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Navinés R, Olive V, Hidalgo-Mazzei D, Langohr K, Vieta E, Martin-Santos R. Burnout in residents during the first wave of the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1286101. [PMID: 38328517 PMCID: PMC10847582 DOI: 10.3389/fpsyt.2023.1286101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The high prevalence of burnout in resident physicians is expected to have increased as a result of the expansion of the pandemic. We conducted a systematic review with a meta-analysis of studies conducted during the first wave of the COVID-19 pandemic on burnout in residents and potential associated risk factors. Methods The search was done in the Web of Science, MEDLINE, Scopus, and Lillac databases (April 2020-October 2021) using a priori protocol based on the PRISMA guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. We estimated the pooled prevalence (95% CI) of burnout and the prevalence ratio (95% CI) of each risk factor associated. Results We included 23 studies from 451 potential initial articles and those written in the English language; all of the collected studies were cross-sectional with anonymous online surveys, involving 4,998 responders (34%), of which 53.2% were female responders, 51% were R1-2, and 71% were in direct contact with COVID-19 patients. Eighty-seven percent presented a low-to-moderate risk of bias. Publication bias was not shown. The estimated pooled prevalence of burnout was 40% (95% CI = 0.26 - 0.57). Burnout was associated with psychiatry history (PR = 4.60, 95% CI = 1.06 - 20.06). There were no differences by gender, civil status, children in-charge, year of residency, or time exposure to COVID-19. Discussion The overall prevalence of burnout in residents during the first wave of the pandemic was in line with the results described in this collective before the pandemic. The presence of a psychiatry history was a potential burnout risk factor, suggesting a high vulnerability during the peak of the stress period and the need to implement mental health surveillance for this subgroup.
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Affiliation(s)
- Ricard Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Victoria Olive
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
- Department of Occupational Risk and Prevention, Hospital Clinic, University of Barcelona (UB), Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Klaus Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona Tech, Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
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Mijić Marić A, Palameta M, Zalihić A, Bender M, Mabić M, Berberović M, Kostić S. Prevalence of burnout among health care workers in the Federation of Bosnia and Herzegovina during the coronavirus disease-2019 pandemic: a cross-sectional study. Croat Med J 2022; 63. [PMID: 36325673 PMCID: PMC9648080 DOI: 10.3325/cmj.2022.63.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the prevalence of burnout syndrome among health care workers in the Federation of Bosnia and Herzegovina (FBiH) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This cross-sectional study was conducted in May and June 2021 using an online survey based on Copenhagen Burnout Inventory. The questionnaire underwent forward and backward translation, preliminary pilot testing, and was assessed for reliability and validity. Personal burnout, work-related burnout, and patient-related burnout were assessed. The survey was sent to the members of the Union of Physicians and Dentists in FBIH, who were asked to forward the link to their medical technicians and nurses. RESULTS A total of 77% of participants experienced some form of burnout. As many as 32% experienced all three forms of burnout. Those actively involved in tackling the COVID-19 pandemic more often experienced burnout. In personal and work-related burnout domains, higher level of burnout was reported among female respondents. Higher work-related and patient-related burnout was reported by physicians compared with medical technicians/nurses. Higher level of patient-related burnout was reported in health care workers aged 30-39 and 50-59 years, among respondents working in primary care, and among physicians. CONCLUSION The majority of health care workers showed moderate or high levels of personal and work-related burnout, with a lower level of patient-related burnout. There is a need for further research into the causes of burnout, as well as for the implementation of organizational interventions aimed to minimize workplace burnout.
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Affiliation(s)
- Ankica Mijić Marić
- Department of Family Medicine, Health Care Center Mostar, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Marnela Palameta
- Department of Family Medicine, Health Care Center Mostar, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Amra Zalihić
- Department of Family Medicine, Health Care Center Mostar, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Bender
- Department of Neurology, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Mirela Mabić
- Faculty of Economics, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Marina Berberović
- University Clinical Hospital Mostar, Emergency Medicine Center, Mostar, Bosnia and Herzegovina
| | - Sandra Kostić
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
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Fumis RRL, Costa ELV, Dal'Col SVC, Azevedo LCP, Pastore Junior L. Burnout syndrome in intensive care physicians in time of the COVID-19: a cross-sectional study. BMJ Open 2022; 12:e057272. [PMID: 35450907 PMCID: PMC9023851 DOI: 10.1136/bmjopen-2021-057272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the prevalence of burnout syndrome among intensive care physicians working in a tertiary private hospital as well as their perceived impact of the COVID-19 pandemic on their life. DESIGN A cross-sectional study. SETTING Intensive care units dedicated to the care of COVID-19 in Hospital Sirio-Libanes, Sao Paulo, Southeastern part of Brazil. PARTICIPANTS Intensive care physicians. INTERVENTIONS Each participant received an envelope with a questionnaire composed of demographic and occupational variables, information related to their personal and professional experiences facing the COVID-19 pandemic and the Maslach Burnout Inventory questionnaire. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome was to assess the prevalence of burnout syndrome among physicians working in an intensive care unit dedicated to the care of COVID-19. RESULTS A total of 51 from the universe of 63 (82%) intensive care physicians participated in the study. Nineteen (37.2%) met the criteria for burnout syndrome. In the three domains that characterise burnout syndrome, we found a low level of personal achievement in 96.1% of physicians interviewed, a high level of depersonalisation in 51.0% and 51.0% with a high level of emotional exhaustion. Decision-making conflicts between the intensive care unit team and other attending physicians were frequent (50% of all conflicts). A third of the participants had been diagnosed with COVID-19, 22 (43.1%) reported having a family member infected and 8 (15.7%) lost someone close to the COVID-19 pandemic. Participants felt that fear of infecting their loved ones was the aspect of their lives that changed most as compared with the prepandemic period. CONCLUSIONS Burnout syndrome was frequent among intensive care unit physicians treating patients with COVID-19 in a large tertiary private hospital. Future studies should expand our results to other private and public hospitals and test strategies to promote intensive care unit physicians' mental health.
