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Caminiti M, Mercogliano M, Cussotto F, Briganti GL, Genovese D, Priano W, Ricciotti GM, Bonaccorso N, Grassi F, Antonelli A, Girolametto G, Spatari G, Gianfredi V, Mariniello A, Marisei M, Minutolo G, Ancona A, De Nicolò V, Berselli N, Gallinoro V, Cosma C, Piunno G, Montagna V, Catalini A. Study Protocol for the Residents' Mental Health Investigation, a Dynamic Longitudinal Study in Italy (ReMInDIt). Healthcare (Basel) 2024; 12:1020. [PMID: 38786430 PMCID: PMC11121525 DOI: 10.3390/healthcare12101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Medical residents constitute a vulnerable population susceptible to mental health disorders. In Italy, this was evident during the COVID-19 pandemic, when medical residents served on the front line and provided significant support to healthcare services. Therefore, the working group on "Public Mental Health" of the Medical Residents' Council of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.) designed the "Residents' mental health investigation, a dynamic longitudinal study in Italy" (ReMInDIt). This longitudinal study aims to assess the mental status of medical residents and to explore potential cause-effect relationships between risk/protective factors (identified among sociodemographic, residency program, and lifestyle characteristics) and mental health outcomes (anxiety and depressive symptoms). Data will be collected from a study population of 3615 residents enrolled in Italian residency programs in public health, occupational medicine, and forensic medicine through an online questionnaire that includes validated tools, requires 10 min for completion, and is disseminated by the residents' Councils. It will be followed by a follow-up administration after 12 months. The ReMInDIt study will play a significant role in generating evidence crucial for enhancing mental health services and promoting protective factors for the mental well-being of this important segment of healthcare professionals.
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Affiliation(s)
- Marta Caminiti
- School of Hygiene and Preventive Medicine, University of Perugia, 06100 Perugia, Italy;
| | | | - Federico Cussotto
- School of Hygiene and Preventive Medicine, Department of Sciences of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy;
| | - Giovanni Leonardo Briganti
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy;
| | - Dario Genovese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro” (PROMISE), University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy; (D.G.); (W.P.); (N.B.)
| | - Walter Priano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro” (PROMISE), University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy; (D.G.); (W.P.); (N.B.)
| | - Giorgia Maria Ricciotti
- School of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy;
| | - Nicole Bonaccorso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro” (PROMISE), University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy; (D.G.); (W.P.); (N.B.)
| | - Fabiano Grassi
- School of Hygiene and Preventive Medicine, Department of Public Health and Infectious Diseases, Sapienza University, P. A. Moro 5, 00161 Rome, Italy; (F.G.); (V.D.N.)
| | - Antonio Antonelli
- School of Hygiene and Preventive Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (A.A.)
| | - Gloria Girolametto
- School of Hygiene and Preventive Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy;
| | - Gloria Spatari
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy;
| | | | - Mariagrazia Marisei
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Giuseppa Minutolo
- Food Hygiene, Nutritional Surveillance and Prevention, Department of Prevention, Provincial Healthcare Authority of Palermo, 90129 Palermo, Italy;
| | - Angela Ancona
- School of Hygiene and Preventive Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (A.A.)
| | - Valentina De Nicolò
- School of Hygiene and Preventive Medicine, Department of Public Health and Infectious Diseases, Sapienza University, P. A. Moro 5, 00161 Rome, Italy; (F.G.); (V.D.N.)
| | - Nausicaa Berselli
- Public Hygiene Service, Public Health Department, Local Health Authority of Modena, 41123 Modena, Italy;
| | - Veronica Gallinoro
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (V.G.); (C.C.)
| | - Claudia Cosma
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (V.G.); (C.C.)
| | - Gaia Piunno
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00161 Rome, Italy;
| | | | - Alessandro Catalini
- UOC Igiene degli Alimenti e Nutrizione, Dipartimento di Prevenzione, AST Macerata, 62100 Macerata, Italy;
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Bai S, Chang Q, Yao D, Zhang Y, Wu B, Shan L. The prevalence and risk factors for major depression and suicidal ideation in medical residents based on a large multi-center cross-sectional study using the propensity score-matched method. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2279-2291. [PMID: 36029313 DOI: 10.1007/s00127-022-02351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We determined the prevalence of major depression and suicidal ideation, and the associated risk factors in a large sample of Chinese resident physicians. METHODS This multi-center cross-sectional study was conducted from December 2019 to February 2020 and involved 1343 residents from eight centers. Extensive characteristics, including demographics, dietary habits, life-related factors, work-related factors, and psychological factors were collected based on a self-reported questionnaire. Specific scales measured the levels of sleep quality, physical activity, depression, perceived organization support, psychological capital, and burnout. Adjusted odds ratios and 95% confidence intervals were determined by binary paired logistic regression. RESULTS Of the residents enrolled in the study, 12.90% suffered from major depression and 9.70% suffered from suicidal ideation. Four overlapped independent risk factors were identified for major depression and suicidal ideation: poor sleep quality (OR = 1.317, OR = 1.200); lower optimism of psychological capital (OR = 0.899, OR = 0.835); higher depersonalization, (OR = 1.086, OR = 1.097); and reduced personal accomplishment (OR = 0.963, OR = 0.962). The inappropriate working duration weekly (< 40 h vs. 40-60 h; OR = 2.812, > 60 h vs. 40-60 h; OR = 1.945), and higher emotional exhaustion (OR = 1.121) were the only risk factors for major depression. Higher hope of psychological capital (OR = 1.077) was only for suicidal ideation. CONCLUSION This study revealed a substantial prevalence of major depression and suicidal ideation in Chinese residents, and identified several shared risk factors for major depression and suicidal ideation. These findings enrich the existing theoretical model of depression and demonstrated a critical need for additional studies that investigate intervention strategies that can address the mental health in residents. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900027707. Registered 24 Nov. 2019, http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China
| | - Qing Chang
- Department of Graduate Medical Education, Health Service Center of Liaoning Province, Shenyang, China
| | - Da Yao
- Department of Graduate Medical Education, Health Service Center of Liaoning Province, Shenyang, China
| | - Yixiao Zhang
- Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China
| | - Liping Shan
- Department of Urology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China.
