Adjustment Disorder as an Occupational Disease: Our Experience in Italy

Knowledge, attitude, and practice towards occupational burnout among doctors and nurses in intensive care unit

BACKGROUND

Occupational burnout is prevalent among doctors and nurses. This study aimed to investigate the knowledge, attitude, and practice (KAP) of ICU doctors and nurses regarding occupational burnout.

METHODS

A cross-sectional study was conducted between December 2023 and June 2024 at the Zhejiang Medical & Health Group Hangzhou Hospital in Zhejiang Province. Demographic information and KAP scores were collected through distributed questionnaires. Occupational burnout was measured by the Maslach Burnout Inventory-General Survey (MBI-GS).

RESULTS

This study included 105 doctors and 165 nurses, with an average age of 32.23 ± 7.38 years. Among all the participants, 6 (2.22%) reported no occupational burnout, 230 (85.19%) experienced moderate occupational burnout, and 34 (12.59%) reported severe occupational burnout. The mean knowledge, attitude, and practice scores were 9.64 ± 4.21 (possible range: 0-18), 29.01 ± 3.15 (possible range: 7-35), and 16.96 ± 4.29 (possible range: 6-30), respectively. Multivariate logistic regression revealed that a higher knowledge score was independently associated with more proactive practice (OR = 1.33, 95% CI: [1.18, 1.50], p < 0.001). Structural equation modeling showed that knowledge positively influenced both (β = 0.33, p < 0.001) and practice (β = 0.37, p < 0.001), while practice negatively impacted the MBI-GS (β = -0.92, p < 0.001).

CONCLUSION

Most ICU doctors and nurses exhibited moderate occupational burnout, with insufficient knowledge, positive attitude, and moderate practice toward occupational burnout. Implementing strategies to increase knowledge and promote active practical engagement is essential to effectively mitigate occupational burnout among ICU staff.

Development and validation of the "Adjustment Disorder Scale for Medically Ill Patients - ETAM"

Background

Adjustment disorder (AD) is common among medically ill patients, yet current evaluation methods do not address the specific characteristics in this population. This study aimed to develop a measurement scale for AD in medically ill patients in Colombia and to find evidence of its validity and reliability.

Methods

This was a scale development and validation study. In the first qualitative phase, items were developed. In the second phase, the content validity of each item was evaluated by patients and clinicians. In the third phase, structural validity, internal consistency, test-retest reliability, criterion validity, and convergent construct validity were assessed. Items were analyzed using a generalized partial credit model within an item response theory framework.

Results

The Adjustment Disorder Scale for Medically Ill Patients (ETAM, for its acronym in Spanish) was developed, comprising 20 items that address the free description of stressful situations in the last 15 days and mental symptoms attributed to them. Evidence of content validity was found. The scale was administered to 512 medically ill patients, revealing a three-dimensional structure: 1) "AD Symptoms", 2) "Impact on Self-Care", and 3) "Impact on Desire to Live". Internal consistency was adequate, with McDonald's omega of 0.95 and Cronbach's alpha between 0.82 and 0.92 for its dimensions. ETAM had high test-retest reliability (intraclass correlation coefficient of 0.98). Criterion validity evidence was obtained with an independent psychiatrist's diagnosis, with an AUROC of 0.99, and convergent validity was consistent with hypotheses of correlation with other instruments with similar constructs. Discrimination and difficulty parameters were calculated for each item.

Conclusion

The ETAM is a scale with evidence of validity and reliability that can be used for the diagnosis of AD in medically ill patients in Colombia.

Modelling self-diagnosed burnout as a categorical syndrome

OBJECTIVE

There is currently little consensus as to how burnout is best defined and measured, and whether the syndrome should be afforded clinical status. The latter issue would be advanced by determining whether burnout is a singular dimensional construct varying only by severity (and with some level of severity perhaps indicating clinical status), or whether a categorical model is superior, presumably reflecting differing 'sub-clinical' versus 'clinical' or 'burning out' vs 'burnt out' sub-groups. This study sought to determine whether self-diagnosed burnout was best modelled dimensionally or categorically.

METHODS

We recently developed a new measure of burnout which includes symptoms of exhaustion, cognitive impairment, social withdrawal, insularity, and other psychological symptoms. Mixture modelling was utilised to determine if scores from 622 participants on the measure were best modelled dimensionally or categorically.

RESULTS

A categorical model was supported, with the suggestion of a sub-syndromal class and, after excluding such putative members of that class, two other classes. Analyses indicated that the latter bimodal pattern was not likely related to current working status or differences in depression symptomatology between participants, but reflected subsets of participants with and without a previous diagnosis of a mental health condition.