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Affiliation(s)
| | - Eduardo Leite Vieira Costa
- Research and Education Institute, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Cardio-Pulmonary Department, University of São Paulo, São Paulo, Brazil
| | | | - Luciano Cesar Pontes Azevedo
- Research and Education Institute, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Emergency Medicine, University of São Paulo, São Paulo, Brazil
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Navinés R, Olivé V, Fonseca F, Martín-Santos R. Work stress and resident burnout, before and during the COVID-19 pandemia: An up-date. MEDICINA CLINICA (ENGLISH ED.) 2021; 157:130-140. [PMID: 35005240 PMCID: PMC8721440 DOI: 10.1016/j.medcle.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Ricard Navinés
- Unidad Funcional de Psiquiatría, Departamento de Medicina, Instituto de Neurociencias, Universidad de Barcelona (UB), Barcelona, Spain.,Societat Catalana de Psiquiatria i Salut Mental (SCPiSM), Barcelona, Spain
| | - Victoria Olivé
- Unidad Funcional de Psiquiatría, Departamento de Medicina, Instituto de Neurociencias, Universidad de Barcelona (UB), Barcelona, Spain.,Servicio de Prevención de Riesgos Laborales, Hospital Clínic, Barcelona, Spain
| | - Francina Fonseca
- Societat Catalana de Psiquiatria i Salut Mental (SCPiSM), Barcelona, Spain.,Grupo de Investigación en Adicciones, Instituto de Investigación Médica Hospital del Mar (IMIM), Universidad Autònoma de Barcelona, Instituto de Neuropsiquiatría y Adicciones (INAD), Red de Trastornos Adictivos (RediTA), Barcelona, Spain
| | - Rocío Martín-Santos
- Grupo de Investigación en Vulnerabilidad, Psicopatología y Género, Servicio de Psiquiatría y Psicología, Programa de Atención al Personal Sanitario, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain.,Unidad Funcional de Psiquiatría, Departamento de Medicina, Instituto de Neurociencias, Universidad de Barcelona (UB), Barcelona, Spain.,Societat Catalana de Psiquiatria i Salut Mental (SCPiSM), Barcelona, Spain
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Daruvala R, Ghosh M, Fratazzi F, Norzan SA, Laha A, Ahmed R, Panda S, Datta SS. Emotional exhaustion in cancer clinicians: A mixed methods exploration. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_168_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Objectives: The aim of the current study was to explore the associations of emotional exhaustion in oncology clinicians and perceptions of doctors about their work–life balance in a developing country. Methods: The current study used quantitative semi-structured interviews and qualitative in-depth interviews to explore emotional exhaustion and burnout in doctors in a tertiary care cancer center. Sociodemographic details, Maslach Burnout Inventory, and Patient Health Questionnaire were used for the quantitative analysis. Results: Increased work pressure (adjusted odds ratio [AOR]: 5.39, 95% confidence interval [CI]: 2.01–14.47, P < 0.01), reduced job-related satisfaction (AOR: 3.56, 95% CI: 1.37–9.25, P < 0.01), being a woman (AOR: 3.4, 95% CI: 1.2–9.5, P < 0.01), and having higher anxiety and depression scores (AOR: 2.89, 95% CI: 1.11–7.46, P = 0.03) were independently associated with higher levels of emotional exhaustion. In the qualitative interviews, many doctors felt working in oncology a satisfying as well as stressful experience. Dealing with palliative and end-of-life situations and counseling patients and their family members about various treatment options contributed to the stress. Male and female clinicians viewed work–life balance differently. Female doctors charted a larger area of influence for which they felt responsible in work and life. Conclusion: Increased work pressure, reduced job satisfaction, and increased affective symptoms contribute to emotional exhaustion in oncology clinicians, and the risk increases especially in female doctors. Having gender-sensitive and employee-friendly policies will likely help in having a nurturing work environment.
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Affiliation(s)
- Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Major Arterial Road, Newtown, Kolkata, India
| | - Maupali Ghosh
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Major Arterial Road, Newtown, Kolkata, India
| | - Francesca Fratazzi
- Newcastle University Business School, Newcastle University, Newcastle NE1 7RU, United Kingdom
| | - Siti Adibah Norzan
- Department of Combined Honours, Newcastle University, Newcastle Upon Tyne, Newcastle NE1 7RU, United Kingdom
| | - Anirban Laha
- Department of Internal Medicine, Tata Medical Centre, Major Arterial Road, Newtown, Kolkata, India
| | - Rosina Ahmed
- Department of Surgical Oncology, Tata Medical Centre, Major Arterial Road, Newtown, Kolkata, India
| | - Samiran Panda
- National AIDS Research Institute, 73, ‘G’-Block, MIDC, Bhosari, Pune, Maharashtra, India
| | - Soumitra Shankar Datta
- Gynaecological Cancer Research Centre, EGA Institute for Women's Health, University College London, London W1T 7DN, United Kingdom
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Khechine W, Ezzaairi F, Sahli J, Belaid I, Daldoul A, Zaied S, Chabchoub I, Ammar N, Hochlaf M, Ben Fatma L, Ben Ahmed S. Burn-out of the Medical Oncology Health Care Professionals
and Associated Factors in Tunisia. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2020-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.
Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.
Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).
Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.
Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.
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[Work stress and resident burnout, before and during the COVID-19 pandemia: An up-date]. Med Clin (Barc) 2021; 157:130-140. [PMID: 34083069 PMCID: PMC8101798 DOI: 10.1016/j.medcli.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
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Alva-Diaz C, Nieto-Gutierrez W, Taype-Rondan A, Timaná-Ruiz R, Herrera-Añazco P, Jumpa-Armas D, Escobedo-Palzae S. Association between daily working hours and depressive symptoms in resident physicians in Peru. ACTA ACUST UNITED AC 2021; 50:22-28. [PMID: 33648691 DOI: 10.1016/j.rcp.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/24/2018] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. METHODS Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. RESULTS The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR=1.11; 95% CI, 1.04-1.17). CONCLUSIONS One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.
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Affiliation(s)
- Carlos Alva-Diaz
- Servicio de Neurología, Departamento de Medicina, Hospital Daniel Alcides Carrión, Callao, Perú; Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú; Red de Eficacia Clínica y Sanitaria, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú.
| | - Wendy Nieto-Gutierrez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú
| | - Raúl Timaná-Ruiz
- Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Percy Herrera-Añazco
- Hospital Nacional Dos de Mayo, Lima, Perú; Universidad San Ignacio de Loyola, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - David Jumpa-Armas
- Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Seimer Escobedo-Palzae
- Sociedad Peruana de Administración en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
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Serling-Boyd N, Miloslavsky EM. Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning. Rheum Dis Clin North Am 2021; 46:73-83. [PMID: 31757288 DOI: 10.1016/j.rdc.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Subspecialty consultation is an increasingly used resource in inpatient medicine. Teaching the primary team is an important element of effective consultation and has many potential benefits. However, within academic medical centers many barriers to effective consultation and the consult learning environment exist. High workload, burnout, inexperience, lack of familiarity between teams, quality of the consult requests, and pushback may impede teaching and learning. Herein, the authors review the role of teaching and learning during consultation, challenges to effective consultation facing fellows, and interventions that can enhance primary team-fellow interactions and learning.
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Affiliation(s)
- Naomi Serling-Boyd
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Eli M Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA.
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Naji L, Singh B, Shah A, Naji F, Dennis B, Kavanagh O, Banfield L, Alyass A, Razak F, Samaan Z, Profetto J, Thabane L, Sohani ZN. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open 2021; 9:E189-E200. [PMID: 33688027 PMCID: PMC8034324 DOI: 10.9778/cmajo.20200068] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice. METHODS We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses. RESULTS In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar. INTERPRETATION Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout. STUDY REGISTRATION PROSPERO no. CRD42018108774.
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Affiliation(s)
- Leen Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
| | - Brendan Singh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Ajay Shah
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Faysal Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Brittany Dennis
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Owen Kavanagh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Laura Banfield
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Akram Alyass
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Fahad Razak
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zainab Samaan
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Jason Profetto
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Lehana Thabane
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zahra N Sohani
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
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11
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Handley NR, Tomescu O, Lopez AM. Well-Being During a Time of Crisis and Beyond: Supporting a Culture of Mindfulness in Oncology Practices. JCO Oncol Pract 2020; 16:713-717. [DOI: 10.1200/op.20.00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nathan R. Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Oana Tomescu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ana Maria Lopez
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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12
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Prentice S, Dorstyn D, Benson J, Elliott T. Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1444-1454. [PMID: 32271234 DOI: 10.1097/acm.0000000000003379] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework. METHOD The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees' burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges' g), comparing trainees' data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression. RESULTS The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns. CONCLUSIONS There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.
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Affiliation(s)
- Shaun Prentice
- S. Prentice is a Master of Psychology (Clinical) and PhD candidate, School of Psychology, University of Adelaide, and research support officer, GPEx, Adelaide, South Australia; ORCID: http://orcid.org/0000-0002-9403-7861
| | - Diana Dorstyn
- D. Dorstyn is senior lecturer, School of Psychology, University of Adelaide, Adelaide, South Australia; ORCID: http://orcid.org/0000-0002-7799-8177
| | - Jill Benson
- J. Benson is senior medical educator, GPEx, and director, Health in Human Diversity Unit, School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Taryn Elliott
- T. Elliott is manager of quality & special projects, GPEx, Adelaide, South Australia
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13
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Kohli D, Padmakumari P. Self-Care, Burnout, and Compassion Fatigue in Oncology Professionals. Indian J Occup Environ Med 2020; 24:168-171. [PMID: 33746430 PMCID: PMC7962510 DOI: 10.4103/ijoem.ijoem_201_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Abstract
Context: With the rising number of cancer cases in India, the stress levels of the treating team have increased. It has affected their self-care and made them susceptible to problems like burnout and compassion fatigue that adversely affect the quality of patient care. Aims: The aim of the study was to assess and compare the levels of burnout, compassion fatigue, and self-care in three groups of oncology professionals (clinical oncologists, nurses, and psychologists). Settings and Design: The study included 134 oncology professionals working in New Delhi, Bengaluru, and Mumbai. Methods and Material: Sociodemographic data sheet, Professional Quality of Life Scale V and Self-Care Assessment Worksheet were used. Statistical Analysis Used: Kruskal-Wallis, Mann-Whitney U test, and Correlation Analysis. Results: The majority of the professionals reported moderate levels of burnout (60.4%) and compassion fatigue (56%). Oncology nurses reported an elevated risk as they scored significantly higher on these domains and had a lower degree of self-care. Interestingly, psychologists reported comparatively lower levels of burnout and compassion fatigue, despite the fact that they interact with the patients at a deeper level, looking after their psychological and emotional needs. Young age and a poor degree of self-care were identified as major risk factors. Conclusions: The moderate levels of burnout and compassion fatigue, though not severe, are a cause of concern and cannot be overlooked. The study highlights the need for self-care in this regard and suggests that individual and institutional level interventions, particularly for nurses and young professionals, would prove useful.
