Changes in alcohol drinking patterns and their consequences among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

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.

Alcohol use disorders among healthcare professionals: a call for action

Alcohol consumption and harmful and hazardous drinking are significant contributors to the global burden of disease, accounting for about 3 million deaths each year globally. Owing to their stressful work environment, healthcare professionals are at a high risk of experiencing physical and mental health problems, particularly alcohol use disorders. Alcohol use disorder among healthcare professionals is of concern as it is associated with decreased work productivity and performance and associated ill health and cognitive impairment. This review, therefore, aimed to gather evidence on the prevalence and associated factors for alcohol use disorders among healthcare professionals. The findings revealed a high prevalence of alcohol use disorders among healthcare professionals, which were worsened during the COVID-19 pandemic. Additionally, there was a glaring dearth of studies conducted in low- and middle-income countries. Urgent interventions and support systems are therefore needed to address these issues. A comprehensive approach, considering individual and organizational factors, alongside evidence-based interventions, training and support programs, can promote workforce well-being and improve the quality of patient care. It is imperative to integrate alcohol use screening, preventive and treatment interventions with primary healthcare and psychiatry services. This will help ensure early diagnosis and timely initiation of preventive and therapeutic measures, reducing the risk of missed opportunities. Furthermore, offering effective human resource management support services to healthcare professionals would significantly enhance their well-being and help prevent alcohol use disorders.

Hazardous, harmful, and dependent alcohol use in healthcare professionals: a systematic review and meta-analysis

Background

Healthcare professionals work in high-pressured and demanding environments, which has been linked to the use of alcohol as a coping strategy. This international review aimed (i) to determine the pooled prevalence of hazardous, harmful, dependent, and frequent binge drinking in healthcare professionals, and (ii) to explore factors associated with variation in these outcomes.

Methods

Scopus, MEDLINE, and PsycINFO were searched from 2003 to 17th November 2022, for studies reporting a prevalence estimate for any outcome among healthcare professionals. Random-effects meta-analyses determined pooled prevalence estimates. Sub-group analyses were conducted, stratifying the meta-analyses by pandemic period vs pre-pandemic period. Meta-regressions explored factors that were associated with variation in the outcomes. PROSPERO (CRD42020173119).

Results

After screening 9,108 records, 64 studies were identified as eligible. The pooled prevalence was 19.98% [95% Confidence Intervals [CI]: 16.05-24.23%] for hazardous alcohol use (K = 52), 3.17% [95% CI: 0.95-6.58%] for harmful drinking (K = 8), 14.59% [95% CI: 7.16-25.05%] for dependent drinking (K = 7), and 17.71% [95% CI: 8.34-29.63%] for frequent binge drinking (K = 11). The prevalence of hazardous drinking was greater during the pandemic (28.19%) compared with pre-pandemic estimates (17.95%), though this was not statistically significant (p = 0.049). Studies including all hospital staff (32.04%) showed higher prevalence estimates for hazardous drinking compared with studies of doctors (16.78%) and nurses (27.02%).

Conclusion

Approximately one fifth of healthcare professionals drink to hazardous levels, with higher prevalence estimates observed during the COVID-19 pandemic. It may be that healthcare professionals used alcohol to cope with the additional trauma and stressors. Further research is needed to investigate whether this is sustained in the post-pandemic period.

Changes in alcohol-related perceptions and behavior among Vietnamese early career doctors after graduation

BACKGROUND: Vietnamese medical students believe becoming “strong” drinkers is important for their future careers working as doctors. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner. OBJECTIVE: This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation. METHODS: In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data. RESULTS: Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors’ drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment. CONCLUSIONS: Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

Substance use among vocational trainees in Australia: differences between medical specialties

BACKGROUND

There have been few large-scale nationally representative studies on the prevalence of substance use among doctors. Additionally, the association of different medical specialties with the use of different substances requires further research.

AIMS

This study aimed to investigate how the use of alcohol, tobacco and illicit drugs varied between junior doctors enrolled in different specialty training programmes.

METHODS

A secondary analysis was conducted on a national survey of 12,252 Australian doctors. The population of interest was junior doctors currently enrolled in a specialty training programme, termed Vocational Trainees (VTs) (n=1890, 15.4% overall sample). Self-report prevalence of current alcohol, tobacco and illicit drug use were assessed, and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine the association between specialty and substance use, adjusting for demographic characteristics when required.

RESULTS

One in six VTs reported hazardous levels of alcohol use (n=268, 17.3%). After adjusting for confounders, the association between the prevalence of alcohol use and the specialties of emergency medicine/ICU (OR=2.15, 95% CI:1.40-3.32, p<0.001), anaesthetics (OR=2.53, 95% CI:1.35-4.76, p=0.004) and obstetrics/gynaecology (OR=1.89, 95% CI:1.19-3.02, p=0.007) remained significant. No significant associations were found between tobacco use/illicit drug use/hazardous alcohol use and medical specialty.

