Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden

Predictors of nurses' work-related mental health during the COVID-19 pandemic: a paired follow-up study

Nurses are essential pillars of society, providing care for the sick. It is crucial for society to ensure that nurses have favorable working conditions, as they face a heightened risk of negative psychological conditions such as depression, anxiety, stress, and emotional exhaustion due to the demanding nature of their work. The strain on healthcare staff, particularly during the COVID-19 pandemic, has underscored these challenges. This study aimed to identify predictors of work-related mental health issues in nurses' work environments. In 2017, a questionnaire was distributed to 9,219 Swedish nurses, with 4,962 responses received. The questionnaire was redistributed during the pandemic in 2020, and 3,107 nurses responded. However, due to missing data and some nurses previously reporting a mental health diagnosis, only 2,030 questionnaires were included in the study. Among these, 143 nurses reported experiencing work-related mental health problems. The data was analyzed by logistic regression analysis, and 6 out of the 24 statements investigated were statistically significant (p < 0.05), i.e., there was a longitudinal association between nurses' work situation and their mental health problems. The six statements were "I do not feel I get enough rest/recuperation between work shifts", "The work pace in my daily work is too high", "I do not feel I have enough support from my coworkers", "I do not experience joy in my daily work", "I do not feel like my daily work is meaningful", and "I do not get enough opportunities at work to utilize my skills and knowledge".

Conclusions

This study revealed that work pace, recovery, support from colleagues, joy, meaningfulness, and development opportunities at work are particularly important for nurses' mental health. Actions in those areas are needed for nurses to have a sustainable work situation.

Problem drinking and comorbidity with mental ill health: a cross-sectional study among healthcare workers in Sweden

AIMS

Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden.

METHODS

This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (N = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList-Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking.

RESULTS

The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout.

CONCLUSIONS

This study demonstrated that ~3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.

Maintaining operability at a high personal cost - a mixed method study on maternal healthcare workers' experiences during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic forced leaders and employees in health care services to take difficult decisions to manage risks associated with employee health and the organizations' functioning. This study aims to identify the changes in employee working routines, job demands, and job resources within Swedish maternal healthcare during the COVID-19 pandemic, and how these changes affected workload and health.

METHODS

Data were derived from the longitudinal COPE Staff study involving midwives and physicians within maternal healthcare. Three focus group discussions with midwives and physicians (n = 13), and open-ended survey responses (n = 604) during the third wave of the pandemic (January to May 2021) were analyzed using deductive content analysis based on the Job Demands-Resources model. Quantitative measures of workload and burnout from three survey waves, both during the pandemic (January to May 2021 [n = 782] and January to March 2022 [n = 503]) and after the pandemic (February to March 2023 [n = 759]), were analyzed.

RESULTS

Multiple changes in working routines were implemented to adhere to national and local guidelines aiming to decrease the spread of Sars-CoV-2. As a result, midwives and physicians experienced increased job demands, including an increased workload and higher emotional and cognitive demands. To balance these demands, new working routines were introduced, and managers increased their efforts to communicate and support the employees. Collegial support also grew. When surveyed, however, most of the maternal healthcare workers said they experienced a high workload. It was found that between 3-7% likely experienced burn out, while another 10% were at risk of burnout during and after the pandemic.

CONCLUSIONS

The pandemic had a large effect on maternal healthcare employees. Strategies and adaptations on an organizational, managerial, and individual level played an important role in modifying the impact on the organization's operations and employees.

Contextualising the job demands-resources model: a cross-sectional study of the psychosocial work environment across different healthcare professions

BACKGROUND

The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative.

AIM

Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers.

METHOD

Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector.

RESULTS

The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions than registered nurses working in the public sector. The situation for nursing assistants was reversed.

CONCLUSION

Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care.