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Affiliation(s)
- Diti Kohli
- Student, M.Sc. Clinical Psychology, Department of Psychology, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - P Padmakumari
- Associate Professor, Department of Psychology, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
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14
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Jalan D, Rubagumya F, Hopman WM, Vanderpuye V, Lopes G, Seruga B, Booth CM, Berry S, Hammad N. Training of oncologists: results of a global survey. Ecancermedicalscience 2020; 14:1074. [PMID: 32863868 PMCID: PMC7434506 DOI: 10.3332/ecancer.2020.1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 01/20/2023] Open
Abstract
While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. In this study, an online survey was distributed through a snowball method for cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs) and high-income countries (HICs) based on World Bank criteria. A total of 273 physicians who were trained in 57 different countries responded to the survey: 33% (90/273), 32% (87/273) and 35% (96/273) in LMICs, UMICs and HICs, respectively. About 60% of respondents were practising physicians and 40% were in training. The proportion of responding trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; p = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; p < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs. Respondents identified several barriers to effective training, including skewed service to education ratio and burnout. With regard to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice and understanding of healthcare systems irrespective of country grouping. In conclusion, the investment in training by the public sector is vital to decreasing the prevalence of self-funding in LMICs. Gaps in research training and enhancement of competencies in research dissemination in LMICs require attention. The instruction on cancer care systems and leadership needs to be incorporated in training curricula in all countries.
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Affiliation(s)
| | | | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario K7L 2V7, Canada
| | | | - Gilberto Lopes
- University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Bostjan Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia 1000
| | | | - Scott Berry
- Department of Oncology, University of Toronto, Toronto ON M4N 3M5, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston ON K7L 5P9, Canada
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15
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THE EVALUATION OF BURNOUT AND COMMUNICATİON SKILLS IN PRIMARY CARE STAFF. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.735875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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16
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Noronha J, Malik A, Bindhulakshmi P, Karimundackal G. Oncology Residency-a Burning Issue, Results of a Questionnaire-Based Survey on Psychological Well-being of Oncology Residents. Indian J Surg Oncol 2020; 11:387-393. [PMID: 33013115 DOI: 10.1007/s13193-020-01183-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022] Open
Abstract
Residency, in particular oncology residency, is a challenging time with extensive academic demands, long working hours, and uncertainty about the future. Our study aimed to evaluate the prevalence and factors associated with burnout, anxiety and depression among oncology residents at a tertiary cancer centre. An anonymised questionnaire-based study was conducted among medical, surgical, paediatric and radiation oncology resident doctors at a tertiary cancer centre in April 2019. We used Copenhagen Burnout Index (CBI) to assess burnout (which includes personal, work-related and patient-related burnout), Patient Health Questionnaire (PHQ9) for depression and Generalised Anxiety Disorder (GAD7) for anxiety. The questionnaire was served to 201 residents. The overall response rate was 70.6%. High personal, work-related and patient-related burnout was identified in 71.1%, 67.6% and 23.2% of the respondents respectively. Medical oncology residents had the highest rate of personal and work-related burnout (95% and 85%) while head and neck oncology residents had the highest rate of patient-related burnout (33.3%). 27.5% of participants were found to have high levels of anxiety on the GAD7 while 14.8% of participants were detected to have a high score on the PHQ9 for depression. High personal burnout and work-related burnout were associated with both high anxiety and depression scores (p < 0.05). There is a high prevalence of burnout, depression and anxiety among oncology residents. With an expected rise in cancer burden in the next decade, psychological issues in caregivers can be expected to increase. Further studies will be needed to determine interventions to reduce psychological distress.