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Kohlfürst DS, Zöggeler T, Karall D, Kerbl R. Workload and job satisfaction among Austrian pediatricians: gender and generational aspects. Wien Klin Wochenschr 2022; 134:516-521. [PMID: 35739286 PMCID: PMC9300563 DOI: 10.1007/s00508-022-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to evaluate different factors that may contribute to workload and job satisfaction among Austrian pediatricians. METHODS We conducted an online survey with 16 questions and performed statistical analyses. RESULTS Of 375 participating pediatricians, 61% were female, 39% male, 61% clinicians, 21% panel doctors and 12% private doctors. Overall, job satisfaction was moderate (6 ± 2.4 on a positive scale of 0-10). Higher working hours (p = 0.014) and higher patient numbers (p = 0.000) were significantly associated with lower job satisfaction. Lowest satisfaction was described for administrative or other nonmedical work. Lack of time for patient consultation was also correlated with poor satisfaction. Pediatricians older than 65 years reported the highest job satisfaction whereas pediatricians between 55 and 65 years and younger than 36 years showed the lowest scores. Although male pediatricians worked significantly more often more than 40 h per week than females (75% vs. 53%, p = 0.000), female pediatricians were less satisfied about the proportion of administrative (p = 0.015) and other nonmedical work (p = 0.014). CONCLUSION New working models considering less workload, particularly less nonmedical work and intensified collaboration between pediatric clinicians and practitioners are needed to allow more available time per patient, to increase job satisfaction and thus to raise attractivity for pediatric primary care.
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Affiliation(s)
- Daniela S Kohlfürst
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
| | - Thomas Zöggeler
- Department of Paediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - Daniela Karall
- Department of Paediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - Reinhold Kerbl
- Department of Paediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben, Austria
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Chen Y, Shen X, Feng J, Lei Z, Zhang W, Song X, Lv C. Prevalence and predictors of depression among emergency physicians: a national cross-sectional study. BMC Psychiatry 2022; 22:69. [PMID: 35090424 PMCID: PMC8795725 DOI: 10.1186/s12888-022-03687-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physicians' depression can damage their physical and mental health and can also lead to prescribing errors and reduced quality of health care. Emergency physicians are a potentially high-risk community, but there have been no large-sample studies on the prevalence and predictors of depression among this population. METHODS A nationally representative cross-sectional survey of 15,243 emergency physicians was conducted in 31 provinces across China between July and September 2019. Multivariable logistic regression analysis was performed to identify predictors of depression. RESULTS A total of 35.59% of emergency physicians suffered from depression. Emergency physicians who were male (OR=0.91) and older [>37 and ≤43 (OR=0.83) or >43 (OR=0.71)], had high (OR=0.63) or middle (OR=0.70) level income, and participated in physical inactivity (OR=0.85) were not more likely to suffer depression. Meanwhile, those who were unmarried (OR=1.13) and smokers (OR=1.12) had higher education levels [Bachelor's degree (OR=1.57) or Master's degree or higher (OR=1.82)], long work tenure [>6 and ≤11 (OR=1.15) or >11;11 (OR=1.19)], poorer health status [fair (OR=1.67) or poor (OR=3.79)] and sleep quality [fair (OR=2.23) or poor (OR=4.94)], a history of hypertension (OR=1.13) and coronary heart disease (OR=1.57) and experienced shift work (OR=1.91) and violence (OR=4.94)]. CONCLUSION Nearly one third of emergency physicians in China suffered from depression. Targeted measures should be taken to reduce the prevalence of depression to avoid a decline in health care quality and adversely impact the supply of emergency medical services.
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Affiliation(s)
- Yueming Chen
- grid.477029.fCentral People’s Hospital of Zhanjiang, Zhanjiang, Guangdong China
| | - Xin Shen
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jing Feng
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Zihui Lei
- grid.33199.310000 0004 0368 7223Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Weixin Zhang
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Avenue, Longhua Zone, Haikou, 571199, Hainan, China.
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China. .,Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.
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Glick H, Ganesh Kumar N, Olinger TA, Vercler CJ, Kraft KH. Resident Mental Health and Burnout: Current Practices and Perspectives of Urology Program Directors. Urology 2021; 160:40-45. [PMID: 34863792 DOI: 10.1016/j.urology.2021.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To understand perspectives of urology program directors (PDs) regarding the management and screening of resident mental health and burnout. METHODS After piloting and survey validation, an IRB-exempt 14 question survey was distributed to PDs of all 145 ACGME accredited urology residency programs. Statistical significance was determined using an alpha value of 0.05 and response plurality was determined by non-overlapping 95% confidence intervals. RESULTS A total of 72 PDs completed the survey (response rate = 49.6%). The majority of PDs (59.7%) do not use standardized screening for resident burnout or mental health. A statistically significant proportion of PDs agreed to implementing periodic mental health (75.0%, 95% CI [65.0%-75.0%]) and burnout (87.6%, 95% CI [79.9%-95.1%]) screening. Female PDs were more likely to agree to implementing mental health screening compared to male PDs (female=94.4% vs male=68.5%; P =.03). If mental health screening was implemented and a resident tested positive, PDs were most concerned about harm to a patient (72.2%, 95% CI [61.9-82.6]) and implications of a positive screen on future licensing and practice (55.6%, 95% CI [44.1-67.0]). CONCLUSION Although the majority of urology PDs believe residents should be periodically screened for burnout and mental health, most do not currently screen their trainees. If mental health screening was implemented, PDs expressed concern about patient harm and challenges associated with future licensing. Our survey results suggest opportunities for improving management of resident burnout and mental health.
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Affiliation(s)
- Hannah Glick
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Thomas A Olinger
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Christian J Vercler
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI.
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Rushing CJ, Casciato DJ, Ead JK, Spinner SM. Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery Residents: A Cross-Sectional Pilot Study. J Foot Ankle Surg 2021; 59:953-956. [PMID: 32487454 DOI: 10.1053/j.jfas.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/21/2019] [Indexed: 02/03/2023]
Abstract
The prevalence of physician burnout among doctors of podiatric medicine (DPM) in the United States remains unknown. The purpose of the present pilot study was to assess perceptions of burnout, personal accomplishment, anxiety, and experiences of shame among DPMs training at Podiatric Medicine and Surgery Residency programs accredited by the Council on Podiatric Medical Education. An anonymous 35-question cross-sectional online survey was developed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Demographic data (sex, age, marital status, postgraduate year) and experiences of shame were also recorded. On December 31, 2018, the survey was distributed for completion. Univariate and bivariate analyses were conducted to obtain summary measures of the predictors and outcomes. Multinomial logistic regression models were obtained to evaluate the associations, and a 2-sided p < .05 was considered statistically significant. A total of 155 responses were eligible for inclusion. Forty-six percent of respondents reported high burnout, and nearly half (54%) reported low personal achievement and moderate to severe anxiety. Most had experienced ≥1 shame event during residency, which was associated with a greater level of anxiety (p < .001). Overall, lower burnout and higher personal achievement scores using the MBI-HSS were associated with lower anxiety scores using the HADS-A questionnaire (p < .001) and the absence of an experienced shame event (p = .039). Given that a potential relationship appears to exist between anxiety/experiences of shame and burnout/personal achievement in the present pilot study, additional longitudinal studies are warranted to discern any causal relationships.