CONCLUSIONS

While rates of substance use and hazardous alcohol use in VTs are similar, if not lower, to the general population, it poses a concern that there are higher rates of alcohol use in certain medical specialties. This article is protected by copyright. All rights reserved.

Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic

AIM

Survey alcohol use and misuse among Chinese psychiatrists during the Coronavirus diseases 2019 (COVID-19) pandemic.

METHODS

We conducted a large-scale, nationwide online survey of psychiatrists regarding their alcohol use during the pandemic. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to assess alcohol use and misuse.

RESULTS

Of 3,815 psychiatrists who completed the survey, alcohol use and misus were 47.5% and 8.2%, respectively, and both were significantly higher in males. The majority (59%) reported no change in alcohol use during the pandemic, one-third (34.5%) reported a decrease, and 6.5% reported an increase. Alcohol misuse was associated with middle-age (OR = 1.418), male sex (OR = 5.089), Northeast China (OR = 1.507), cigarette-smoking (OR = 2.335), insomnia (OR = 1.660), and regular exercise (OR = 1.488). A master's degree (OR = 0.714) and confidence in clinical work (OR = 0.610) were associated with less alcohol misuse. Those who reported a decrease in alcohol use during the pandemic were more likely to be male (OR = 2.011), located in Northeast China (OR = 1.994), and feel confident in their clinical work (OR = 1.624). Increased alcohol use was significantly associated with insomnia (OR = 3.139).

CONCLUSIONS

During the COVID-19 pandemic, alcohol use and misuse among Chinese psychiatrists declined. While males were more likely to misuse alcohol, they were also more likely to have reduced their intake. Age, location, and lifestyle factors also predicted alcohol use and misuse. Further examination of specific factors that reduced alcohol use and misuse may help guide public health efforts to sustain the lower rates beyond the pandemic.

Health Professionals' Attitudes Toward Alcoholism and Associated Issues: A Comparative Study in a Brazilian Sample

Attitudes of health professionals have an effect on the quality of care provided to individuals with alcohol use disorders. The identification of health professionals' attitudes supports strategies that promote positive attitudes and improve the quality of the health care provided to this population. This is a descriptive cross-sectional study with 831 health professionals. Data were collected using the scale of attitudes toward alcohol, alcohol use disorder, and individuals with alcohol use disorders. Pearson test, Analysis of Variance, and Bayesian linear regression were used to analyze the data. There was a predominance of positive attitudes among all professional categories, with the exception of attitudes toward the etiology of alcohol use disorder and attitudes toward alcoholic beverages and their use. The respondent's age and professional category influenced his or her attitudes toward alcohol and associated issues. There are differences in the attitudes of professionals from different professional groups, which may contribute to inconsistencies in the care provided for individuals with alcohol use disorders. The results of our study suggest that strategies regarding the training and continuing education of health professionals that consider the particularities of each profession be instituted to improve professionals' attitudes, thus improving their ability to address issues related to alcohol use disorders and encourage alcoholic patients to engage in treatment.

Alcohol Use Among Mental Health Professionals in China: A Nationwide Cross-sectional Survey

AIM

To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems.

METHODS

As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use.

RESULTS

13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206-4.439), being a doctor (OR = 1.259; CI = 1.052-1.506), being divorced or widowed (OR = 1.979; CI = 1.467-2.666), having an associate degree or less (OR = 1.809; CI = 1.040-3.147), working in Northeast China (OR = 1.538; CI = 1.281-1.848) and the habit of smoking (OR = 3.345; CI = 2.280-3.967) were significantly associated with alcohol misuse.

CONCLUSIONS

Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.

Alcohol use and associated factors among physicians and nurses in northeast Brazil

The consequences of alcohol use are closely related to its pattern of intake. The aim of this study is to analyze the pattern of alcohol use by doctors and nurses. Associated co-factors have also been considered. We calculated a representative sample of doctors and nurses from two hospitals in Maranhão, Northeastern Brazil. The Alcohol Use Disorders Identification Test (AUDIT) was employed to assess patterns of alcohol consumption. A score ≥8 was defined as alcohol misuse, and an answer to question number 3 > 1 was indicative of heavy episodic drinking (HED). In order to identify factors associated with HED and alcohol misuse, bivariate and multiple logistic regression analyses were performed with SPSS v20.0. A sample of 510 professionals was examined and 25% of those were abstainers; among those who had drinks containing alcohol, 86% were classified as low-risk alcohol use, scoring lower than 8, while 10.6% of the whole sample was categorized as alcohol misusers, scoring more than 8. The habit of smoking (OR = 6.02; CI: 1.71-21.16), following the Catholic religion (OR = 3.55; CI: 2.47-8.58), and also gender (OR = 3.09; CI: 1.68-5.71) were independently associated with alcohol misuse. HED was found in 14.3%. Younger age (OR = 0.96; CI: 0.92-0.98), male gender (OR = 5.13; CI: 2.55-10.30), the Catholic religion (OR = 3.22; CI: 1.44-7.21), and smoking habits (OR = 5.25; CI: 1.26-21.75) were associated with HED. Therefore, physicians and nurses have a lesser prevalence of abstainers, similar rates of alcohol misuse, and greater prevalence of HED when compared to the general Brazilian adult population. More studies involving these professionals need to be carried out in other Brazilian states in order to determine whether the results can be understood as widespread throughout the country.