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Affiliation(s)
- Jarin Noronha
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Akshat Malik
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Bindhulakshmi
- Advanced Centre for Women's Studies, Tata Institute of Social Sciences, Mumbai, India
| | - George Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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17
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Kust D, Murgic J, Vukovic P, Kruljac I, Prpic M, Zilic A, Lengyel C, Wdowiak K, Simaskaite L, Mutlu Gunaydin U, Tica Sedlar I, Fountzilas E, Janzic U, Coroian I, Durutovic I, Pellegrino B, Petrova M, Huti E, Napolskaia E, Seruga B, Balenovic A, Frobe A, Luetic K. Oncologist Burnout Syndrome in Eastern Europe: Results of the Multinational Survey. JCO Oncol Pract 2020; 16:e366-e376. [PMID: 32048930 DOI: 10.1200/jop.19.00470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Burnout is defined as a three-dimensional syndrome-emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)-caused by chronic occupational stress. The aim of the current study was to investigate the prevalence of burnout among oncologists in Eastern Europe and to identify the contributing factors. METHODS The study was conducted as an online survey between October 2017 and March 2018. Oncologists (including medical, radiation, clinical, and surgical oncologists) from 19 countries were invited to participate. The survey consisted of 30 questions, including the standardized burnout instrument, Maslach Burnout Inventory, and eight demographic questions. Burnout risk was scored according to the scoring manual for health care workers. RESULTS The study included 637 oncologists. Overall, 28% were at low or intermediate risk and 72% were at high risk for burnout. Forty-four percent of participants were at high risk for EE, 28.7% for DP, and 47.3% for PA. EE risk was associated with female sex. DP risk was highest among clinical and radiation oncologists, whereas PA risk was positively correlated with years of service, percentage of cancer deaths, and availability of the number of oncologists. In multivariate logistic regression analysis, burnout was significantly associated with standardized cancer mortality and fewer years of practice. CONCLUSION Burnout among oncologists in Eastern Europe is high, and younger oncologists are the most vulnerable group. Preventive measures should be taken to address this issue, which negatively affects optimal care delivery and poses a threat to oncologists' health and well-being.
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Affiliation(s)
- Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Petra Vukovic
- Department of Medical Oncology, University Hospital for Tumors, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Ivan Kruljac
- Department of Internal Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Marin Prpic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Zilic
- Intensive Oncology and Supportive Care Department, Clinic For Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Kamil Wdowiak
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland
| | - Lina Simaskaite
- Department of Oncology and Hematology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ulug Mutlu Gunaydin
- Department of Medical Oncology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ivana Tica Sedlar
- Clinic of Oncology, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Elena Fountzilas
- Department of Medical Oncology, Euromedica General Clinic, Thessaloniki, Greece
| | - Urska Janzic
- Medical Oncology Unit, University Clinic Golnik, Golnik, Slovenia
| | - Iulia Coroian
- Medical Oncology Department, Oncology Institute Prof. Dr. I. Chiricuta, Cluj-Napoca, Romania
| | - Ivana Durutovic
- Clinic for Oncology and Radiotherapy, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Mila Petrova
- Department of Medical Oncology, Multi Profile Hospital for Active Treatment Nadezhda, Sofia, Bulgaria
| | - Emiljana Huti
- Department of Oncology, American Hospital Tirana II, Tirana, Albania
| | - Elena Napolskaia
- Outpatient Department, Clinical Scientifical Practical Center of Specialized Kinds of Medical Care (Oncology), Saint Petersburg, Russia
| | - Bostjan Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Ana Frobe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Kresimir Luetic
- Department of Gastroenterology and Hepatology, Clinical Hospital "Sveti Duh," Zagreb, Croatia
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18
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Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2020; 28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf. [PMID: 33409499 PMCID: PMC7785092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.
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Affiliation(s)
- Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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19
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de Matos LBN, Fumis RRL, Nassar Junior AP, Lacerda FH, Caruso P. Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:234-242. [PMID: 31597490 DOI: 10.1177/1937586719878445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors. BACKGROUND There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied. METHODS Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory. RESULTS Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02). CONCLUSIONS Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.
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Affiliation(s)
- Liane Brescovici Nunes de Matos
- Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.,Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de, São Paulo, Brazil
| | | | | | | | - Pedro Caruso
- Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.,Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de, São Paulo, Brazil
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20
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Dubale BW, Friedman LE, Chemali Z, Denninger JW, Mehta DH, Alem A, Fricchione GL, Dossett ML, Gelaye B. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health 2019; 19:1247. [PMID: 31510975 PMCID: PMC6737653 DOI: 10.1186/s12889-019-7566-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Burnout is characterized by physical and emotional exhaustion from long-term exposure to emotionally demanding work. Burnout affects interpersonal skills, job performance, career satisfaction, and psychological health. However, little is known about the burden of burnout among healthcare providers in sub-Saharan Africa. METHODS Relevant articles were identified through a systematic review of PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO). Studies were selected for inclusion if they examined a quantitative measure of burnout among healthcare providers in sub-Saharan Africa. RESULTS A total of 65 articles met our inclusion criteria for this systematic review. Previous studies have examined burnout in sub-Saharan Africa among physicians (N = 12 articles), nurses (N = 26), combined populations of healthcare providers (N = 18), midwives (N = 2), and medical or nursing students (N = 7). The majority of studies assessed burnout using the Maslach Burnout Inventory. The highest levels of burnout were reported among nurses, although all healthcare providers showed high burnout. Burnout among healthcare providers is associated with their work environments, interpersonal and professional conflicts, emotional distress, and low social support. CONCLUSIONS Available studies on this topic are limited by several methodological challenges. More rigorously designed epidemiologic studies of burnout among healthcare providers are warranted. Health infrastructure improvements will eventually be essential, though difficult to achieve, in under-resourced settings. Programs aimed at raising awareness and coping with burnout symptoms through stress management and resilience enhancement trainings are also needed.