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Affiliation(s)
- Calvin J Rushing
- Foot and Ankle Surgeon, Westside Regional Medical Center, Plantation, FL; Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL.
| | - Dominick J Casciato
- Doctor of Podiatric Medicine Candidate, Barry University School of Podiatric Medicine & Surgery, Miami Shores, FL
| | - Joey K Ead
- Doctor of Podiatric Medicine Candidate, Barry University School of Podiatric Medicine & Surgery, Miami Shores, FL
| | - Steven M Spinner
- Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL; Residency Director, Westside Regional Medical Center, Plantation, FL
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Alva-Diaz C, Nieto-Gutierrez W, Taype-Rondan A, Timaná-Ruiz R, Herrera-Añazco P, Jumpa-Armas D, Escobedo-Palzae S. Association between daily working hours and depressive symptoms in resident physicians in Peru. ACTA ACUST UNITED AC 2021; 50:22-28. [PMID: 33648691 DOI: 10.1016/j.rcp.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/24/2018] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. METHODS Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. RESULTS The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR=1.11; 95% CI, 1.04-1.17). CONCLUSIONS One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.
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Affiliation(s)
- Carlos Alva-Diaz
- Servicio de Neurología, Departamento de Medicina, Hospital Daniel Alcides Carrión, Callao, Perú; Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú; Red de Eficacia Clínica y Sanitaria, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú.
| | - Wendy Nieto-Gutierrez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú
| | - Raúl Timaná-Ruiz
- Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Percy Herrera-Añazco
- Hospital Nacional Dos de Mayo, Lima, Perú; Universidad San Ignacio de Loyola, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - David Jumpa-Armas
- Instituto de Evaluación de Tecnologías en Salud en Investigación, EsSalud, Lima, Perú; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Seimer Escobedo-Palzae
- Sociedad Peruana de Administración en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
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Elhadi M, Khaled A, Malek AB, El-Azhari AEA, Gwea AZ, Zaid A, Elturki SM, Aburgegah A, Abu Ageila MAK, Alhadi A, Albashkar HA, Alshareef AM, Ben Nama AB, Sahboun NAM, Ahmed H. Prevalence of anxiety and depressive symptoms among emergency physicians in Libya after civil war: a cross-sectional study. BMJ Open 2020; 10:e039382. [PMID: 32859667 PMCID: PMC7454180 DOI: 10.1136/bmjopen-2020-039382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We aimed to identify the prevalence of depression and anxiety among physicians working in the emergency departments of nine tertiary care centres in Libya. DESIGN This was a cross-sectional study. SETTING Nine main tertiary centres in Libya PARTICIPANTS: Emergency department doctors were surveyed between December 2018 and February 2019. INTERVENTION The standardised Hospital Anxiety and Depression Scale (HADS) was selected as a measurement tool for analysing anxiety and depression symptoms; a HADS score of 8 indicated anxiety as well as depression symptoms. The primary outcomes were anxiety and depression, which were tabulated with independent sociodemographic variables. χ2 tests were conducted to compare the prevalence of anxiety and depression between the groups. Statistical analysis was performed using SPSS V.25. RESULTS A total of 108 out of 150 (72%) emergency physicians from all levels participated in the study and took the survey. The emergency physicians had a mean±SD age of 31.2±4.5 years, and were predominantly males (74 out of 108, 68.5%). Overall, 49 (45.4%) physicians reached the cut-off score to define both depression and anxiety (ie, a score ≥8). In terms of violence, 71 (65.7%) reported incidents of verbal violence, while 26 (24.1%) reported physical violence or abuse by militias. In addition, 28 reported being threatened by militias. CONCLUSION The high prevalence rate of anxiety and depression is of concern, and the high rate of physical and verbal abuse highlights the range of abuse endured by doctors in Libya. Therefore, screening for anxiety and depression at regular intervals is needed to avoid the deterioration of mental health, which can increase the risk of suicide and dropping out, and decrease the level of healthcare for patients.
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Affiliation(s)
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | | | | | | | | | | | - Hazem Ahmed
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Muhamad Ramzi NSA, Deady M, Petrie K, Crawford J, Harvey SB. Help-seeking for depression among Australian doctors. Intern Med J 2020; 51:2069-2077. [PMID: 32833296 DOI: 10.1111/imj.15035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Depression is common among doctors. However, concerns remain that doctors are unlikely to ask for help when symptoms of depression arise. AIMS To determine rates and patterns of help-seeking for depression among doctors and to identify predictors of and barriers to such behaviour. METHODS A secondary analysis was conducted on a nation-wide survey of 12 252 Australian doctors. The study sample consisted of doctors who reported having ever felt seriously depressed (n = 4154; 33.9% of total sample). Rates of help-seeking, professional help-seeking behaviours and self-reported barriers were explored. Logistic regression was used to examine the association between professional help-seeking and predetermined predictive factors. RESULTS Sixty percent (95% confidence interval (CI): 58.5-61.5) of doctors who have ever felt seriously depressed reported some form of professional help-seeking for depression. The most common barrier to help-seeking was 'privacy/confidentiality'. Females (odds ratio (OR) = 1.74; 95% CI: 1.50-2.01; P < 0.001), locally trained doctors (OR = 1.34; 95% CI: 1.12-1.59; P = 0.001) and senior doctors (OR = 1.35; 95% CI: 1.14-1.61; P = 0.001) were more likely to seek professional help than their counterparts. Compared with general practitioners, psychiatrists (OR = 1.565; 95% CI: 1.15-2.13; P = 0.004) were more likely to seek professional help while surgeons (OR = 0.518; 95% CI: 0.37-0.72; P < 0.001) and pathologists/radiologists (OR = 0.695; 95% CI: 0.49-0.99; P = 0.043) were less likely. CONCLUSION While it is reassuring that the majority of depressed doctors were able to seek professional help, many were not. Major barriers to professional help-seeking, particularly concerns about confidentiality and impact on career, remain a problem. Male, overseas-trained, junior doctors, surgeons and pathologists/radiologists were less likely to seek help for depression. Targeted interventions are required to increase appropriate help-seeking for depression in doctors.