CONCLUSION

Findings indicated that sub-categories of self-identified burnout experienced by the lay population may exist. A previous diagnosis of a mental illness from a mental health professional, and therefore potentially a psychological vulnerability factor, was the most likely determinant of the bimodal data, a finding which has theoretical implications relating to how best to model burnout.

Impact of COVID-19 Pandemic on Stress and Burnout Levels amongst Emergency Medical Technicians: A Cross-Sectional Study in Spain

BACKGROUND

Emergency medical technicians (EMTs) are essential health care workers (HCWs). Although they play an extraordinary role during the COVID-19 pandemic, they are mostly exposed to various occupational health and safety risks that have significantly impacted their mental health, giving rise to symptoms, such as stress and burnout.

AIM

This study aimed to assess the perceived levels of stress and burnout amongst EMTs in relation to their socio-demographic characteristics and to explore the associations between their stress and burnout levels during the COVID-19 pandemic.

METHODS

This work is an observational cross-sectional design study conducted between 29 March and 30 April 2021, with a convenience sample of 280 Spanish EMTs yielding a response rate of 28%. The online survey had 42 items that aimed to determine participants' socio-demographic characteristics, the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory (MBI).

RESULTS

The results showed that more than half of the EMTs (53%) perceived a moderate stress level, 37% perceived moderate levels of emotional exhaustion (EE) and 40% had moderate levels of depersonalization (DP). Furthermore, 48% had low levels of personal accomplishment (PA). Gender, age, having personal protective equipment (PPE) and experiencing fear of infection were statistically significant areas where participants experienced greater stress (p < 0.05). A positive correlation between stress, EE and DP and a negative correlation between stress and the PA subdimension of burnout were found.

CONCLUSIONS

The COVID-19 pandemic had a tremendous impact on the mental health of ambulance EMTs. Further studies building on this study and others on the psychological status of EMTs before the pandemic and follow-up during the pandemic, as well as deeper investigations on their work conditions, are needed to facilitate the implementation of various interventions. Such efforts can mitigate the negative impacts of the pandemic on their mental health, and prepare them for future disasters.KEY MESSAGEThe COVID-19 pandemic has affected the lives of the majority of the world's population. In particular, it has impacted the mental health of various communities, including HCWs. Highly stressful and insecure work conditions have placed frontline HCWs at a high risk of psychological distress, making them victims and service providers simultaneously.

Interventions to reduce the risk of mental health problems in health and social care workplaces: A scoping review

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals' mental health are also needed.

Assessment of Occupational Burnout among Intensive Care Unit Staff in Jazan, Saudi Arabia, Using the Maslach Burnout Inventory

Objective. ICU workers are among the healthcare staff exposed to high occupational burnout in their daily interactions with patients, especially during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors of burnout among ICU staff in the Jazan region of Saudi Arabia. Methods. A cross-sectional study was conducted using the Maslach Burnout Inventory (MBI), which was distributed to ICU staff between August 1 and November 30, 2021. A total of 150 ICU workers were invited to participate in the study. Results. A total of 104 ICU staff responded to the survey (69% response rate), including 62 nurses, 30 physicians, and 12 respiratory therapists. Among the respondents, 63 (61%) were female and 41 (39%) were male. The mean scores for emotional exhaustion, depersonalization, and personal accomplishment were 22.44 ± 14.92, 9.18 ± 7.44, and 29.58 ± 12.53, respectively. The ICU staff at high risk of emotional exhaustion, depersonalization, and personal accomplishment were 36%, 28%, and 47%, respectively. The leading cause of burnout among ICU staff in the study was workload, and taking a vacation was the most cited coping mechanism for occupational burnout. Conclusion. ICU staff are at high risk of emotional exhaustion, depersonalization, and lack of personal accomplishment. Policymakers should implement regulations that ensure hospitals have adequate employees to reduce the workload that leads to occupational burnout.

The background and current state of implementing a legal system for stress checks in Japan

This paper discusses the development process, outline, main design points, post-enactment operation, and related research trends based on my own experiences from the formulation of the stress check system. Additionally, it surveys related literature and is the first of its kind to discuss future developments from a legal point of view. The ultimate purpose of the stress check system is to stimulate concrete measures for workplace environment improvements. However, despite frequent group analysis, effective measures for improving the environment have been limited. In this paper, based on past studies, I argue that reduced stress and other effects can be observed in workplaces in which such measures have been implemented, providing qualitative outcomes for workers. In addition, basic data can and has been accumulated for subsequent policies and measures. I conclude that realizing human and organizational individuality as well as supporting growth and environmental adaptation are key to the implementation of effective mental health measures.