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Affiliation(s)
- Benyam W Dubale
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren E Friedman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 505, Boston, MA, 02115, USA
| | - Zeina Chemali
- The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John W Denninger
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darshan H Mehta
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gregory L Fricchione
- The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle L Dossett
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 505, Boston, MA, 02115, USA. .,The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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Pintarić Japec V, Vučemilo L, Kust D, Babacanli A, Dodig D, Štefančić V, Vučur K, Brechelmacher A, Katavić M, Luetić K, Kopjar T. Burnout among Croatian physicians: a cross sectional national survey. Croat Med J 2019. [PMID: 31187954 PMCID: PMC6563170 DOI: 10.3325/cmj.2019.60.255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To investigate the prevalence of burnout syndrome among physicians of all specialties, including residents and non-specialists, on a national level in Croatia. Methods This cross-sectional study, conducted in October 2017, used anonymous online survey based on the Maslach Burnout Inventory Human Services Survey. The Croatian version of the inventory was assessed for acceptability, factorial validity, and reliability. Key dimensions of burnout – emotional exhaustion, depersonalization, and lack of personal accomplishment were assessed. Respondents scoring high for emotional exhaustion or depersonalization were defined as burned-out. Results The response rate was 18% (2557/14 427). Respondents’ median age was 41 years (range 25-80), and 68% (1737/2557) were women. Good sampling adequacy and scale reliability were confirmed. Factorial validity suggested the presence of three overall factors, and no items were eliminated. Sixty-three percent of physicians were burned-out. High score on emotional exhaustion, depersonalization, and reduced personal accomplishment were found in 58%, 29%, and 52% of respondents, respectively. As many as 16% of the respondents simultaneously experienced high levels of all three burnout dimensions. Multivariate logistic regression analysis revealed that residents and physicians in tertiary or primary care were at an increased risk of burnout, while physicians working in institutes were at a decreased risk. Conclusion Active national measures are needed to reduce the high prevalence of burnout among Croatian physicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tomislav Kopjar
- Tomislav Kopjar, Department of Cardiac Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
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22
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Pasqualucci PL, Damaso LLM, Danila AH, Fatori D, Lotufo Neto F, Koch VHK. Prevalence and correlates of depression, anxiety, and stress in medical residents of a Brazilian academic health system. BMC MEDICAL EDUCATION 2019; 19:193. [PMID: 31185960 PMCID: PMC6558838 DOI: 10.1186/s12909-019-1621-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/22/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system. METHODS In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15. RESULTS A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores. CONCLUSIONS Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.
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Affiliation(s)
| | | | - Arthur Hirschfeld Danila
- Instituto de Psiquiatria, Universidade de Sao Paulo, 1967, Oscar Freire, São Paulo, 05409011 Brazil
| | - Daniel Fatori
- Instituto de Psiquiatria, Universidade de Sao Paulo, 1967, Oscar Freire, São Paulo, 05409011 Brazil
| | - Francisco Lotufo Neto
- Instituto de Psiquiatria, Universidade de Sao Paulo, 1967, Oscar Freire, São Paulo, 05409011 Brazil
| | - Vera Hermina Kalika Koch
- Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
- Comissao de Residencia Medica (COREME), Universidade de Sao Paulo, São Paulo, Brazil
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23
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Yates M, Samuel V. Burnout in oncologists and associated factors: A systematic literature review and meta-analysis. Eur J Cancer Care (Engl) 2019; 28:e13094. [PMID: 31090179 DOI: 10.1111/ecc.13094] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/07/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oncologists may be particularly at risk of burnout. This systematic literature review and meta-analysis explores the prevalence of burnout and associated factors in oncologists. METHODS The authors assessed 26 studies that utilised the Maslach Burnout Inventory (MBI) tool to measure burnout. Pooled prevalence rates were calculated via meta-analysis (MetaXL) using random effects models. RESULTS Approximately 5,768 oncologists provided burnout data. A significant number experience burnout as highlighted by the pooled prevalence rates for MBI subscales of: emotional exhaustion at 32%; depersonalisation at 24%; and low personal accomplishment at 37%. Eighteen of the studies reported factors found to be significantly associated with high levels of burnout in oncology physicians. These were grouped into demographic differences, individual factors and work factors. CONCLUSION Burnout was found to affect a significant proportion of oncologists. Burnout was associated with being single, being younger in age, reduced psychological well-being, difficulties outside of work, workplace demands and workplace stress. Burnout has considerable implications for oncology physicians and patient safety. Further insight into individual factors, and factors associated with lower burnout would be beneficial.
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Low ZX, Yeo KA, Sharma VK, Leung GK, McIntyre RS, Guerrero A, Lu B, Sin Fai Lam CC, Tran BX, Nguyen LH, Ho CS, Tam WW, Ho RC. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091479. [PMID: 31027333 PMCID: PMC6539366 DOI: 10.3390/ijerph16091479] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I2 statistic and Cochran's Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0-57.0%, I2 = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28-0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10-0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99-99.45), neurology (71.93%, 95% CI: 65.78-77.39), and general surgery (58.39%, 95% CI: 45.72-70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09-51.58), oncology (38.36%, 95% CI: 32.69-44.37), and family medicine (35.97%, 95% CI: 13.89-66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8-67.85); in several European countries it was 27.72% (95% CI: 17.4-41.11) and in North America it was 51.64% (46.96-56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.
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Affiliation(s)
- Zhi Xuan Low
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Keith A Yeo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Gilberto K Leung
- Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
- Department of Toxicology and Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Anthony Guerrero
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | - Brett Lu
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | | | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Vietnam Young Physicians' Association, Hanoi 100000, Vietnam.
| | - Long H Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.
| | - Wilson W Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore 119228, Singapore.
- Centre of Excellence in Behavioral Medicine, Nguyen Tat Thanh University (NTTU), Ho Chi Minh City 70000, Vietnam.
