Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey

Mental health in midwifery students: A French nationwide survey

BACKGROUND

Poor mental health in health students is a major public health issue, impacting personal quality of life and functioning, curriculum and care quality to patients.

PROBLEM

Few studies to date have examined mental health in midwifery students.

AIM

To evaluate the midwifery students'mental health.

METHODS

An online cross-sectional survey was performed between 02/11/2023 and 11/12/2023. Anonymous questionnaires were sent to midwife students via academic emails by all midwife faculties in France. We assessed the prevalence of current depressive symptoms, current generalised anxiety symptoms, burnout for students in internship, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum with specific questions. Multivariate logistic regression was performed to identify the main factors associated with major depressive disorder and suicidal ideation.

FINDINGS

Among midwifery students, 1920 (response rate: 51.9 %) were included. The prevalences of current depressive symptoms, anxiety symptoms, burnout, 12-month major depressive disorder, and 12-month suicidal ideation were 62 %, 47 %, 44 %, 13 % and 14 %, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19 %, 1.8 % and 0.7 %, respectively. In multivariable analyses, having important financial difficulties and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation.

DISCUSSION

>1 in 10 students suffered from 12-month depression and/or suicidal ideation, and almost half of them expressed various distressing symptoms.

CONCLUSION

These alarming results highlighted the need for interventions to improve mental health in midwifery students, including safer conditions of education and living.

Mental health training for physicians supervising resident physicians: a cluster randomised controlled trial

OBJECTIVE

To evaluate an online training program for physician supervisors with the aim of promoting a mentally healthy workplace by improving their use of both responsive and preventive mental health support strategies.

STUDY DESIGN

Cluster randomised, waitlist-controlled trial.

SETTING, PARTICIPANTS

Royal Australasian College of Physicians fellows who were supervising at least one resident physician in any of the 31 primary health networks in Australia and 20 district health boards in New Zealand (health network clusters).

INTERVENTION

A brief online skills-based mental health training program, comprising twelve modules grouped into three topics: common mental illnesses; helping trainees you are concerned about (responsive strategies); and minimising mental health risks at work (preventive strategies).

MAIN OUTCOME MEASURES

Change between baseline and the 3-month assessment in self-reported recommended supervisor behaviours; differences between intervention and control groups in recommended behaviour scores three weeks, three months, and six months after the program.

RESULTS

Ninety physicians from 20 health network clusters were allocated to the intervention group, 88 physicians from 22 clusters to the control group. Intervention group participants reported greater positive change in behaviour across the study period than those in the control group (mixed model repeated measures analysis, group × time interaction: P < 0.001). The mean change in self-reported supervisory behaviour score was higher for the intervention than the control group at the 3-week (mean difference in score, 1.6; 95% confidence interval [CI], 0.8-2.4), 3-month (0.9; 95% CI, 0.2-1.6), and 6-month assessments (1.9; 95% CI, 1.1-2.7). The mean change in self-reported responsive behaviour score was also greater for the intervention group at the 3-week (mean difference, 2.3; 95% CI, 1.5-3.1), 3-month (1.0; 95% CI, 0.2-1.9), and 6-month assessments (2.0; 95% CI, 1.1-2.9); differences in the mean change in preventive behaviour scores were statistically significant at the 3-week (mean difference, 1.1; 95% CI, 0.1-2.2) and 6-month assessments (1.8; 95% CI, 0.8-2.8), but not the 3-month assessment (0.8; 95% CI, -0.1 to 1.7).

CONCLUSIONS

Brief online mental health training for senior physicians can lead to changes in their self-reported behaviour for supporting the mental health needs of resident physicians. Whether this leads to better mental health for resident physicians should be investigated.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12619001496101 (prospective).

Associations between workplace violence and suicidal ideation among Chinese medical staff: a propensity score matching analysis

Physical and mental health problems had been identified as the negative outcomes of workplace violence (WPV) against medical staff. Considering the proven associations between physical and mental health and suicidal ideation, it is reasonable to assume that WPV may associate with suicidal ideation. However, few studies were conducted to explore the relationship between WPV and their suicidal ideation against medical staff. Based on a cross-sectional design, 3, 426 medical staff working in general hospitals were interviewed in Shandong Province, China. Socio-demographic characteristics, work-related factors, psychological variables, WPV, and suicidal ideation were evaluated. Propensity score matching (PSM) was performed to explore the association between WPV and suicidal ideation. The prevalence of suicidal ideation among medical staff was 9.1% (312/3426), and 52.2% (1788/3426) of medical staff reported the WPV experience. Before PSM, we found that the association between WPV and suicidal ideation was statistically significant (aOR = 1.606, p < 0.01). After PSM, there was a statistically significant correlation between WPV and suicidal ideation (aOR = 1.525, p < 0.01). This study supported the correlations between WPV against medical staff and their suicidal ideation. The results of PSM further implied that WPV might cause suicidal ideation among medical staff. Psychological health, especially for suicidal ideation, should be paid attention for medical staff with WPV experiences.

A scoping review of mental health status in Australian medical students and doctors-in-training (DiT)

Background and Aims

The study and practice of medicine are known to contribute to burnout in medical students and junior doctors. There is limited data on the degree of mental health burden for Australian medical students and doctors-in-training (DiT). This scoping review aims to explore the impact of medical training on the mental health of Australian medical students and DiT. Exploring the mental health landscape across different stages of training will help to establish putative factors underlying psychiatric comorbidities in this demographic.

Methods

The Joanna Brigs Institute (JBI) framework for scoping review was utilized, involving the Population/Concept/Context (PCC) criteria to identify the target population and develop the search strategy. Peer-reviewed articles, published in English from 2012 to 2022 focusing on Australian medical students' and doctors-in-training mental health were considered.

Results

Of the 177 articles identified, 24 studies were included in the review. The majority of the studies focused on DiT (n = 19) of which interns and residents were most well represented (n = 12) followed by surgical training (n = 5), with general practice (GP) (n = 2) and physician specialties (nil) being poorly represented. Most studies were quantitative (n = 18), with qualitative studies(n = 6) under represented. Common mental health themes identified were overall psychological distress, burnout, and depression/suicidal ideation with workplace harassment and discrimination being less well represented.

Conclusions

Australian DiT are not equally represented in the literature with how different specialty training pathways impact their mental health. Most studies were cross-sectional, preventing a detailed longitudinal assessment of burnout and work-associated psychological distress.

Suicide and depressive symptoms possible correlates among a sample of Egyptian physicians: observational cross-sectional study (online survey)

BACKGROUND

Compared to other occupations, physicians are more susceptible to depression and suicide. Suicide among physicians in some countries reached up to 1.5- to threefold higher than the general population. However, this rate was not homogenous in all countries. Most of the Egyptian studies were related to the stressful pandemic event, but the actual prevalence of depression among physicians is still under research. To the best of the researcher's knowledge, no other study has been conducted to evaluate the risk of suicide among Egyptian physicians.