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Affiliation(s)
| | - Mark Deady
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Katherine Petrie
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Joanna Crawford
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
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Chisholm-Burns MA. Building resilience to combat stress, burnout, and suicidal ideation among pharmacists. Am J Health Syst Pharm 2019; 76:1364-1367. [PMID: 31505558 DOI: 10.1093/ajhp/zxz172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Marie A Chisholm-Burns
- University of Tennessee Health Science Center College of PharmacyMemphis, Knoxville, and Nashville, TN
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11
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Al Atassi H, Shapiro MC, Rao SR, Dean J, Salama A. Oral and Maxillofacial Surgery Resident Perception of Personal Achievement and Anxiety: A Cross-Sectional Analysis. J Oral Maxillofac Surg 2018; 76:2532-2539. [DOI: 10.1016/j.joms.2018.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/20/2022]
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12
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Marzouk M, Ouanes-Besbes L, Ouanes I, Hammouda Z, Dachraoui F, Abroug F. Prevalence of anxiety and depressive symptoms among medical residents in Tunisia: a cross-sectional survey. BMJ Open 2018; 8:e020655. [PMID: 30037867 PMCID: PMC6059333 DOI: 10.1136/bmjopen-2017-020655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the prevalence of anxiety and depressive symptoms and the associated risk factors among Tunisian medical residents. DESIGN Cross-sectional survey. SETTING Faculty of Medicine, Tunis. PARTICIPANTS All Tunisian medical residents brought together between 14 and 22 December 2015 to choose their next 6-month rotation. INTERVENTION The items of the Hospital Anxiety and Depression (HAD) questionnaire were employed to capture the prevalence of anxiety and/or depression among the residents. The statistical relationships between anxiety and depression (HAD score) and sociodemographic and work-related data were explored by Poisson regression. RESULTS 1700 out of 2200 (77%) medical residents (mean age: 28.5±2 years, female: 60.8%) answered the questionnaire. The mean working hours per week was 62±21 hours; 73% ensured a mean of 5.4±3 night shifts per month; and only 8% of them could benefit from a day of safety rest. Overall, 74.1% of the participating residents had either definite (43.6%) or probable (30.5%) anxiety, while 62% had definite (30.5%) or probable (31.5%) depression symptoms, with 20% having both definite anxiety and definite depression. The total HAD score was significantly associated with the resident's age (OR=1.014, 95% CI 1.006 to 1.023, p=0.001); female gender (OR=1.114, 95% CI 1.083 to 1.145, p<0.0001); and the heavy burden of work imposed on a weekly or monthly basis, as reflected by the number of night shifts per month (OR=1.048, 95% CI 1.016 to 1.082, p=0.03) and the number of hours worked per week (OR=1.008, 95% CI 1.005 to 1.011, p<0.0001). Compared with medical specialties, the generally accepted difficult specialties (surgical or medical-surgical) were associated with a higher HAD score (OR=1.459, 95% CI 1.172 to 1.816, p=0.001). CONCLUSION Tunisian residents experience a rate of anxiety/depression substantially higher than that reported at the international level. This phenomenon is worrying as it has been associated with an increase in medical errors, work dissatisfaction and attrition. The means of improving the well-being of Tunisian medical residents are explored, emphasising those requiring immediate implementation.
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Affiliation(s)
- Mehdi Marzouk
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
| | - Lamia Ouanes-Besbes
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
| | - Islem Ouanes
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
| | - Zeineb Hammouda
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
| | - Fahmi Dachraoui
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
| | - Fekri Abroug
- Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
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Chen CY, Yu NW, Huang TH, Wang WS, Fang JT. Harm avoidance and depression, anxiety, insomnia, and migraine in fifth-year medical students in Taiwan. Neuropsychiatr Dis Treat 2018; 14:1273-1280. [PMID: 29844675 PMCID: PMC5962300 DOI: 10.2147/ndt.s163021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE During medical school training, increased stress, depression, and anxiety are common. Certain personality traits, particularly harm avoidance (HA), may increase the risk of psycho-pathological disorders, insomnia, and migraine among medical students. This study evaluated the role HA may play on levels of stress, depression, anxiety, and insomnia among Taiwanese medical students starting their fifth and final year of medical school. PATIENTS AND METHODS A series of self-report questionnaires were used to measure the severity of anxiety, depression, and insomnia, as well as somatic symptoms, particularly migraine headache, among 143 Taiwanese fifth-year medical students (94 males and 49 females). Most had normal or mild levels of anxiety, depression, insomnia, and migraine. RESULTS HA personality trait was significantly associated with depression (all P ≤ 0.001) after adjusting for other factors. HA was not significantly associated with anxiety, insomnia, or migraine headache days. CONCLUSION HA personality trait was significantly associated with depression among fifth-year medical students in Taiwan.
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Affiliation(s)
- Ching-Yen Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Nan-Wen Yu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tien-Hao Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Shin Wang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ji-Tseng Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
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14
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Availability of Emotional Support and Mental Health Care for Pediatric Residents. Acad Pediatr 2017; 17:424-430. [PMID: 28137673 DOI: 10.1016/j.acap.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Resident mental health (MH) problems can be associated with reduced empathy and increased medical errors. The Accreditation Council for Graduate Medical Education mandates resident MH support services, but it is unknown if these services are accessible and meet resident needs. We sought to describe the prevalence of anxiety and depression in current pediatric residents in New York State (NYS), and their self-reported use of and barriers to support services. METHODS We developed an online survey and distributed it to all categorical pediatric residents in 9 NYS programs. Items addressing self-concern for clinical anxiety and depression and use of MH services were pilot tested for content and construct validity. The validated Patient Health Questionnaire-2 (PHQ-2) measured depressive symptoms. Analyses used descriptive and chi-square tests. RESULTS Respondents included 227 residents (54% response rate) distributed across training levels and programs. Many reported "often" or "almost always" feeling stress (52%), physical exhaustion (41%), and mental exhaustion (35%); 11% had PHQ-2-defined depressive symptoms. Some thought that their stress levels raised concern for clinical depression (25%) or anxiety (28%); among these, only 44% and 39%, respectively, had sought care. More women reported physical exhaustion (P < .05). Only 45% of residents reported educational offerings on resident MH; 66% wanted to know more about available resources. Barriers to receipt of services included inflexible schedules (82%), guilt about burdening colleagues (65%), fear of confidentiality breach (46%), and difficulty identifying services (44%). CONCLUSIONS Pediatric residents frequently experience MH symptoms, but many do not know about or use support services. Programs should enhance MH support by overcoming barriers and increasing resident awareness of services.