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Lall MD, Gaeta TJ, Chung AS, Dehon E, Malcolm W, Ross A, Way DP, Weichenthal L, Himelfarb NT. Assessment of Physician Well-being, Part One: Burnout and Other Negative States. West J Emerg Med 2019; 20:278-290. [PMID: 30881548 PMCID: PMC6404708 DOI: 10.5811/westjem.2019.1.39665] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/24/2019] [Accepted: 01/21/2019] [Indexed: 01/08/2023] Open
Abstract
Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting. Part One begins with a discussion of burnout and focuses on assessment tools to measure burnout and other negative states. Part Two of the series examines the assessment of well-being, coping skills, and other positive states.
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Affiliation(s)
- Michelle D Lall
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Theodore J Gaeta
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Emergency Medicine, New York, New York
| | - Arlene S Chung
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Erin Dehon
- University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi
| | - William Malcolm
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Adam Ross
- University of Louisville School of Medicine, Department of Emergency Medicine, Louisville, Kentucky
| | - David P Way
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Lori Weichenthal
- University of San Francisco-Fresno, Department of Emergency Medicine, Fresno, California
| | - Nadine T Himelfarb
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Burnout and Resiliency in Canadian Oncology Residents: A Nationwide Resident and Program Director Survey. Pract Radiat Oncol 2019; 9:e118-e125. [DOI: 10.1016/j.prro.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/11/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022]
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Prevalence of burnout, depression and job satisfaction among French senior and resident radiation oncologists. Cancer Radiother 2018; 22:784-789. [DOI: 10.1016/j.canrad.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
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Paiva CE, Martins BP, Paiva BSR. Doctor, are you healthy? A cross-sectional investigation of oncologist burnout, depression, and anxiety and an investigation of their associated factors. BMC Cancer 2018; 18:1044. [PMID: 30367614 PMCID: PMC6203972 DOI: 10.1186/s12885-018-4964-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose Doctors who work at cancer hospitals are at high risk of developing emotional distress. This study evaluated the prevalence of burnout, anxiety, and depression in a sample of oncologists of various specialties and sought to identify how much of this distress is explained by specific pre-established characteristics. Methods This cross-sectional study used online surveys. Burnout was measured using the Maslach Burnout Inventory (MBI), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). The variables associated with p-values < 0.10 in the univariate analyses were included in blocks of hierarchical binary logistic regression models to identify the predictors of burnout, depression, and anxiety. Results Of the 227 physicians (response rate = 70.5%), 132 (58.1%) were identified as having burnout (high emotional exhaustion [EE] and depersonalization [DP]); furthermore, 28 (12.3%) had depression (HADS-D ≥ 11), and 44 (19.4%) had anxiety (HADS-A ≥ 11). The block of perceptions related to the workplace explained 22.4%, 7.7%, and 10.6% of the variances of burnout, depression, and anxiety, respectively. On the other hand, the outside-of-work characteristics block explained only 3.1%, 13.4%, and 3.4% of the variances of burnout, depression, and anxiety, respectively. Conclusions Work-related stressors are associated with burnout, but few are associated with anxiety and depression. Outside-of-work characteristics explained little of the distress reported by physicians. Strategies focused on perceptions of professional recognition and lower workloads that stimulate positive relationships between doctors and other health professionals are desirable in oncological context. Electronic supplementary material The online version of this article (10.1186/s12885-018-4964-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. .,Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. .,Departamento de Oncologia Clínica, Divisão de Mama e Ginecologia, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil.
| | | | - Bianca Sakamoto Ribeiro Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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29
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Rodrigues Filho EM, Junges JR. Burnout entre médicos intensivistas ou Sociedade do burnout. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018180007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Os médicos que atuam em unidades críticas são propensos a exaustão emocional, manifestações de despersonalização e insatisfação profissional. Essas três manifestações compõem o que foi identificado como burnout e são motivo de crescente preocupação. Neste artigo, os autores revisam a literatura disponível sobre o burnout entre os médicos intensivistas, mas discutem-no sob uma ótica que inclui o problema em uma manifestação mais ampla, relacionada ao culto do desempenho e à subsunção da vida ao capital, entendendo esse fenômeno como relacionado com a sociedade do burnout. Também se discutem iniciativas para combater esse quadro na perspectiva de uma visão ampliada do conceito de biopolítica, especialmente a psicopolítica.
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30
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Gouveia PADC, Ribeiro MHC, Aschoff CADM, Gomes DP, Silva NAFD, Cavalcanti HAF. Factors associated with burnout syndrome in medical residents of a university hospital. Rev Assoc Med Bras (1992) 2017; 63:504-511. [PMID: 28876426 DOI: 10.1590/1806-9282.63.06.504] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine the prevalence of burnout syndrome among resident physicians of various specialties and to evaluate associated factors. Method: The Maslach Burnout Inventory questionnaire and a sociodemographic questionnaire were used to evaluate factors associated with the syndrome. Burnout was defined as the association of high emotional exhaustion, depersonalization and low professional achievement. Multivariate analysis was performed after adjustment of the Poisson model with the identification of risk factors and calculation of prevalence ratios (PR). Of the 250 resident physicians registered with Hospital das Clínicas of Pernambuco, 129 participated in the study. Results: In the three domains that characterize burnout syndrome, we found a low level of professional achievement in 94.6% of resident physicians interviewed, a high level of depersonalization in 31.8%, and 59.7% with a high level of emotional exhaustion. The prevalence of burnout was 27.9%. Having suffered a stressful event in the last six months (PR: 8.10; 95CI 1.2-57.2) and being a student of surgical specialty (PR: 1.99; 95CI 1.2-3.3) were independently associated with burnout. Conclusion: The prevalence of burnout found in resident physicians is in accordance with previous Brazilian studies. Residents of surgical specialties and those who suffered some stressful event were identified as susceptible in this study. The early identification of risk factors is fundamental for the implementation of preventive measures against burnout syndrome.