AIM

The study aimed to screen for depressive symptoms and suicide among Egyptian physicians and to investigate the correlates associated with suicide ideations.

METHODS

This cross-sectional survey included Egyptian physicians recruited online by Google Forms. Depressive symptoms were screened using the Beck Depression Scale (BDI-II), while suicidal ideas were assessed using the Suicidal Ideation Attributes Scale (SIDAS).

RESULTS

Six hundred sixty Egyptian physicians completed the survey following a two-week pilot study between January 10 and July 16, 2023. The average age was 39.1 years, and 71.4% were married. 49.1% were medical specialists. The median daily working hours were eight, and 27.7% of the physicians attended night shifts. 22.3% had a psychiatric illness, and 34.3% had a chronic disease. Younger and single physicians of both sexes were more prone to suicide risk (p-value = 0.019 and 0.021, respectively). Those with psychiatric or chronic medical disorders had a higher suicidal risk (p-values < 0.001 and 0.004, respectively). Physicians with fewer academic degrees and those who work longer hours or night shifts had more depressive symptoms (p-values < 0.001 and 0.009, respectively). The risk of depression and suicide is almost the same in all medical specialties. The SIDAS suicide score and the Beck depression score revealed a statistically significant association (r = 0.288, p-value < 0.001).

CONCLUSION

Suicide risk is higher among younger, single physicians of both sexes, as well as those with psychiatric or chronic medical disorders. More depressive symptoms are seen in physicians who have more extended hours or night shifts and who have fewer academic degrees. Almost all medical specialties carry the same risk of depression and suicide. Longitudinal research is recommended for regular follow-up of suicidal thoughts and depressive symptoms.

Work-related factors and the risk of common mental disorder 1 year later: A prospective cohort study among junior doctors

OBJECTIVE

This study investigated the relationship between work-related factors at baseline and the risk of common mental disorder at 12 month follow-up among a cohort of junior doctors.

METHOD

The data comprised the junior doctor respondents from two annual waves of the 'Medicine in Australia: Balancing Employment and Life' (MABEL) survey, a national longitudinal cohort of Australian doctors. Individual and work-related risk factors were assessed at baseline and the mental health outcome of caseness of common mental disorder (CMD) was assessed using the 6-item Kessler Psychological Distress Scale at 12-month follow-up. Unadjusted and adjusted logistic regressions were conducted to estimate the association between each baseline variable and the likelihood of CMD caseness at follow-up 1 year later.

RESULTS

Among 383 junior doctors, 24 (6%) had CMD 1 year later. Five work-related baseline variables were significantly associated with a higher likelihood of CMD 1 year later in adjusted models; lack of social support in work location (odds ratios (OR) = 6.11; 95% confidence intervals (CI) = [2.52, 14.81]), work-life imbalance (OR = 4.50; 95% CI = [1.31, 15.46]), poor peer support network in the workplace (OR = 2.61; 95% CI = [1.08, 6.27]), perceptions of patient expectations (OR = 2.46; 95% CI = [1.06, 5.71]) and total weekly work hours (OR 1.04; 95% CI = [1.01, 1.07]; p = 0.002)in models adjusting for gender.

CONCLUSION

These results identify key modifiable work-related factors that are associated with junior doctors' future mental health. Our findings suggest the need for a greater focus upon interpersonal factors and work-life balance in multi-level interventions while continuing to address workplace and system-level factors to prevent future mental disorder in junior doctors.

Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012-2020)

Long working hours and overwork have recently emerged as pressing public health concerns. We explored the association between long working hours and suicidal ideation in female workers. A total of 8017 women (24,331 observations) from the fourth to eighth waves of the Korean Longitudinal Survey of Women and Families (2012-2020) were analyzed. To address the repeated measurements within each participant, we employed a generalized estimating equation to estimate the odds ratio (OR) and 95% confidence intervals (CIs). The prevalence of suicidal ideation was 1.9% for those working 35-40 h/week and 4.4% for those working ≥55 h/week. Compared to individuals working 35-40 h/week, those working ≥55 h/week were more likely to experience concurrent suicidal ideation (OR [95% CI]:1.85 [1.43-2.39]). The OR (95% CI) of the association between long working hours and onset of suicidal ideation in the subsequent wave was 1.69 (1.20-2.38) for ≥55 h/week. In subgroup analysis, this association was pronounced among workers with low-income levels (OR [95% CI]: 1.97 [1.29-3.02]) and blue-collar occupations (OR [95% CI]: 2.27 [1.41-3.66]). Policy efforts are required to protect the mental health of female workers exposed to long working hours.

Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors

BACKGROUND

Evidence attests a link between junior doctors' working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions.

AIMS

To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships.

METHOD

Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively.

RESULTS

Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15-4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07-1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships.

CONCLUSIONS

This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors' mental health.

Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists

INTRODUCTION

Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear.

MATERIALS AND METHODS

We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models.

RESULTS

Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction.

CONCLUSIONS

Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades

OBJECTIVE

To examine the relative risk of suicide among healthcare professionals compared to other occupations and examine changes in suicide rates over time.

METHODS

Suicide cases were identified using the National Coronial Information System and were included if they were recorded as a death by intentional self-harm between 2001 and 2017 and were by an employed adult aged 20-69 with a known occupation at the time of death. Suicide methods were reported descriptively. Workforce data at the population level was extracted from the Australian Bureau of Statistics 2011 Census. Age-standardised suicide rates per 100,000 person-years for each of the four occupational groups were calculated using direct standardisation and using the Australian Bureau of Statistics population-level data from the 2011 Census. Negative binomial regression was used to estimate suicide risk by healthcare employment status and profession, to investigate differences by sex and to examine trends in suicide rates over time, using rate ratios and 95% confidence intervals.

RESULTS

Healthcare professionals were at increased risk of suicide compared to other occupations (rate ratio = 1.30, 95% confidence interval = [1.19, 1.42], p < 0.001), controlling for age, sex and year of death. Nurses and midwives were identified as being at significantly increased risk of suicide (rate ratio = 1.95, 95% confidence interval = [1.73, 2.19], p < 0.001). Suicide rates among female medical practitioners increased substantially over time (p = 0.01).

CONCLUSION

Health professionals are at significantly increased risk of suicide, though the relative risk of different groups is changing over time. There has been a substantial increase in the risk of suicide among female medical practitioners with rates of suicide in this group more than doubling over the last two decades. Findings highlight the need for targeted suicide prevention initiatives for healthcare professionals.

Common mental disorder and suicidality among doctors: differences by specialty

BACKGROUND

Common mental disorders (CMDs) and suicidal ideation (SI) are prevalent among doctors, yet limited evidence exists investigating the relationship of specialty area to these outcomes.

AIMS

This study aimed to determine the prevalence of likely CMD and SI among doctors and to investigate whether likelihood of these outcomes varied by area of medical specialty.