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Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA 2015; 314:2373-83. [PMID: 26647259 PMCID: PMC4866499 DOI: 10.1001/jama.2015.15845] [Citation(s) in RCA: 725] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.
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Affiliation(s)
- Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco A Ramos
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Narinder Bansal
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Rida Khan
- Department of Medicine, Baylor College of Medicine, Texas Medical Center, Houston
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | | | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, Department of Psychiatry, University of Michigan, Ann Arbor
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Guille C, Zhao Z, Krystal J, Nichols B, Brady K, Sen S. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial. JAMA Psychiatry 2015; 72:1192-8. [PMID: 26535958 PMCID: PMC4866804 DOI: 10.1001/jamapsychiatry.2015.1880] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In the United States, approximately 1 physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing more than 4-fold during the first 3 months of internship year. Despite this increase, to our knowledge, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. OBJECTIVE To assess the effectiveness of a web-based cognitive behavioral therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted at 2 university hospitals with 199 interns from multiple specialties during academic years 2009-2010 or 2011-2012. The current study was conducted from May 2009 to June 2010 and May 2011 to June 2012, and data were analyzed using intent-to-treat principles, including last observation carried forward. INTERVENTIONS Interns were randomly assigned to 2 study groups (wCBT and attention-control group [ACG]), and completed study activities lasting 30 minutes each week for 4 weeks prior to starting internship year. Participants assigned to wCBT completed online CBT modules and those assigned to ACG received emails with general information about depression, suicidal thinking, and local mental health professionals. MAIN OUTCOMES AND MEASURES The Patient Health Questionnaire-9 was used to assess suicidal ideation (ie, "thoughts that you would be better off dead or hurting yourself in some way") prior to the start of intern year and at 3-month intervals throughout the year. RESULTS A total of 62.2% of interns (199 of 320) agreed to take part in the study; 100 were assigned to the wCBT group and 99 to the ACG. During at least 1 point over the course of internship year, 12% of interns (12 of 100) assigned to wCBT endorsed suicidal ideation compared with 21.2% of interns (21 of 99) assigned to ACG. After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT were less likely to endorse suicidal ideation during internship year (relative risk, 0.40; 95% CI, 0.17- 0.91; P = .03) compared with those assigned to ACG. CONCLUSIONS AND RELEVANCE This study demonstrates that a free, easily accessible, brief wCBT program is associated with reduced likelihood of suicidal ideation among medical interns. Prevention programs with these characteristics could be easily disseminated to medical training programs across the country. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12610000628044.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, 29425
| | - Zhuo Zhao
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - John Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, 29425
| | - Breck Nichols
- Department of Pediatrics, University of Southern California, Los Angeles, CA 90089
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, 29425
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
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Chen CY, Lin SH, Li P, Huang WL, Lin YH. The role of the harm avoidance personality in depression and anxiety during the medical internship. Medicine (Baltimore) 2015; 94:e389. [PMID: 25590843 PMCID: PMC4602540 DOI: 10.1097/md.0000000000000389] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine whether physicians with harm avoidance (HA) personality traits were more prone to developing increased anxiety and depression during the medical internship. A prospective longitudinal study of 74 medical interns was carried out using repeated measures of symptoms of anxiety and depression with the Beck Anxiety and Depression Inventories (BAI and BDI) before, at the 3rd, 6th, and 12th months during the internship, and 2 weeks after the internship was completed. Baseline personality was assessed by the Tridimensional Personality Questionnaire with 3 dimensions: novelty-seeking, HA, and reward dependence (RD). Levels of both depression and anxiety increased (6.4 and 3.4 on scores for BDI and BAI, respectively) during the internship and returned to baseline 2 weeks after it ended. HA scores were significantly correlated with depression and anxiety (0.3 scores on both the BDI and the BAI) and the scores for RD were significantly correlated with anxiety but not with depression. The interaction of HA and point in internship showed no significant differences. Internship plays a major role in the increase in depression and anxiety. A HA personality was also associated with the development of both depression and anxiety.
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Affiliation(s)
- Ching-Yen Chen
- From the School of Medicine, Chang Gung University, Taoyuan, Taiwan (C-YC, PL); Department of Psychiatry, Chang Gung Memorial Hospital at Lin-Kou, Taoyuan, Taiwan (C-YC, PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (S-HL); Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan (W-LH); Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Y-HL)
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18
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Joules N, Williams DM, Thompson AW. Depression in Resident Physicians: A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojd.2014.33013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lin YH, Chen CY, Lin SH, Liu CH, Weng WH, Kuo TBJ, Yang CCH. Gender differences in cardiac autonomic modulation during medical internship. Psychophysiology 2013; 50:521-7. [PMID: 23517383 DOI: 10.1111/psyp.12038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 01/25/2013] [Indexed: 11/30/2022]
Abstract
Medical internship is known to be a time of high stress and long working hours, which increases the risk of depression and cardiovascular disease. Gender differences in medical interns' cardiovascular risk have not been reported previously. Thirty-eight medical interns (29 males) were repeatedly tested for depressive symptoms using the Hospital Anxiety and Depression Scale and 5-min spectral analysis of heart rate variability (HRV) at 3-month intervals during their internship. Among the male interns, the variance of the heart rate decreased at 6, 9, 12 months, and a reduced high frequency, which suggests reduced cardiac parasympathetic modulation, was found at 9 and 12 months into their internship. Increased depressive symptoms were also identified at 12 months in the male group. No significant differences in depression or any of the HRV indices were identified among the female interns during their internship.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Cohen D, Rhydderch M. Support for tomorrow's doctors: getting it right, meeting their needs. Occup Med (Lond) 2013; 63:2-4. [PMID: 23292339 DOI: 10.1093/occmed/kqs179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Trout AT, Wang PI, Cohan RH, Bailey JE, Khalatbari S, Myles JD, Dunnick NR. Apprenticeships ease the transition to independent call: an evaluation of anxiety and confidence among junior radiology residents. Acad Radiol 2011; 18:1186-94. [PMID: 21719320 DOI: 10.1016/j.acra.2011.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/08/2011] [Accepted: 04/09/2011] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to quantify resident anxiety when beginning independent call and to assess whether an apprenticeship experience (buddy call) can lessen anxiety and improve confidence. MATERIALS AND METHODS A prospective cohort comparison of two groups of radiology residents beginning independent call, one of which was provided with a buddy call experience, was performed. Anxiety and confidence were assessed using the Endler Multidimensional Anxiety Scales-State (EMAS-S), with total score, autonomic emotional, and cognitive worry components, and a five-point, Likert-type scale, respectively. Both groups were asked about the perceived value of a buddy call experience. RESULTS EMAS-S scores improved significantly over 5 days of call in both groups (control, n = 10, P = .0005; buddy call, n = 9, P = .0001), and image interpretation confidence correspondingly increased (control, P = .0004; buddy call, P = .003). Compared to the control group, autonomic emotional scores were significantly lower in the buddy call group on the first day of independent call (P = .040), and cognitive worry and total EMAS-S scores were significantly lower on day 5 (both P values = .03). Buddy call was independently associated with improved autonomic emotional and film interpretation confidence scores (both P values = .02). All members of the buddy call group indicated that the experience was very helpful in preparing for call. CONCLUSIONS Beginning independent call is associated with high anxiety, and buddy call reduces that anxiety, beyond the effect of time alone. Residents who participated in buddy call found it helpful in preparing for independent call. These findings support the use of buddy call and tiered call structures as means to introduce junior residents to independent call.
