Stress-coping styles of 459 emergency care physicians in Germany

Risk and protection factors of mental stress among medical staff in the third year of the COVID-19 pandemic

Background

The COVID-19 pandemic placed an extraordinary burden on health care workers (HCW), who are reported to suffer from great mental stress. The current study investigates the mental health of HCW in the later phases of the pandemic.

Methods

HCW completed the following questionnaires online (06/2021-02/2022, N=159): demographics (age, gender, profession, ward), Impact of Event Scale (IES-R, posttraumatic stress), State Trait Anxiety Inventory (STAI-S, state anxiety), stress-coping questionnaire (SVF-78), and bespoke corona-specific stress and protective-factor questions (5 items each). We used factor analysis to test scale properties and regression-type methods (t-tests, ANOVA, multiple regression) for hypothesis tests and effect-size estimation.

Results/discussion

Mental stress in HCW is influenced by similar factors as described for earlier phases. However, differences to earlier phases were found in ward affiliation which is no longer a variable of concern for explaining differences in mental health of HCW. Further, even if nurses are the occupational group with the highest mental stress as in prior research, detailed analysis shows that medical specialists with close proximity to patients with a high-level of responsibility are the most burdened sub-group. Unlike nurses, they suffer from high levels of anxiety in addition to high levels of post-traumatic and COVID-specific stress. Analyses showed further that COVID-specific stress is the strongest predictor of mental stress, wherein COVID-specific stress factors remain the same as reported in literature on the early pandemic phases. HCW showed to use still more positive than negative coping strategies. Negative strategies increased as expected mental stress, whereas positive strategies alleviated only anxiety. Additionally, we found that doctors benefited from many protective factors while nurses had access to fewer protective factors like earlier waves.

Conclusion

Data show that HCW still suffer from mental stress in the third year of the pandemic. HCW of all hospital wards may be affected by mental stress and need attention and protective measures. Medical specialists are the most burdened subgroup. Detailed analyses show that properties other than occupation, gender, or ward affiliation are more appropriate to evaluate mental stress of HCW. The findings have implications for developing specialized protection strategies for the post-pandemic phase and future pandemics.

Validation of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Background

Preoperative anxiety is an unpleasant state of tension that may impact patients’ post-operative pain and satisfaction. The level of preoperative anxiety should be routinely identified. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-reported questionnaire that is used to quickly assess preoperative anxiety and information needs with good psychometric properties.

Objectives

To validate the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to explore coping strategies used by patients in dealing with surgery and anesthetic.

Methods

The cross-cultural validation of APAIS involved the translation of a Chinese version of APAIS and an investigation of its psychometric properties and clinical applicability. Forward-back translation and a pilot study were performed to produce a Chinese adaptation of APAIS. The inpatients of the orthopedic, otolaryngology, and general surgery department scheduled for general anesthesia surgery were enrolled to complete psychometric testing. The reliability was assessed using Cronbach’s alpha. Exploratory factor analysis and confirmatory factor analysis were calculated to assess construct validity. The criteria validity was analyzed using the correlation between APAIS and State-trait anxiety inventory-state (STAI-S) and Visual analogue scale-anxiety (VAS-A). Coping styles were evaluated using the Medical Coping Modes Questionnaire (MCMQ) score that covered three domains: confrontation, avoidance, and resignation. The impact of different coping styles on patients’ anxiety was explored.

Results

A total of 204 valid questionnaires were collected the day before surgery. Cronbach’s alpha coefficients were 0.862 for the anxiety scale and 0.830 for the information scale. Exploratory factor analysis with oblique rotation revealed two factors that explained 76.45% of the total variances. A confirmatory factor analysis showed a two-factor model with an adequate model fit (root mean square error of approximation: 0.073, goodness-of-fit: 0.966). The APAIS anxiety score significantly correlated with STAI-S (r = 0.717, P < 0.01) and VAS-A (r = 0.720, P < 0.01). For the three coping strategies, preoperative anxiety had a low correlation with confrontation (r = 0.33, P < 0.01) and resignation (r = 0.22, P < 0.05).

Conclusions

The Chinese version of APAIS is a valid and reliable instrument for assessing preoperative anxiety. Use of this measurement tool for Chinese patients is feasible and shows promising results.

Stress coping styles among anaesthesiology and intensive care unit personnel - links to the work environment and personal characteristics: a multicentre survey study

BACKGROUND

High levels of stress among anaesthesiology and intensive care unit workers are commonly reported. Personnel in these units are prone to stress because of specific characteristics of their work. Their development of skills to cope with stress may affect their psychophysical condition and, consequently, patient safety.

OBJECTIVES

The aim of this study was to define the coping styles of anaesthesiology and intensive care unit personnel and to evaluate the connections between the work environment as well as personal characteristics and the dominant coping styles.