METHODS

A secondary analysis of a representative national survey of 12,252 Australian doctors was conducted. Demographic and work-related variables, SI and CMD (GHQ-28), were assessed among doctors (n = 7037; 57%) working in a range of specialty areas. Logistic regression was used to examine the association between specialty and mental health outcomes in unadjusted and adjusted models.

RESULTS

Almost one-quarter of doctors (n = 1560; 23%) reported symptom levels indicating likely CMD whilst 9% (n = 667) reported SI in the last year. Doctors in surgery (adjusted odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.54-0.97, P = 0.03) were at significantly lower risk of CMD than General Practitioners (GPs), whilst doctors in anaesthetics (adjusted OR = 1.45; 95% CI 1.09-1.93, P = 0.01) and paediatrics (adjusted OR = 1.88; 95% CI 1.02-3.47, P = 0.04) were at significantly higher risk of experiencing SI compared to GPs after accounting for confounders.

CONCLUSIONS

Results demonstrated that doctors in Australia working in certain specialties, specifically anaesthetics and paediatrics, were at significantly greater risk of suicidal ideation compared to GPs after accounting for confounders. Interventions to address CMD and SI among doctors in all specialties remain urgently needed.

A study protocol outlining the development and evaluation of a training program for frontline managers on leading well-being and the psychosocial work environment in Danish hospital settings - a cluster randomized waitlist controlled trial

BACKGROUND

Hospital staff are often exposed to stressful psychosocial working conditions and report high levels of stress and burnout, which may negatively impact the safety of employees and patients. Managers hold unique knowledge of workplace conditions and needs of employees, but leadership interventions to improve the well-being of managers and employees in hospital settings are scarce. This study evaluates the effects of a leadership intervention based on a health-oriented leadership approach on the well-being and psychosocial work environment aspects of managers and employees.

METHODS/DESIGN

The study is designed as a randomized, waitlist-controlled trial with two groups (intervention and waitlist control group) and measurements at baseline, 6- and 12-month follow-up. We aim to include 200 frontline managers in Danish hospital settings and their approximately 5,000 employees. The leadership training comprises five full day modules and four smaller group-training sessions over a period of 5 months. The main aim is to improve stress, burnout, self-care, and perceived level of staff-care among managers and employees. Sickness absence will also be assessed at both manager and employee level. In addition, several psychosocial factors will be assessed at the employee level. A quantitative and qualitative process evaluation will also be conducted.

DISCUSSION

Action towards supporting the mental health of hospital employees is important to maintain a strong healthcare system. There is increasing recognition that best practice in workplace mental health requires an integrated approach that prevents harm and promotes positive mental health. There is also increasing understanding of the key role managers' play in maintaining well-being within the workplace, however they often report a lack of knowledge and skills to promote employee mental health. The current leadership training program has been developed for frontline managers working in a hospital setting. The aim is to increase managers' application of strategies to facilitate a healthy psychosocial work environment to benefit well-being and mental health among staff and managers themselves.

TRIAL REGISTRATION

The study was retrospectively registered on November 21, 2022 in Clinical Trial.gov with identifier: NCT05623371.

[Physician working hours and effects on health, satisfaction and healthcare]

Changes in the working environment with respect to innovative working time models are also increasingly affecting patient care. The number of physicians working part-time, for example, is continuously rising. At the same time, a general increase in chronic diseases and multimorbid conditions as well as the growing shortage of medical staff, leads to more workload and dissatisfaction among this profession. This short overview summarizes the current study situation and associated consequences regarding working hours of physicians and gives a first explorative overview of possible solutions.

Moral injury and suicidal ideation among health professionals: The role of mental health

BACKGROUND

The prolonged COVID-19 pandemic has burdened health professionals mentally and physically. This study aims to explore the relationship between moral injury (MI) and suicidal ideation (SI), and the role of mental health conditions in this relationship.

METHODS

Three-wave repeated online cross-sectional study with a total of 10,388 health professionals were conducted in different stages (2020-2022) of the COVID-19 pandemic in mainland China. Participants completed the Chinese version of the Moral Injury Symptoms Scale-Health Professional, Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 coupled with a blanket of scales.

RESULTS

The prevalence of SI and MI among health professionals was 9.8 % and 40.2 %, respectively. The prevalence risk of SI was lower in wave 2 (OR = 0.64, 95 % CI: 0.54-0.77) and wave 3 (OR = 0.71, 95 % CI: 0.60-0.84) when compared with wave 1. MI (OR = 4.66, 95 % CI: 3.99-5.43), medical error (OR = 1.15, 95 % CI: 1.00-1.32), workplace violence (OR = 1.13, 95 % CI: 0.97-1.32), depression (OR = 94.08, 95 % CI: 63.37-139.69), anxiety (OR = 25.54, 95 % CI: 21.22-30.74), PTSD (OR = 24.51, 95 % CI: 19.01-31.60) were associated with a higher risk of SI. The mediation model revealed that depressive, anxiety, and PTSD symptoms explained 90.6 % of the total variance in the relationship between MI and SI.

CONCLUSIONS

The risk of SI has reduced among health professionals since the first peak of the COVID-19 pandemic in China. MI may contribute to prevalent SI, and mental health conditions, especially depressive symptoms, play a significant role as mediators.

LIMITATIONS

Cross-sectional design precludes the investigation of casual relationships. The nonrandom sampling method limits the generalization.

Association between long working hours and mental health among nurses in China under COVID-19 pandemic: based on a large cross-sectional study

OBJECTIVE

Nurses were more likely to experience mental disorders due to long working hours and irregular schedules. However, studies addressing this issue are scarce; therefore, we aimed to investigate the association between long working hours and mental health in Chinese nurses during the coronavirus disease pandemic.

METHODS

A cross-sectional study was conducted with 2,811 nurses at a tertiary hospital in China from March to April 2022. We collected data on demographic, psychological characteristics, dietary habits, life, and work-related factors using a self-reported questionnaire and measured mental health using Patient Health Questionnaire-9 and General Anxiety Disorder-7. Binary logistic regression to determine adjusted odds ratios and 95% confidence intervals.

RESULTS

The effective response rates were 81.48%, 7.80% (219), and 6.70% (189) of the respondents who reported depression and anxiety, respectively. We categorized the weekly working hours by quartiles. Compared with the lowest quartile, the odds ratios and 95% confidence intervals across the quartiles for depression after adjustment were 0.98 (0.69, 1.40), 10.58 (2.78, 40.32), and 1.79 (0.81, 3.97) respectively, the P for trend was 0.002. The odds ratios across the quartiles for anxiety after adjustment were 0.87 (0.59, 1.30), 8.69 (2.13, 35.46), and 2.67 (1.26, 5.62), respectively, and the P for trend was 0.008.

CONCLUSIONS

This study demonstrated that extended working hours increased the risk of mental disorders among nurses during the coronavirus disease pandemic, particularly in those who worked more than 60 h per week. These findings enrich the literature on mental disorders and demonstrate a critical need for additional studies investigating intervention strategies.