Factors influencing doctors' counselling on patients' lifestyle habits: a cohort study

Background

Lifestyle changes are important for prevention and treatment of many common diseases, and doctors have an important role in the lifestyle counselling of patients. It is important to know more about factors influencing lifestyle counselling.

Aim

To investigate the frequency of counselling about physical activity compared to that about alcohol habits; the impact of doctors' own physical activity and alcohol habits on patient counselling about these lifestyle dimensions; and whether perceived mastery of clinical work or vulnerable personality have a confounding or moderating effect on these associations.

Design & setting

In this nationwide cohort survey, a total of 978 doctors in Norway were surveyed by postal questionnaires in 1993/94 and 2014. The response rate was 562/978 (57%).

Method

The outcome variables were questions on frequency of asking about alcohol and exercise habits. Explanatory variables were questions on doctors' own exercise habits, drinking habits (using Alcohol Use Disorders Identification Test [AUDIT]), perceived mastery of clinical work, vulnerable personality, and specialty. Associations were studied by linear regression analysis.

Results

Of the 526 responders, 307 (58%) reported asking usually/often about exercise habits, while n = 140/524 (27%) usually/often asked about alcohol habits. A doctor's own physical activity level was associated with frequency of asking about physical activity (unstandardised regression coefficient [B] = 0.07; 95% confidence intervals [CI] = 0.01 to 0.13). There were no significant associations between doctors' own lifestyle habits and counselling on alcohol habits. Doctors with low levels of vulnerability asked more frequently about physical activity, regardless of their own physical activity habits (F = 2.41, P = 0.048).

Conclusion

Doctors' own lifestyles influenced their preventive counselling about physical activity, but not about alcohol. Vulnerability moderated these effects, indicating the importance of early interventions to help doctors with a vulnerable personality to handle negative criticism from patients.

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study

BACKGROUND

We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking.

METHODS

Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations.

RESULTS

Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness.

CONCLUSIONS

Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.

Substance Use Disorders Among Danish Physicians: An Explorative Study of the Professional Socialization and Management of Colleagues With Substance Use Disorders

AIM

This study has 2 aims. Firstly, we explore and analyze the associations between physicians' unhealthy substance use and various work-cultural and social aspects; secondly, we describe how substance use disorder (SUD defined as by Alcohol Use Disorders Identification Test [AUDIT] and Drug Use Disorders Identification Test [DUDIT]) among colleagues is managed and how physicians seek help.

METHOD

During the spring of 2014, a nationwide cross-sectional study was conducted as an anonymous electronic survey among a randomly weighted sample of medical specialists, junior hospital doctors, and general practitioners in Denmark. A total of 4000 physicians (approximately 1333 from each group) were sampled, and 1943 responded (49%). The survey included the AUDIT, the DUDIT, and questions on health and psychological issues.

RESULTS

Among the physicians in our study, 18.3% had an AUDIT exceeding 8 (hazardous or harmful alcohol use) and 3.2% had a DUDIT exceeding 1. Of these, 12.9% reported that their substance use had negative consequences for their social networks, and 34% to 42% reported no openness about substance use at their workplace. In total, 4 physicians (1%) of the 383 physicians with risky substance use reported to have been in regular treatment for SUDs. Most of the physicians with an unhealthy consumption of substances (78%) reported that it was irrelevant for them to seek help. Half of them reported that they had limited or insufficient knowledge of SUD. Around 55% of the physicians would encourage colleagues with SUDs to seek treatment.

CONCLUSIONS

Around 50% of physicians reported that their "SUD knowledge" was relevant, but limited or not satisfactory. One-third never experienced openness about SUD at work. More than half wished to encourage a colleague with SUD to seek treatment. Three quarters of the physicians with unhealthy substance use reported that they found it irrelevant to seek help.

Assessment of alcohol use in health professionals during the economic crisis

The aim of this study was to investigate the use of alcohol in health professionals during the economic crisis in Greece. The sample included 579 health professionals. Despite the fact that alcohol consumption was low and women held more negative views on the effectiveness of its use compared to men, they consumed more than men both in quantity (mean 1.57 vs 1.46, p=0.291) and in frequency (mean 1.98 vs 1.73, p=0.132). Employees with a higher level of education expressed more opposition to the use of alcohol than those with a basic level of education (93.5% vs 66.7%, p=0.004). There was a significant positive correlation between the amount of alcohol consumed after a stressful event and the frequency with which this amount of alcohol consumption occurred in workers.

Health professionals' alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: a systematic review

Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base.

Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

BACKGROUND

Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described.

METHODS

Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life).

RESULTS

The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = -3.4; p = 0.001), wished own death (t = -3.1; p = 0.002) and had thoughts of taking own life (t = -3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings.

CONCLUSIONS

Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.