METHODS

Anaesthesiology and intensive care unit personnel from 15 selected Polish hospitals were surveyed using the Coping Inventory for Stressful Situations, which examines task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The Perceived Stress Scale was used to assess stress levels.

RESULTS

The analysis included 425 successfully completed surveys. The examined population was divided into two groups: Group N comprised 311 nurses (73.18%) and group P comprised 114 physicians (26.82%). For 167 participants (39.29%), the dominant coping style was defined. The most common style was the task-oriented coping style; it was dominant in 96 participants (22.58% of the entire examined population). This style was significantly predominant among men. The domination of some coping styles coexisted with marital status, number of children and financial situation. The occurrence of different coping styles did not significantly differ among workers at different-sized hospitals, with different job seniority or with different living locations. Perceived stress was correlated with all coping styles.

CONCLUSIONS

Work-related stress among anaesthesiology and intensive care unit workers is an important problem. Further investigations of stress levels and the causes and effects of stress in this population are necessary.

Le syndrome postgarde de nuit chez les médecins urgentistes : caractéristiques et facteurs influençants

Introduction : Les urgentistes connaissent une privation de sommeil en lendemain de garde. Beaucoup ont des perceptions ou des comportements inhabituels que nous appelons syndrome post-garde de nuit (PGN). L’objectif principal était de caractériser le syndrome PGN des urgentistes. Les objectifs secondaires étaient d’établir une note évaluant le syndrome PGN et de déterminer les facteurs influençant ce syndrome PGN.

Méthode : Étude prospective de cohorte, observationnelle, multicentrique, auprès des urgentistes du Gard et de l’Hérault entre janvier et juin 2017. Deux questionnaires informatiques anonymes étaient diffusés aux structures d’urgences du Gard et de l’Hérault. En journée normale, hors sortie de garde, un questionnaire colligeait les symptômes ressentis habituellement en lendemain de garde, à coter entre 0 et 10. En sortie de garde, un autre questionnaire s’intéressait au ressenti de la garde réalisée et aux caractéristiques de cette garde. Les médecins étaient encouragés à répondre aux deux questionnaires.

Résultats : Cent treize médecins (45 %) ont répondu, 67 (59 %) à distance d’une garde et 46 (41 %) en post-garde immédiat. Le syndrome PGN comprend des symptômes somatiques (échelle visuelle analogique (EVA) = 5 [2–8]), comportementaux (EVA = 7 [3–8]), liés à l’humeur (EVA = 7[5–8]) et psychiques (EVA = 6 [4–8]). Ces symptômes en post-garde immédiat étaient ressentis de manière moins importante que lorsque décrit à distance (respectivement p = 0,001, p <0,001, p < 0,001, p = 0,002). Les gardes de SMUR (service mobile d’urgence et de réanimation) et de traumatologie étaient associées à un syndrome PGN moins marqué (respectivement p =0,035 et p = 0,02) que les gardes des filières médico-chirurgicales.

Conclusion : Il s’agit de la première évaluation du syndrome PGN chez les urgentistes français. Les symptômes en sont moins importants en post-garde immédiat. Les gardes de traumatologie et de SMUR semblent mieux tolérées.

Burnout and gender in surgical training: A call to re-evaluate coping and dysfunction

BACKGROUND

Physicians experience burnout and mental illness at significantly higher rates than the general population, with sequelae that negatively affect providers, patients, and the healthcare system at large. Gender is rarely considered in characterizing the problem or vetting interventions.

METHODS

Using data from a recent national survey and a longitudinal pilot study of general surgery residents, we examined gender variation in burnout and distress.

RESULTS

In the national survey, male residents had higher depersonalization and female residents had higher alcohol misuse, with a significant association between alcohol misuse, high depersonalization and low anxiety not seen in males. In the longitudinal pilot study, males' burnout scores were higher and had a greater contribution from depersonalization. Both males and females had increasing prevalence of high depersonalization over the intern year.

CONCLUSIONS

Residency affects males and females differently in ways that merit further investigation and better understanding to effectively address burnout and distress.

Kinds of individuals defined by patterns of variables

This paper argues that investigators should consider replacing the popular practice of comparing individuals varying in gender, social class, and/or ethnicity on one or more continuous measures with a search for kinds of individuals defined by patterns of properties that include not only their values on outcome measures but also their gender, social class, and ethnicity. Investigators who believe that a particular predictor contributes to an outcome independent of the gender, class, or ethnicity of the participants often implement statistical procedures that promise to remove the contributions of the above categories. These analyses lead to misleading conclusions when the controlled category is correlated with the dependent measures. The final sections summarize the properties of genders, classes, and ethnic groups that make distinctive contributions to many psychological outcomes. The paper ends by noting that a society's ethical beliefs constitute a defensible basis for ignoring the biological properties associated with these categories in order to allow members of these groups access to whatever educational or occupational goals they desire.