Perception of National Youth Service Corps (NYSC) among corps medical doctors in Nigeria: a cross-sectional study

BACKGROUND

The National Youth Service Corps (NYSC) is a compulsory one-year programme for graduates of tertiary schools including doctors. This study was conducted to find out the benefits and challenges of the programme among corps medical doctors as well as their treatment in their places of primary assignment (PPAs). The study would influence policymaking so as to improve the experiences of corps medical doctors and help NYSC to achieve its objectives.

METHODS

A descriptive cross-sectional survey was conducted among 399 medical doctors doing their compulsory national youth service in Nigeria. The research instrument was developed by the researchers and pretested before use. The outcome variables were: overall benefit, overall challenge and overall PPA treatment. The data obtained were analyzed using descriptive statistics and chi-square test using p < 0.05.

RESULTS

Majority of respondents (83.5%) believed that the scheme offered one or more benefits to corps medical doctors (overall benefit). These benefits include exposure to new culture (47.6%), gaining medical/surgical skills (36.3%) and finding a lover/spouse (4.5%). Similarly, most of respondents (89.2%) reported one or more challenges (overall challenge). Some of the challenges reported include; no provision of accommodation (51.6%), poor remuneration (44.7%) and exploitation of corps doctors by their employers (41.4%). There was a statistically significant association between overall benefit and region of deployment (p value: 0.013). Region of deployment and marital status were found to have a statistically significant association with the overall challenge with p-values of 0.031 and < 0.001 respectively. Overall treatment at PPAs was mostly reported to be bad (77.2%) and it had a statistically significant association with marital status (p-value: 0.002) and religion (p-value: 0.024).

CONCLUSION

Most respondents reported poor PPA treatment and this calls on the government and other stakeholders to take drastic measures to improve the welfare of corps medical doctors in order to positively influence their perception of the scheme and encourage their continued participation.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study

BACKGROUND

Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize.

AIM

To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic.

METHODS

A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models.

FINDINGS

Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]).

INTERPRETATION

Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.

Factors Contributing to Stress and Well-Being Among Trainee Psychiatrists in Victoria, Australia

Doctors in training experience stress, as they balance the demands of working and studying at the same time. As evidenced by reports of suicides among trainee doctors, it is clear that the level of stress they experience is dangerously high. Long working hours, which can lead to exhaustion, burnout, and time taken away from meaningful activities and relationships outside of work, are a large contributor to trainee stress and increase the likelihood of mental illness and suicidal ideation. For psychiatry trainees, this workload burden is also compounded by a high emotional burden associated with the nature of their work, including patient suicides, aggression, and threats. This study sought to investigate the factors that contribute to the stress and well-being of psychiatry trainees, through in-depth interviews analyzed via qualitative, template analysis. The main sources of stress identified were workload, aspects related to the psychiatry training program, and workplace-based aggression. Supervision, external supports such as family and health professionals, and distraction or "switching off" were the main sources of well-being support. Overall, this study highlighted the importance of structural factors in the workplace and training program in psychiatry trainee stress and well-being levels. Workload and training commitments limited the amount of time trainees could devote to well-being-related activities, despite their awareness of these. This study contributes useful insights into how we can better look after the mental health and well-being of psychiatry trainees, as future leaders of our mental health system.

Prevalence and Associated Factors of Suicidal Ideation among Almeda Textile Factory Workers in Adwa, Tigray, Ethiopia: A Cross-Sectional Study

Background

Suicidal ideation among textile factory workers is a major public health concern worldwide and is associated with a higher risk of completed suicide. However, there are limited studies that determined the prevalence and the potential determinants of suicidal ideation in Africa, including Ethiopia. Therefore, this study is aimed at exploring the prevalence of suicidal ideation and associated factors among textile factory workers in Almeda textile factory in Adwa, Ethiopia.

Methods

An institutional-based cross-sectional study design was conducted from May 3, 2020, to June 16, 2020, at Almeda textile factory in Adwa. A total of 409 workers were identified using a systematic random sampling technique. Data were collected using a self-administered questionnaire using suicidality module of Composite International Diagnostic Interview. Data were analyzed using SPSS version 22.0, and logistic regression model was employed. Adjusted odds ratio with a 95% confidence interval was computed, and statistical significance was declared at p value < 0.05.

Result

In this study, the prevalence of suicidal ideation was found to be 8.8% (95% CI: 6.1, 11.5). Working more than 48 hours per week (AOR = 2.88, 95% CI: 1.18, 7.04), depression (AOR = 3.90, 95% CI: 1.60, 9.50), work-related physical injury (AOR = 5.95, 95% CI: 2.37, 14.94), and interpersonal conflict (AOR = 3.54, 95% CI: 1.40, 8.90) were the significant factors associated with suicidal ideation. Conclusion and Recommendation. In this study, suicidal ideation among Almeda textile production workers was a significant problem. Factors including depression, work-related exposure to physical injury, long working hour, and interpersonal conflict can enlarge suicidal ideation.

Thoughts of suicide or self-harm among Australian healthcare workers during the COVID-19 pandemic

OBJECTIVE

To identify the prevalence and predictors of (a) thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic and (b) help-seeking among those healthcare workers with thoughts of suicide or self-harm.

METHOD

Analysis of data from the Australian COVID-19 Frontline Healthcare Workers Study, an online survey of healthcare workers conducted during the second wave of the COVID-19 pandemic in Australia. Outcomes of interest were thoughts of suicide or self-harm as measured through the Patient Health Questionnaire for depression and help-seeking behaviours.

RESULTS

Overall, 819 (10.5%) of 7795 healthcare workers reported thoughts of suicide or self-harm over a 2-week period. Healthcare workers with these thoughts experienced higher rates of depression, anxiety, post-traumatic stress disorder and burnout than their peers. In multivariable models, the odds of suicide or self-harm thoughts were higher among workers who had friends or family infected with COVID-19 (odds ratio = 1.24, 95% confidence interval = [1.06, 1.47]), were living alone (odds ratio = 1.32, 95% confidence interval = [1.06, 1.64]), younger (⩽30 years cf. >50 years; odds ratio = 1.70, 95% confidence interval = 1.36-2.13), male (odds ratio = 1.81, 95% confidence interval = [1.49, 2.20]), had increased alcohol use (odds ratio = 1.58, 95% confidence interval = [1.35, 1.86]), poor physical health (odds ratio = 1.62, 95% confidence interval = [1.36, 1.92]), increased income worries (odds ratio = 1.81, 95% confidence interval = [1.54, 2.12]) or prior mental illness (odds ratio = 3.27, 95% confidence interval = [2.80, 3.82]). Having dependent children was protective (odds ratio = 0.75, 95% confidence interval = [0.61, 0.92]). Fewer than half (388/819) of the healthcare workers who reported thoughts of suicide or self-harm sought professional support. Healthcare workers with thoughts of suicide or self-harm were more likely to seek support if they were younger (⩽30 years cf. >50 years; odds ratio = 1.78, 95% confidence interval = [1.13, 2.82]) or had prior mental health concerns (odds ratio = 4.47, 95% confidence interval = [3.25, 6.14]).