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Affiliation(s)
- Pedro Alves da Cruz Gouveia
- Internal Medicine Service, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Maria Hosana Chaves Ribeiro
- Internal Medicine Service, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
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Fumis RRL, Junqueira Amarante GA, de Fátima Nascimento A, Vieira Junior JM. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Ann Intensive Care 2017. [PMID: 28639161 PMCID: PMC5479870 DOI: 10.1186/s13613-017-0293-2] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Burnout appears to be common among critical care providers. It is characterized by three components: emotional exhaustion, depersonalization and personal accomplishment. Moral distress is the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. We aimed to estimate the correlation between moral distress and burnout among all intensive care unit (ICU) and the step-down unit (SDU) providers (physicians, nurses, nurse technicians and respiratory therapists). Methods A survey was conducted from August to September 2015. For data collection, a self-administered questionnaire for each critical care provider was used including basic demographic data, the Maslach Burnout Inventory (MBI) and the Moral Distress Scale-Revised (MDS-R). Correlation analysis between MBI domains and moral distress score and regression analysis to assess independent variables associated with burnout were performed. Results A total of 283 out of 389 (72.7%) critical care providers agreed to participate. The same team of physicians attended both ICU and SDU, and severe burnout was identified in 18.2% of them. Considering all others critical care providers of both units, we identified that overall 23.1% (95% CI 18.0–28.8%) presented severe burnout, and it did not differ between professional categories. The mean MDS-R rate for all ICU and SDU respondents was 111.5 and 104.5, respectively, p = 0.446. Many questions from MDS-R questionnaire were significantly associated with burnout, and those respondents with high MDS-R score (>100 points) were more likely to suffer from burnout (28.9 vs 14.4%, p = 0.010). After regression analysis, moral distress was independently associated with burnout (OR 2.4, CI 1.19–4.82, p = 0.014). Conclusions Moral distress, resulting from therapeutic obstinacy and the provision of futile care, is an important issue among critical care providers’ team, and it was significantly associated with severe burnout. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0293-2) contains supplementary material, which is available to authorized users.
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Kanmogne GD, Qiu F, Ntone FE, Fonsah JY, Njamnshi DM, Kuate CT, Doh RF, Kengne AM, Tagny CT, Nchindap E, Kenmogne L, Mbanya D, Cherner M, Heaton RK, Njamnshi AK. Depressive symptoms in HIV-infected and seronegative control subjects in Cameroon: Effect of age, education and gender. PLoS One 2017; 12:e0171956. [PMID: 28231258 PMCID: PMC5322951 DOI: 10.1371/journal.pone.0171956] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/27/2017] [Indexed: 12/03/2022] Open
Abstract
Depression is a leading cause of HIV/AIDS disease burden; it worsens health outcomes and quality of life. Addressing this problem requires accurate quantification of the extra burden of depression to HIV/AIDS in a given population, and knowledge of the baseline depression prevalence in the general population. There has been no previous study of depression in the general Cameroonian population. The current study attempts to address that important need. We used the Beck Depression Inventory-II to assess the prevalence and severity of depressive symptoms in 270 HIV-infected and seronegative Cameroonians. Univariate analyses showed a trend toward higher depressive symptoms among cases, compared to controls (p = 0.055), and among older subjects (>40 years), compared to younger subjects (≤40 years) (p = 0.059). Analysis of depression severity showed that 33.73% of cases had moderate-to-severe depressive symptoms, compared to 19.8% of controls (p<0.01). However, multivariable negative binomial regression analyses showed no effect of age, HIV status, CD4 levels, viral loads, ART, or opportunistic infections on the risk of depressive symptoms. Both univariate and multivariable regression analyses showed significantly higher risk of depressive symptoms among females compared to males; this was significant for both female controls and female cases. Female cases had significantly higher CD4 cell counts and lower viral loads, compared to males. Both univariate and multivariable regression analyses showed that lower education (≤10 years) was associated with increased risk of depressive symptoms. This study shows a high prevalence of depressive symptoms among seronegative controls and HIV-infected Cameroonians. Integrating care for mental disorders such as depression into primary health care and existing HIV/AIDS treatment programs in Cameroon may improve the wellbeing of the general population and could lower the HIV/AIDS burden.
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Affiliation(s)
- Georgette D. Kanmogne
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
| | - Fang Qiu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Félicien E. Ntone
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Julius Y. Fonsah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Dora M. Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Callixte T. Kuate
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Roland F. Doh
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Anne M. Kengne
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Claude T. Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Mariana Cherner
- HIV Neurobehavioral Research Center, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Robert K. Heaton
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, San Diego, California, United States of America
| | - Alfred K. Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
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Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA 2015; 314:2373-83. [PMID: 26647259 PMCID: PMC4866499 DOI: 10.1001/jama.2015.15845] [Citation(s) in RCA: 724] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.
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Affiliation(s)
- Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco A Ramos
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Narinder Bansal
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Rida Khan
- Department of Medicine, Baylor College of Medicine, Texas Medical Center, Houston
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | | | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, Department of Psychiatry, University of Michigan, Ann Arbor
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