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Guille C, Speller H, Laff R, Epperson CN, Sen S. Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. J Grad Med Educ 2010; 2:210-4. [PMID: 21975622 PMCID: PMC2941380 DOI: 10.4300/jgme-d-09-00086.1] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/12/2010] [Accepted: 03/29/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Compared with graduate students and young adults in the general population, depression is more prevalent among training physicians, yet physicians are often reluctant to seek mental health treatment. The purpose of this study is to identify perceived barriers to mental health treatment among depressed training physicians. METHODS Subjects for this study were drawn from intern classes during the 2007-2008 and 2008-2009 academic years from 6 and 13 participating community and university hospitals, respectively. At 3-month intervals throughout the intern year, participants completed the Patient Health Questionnaire regarding current depressive symptoms and questions regarding current mental health treatment. We explored potential barriers to mental health treatment at the end of the intern year and determined the proportion of subjects screening positive for depression and seeking treatment through analysis of subject responses. Stepwise binary logistic regression was conducted to compare baseline characteristics among depressed interns who sought mental health treatment and those that did not. RESULTS Of the 42.5% (278 of 654) of interns who screened positive for depression, 22.7% (63 of 278) reported receiving treatment during the intern year. The most frequently cited barriers to seeking treatment were time (91.5%), preference to manage problems on their own (75.1%), lack of convenient access (61.8%), and concerns about confidentiality (57.3%). Interns who had previously sought treatment for depression were more likely to seek treatment during internship. CONCLUSIONS Despite high rates of depression, few interns appear to seek mental health treatment due to time constraints, lack of convenient access, concerns about confidentiality, and a preference to manage problems on their own. By identifying barriers to mental health treatment we can begin to remove obstacles to the delivery of evidence-based treatments and implement prevention, screening, and early detection programs to improve the mental health of physicians in training.
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Affiliation(s)
- Constance Guille
- Corresponding author: Constance Guille, MD, Department of Psychiatry & Behavioral Science, 67 President St, 2nd floor South Bldg MSC 861, Charleston, SC 29425, 860.335.2554,
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Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J, Guille C. A prospective cohort study investigating factors associated with depression during medical internship. ACTA ACUST UNITED AC 2010; 67:557-65. [PMID: 20368500 DOI: 10.1001/archgenpsychiatry.2010.41] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Although the prevalence of depression among medical interns substantially exceeds that of the general population, the specific factors responsible are not well understood. Recent reports of a moderating effect of a genetic polymorphism (5-HTTLPR) in the serotonin transporter protein gene on the likelihood that life stress will precipitate depression may help to understand the development of mood symptoms in medical interns. OBJECTIVES To identify psychological, demographic, and residency program factors that are associated with depression among interns and to use medical internship as a model to study the moderating effects of this polymorphism. DESIGN A prospective cohort study. SETTING Thirteen US hospitals. PARTICIPANTS Seven hundred forty interns entering participating residency programs. MAIN OUTCOME MEASURES Subjects were assessed for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), a series of psychological traits, and the 5-HTTLPR genotype prior to internship and then assessed for depressive symptoms and potential stressors at 3-month intervals during internship. RESULTS The PHQ-9 depression score increased from 2.4 prior to internship to a mean of 6.4 during internship (P < .001). The proportion of participants who met PHQ-9 criteria for depression increased from 3.9% prior to internship to a mean of 25.7% during internship (P < .001). A series of factors measured prior to internship (female sex, US medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score, and higher neuroticism) and during internship (increased work hours, perceived medical errors, and stressful life events) was associated with a greater increase in depressive symptoms during internship. In addition, subjects with at least 1 copy of a less-transcribed 5-HTTLPR allele reported a greater increase in depressive symptoms under the stress of internship (P = .002). CONCLUSIONS There is a marked increase in depressive symptoms during medical internship. Specific individual, internship, and genetic factors are associated with the increase in depressive symptoms.
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Affiliation(s)
- Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
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Lam TP, Wong JGWS, Ip MSM, Lam KF, Pang SL. Psychological well-being of interns in Hong Kong: what causes them stress and what helps them. MEDICAL TEACHER 2010; 32:e120-e126. [PMID: 20218827 DOI: 10.3109/01421590903449894] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Many doctors experience psychological ill health. Interns are known to be particularly vulnerable. AIM To examine the level of depression, anxiety and stress in interns in Hong Kong, as well as the causes and how they cope. METHODS A questionnaire was designed based on the themes identified in three focus groups of medical graduates of Year 2004 of the University of Hong Kong. The 21-item Depression, Anxiety and Stress Scale (DASS 21) was also administered. All 155 graduates of the same year were invited to participate with a response rate of 63%. RESULTS Percentages of respondents with abnormal levels of depression, anxiety and stress were 35.8%, 35.4% and 29.2%, respectively. Frequent calls during night shift, long working hours and heavy workload constituted the most significant stressors. Factor analysis of the stressors showed that seven factors could explain 68% of the total variance: multidisciplinary team working issues, clinical difficulties, job seeking and employment, workload issues, ethical and interpersonal issues, adjustment to job rotation and performance appraisal. Holidays, peers and sleep offered the most significant relief. CONCLUSION Interns experience considerable depression, anxiety and stress. The source of stress is multi-faceted, but workload is the most significant stressor. Peer support groups may relief stress.