CONCLUSION

One in 10 Australian healthcare workers reported thoughts of suicide or self-harm during the pandemic, with certain groups being more vulnerable. Most healthcare workers with thoughts of suicide or self-harm did not seek professional help. Strong and sustained action to protect the safety of healthcare workers, and provide meaningful support, is urgently needed.

Associations between Drinking Behaviors and Meaning in Life: Evidence from Primary Care Professionals in China

(1) Background: Although the associations between drinking behaviors and emotional problems have been supported in several previous studies, the associations between drinking behaviors and meaning in life have not been explored until now. We aimed to test the associations between drinking behaviors and meaning in life among primary care professionals, after controlling for depression. (2) Methods: In the current study, we collected 1453 valid questionnaires based on a cross-sectional design. Meaning in life, drinking behaviors, physical diseases, depression, work-related variables, and some other social-demographic variables were evaluated. (3) Results: The results support that after controlling for depression, regular milk drinking (β = 1.387, p = 0.026), and regular juice drinking (β = 2.316, p = 0.030) were associated with higher meaning in life, while regular water drinking (β = −1.448, p = 0.019) was negatively associated with meaning in life. In addition to this, the results showed that the older age (β = 0.098, p = 0.001), preventive medicine majors (β = 4.281, p = 0.013), working fewer days per week (β = −0.942, p = 0.004), licensed (assistant) technician qualification (β = 2.921, p = 0.036), and no depression (β = −0.203, p < 0.001) were positively associated with meaning in life. (4) Conclusion: This study supported the association between drinking behaviors and meaning in life, even after controlling depression. These findings imply that we can further explore this association and its mechanisms in future studies.

Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners

BACKGROUND

Locus of control (LoC) is a social cognition, that relates to the level of self-control that people have over their personal environment that influences their life. In this context, LoC is frequently associated with work-related behavioral outcomes, ranging from job attitudes, career behaviors, stress, and burnout.

OBJECTIVE

To investigate the association between LoC, and work-related behavioral factors, socio-cultural factors, and personal factors among Australian General Practitioners (GPs).

METHODS

This study utilized data from the 2010 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Locus of control (LoC) was measured by a 7-point Likert scale based on Pearlin-Schooler Mastery/Self-efficacy 7-item Scale. Higher score indicated lower internal LoC. Multivariate linear regression model was performed to determine the independent predictors of LoC.

RESULTS

Of 3,664 GP participants, LoC did not differ by gender. Poor/fair self-rated health, working in urban location, running a stressful practice, poor balance of professional and personal commitments, poor support network, financial circumstances after retirement, and perception of unrealistic expectation by patients were significant predictors for a lower Internal LoC in a multivariate linear regression model. Adjusted R² explained 22.4% of variation in predicting the LoC in our models.

CONCLUSIONS

LoC of Australian GPs is negatively affected by poor work-life balance, inadequate support, and unrealistic patient expectation. These work-place specific factors could be targeted by interventions to improve GPs wellbeing.

Strategies Australian junior doctors use to maintain their mental, physical and social well-being: a qualitative study

OBJECTIVES

This study aimed to uncover the strategies that junior doctors implement to maintain their mental, physical and social well-being, and the barriers they experience in practising these strategies.

PARTICIPANTS

Fifteen junior doctors in their postgraduate year 1 or 2 currently practising in Australia were recruited.

OUTCOME MEASURES

Semistructured interviews were conducted, and the transcripts underwent thematic analysis.

RESULTS

Three key themes emerged from thematic analysis, namely: well-being strategies, barriers to well-being and and future interventions. Exercise, a healthy and balanced diet, quality sleep, and workplace organisations were frequently reported well-being strategies. High workload, unpredictable routines, lack of familiarity with the healthcare system and ongoing stigma surrounding mental health were seen as barriers to well-being. Suggested interventions included increased control over rosters, subsidised access to facilities such as gyms and increased internship preparedness programmes organised by the medical schools.

CONCLUSIONS

The findings from this study may assist in developing more personalised and targeted methods to help junior doctors maintain their mental, physical and social well-being. Future studies may address the structural and systemic changes required to develop a workforce that fosters the well-being of junior doctors and reduces the institutional barriers to practising well-being strategies.

Relationship between working conditions and psychological distress experienced by junior doctors in the UK during the COVID-19 pandemic: a cross-sectional survey study

OBJECTIVES

This paper explored the self-reported prevalence of depression, anxiety and stress among junior doctors during the COVID-19 pandemic. It also reports the association between working conditions and psychological distress experienced by junior doctors.

DESIGN

A cross-sectional online survey study was conducted, using the 21-item Depression, Anxiety and Stress Scale and Health and Safety Executive scale to measure psychological well-being and working cultures of junior doctors.

SETTING

The National Health Service in the UK.

PARTICIPANTS

A sample of 456 UK junior doctors was recruited online during the COVID-19 pandemic from March 2020 to January 2021.

RESULTS

Junior doctors reported poor mental health, with over 40% scoring extremely severely depressed (45.2%), anxious (63.2%) and stressed (40.2%). Both gender and ethnicity were found to have a significant influence on levels of anxiety. Hierarchical multiple linear regression analysis outlined the specific working conditions which significantly predicted depression (increased demands (β=0.101), relationships (β=0.27), unsupportive manager (β=-0.111)), anxiety (relationships (β=0.31), change (β=0.18), demands (β=0.179)) and stress (relationships (β=0.18), demands (β=0.28), role (β=0.11)).

CONCLUSIONS

The findings illustrate the importance of working conditions for junior doctors' mental health, as they were significant predictors for depression, anxiety and stress. Therefore, if the mental health of junior doctors is to be improved, it is important that changes or interventions specifically target the working environment rather than factors within the individual clinician.

The Effects of Long Working Hours on Mental Health Among Resident Physicians in Saudi Arabia

Purpose

To examine the effect of long working hours on anxiety and depression among resident physicians working in Makkah, Saudi Arabia.

Methods

This is a cross-sectional study using an anonymous and confidential self-administered electronic questionnaire. Mental health status (depression and anxiety) is measured using hospital anxiety and depression scale. A multi-stage stratified sampling technique was used. Data were analyzed using the SPSS version 24.0. The Chi-square test and ordinal logistic regression (OLR) were used to test the association.

Results

A total of 258 medical residents participated in the study. The prevalence of anxiety was 39.5% (n=102) and depression was 20.9% (n=54). In multivariate OLR against anxiety, working more than 64 hours per week was significantly associated (p=0.013) with an increase in the odds of observing a higher level of anxiety (odds ratio=2.91, 95% confidence interval (CI):1.25–6.77) compared with working up to 40 hours per week after adjusting for age, amount of sleep and exposure to injustice. For the depression multivariate OLR, it would increase the odds of observing a higher level of depression for working 41–48, 49–64 and more than 64 hours per week by 2.21 (95% CI:1.07–4.58, P=0.033), 2.07 (95% CI:1.01–4.27, P=0.049) and 2.37 (95% CI:1.03–5.50, P=0.044) respectively, compared with working up to 40 hours per week and adjusting for the amount of sleep and exposure to injustice.