Associations between job demand-control-support and high burnout risk among physicians in Sweden: a cross-sectional study

BACKGROUND

The knowledge about job demands, control, and support, and their potential associations with burnout risk among physicians in Sweden, is limited. This study aimed to explore (i) factors of the JobDemand-Control-Support (J-DCS) model across different groups of physicians in Sweden, (ii) their association with high burnout risk, and (iii) the potential buffering impact of job control and support.

METHODS

Cross-sectional data from the Swedish Longitudinal Occupational Health in Healthcare Survey (LOHHCS) study cohort was used. In 2021, a total of 2032 respondents submitted questionnaire data comprising J-DCS measures (i.e., job demands, workplace control and task-level control, and social support from peers and managers). Burnout risk was measured using the Burnout Assessment Tool. Binary logistic regression models were used to investigate the associations between the J-DCS variables and high burnout risk. Interaction analysis was performed to explore any moderation of the associations.

RESULTS

Job demands were significantly associated with increased odds of high burnout risk (odds ratio (OR) 2.71, 95% confidence interval (CI) 1.91-3.84. Workplace control (OR 0.50, 95% CI 0.35-0.71) and peer support (OR 0.61, 95% CI 0.48-0.77) were significantly associated with reduced odds of high burnout risk. The interaction analysis showed no significant moderation of the association between job demands and high burnout risk by either peer support or workplace control, and no buffering impact was found.

CONCLUSION

Job demands were associated with high burnout risk among physicians in Sweden. Although workplace control and peer support had inverse associations with high burnout risk, no moderation or buffering impact on the association between job demands and high burnout risk was found. Longitudinal studies are needed to confirm these associations.

Associations between effort-reward imbalance and risk of burnout among Swedish physicians

BACKGROUND

The high prevalence of burnout among Swedish physicians may have several possible effects on individuals and society. However, further investigations of work-related factors associated with the risk of burnout among Swedish physicians are needed.

AIMS

We aimed to study the associations between psychosocial work factors, based on the effort-reward imbalance (ERI) model, and the risk of burnout among Swedish physicians.

METHODS

A representative sample of 7200 Swedish physicians was invited in 2021. Data were gathered through questionnaires, with a response rate of 41%. Logistic regression models were used to study the associations between exposure to ERI and the risk of burnout.

RESULTS

Approximately 62% of Swedish physicians were exposed to a high ERI. Exposure to a high ERI was associated with 11 times increased risk (95% confidence interval 6.5-20.0) of burnout in adjusted models. Large variations in the prevalence of ERI and risk of burnout across sociodemographic and occupational factors were identified, particularly across different clinical specialties.

CONCLUSIONS

A majority of Swedish physicians were exposed to high levels of work-related stress, strongly associated with an increased risk of burnout. This population-based cross-sectional study underlines the need to further study variations of work-related stress across clinical specialties and to monitor occupational health among physicians longitudinally.

Development and Psychometric Test of the Salutogenic Survey on Sustainable Working Life for Nurses: Identifying Resistance Resources against Stress

Extensive research shows nurses' work environment to be particularly stressful. This study develops, explores, and psychometrically tests a new profession-specific questionnaire identifying generalised and specific resistance resources, that make it possible to measure resources to manage work-related stress. An exploratory study design was employed. The questionnaire development was inspired by the MEASURE approach and the salutogenic theory of health. Building on the results from a literature review of nursing research and salutogenesis, supplemented by twelve interviews with hospital nurses, an item pool was generated. The first version was pilot-tested in a group of nurses who were studying to become specialist nurses. The second version of the questionnaire was psychometrically tested on a sample of registered nurses in close patient care (n = 475), analysed using confirmatory factor analysis to test seven predefined domains of the questionnaire. The analysis revealed a first order seven-domain model of 21 items: job satisfaction, professional role, work motivation, commitment, belonging in the workplace, factors and conditions for remaining in the profession, and workload. The structure of the questionnaire indicates its usefulness in clinical practice for measuring resistance resources.