, several psychosocial factors such as self-reproach, derealization, depressive moods, depersonalization, and anxiety traits were statistically significantly associated with SI in both men and women. However, multivariate analysis using the stepwise method distinguished gender differences. Low social/family support and depersonalization were statistically significantly associated with SI in men, while depressive moods and an anxiety state were significantly associated with SI in women. The relation between derealization and SI was statistically significant in women but not significant in men.

[Prevalence of burnout among anesthesiologists at Hospital Universitario Virgen Macarena de Sevilla]

Burnout, characterized by emotional exhaustion, depersonalization, and lowered sense of professional accomplishment, is a consequence of chronic stress. Few studies have been published on burnout in anesthesiology even though this specialty is considered particularly stressful. We surveyed members of the department of anesthesiology and postoperative care in our hospital, using an anonymous questionnaire including items on social and personal characteristics and the Spanish language version of the Maslach Burnout Inventory. Forty-valid questionnaires were returned, for a response rate of 69.4%. Mean (SD) scores were 19.5 (9.5) points for emotional exhaustion, 7.4 (5.5) for depersonalization, and 32.5 (9.1) for professional accomplishment. We detected high levels of emotional exhaustion in 19.5% of the anesthesiologists and of depersonalization in 31.7%. Scores reflecting low levels of sense of personal accomplishment were recorded for 41.4%. Scores for concern on at least 1 subscale were noted for 58.3% of the anesthesiologists, on 2 subscales for 21.8%, and on 3 subscales for 12.1%. No significant differences were detected in relation to gender, age, stage in professional life, or employment status. Burnout levels in our department are similar to those reported for anesthesiologists in other countries and detectably lower than those of other specialties in Spain.

Depersonalisation/derealisation symptoms in vestibular disease

BACKGROUND

Depersonalisation is a subjective experience of unreality and detachment from the self often accompanied by derealisation; the experience of the external world appearing to be strange or unreal. Feelings of unreality can be evoked by disorienting vestibular stimulation.

OBJECTIVE

To identify the prevalence of depersonalisation/derealisation symptoms in patients with peripheral vestibular disease and experimentally to induce these symptoms by vestibular stimulation.

METHODS

121 healthy subjects and 50 patients with peripheral vestibular disease participated in the study. For comparison with the patients a subgroup of 50 age matched healthy subjects was delineated. All completed (1) an in-house health screening questionnaire; (2) the General Health Questionnaire (GHQ-12); (3) the 28-item depersonalisation/derealisation inventory of Cox and Swinson (2002). Experimental verification of "vestibular induced" depersonalisation/derealisation was assessed in 20 patients and 20 controls during caloric irrigation of the labyrinths.

RESULTS

The frequency and severity of symptoms in vestibular patients was significantly higher than in controls. In controls the most common experiences were of "déjà vu" and "difficulty in concentrating/attending". In contrast, apart from dizziness, patients most frequently reported derealisation symptoms of "feel as if walking on shifting ground", "body feels strange/not being in control of self", and "feel 'spacey' or 'spaced out'". Items permitted discrimination between healthy subjects and vestibular patients in 92% of the cases. Apart from dizziness, caloric stimulation induced depersonalisation/derealisation symptoms which healthy subjects denied ever experiencing before, while patients reported that the symptoms were similar to those encountered during their disease.

CONCLUSIONS

Depersonalisation/derealisation symptoms are both different in quality and more frequent under conditions of non-physiological vestibular stimulation. In vestibular disease, frequent experiences of derealisation may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference which makes the patient feel he or she is detached or separated from the world.

Stress and burnout among Portuguese anaesthesiologists

BACKGROUND AND OBJECTIVE

Anaesthesiology is considered a stressful occupation. Our purpose was to assess stress and burnout among Portuguese anaesthesiologists.

METHODS

A cross-sectional survey based on an anonymous questionnaire was sent to all Portuguese anaesthesiologists registered by the Portuguese Medical Association. Data on patient characteristics and professional variables, perceived stress (Perceived Stress Scale), the subscale of work satisfaction of the Pressure Management Indicator scale, burnout (Maslach Burnout Inventory) and main stress factors were collected. The proportion of participation was 31.8%.

RESULTS

The average value of perceived stress scale was 24.0 (range: 0-56). Among the 263 anaesthesiologists, 57.9% experienced emotional exhaustion, 44.8% lack of personal accomplishment and 90.9% depersonalisation. Lack of personal accomplishment increased with number of children among women but not among men; depersonalisation was more frequent among anaesthesiologists working in community hospitals and anaesthesiologists with leadership functions experienced less professional stress.

CONCLUSION

There are stress conditions and burnout amongst Portuguese anaesthesiologists. The prevalence of depersonalisation was extremely high in the studied sample. Emotional exhaustion is partially explained by high perceived-stress and low satisfaction with organisation in the job according to Pressure Management Indicator scale.

Depersonalization in psychiatric patients: a transcultural study

There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences.

[Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale]

INTRODUCTION

The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research.

METHODS

This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS).

RESULTS

38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively).

CONCLUSION

The Spanish version of the CDS has good reliability and validity, similar to the original instrument.

Emotional burn-out in official teachers, Medellín, Colombia, 2005

OBJECTIVE

Exploring signs of emotional and physical weakness or Burnout syndrome in qualified teachers in Medellin, Colombia, 2005.

METHODS

A cross-sectional study was applied to a random bi-stage sample of 239 teachers who filled in a questionnaire by themselves to explore demographic, work and social variables and dimensions of the Burnout syndrome, according to the Maslach Burnout Inventary (MBI).

RESULTS

The findings showed that 23.4% of the sample presented signs of Burnout and a further 23.4% were at risk of suffering it; emotional weakness and depersonalisation were present in both subgroups.

CONCLUSIONS

A relationship between Burnout signs and some of the variables studied was found. It is suggested that personal, family and social variables potentially associated with the syndrome should be explored more deeply.

Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity

OBJECTIVE

To investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults in the community.

METHOD

Psychiatric interviews were administered to a sample of 658 adult participants in the Children in the Community Study, a community-based longitudinal study.

RESULTS

Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders were to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders were to have DD.

CONCLUSIONS

DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders.

[Dissociative disorders]

There are problems with dissociative and conversion disorders with respect to classification, diagnosis, and therapeutic strategies which can only be understood in the historic context of hysteria. Even current diagnostic systems such as the DSM-IV and ICD-10 differ in the classification of such disorders. High prevalence rates ranging from 3% in the general population to 30% in clinical samples underscore their clinical relevance, and traumatic experiences play a major role in the pathogenesis. High rates of comorbid psychiatric disorders, the tendency to chronicity, and concepts of somatization (particularly in patients with conversion disorders) complicate psychotherapeutic approaches. Depending on the treatment goals, both psychodynamic and cognitive-behavioral methods can be applied, supplemented by specific techniques from trauma therapy, e.g. EMDR.