Conclusion

Resident physicians are at increased risk of developing anxiety and depression which is influenced by long working hours and a variety of other factors. Therefore, attention needs to be paid to this association. The implementation of interventions for the prevention and screening of physicians’ mental health disorders is needed.

Transforming the journey together: Baseline findings from a longitudinal, co-designed study on psychiatry trainee experiences of training and wellbeing

OBJECTIVE

Junior doctors have high rates of burnout resulting in downstream impacts on patient care. The aim of this study is to capture cross-sectional data on a cohort of psychiatry trainees. These data will be used to inform a wider project investigating psychiatry trainee mental health and wellbeing.

METHOD

This paper reports on the 2019 baseline data of psychiatry trainees enrolled in a formal education course at the University of Sydney, Australia. The data were collected with an online survey using a range of validated mental health and wellbeing scales. This descriptive study involved psychiatry trainees as co-designers.

RESULTS

Our research findings are in keeping with the existing literature on the poor mental health and wellbeing of doctors with significantly higher levels of anxiety and exhaustion found in female trainees and carers. Despite this, the cohort had high scores on the flourishing scale.

CONCLUSIONS

Concern around the wellbeing of junior doctors in Australia appears justified. We need to move beyond focussing on individual action to systems-based approaches to improving wellbeing and ongoing sustainability of the psychiatry trainee workforce in NSW.

Differential Impacts of the COVID-19 Pandemic on Mental Health Symptoms and Working Conditions for Senior and Junior Doctors in Australian Hospitals

OBJECTIVE

This study investigated severity, prevalence, and predictors of workplace disruption and mental health symptoms in Australian junior and senior hospital medical staff during the COVID-19 pandemic.

METHODS

A cross-sectional survey collected data on demographics, workplace disruption, personal relationships, and mental health.

RESULTS

One thousand twenty-one (62.1%) senior and 745 (37.9%) junior medical staff, located primarily in Victoria, completed the survey. Work disruptions were common but varied by seniority, withjunior staff more frequently exposed to COVID- 19 (P < 0.001). Symptoms of anxiety, depression, post-traumatic stress disorder and burnout were common but significantly higher in junior doctors (P  = 0.011 to < 0.001). Common predictors for experiencing mental health symptoms were identified, including prior mental health diagnoses and worsening personal relationships.

CONCLUSIONS

COVID-19 has had significant but varied impacts on junior and senior doctors, with junior doctors particularly susceptible to harm to mental health. Interventions to safeguard hospital medical staff and prevent attrition of this important workforce are urgently needed.

Overtime claiming among Australian doctors-in-training

ObjectiveTo quantify patterns of overtime among doctors-in-training in New South Wales and to explore the reasons doctors-in-training cite for not claiming overtime worked.MethodsA confidential online self-reporting survey was conducted of post-graduate doctors-in-training, working in hospitals in NSW, from post-graduate year 1 through to completion of specialist training. Questions sought to determine the average amount of overtime worked, overtime claiming patterns, and reasons why overtime was not claimed. Comparisons were made by level of training and specialty training pathway.ResultsA total of 1351 valid responses were received. Unrostered overtime was extremely common, as was underpayment for work completed. Though 73.5% of respondents reported working at least 5 h of unrostered overtime per fortnight, only 15.6% of respondents reported claiming all their unrostered overtime, and among those who did claim overtime, only 45.5% reported being paid the amount in full. Common reasons for not claiming overtime included workplace cultural expectations (37.0%), and overtime not falling under approved reasons (32.6%). There were statistically significant differences (P < 0.001) in all response categories between critical care, physician and surgical training pathways.ConclusionsThe survey data demonstrated a significant disconnect between expectations and reality of working hours among doctors-in-training. This is indicative of concerns regarding loss of income, impaired ability to plan workforce allocation due to hidden workload, and possibly impaired wellbeing.

Mental health consequences of COVID-19 in house staff physicians

Background: A new coronavirus, SARS-CoV-2, was associated with a newly identified respiratory syndrome, COVID-19 in Wuhan, China, in early December 2019. SARS-CoV-2 rapidly spread across the globe, imposing increased working hours and workloads for healthcare workers. We have evaluated the prevalence of mental health outcomes and associated factors in house staff physicians in Panama. Methods: A cross-sectional study was undertaken from July 23, 2020, to August 13, 2020. Snowball sampling was used to recruit participants. Then, an electronic questionnaire with scales to evaluate anxiety disorders (GAD-7), depression (PHQ-9) and post-traumatic stress (IES-R) was administered. In addition, socio-demographic variables, clinical history of mental disorders and COVID-19 exposure were evaluated. Independent analyses for each mental health outcome were undertaken using a logistic regression analysis. Results: A total of 517/1,205 (42.9%) interns and residents were recruited nationwide. The overall prevalence of depression symptoms was 25.3%, 13.7% for anxiety and 12.2% for post-traumatic stress. At least 9.3% participants reported having suicidal ideation. The most parsimonious model showed females had a higher prevalence of mental health disorders across results, and married participants were more likely to present depression (OR, 1.73; 95% CI, 1.03-2.91; P = 0.039) or at least one mental health disorder (OR, 1.66; 95% CI, 1.03-2.68; P = 0.039). Conclusions: A high prevalence of mental health disorders was found, showing the need to mitigate this emotional burden among healthcare workers in the current context of the COVID-19 pandemic.

Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: a nationwide questionnaire-based survey

OBJECTIVES

This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan.

DESIGN

A nationwide, questionnaire-based survey.

SETTING

Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020.

PARTICIPANTS

Valid responses were obtained from 4306 physicians (response rate: 49%).

OUTCOME MEASURES

Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables.

RESULTS

Regarding the Japanese Burnout Scale, the highest score was recorded for 'sense of personal accomplishment', followed by 'emotional exhaustion' and 'depersonalization'. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds (reference: <200 beds, OR: 0.23, 95% CI: 0.07 to 0.82).

CONCLUSIONS

Many Japanese residents demonstrated a tendency to experience burnout and suicidal ideation. Female sex, low income, long working hours and insufficient hospital beds were associated with suicidal ideation. To ensure physicians' health and patients' safety, it is necessary to advance workstyle reform for physicians.

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic

Background

Junior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID‐19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises.

Aims

To investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID‐19 pandemic.

Methods

Australian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free‐text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis.

Results

Participants were predominantly female (73.2%), aged 31–40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0–5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID‐19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors.

Conclusions

Challenging workplace cultures and conditions, which have worsened during the COVID‐19 pandemic, are associated with poor psychological well‐being in junior doctors. There exists a need for long‐term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well‐being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

A cross-sectional study of the psychological status of 33,706 hospital workers at the late stage of the COVID-19 outbreak

BACKGROUND

Hospital workers have been under intense psychological pressure since the COVID-19 outbreak. We analyzed the psychological status of hospital staff in the late period of the COVID-19 to provide a basis for the construction of global health care after the COVID-19 outbreak.