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Affiliation(s)
- T P Lam
- Family Medicine Unit, Department of Medicine, The University of Hong Kong, Hong Kong, PR China.
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Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, Kent A, Kunkel M, Schechter J, Tate J. Depressive symptoms in medical students and residents: a multischool study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:236-41. [PMID: 19174678 DOI: 10.1097/acm.0b013e31819391bb] [Citation(s) in RCA: 258] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND This multisite, anonymous study assessed depressive symptoms and suicidal ideation in medical trainees (medical students and residents). METHOD In 2003-2004, the authors surveyed medical trainees at six sites. Surveys included content from the Center for Epidemiologic Studies-Depression scale (CES-D) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) (measures for depression), as well as demographic content. Rates of reported major and minor depression and of suicidal ideation were calculated. Responses were compared by level of training, gender, and ethnicity. RESULTS More than 2,000 medical students and residents responded, for an overall response rate of 89%. Based on categorical levels from the CES-D, 12% had probable major depression and 9.2% had probable mild/moderate depression. There were significant differences in depression by trainee level, with a higher rate among medical students; and gender, with higher rates among women (chi2 = 10.42, df = 2, and P = .005 and chi2 = 22.1, df = 2, and P < .001, respectively). Nearly 6% reported suicidal ideation, with differences by trainee level, with a higher rate among medical students; and ethnicity, with the highest rate among black/African American respondents and the lowest among Caucasian respondents (chi2 = 5.19, df = 1, and P = .023 and chi2 = 10.42, df = 3, and P = .015, respectively). CONCLUSIONS Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees.
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Affiliation(s)
- Deborah Goebert
- Department of Psychiatry, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii 96813, USA.
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Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008; 336:488-91. [PMID: 18258931 PMCID: PMC2258399 DOI: 10.1136/bmj.39469.763218.be] [Citation(s) in RCA: 716] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors. DESIGN Prospective cohort study. SETTING Three urban freestanding children's hospitals in the United States. PARTICIPANTS 123 residents in three paediatric residency programmes. MAIN OUTCOME MEASURES Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month. RESULTS 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2). CONCLUSIONS Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.
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Affiliation(s)
- Amy M Fahrenkopf
- Harvard Medical School, Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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Yi MS, Mrus JM, Mueller CV, Luckhaupt SE, Peterman AH, Puchalski CM, Tsevat J. Self-rated health of primary care house officers and its relationship to psychological and spiritual well-being. BMC MEDICAL EDUCATION 2007; 7:9. [PMID: 17474998 PMCID: PMC1876223 DOI: 10.1186/1472-6920-7-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 05/02/2007] [Indexed: 05/08/2023]
Abstract
BACKGROUND The stress associated with residency training may place house officers at risk for poorer health. We sought to determine the level of self-reported health among resident physicians and to ascertain factors that are associated with their reported health. METHODS A questionnaire was administered to house officers in 4 residency programs at a large Midwestern medical center. Self-rated health was determined by using a health rating scale (ranging from 0 = death to 100 = perfect health) and a Likert scale (ranging from "poor" health to "excellent" health). Independent variables included demographics, residency program type, post-graduate year level, current rotation, depressive symptoms, religious affiliation, religiosity, religious coping, and spirituality. RESULTS We collected data from 227 subjects (92% response rate). The overall mean (SD) health rating score was 87 (10; range, 40-100), with only 4 (2%) subjects reporting a score of 100; on the Likert scale, only 88 (39%) reported excellent health. Lower health rating scores were significantly associated (P < 0.05) with internal medicine residency program, post-graduate year level, depressive symptoms, and poorer spiritual well-being. In multivariable analyses, lower health rating scores were associated with internal medicine residency program, depressive symptoms, and poorer spiritual well-being. CONCLUSION Residents' self-rated health was poorer than might be expected in a cohort of relatively young physicians and was related to program type, depressive symptoms, and spiritual well-being. Future studies should examine whether treating depressive symptoms and attending to spiritual needs can improve the overall health and well-being of primary care house officers.
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Affiliation(s)
- Michael S Yi
- Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph M Mrus
- Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- HSR&D Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
- Tibotec Therapeutics Clinical Affairs, East Bridgewater, NJ, USA
| | - Caroline V Mueller
- Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara E Luckhaupt
- Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Amy H Peterman
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Christina M Puchalski
- Department of Medicine, George Washington University Medical Center, Washington, DC, USA
- George Washington Institute for Spirituality and Health, Washington, DC, USA
| | - Joel Tsevat
- Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
- Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA
- HSR&D Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
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Eller T, Aluoja A, Vasar V, Veldi M. Symptoms of anxiety and depression in Estonian medical students with sleep problems. Depress Anxiety 2006; 23:250-6. [PMID: 16555263 DOI: 10.1002/da.20166] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
High emotional stress in medical students has been observed in many studies. Our aim in this article was to assess the prevalence of symptoms of anxiety and depression among Estonian medical students and to find relationships between sleep complaints and emotional symptoms. The study group consisted of 413 medical students, ages 19-33 years, at the University of Tartu. Each was asked to complete two questionnaires: the Emotional State Questionnaire (EST-Q), containing 28 questions, and the Questionnaire on Sleep and Daytime Habits, with 25 questions. The anxiety and depression subscales from the EST-Q were applied. From the study group, 21.9% students had symptoms of anxiety, and 30.6% had symptoms of depression. The frequency of anxiety and depressive symptoms was higher in females. In regression and multiple regression analysis, we determined which sleep problems were related to emotional symptoms. The associations were different for men and women. In women, anxiety remained significantly related to waking up because of nightmares and feeling tired in the morning; depressive symptoms were related to difficulties in getting to sleep at night, waking up because of nightmares and nocturnal eating habits, daytime sleepiness, and sleepiness during school lessons. In men, significant relations were clear only for depression: difficulties in falling asleep at night before an exam and subjective sleep quality. The study demonstrated that a high percentage of medical students had emotional symptoms. We found that some sleep problems indicated underlying symptoms of anxiety and depression.
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Affiliation(s)
- Triin Eller
- Department of Psychiatry, University of Tartu, Tartu, Estonia.