What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies

In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians' experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.

A descriptive study of claims for occupational mental disorder: adjustment disorder

Background

The number of claims of Industrial Accidents Compensation Insurance (IACI) for mental illness has increased. In particular, the approval rate was higher in cases with confirmed incident circumstances such as adjustment disorder, acute stress disorder, and post-traumatic stress disorder. With increased numbers of filed IACI applications and their approval rates, the need to evaluate various work-related incidents and stressors consistently is also increasing.

Method

In January 2015–December 2017, among the cases of industrial accidents filed for mental illness and suicide by the Korea Workers' Compensation and Welfare Service, 76 filed or approved adjustment disorder cases were included. The cases of adjustment disorder were applied in this study to the “Criteria for Recognition of Mental Disorders by Psychological Loads” established in Japan in 2011 and investigated if cases were approved/rejected consistently. Additionally, features with the greatest influence on approval/rejection were examined quantitatively.

Results

The number of applications more than doubled from 2015 to 2017, with the approval rate rising from 66.7% to 90.6%. Among the major categories, applications of adjustment disorder related to “interpersonal relationships” were the largest number of applications. Applications related to “sexual harassment”, “interpersonal relationships”, and “accidents and experiences including fires” showed relatively higher approval rate. The approval rate was the lowest in the case of “change in the amount and quality of work”.

Conclusions

Approved cases tend to have special precedents and strong intensity. The main reasons for the rejection were that there were no special precedents and that the intensity of the case was weak. These 2 were the most important factors in determining approval/rejection.

Misdiagnosis in occupational and environmental medicine: a scoping review

INTRODUCTION

There has been no comprehensive review for misdiagnosis in Occupational and Environmental Medicine (OEM). The possible ramifications of an occupational disease (OD) or an environmental disease (ED) misdiagnosis are not just confined to the individual case but may extend to others exposed to the occupational or environmental hazard. Therefore, a comprehensive scoping review of published literature is imperative for understanding the nature of misdiagnoses in OEM.

METHODS

A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (on 06 November 2020). All collected OEM misdiagnoses were classified based on 2 conceptual frameworks, the typical framework, and the causation model. The distribution of misdiagnosis across each medical specialty, each diagnostic step of the typical framework and the causation model, and false-negative and false-positive were summarized.

RESULTS

A total of 79 articles were included in the scoping review. For clinical specialty, pulmonology (30 articles) and dermatology or allergy (13 articles) was most frequent and second-most frequent, respectively. For each disease, occupational and environmental interstitial lung diseases, misdiagnosed as sarcoidosis (8 articles), and other lung diseases (8 articles) were most frequent. For the typical framework, the most vulnerable step was the first step, evidence of a disease (38 articles). For the causation model, the first step, knowledge base, was the most vulnerable step (42 articles). For reported articles, the frequency of false-negative (55 articles) outnumbered the frequency of false-positive (15 articles).

DISCUSSION

In OEM, compared to general medicine, causal misdiagnosis associated with the probability of causation is also important. For making a diagnosis in OEM, a knowledge base about possible ODs and EDs is essential. Because of this reason, the education and training of treating physicians for common ODs and EDs are important. For ODs and EDs, various intentional behaviors of stakeholders should be considered. This scoping review might contribute to the improvement of understanding for misdiagnosis in OEM.

Prevalence of burnout syndrome among Italian volunteers of the Red Cross: a cross-sectional study

Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.

Psychosocial status during the prevalence of COVID-19 disease: the comparison between healthcare workers and general population

The prevalence of COVID-19 disease continues to be a significant psychosocial status among health care workers (HCWs) and the general population worldwide. This cross sectional study aimed to compare the psychosocial status between healthcare workers and general population during the prevalence of COVID-19 disease in southeast Iran. Totally 415 health care workers of a medical service center for COVID-19 patients and 1023 people of general population participated in the study. An online socio-demographic characteristics questionnaire, General Health Questionnaire (GHQ -28), and Generalized Anxiety Disorder 7-item (GAD-7) were utilized to evaluate psychosocial status. According to GHQ, the psychological disorders of the HCWs were significantly higher than that of the general population (P < 0.001). According to GAD-7, no significant difference was found between general population and HCWs. Multivariate logistic analysis showed no difference between general population and HCWs in the psychological disorder. Although HCWs suffered from psychological disorders more than general population, nearly one third to half of the participants in both groups had psychosocial disorders.