METHODS

We used online surveys to assess participants' self-reported symptoms at the late stage of the outbreak. This study collected data on sociodemographic characteristics, epidemic-related factors, psychological status (PHQ-9, GAD-7, and PHQ-15), psychological assistance needs, perceived stress and support, PTSD symptoms (PCL-C) and suicidal and self-injurious ideation (SSI). Participants were hospital workers in all positions from 46 hospitals. Chi-square tests to compare the scales and logistic regression analysis were used to identify risk factors for PTSD and SSI.

RESULTS

Among the 33,706 participants, the prevalences of depression, anxiety, somatic symptoms, PTSD symptoms, and SSI were 35.8%, 24.4%, 49.7%, 5.0%, and 1.3%, respectively. Logistic regression analysis showed that work in a general ward, attention to the epidemic, high education, work in non-first-line departments, insufficient social support, and anxiety and somatization symptoms were influencing factors of PTSD (P<0.05). The independent risk factors for SSI were female gender; psychological assistance needs; contact with severe COVID-19 patients; high stress at work; single or divorced marital status; insufficient social support; and depression, anxiety or PTSD symptoms (P<0.05).

LIMITATIONS

This cross-sectional study could not reveal causality, and voluntary participation may have led to selection bias. The longer longitudinal studies are needed to determine the long-term psychological impact.

CONCLUSION

This COVID-19 pandemic had a sustained, strong psychological impact on hospital workers, and hospital workers with PTSD symptoms were a high-risk group for SSI in the later period of the epidemic. Continuous attention and positive psychological intervention are of great significance for specific populations.

Breaking barriers to remain healthy and fit during a residency in anaesthesiology

Anaesthesiology is a high-demand speciality of medicine in terms of long and unpredictable work hours, stressful work requirements, pressure for a cent per cent productivity in academics, clinical work and research. Higher stress levels can cause non-communicable diseases like hypertension, obesity and depressed immunity, among many others. In the journey as a trainee anaesthetist, vigorous and diligent efforts are needed to gain perfection in knowledge and skills ultimately. While this path is being transversed, it is essential to address physical and mental fitness by exercising it to the recommended benefits, to ward away stress and burnout. In this special article, the authors will discuss the barriers young anaesthesia trainees face to staying healthy and fit during their training and practical and appropriate measures to mitigate the same through intervention at various levels of hierarchy.

Disturbance of the Circadian System in Shift Work and Its Health Impact

The various non-standard schedules required of shift workers force abrupt changes in the timing of sleep and light-dark exposure. These changes result in disturbances of the endogenous circadian system and its misalignment with the environment. Simulated night-shift experiments and field-based studies with shift workers both indicate that the circadian system is resistant to adaptation from a day- to a night-oriented schedule, as determined by a lack of substantial phase shifts over multiple days in centrally controlled rhythms, such as those of melatonin and cortisol. There is evidence that disruption of the circadian system caused by night-shift work results not only in a misalignment between the circadian system and the external light-dark cycle, but also in a state of internal desynchronization between various levels of the circadian system. This is the case between rhythms controlled by the central circadian pacemaker and clock genes expression in tissues such as peripheral blood mononuclear cells, hair follicle cells, and oral mucosa cells. The disruptive effects of atypical work schedules extend beyond the expression profile of canonical circadian clock genes and affects other transcripts of the human genome. In general, after several days of living at night, most rhythmic transcripts in the human genome remain adjusted to a day-oriented schedule, with dampened group amplitudes. In contrast to circadian clock genes and rhythmic transcripts, metabolomics studies revealed that most metabolites shift by several hours when working nights, thus leading to their misalignment with the circadian system. Altogether, these circadian and sleep-wake disturbances emphasize the all-encompassing impact of night-shift work, and can contribute to the increased risk of various medical conditions. Here, we review the latest scientific evidence regarding the effects of atypical work schedules on the circadian system, sleep and alertness of shift-working populations, and discuss their potential clinical impacts.

Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic

BACKGROUND

Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic.

METHODS

A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27 August and 23 October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking.

RESULTS

The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups.

CONCLUSIONS

Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians: A longitudinal cohort study

Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians' risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1-3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68-3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61-4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44-3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88-17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1-3 days) sickness absence among hospital physicians.

Impact of spirituality and religiosity on suicidal risk among a sample of lebanese psychiatric in-patients

OBJECTIVES

To evaluate the prevalence of suicidality among the psychiatric inpatients community in Lebanon, and to elucidate the effect of religiosity and spirituality on suicidal thoughts or behaviours.

METHODS

A total sample of 159 patient consecutively admitted to a psychiatric hospital was interviewed. The Ask Suicide-screening Questionnaire (ASQ) was used to assess suicidal risk; the Mature Religiosity Scale (MRS) and the Spirituality Index for Well Being (SIWB) scales were used to assess religiosity and spirituality.

RESULTS

We found that 45.6% of the participants screened positively on the ASQ, including 37.5% with acute suicidal ideation. A backward logistic regression, taking the negative/positive screening ASQ as the dependent variable, showed that a positive family history of suicide and depression were significantly associated with higher positive suicidal screening, whereas higher spirituality was significantly associated with lower positive suicidal screening. When forcing the mature religiosity scale as an independent variable, the results remained the same.

CONCLUSION

Spiritual well-being might be considered an important factor to explore among psychiatric patients. Psychiatric inpatients have a high risk for suicide; the challenge remains for clinicians to identify upon admission patients that are most likely to die from suicide.Key pointsA positive family history of suicide and depression was significantly associated with higher suicidality.Higher spirituality, but not religiosity, was significantly associated with lower suicidality.Spiritual well-being might be considered an important factor to explore among psychiatric patients.The challenge remains for clinicians to identify patients that are most likely to die from suicide upon admission.

High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.

Aims

The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.

Methods

A nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected.

Results

A total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19.

Conclusions

The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Occupational Disruptions during the COVID-19 Pandemic and Their Association with Healthcare Workers' Mental Health

Background: The COVID-19 crisis has caused prolonged and extreme demands on healthcare services. This study investigates the types and prevalence of occupational disruptions, and associated symptoms of mental illness, among Australian frontline healthcare workers during the COVID-19 pandemic. Methods: A national cross-sectional online survey was conducted between 27 August and 23 October 2020. Frontline healthcare workers were invited to participate via dissemination from major health organisations, professional associations or colleges, universities, government contacts, and national media. Data were collected on demographics, home and work situations, and validated scales of anxiety, depression, PTSD, and burnout. Results: Complete responses were received from 7846 healthcare workers (82.4%). Most respondents were female (80.9%) and resided in the Australian state of Victoria (85.2%). Changes to working conditions were common, with 48.5% reporting altered paid or unpaid hours, and many redeployed (16.8%) or changing work roles (27.3%). Nearly a third (30.8%) had experienced a reduction in household income during the pandemic. Symptoms of mental illness were common, being present in 62.1% of participants. Many respondents felt well supported by their workplaces (68.3%) and believed that workplace communication was timely and useful (74.4%). Participants who felt well supported by their organisation had approximately half the risk of experiencing moderate to severe anxiety, depression, burnout, and PTSD. Half (50.4%) of respondents indicated a need for additional training in using personal protective equipment and/or caring for patients with COVID-19. Conclusions: Occupational disruptions during the COVID-19 pandemic occurred commonly in health organisations and were associated with worse mental health outcomes in the Australian health workforce. Feeling well supported was associated with significantly fewer adverse mental health outcomes. Crisis preparedness focusing on the provision of timely and useful communication and support is essential in current and future crises.

Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations, or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%), or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with increased risk of anxiety, depression, post-traumatic stress disorder, and burnout. Conversely, feeling appreciated by the community protected against these risks in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

'…the way it was staffed during COVID is the way it should be staffed in real life…': a qualitative study of the impact of COVID-19 on the working conditions of junior hospital doctors

OBJECTIVES

COVID-19 has prompted the reconfiguration of hospital services and medical workforces in countries across the world, bringing significant transformations to the work environments of hospital doctors. Before the pandemic, the working conditions of hospital doctors in Ireland were characterised by understaffing, overload, long hours and work-life conflict. As working conditions can affect staff well-being, workforce retention and patient outcomes, the objective of this study was to analyse how the pandemic and health system response impacted junior hospital doctors' working conditions during the first wave of COVID-19 in Ireland.

METHODS AND ANALYSIS

Using a qualitative study design, the article draws on semi-structured interviews with 30 junior hospital doctors. Informed by an abductive approach that draws iteratively on existing literature and empirical data to explain unexpected observations, data were analysed using inductive and deductive coding techniques to identify the key themes reflecting the experiences of working in Irish hospitals during the first wave of COVID-19. We use the Consolidated Criteria for Reporting Qualitative Research to present this research.

RESULTS

Our analysis generated three themes which demonstrate how COVID-19 prompted changes in medical staffing which in turn enhanced interviewees' work environments. First, interviewees felt there were more doctors staffing the hospital wards during the first wave of the pandemic. Second, this had positive implications for a range of factors important to their experience of work, including the ability to take sick leave, workplace relationships, collective workplace morale, access to senior clinical support and the speed of clinical decision-making. Third, interviewees noted how it took a pandemic for these improvements to occur and cautioned against a return to pre-pandemic medical staffing levels, which had negatively impacted their working conditions and well-being.

CONCLUSIONS

Interviewees' experience of the first wave of COVID-19 illustrates how enhanced levels of medical staffing can improve junior hospital doctors' working conditions. Given the pervasive impact of staffing on the quality of interviewees' work experience, perhaps it is time to consider medical staffing standards as a vital job resource for hospital doctors and a key policy lever to enhance medical workforce retention. In a global context of sustained COVID-19 demands, pressures from delayed care and international health worker shortages, understanding frontline experiences and identifying strategies to improve them are vital to the development of more sustainable work practices and to improve doctor retention.

Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study

OBJECTIVES

This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors.

DESIGN

Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.

SETTING

NHS in England.

PARTICIPANTS

A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves.

RESULTS

Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable.

CONCLUSION

This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.

Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study

OBJECTIVES

This paper reports findings identifying foundation and junior doctors' experiences of occupational and psychological protective factors in the workplace and sources of effective support.

DESIGN

Interpretative, inductive, qualitative study involving in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.

SETTING

National Health Service in the UK.

PARTICIPANTS

Participants were recruited from junior doctors through social media (eg, the British Medical Association (BMA) junior doctors' Facebook group, Twitter and the mental health research charity websites). A purposive sample of 16 females and 5 males, ethnically diverse, from a range of specialities, across the UK. Junior doctor participants self-identified as having stress, distress, anxiety, depression and suicidal thoughts or having attempted to kill themselves.

RESULTS

Analysis identified three main themes, with corresponding subthemes relating to protective work factors and facilitators of support: (1) support from work colleagues - help with managing workloads and emotional support; (2) supportive leadership strategies, including feeling valued and accepted, trust and communication, supportive learning environments, challenging stigma and normalising vulnerability; and (3) access to professional support - counselling, cognitive-behavioural therapy and medication through general practitioners, specialist support services for doctors and private therapy.

CONCLUSIONS

Findings show that supportive leadership, effective management practices, peer support and access to appropriate professional support can help mitigate the negative impact of working conditions and cultures experienced by junior doctors. Feeling connected, supported and valued by colleagues and consultants acts as an important buffer against emotional distress despite working under challenging working conditions.

Suicidal and self-harm ideation among Chinese hospital staff during the COVID-19 pandemic: Prevalence and correlates

The COVID-19 pandemic put global medical systems under massive pressure for its uncertainty, severity, and persistence. For detecting the prevalence of suicidal and self-harm ideation (SSI) and its related risk factors among hospital staff during the COVID-19 pandemic, this cross-sectional study collected the sociodemographic data, epidemic-related information, the psychological status and need, and perceived stress and support from 11507 staff in 46 hospitals by an online survey from February 14 to March 2, 2020. The prevalence of SSI was 6.47%. Hospital staff with SSI had high family members or relatives infected number and the self-rated probability of infection. Additionally, they had more perceived stress, psychological need, and psychological impact. On the contrary, hospital staff without SSI reported high self-rated health, willingness to work in a COVID-19 ward, confidence in defeating COVID-19, and perceived support. Furthermore, they reported better marital or family relationship, longer sleep hours, and shorter work hours. The infection of family members or relatives, poor marital status, poor self-rated health, the current need for psychological intervention, perceived high stress, perceived low support, depression, and anxiety were independent factors to SSI. A systematic psychological intervention strategy during a public health crisis was needed for the hospital staff's mental well-being.

Can an online mental health training program improve physician supervisors' behaviour towards trainees?

BACKGROUND

Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees.

AIM

To test the feasibility and acceptability of a tailored online mental health training program and ascertain the potential effectiveness of the program to alter the confidence and behaviours of physician supervisors.

METHODS

Thirty Australian hospital-based physicians who were supervising physician trainees, participated in this quasi-experimental pre-post pilot study. All received the intervention which comprised twelve 5-minute modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests.

RESULTS

Thirty physicians completed the baseline assessment, and 23 (76.7%) completed all program modules. Most participants found the program engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (p=0.002), confidence to initiate conversations about mental health with staff (p<0.001), and application of preventive and responsive supervisory behaviours to support the mental health needs of those they supervise (p<0.001).

CONCLUSIONS

This online mental health training program for physician supervisors was feasible and associated with improved confidence and behaviour to support the mental health needs of trainees they supervised. This article is protected by copyright. All rights reserved.