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Becker JL, Milad MP, Klock SC. Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents. Am J Obstet Gynecol 2006; 195:1444-9. [PMID: 17074551 DOI: 10.1016/j.ajog.2006.06.075] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 06/17/2006] [Accepted: 06/27/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was undertaken to measure career satisfaction among obstetrics and gynecology residents and assess its relationship to burnout, depression, and malpractice concerns. STUDY DESIGN A 63-item, anonymous, self-administered survey was distributed to residents at 23 randomly selected obstetric and gynecologic residency programs in the United States. The outcome measures included the Maslach Burnout Inventory-Human Services Survey, the Center for Epidemiological Studies-Depression Scale, and perceptions of malpractice and career satisfaction. RESULTS Eighty-three percent of the residents were either "very or somewhat satisfied" with their career choice. The majority (89.8%) showed evidence of moderate burnout and 34.2% were considered depressed. Ninety-six percent were concerned about malpractice with 35% pursuing fellowship solely because of malpractice concerns. Residents dissatisfied with their career choice were twice as likely to be depressed (30% vs 55%, P = .03). Both emotional exhaustion (P < .0001) and consideration of fellowship because of malpractice (P < .0001) were strongly predictive of diminishing career satisfaction. CONCLUSION Resident career satisfaction was inversely correlated with burnout and depression, which were more prevalent than expected. Overall, residents were satisfied with their career choice, but also negatively influenced by malpractice concerns.
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Affiliation(s)
- Julie L Becker
- Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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Yi MS, Luckhaupt SE, Mrus JM, Mueller CV, Peterman AH, Puchalski CM, Tsevat J. Religion, spirituality, and depressive symptoms in primary care house officers. ACTA ACUST UNITED AC 2006; 6:84-90. [PMID: 16530144 DOI: 10.1016/j.ambp.2005.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 09/20/2005] [Accepted: 10/05/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The arduous nature of residency training places house officers at risk for depression. We sought to determine the prevalence of depressive symptoms in pediatric (PED), internal medicine (IM), family medicine (FM), and combined internal medicine-pediatric (IMPED) house staff, and spiritual/religious factors that are associated with prevalence of depressive symptoms. METHODS PED, IM, FM, and IMPED residents at a major teaching program were asked to complete a questionnaire during their In-Training Examination. Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression Scale. Independent variables included demographics, residency program type, postgraduate level, current rotation, health status, religious affiliation, religiosity, religious coping, and spirituality. RESULTS We collected data from 227 subjects. Their mean (SD) age was 28.7 (3.8) years; 131 (58%) were women; 167 (74%) were white; and 112 (49%) were PED, 62 (27%) were IM, 27 (12%) were FM, and 26 (12%) were IMPED residents. Fifty-seven house officers (25%) met the criteria for having significant depressive symptoms. Having depressive symptoms was significantly associated (P< .05) with residency program type, inpatient rotation status, poorer health status, poorer religious coping, and worse spiritual well-being. In multivariable analyses, having significant depressive symptoms was associated with program type, poorer religious coping, greater spiritual support seeking, and worse spiritual well-being. CONCLUSIONS Depressive symptoms are prevalent among house officers and are associated with certain residency program types and with residents' spiritual and religious characteristics. Identifying residents with depressive symptoms and potentially attending to their spiritual needs may improve their well-being.
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Affiliation(s)
- Michael S Yi
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, OH 45267, USA.
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Mitchell M, Srinivasan M, West DC, Franks P, Keenan C, Henderson M, Wilkes M. Factors affecting resident performance: development of a theoretical model and a focused literature review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:376-89. [PMID: 15793024 DOI: 10.1097/00001888-200504000-00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE The clinical performances of physicians have come under scrutiny as greater public attention is paid to the quality of health care. However, determinants of physician performance have not been well elucidated. The authors sought to develop a theoretical model of physician performance, and explored the literature about factors affecting resident performance. METHOD Using expert consensus panel, in 2002-03 the authors developed a hypothesis-generating model of resident performance. The developed model had three input factors (individual resident factors, health care infrastructure, and medical education infrastructure), intermediate process measures (knowledge, skills, attitudes, habits), and final health outcomes (affecting patient, community and population). The authors used factors from the model to focus a PubMed search (1967-2002) for all original articles related to the factors of individual resident performance. RESULTS The authors found 52 original studies that examined factors of an individual resident's performance. They describe each study's measurement instrument, study design, major findings, and limitations. Studies were categorized into five domains: learning styles/personality, social/financial factors, practice preferences, personal health, and response to job environment. Few studies examined intermediate or final performance outcomes. Most were single-institution, cross-sectional, and survey-based studies. CONCLUSIONS Attempting to understand resident performance without understanding factors that influence performance is analogous to examining patient adherence to medication regimens without understanding the individual patient and his or her environment. Based on a systematic review of the literature, the authors found few discrete associations between the factors of individual resident and the resident's actual job performance. Additionally, they identify and discuss major gaps in the educational literature.
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Affiliation(s)
- Maya Mitchell
- Department of Medicine, University of California, Davis, School of Medicine, 4150 V. Street, Suite 2400, Sacramento, CA 95817, USA
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Abstract
An impaired physician is one unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency. Current estimates are that approximately 15% of physicians will be impaired at some point in their careers. Although physicians may not have higher rates of impairment compared with other professionals, factors in their background, personality, and training may contribute and predispose them to drug abuse and mental illness, particularly depression. Many physicians possess a strong drive for achievement, exceptional conscientiousness, and an ability to deny personal problems. These attributes are advantageous for "success" in medicine; ironically, however, they may also predispose to impairment. Identifying impairment is often difficult because the manifestations are varied and physicians will typically suppress and deny any suggestion of a problem. Identification is essential because patient well-being may be at stake, and untreated impairment may result in loss of license, health problems, and even death. Fortunately, once identified and treated, physicians often do better in recovery than others and typically can return to a productive career and a satisfying personal and family life.
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Affiliation(s)
- E V Boisaubin
- Department of Medicine, University of Texas Medical Branch, Galveston 77555-0566, USA.
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Levey RE. Sources of stress for residents and recommendations for programs to assist them. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2001; 76:142-50. [PMID: 11158832 DOI: 10.1097/00001888-200102000-00010] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Bridging the gap between graduation from medical school and being board eligible in a medical specialty is a lengthy and arduous process. The fact that stress is typical during the residency training period is well-documented in the literature, as are its many situational, professional, and personal sources, which the author reviews: heavy work-load, sleep deprivation, difficult patients, poor learning environments, relocation issues, isolation and social problems, financial concerns, cultural and minority issues, information overload, and career planning issues. Stress can also stem from and exacerbate gender-related issues and problems for significant others, spouses, and family members. The author also describes less commonly documented sources of stress-often overlooked or postponed so long that stresses are inevitable for all concerned. These are associated with residents who perform marginally and in some cases should not have been passed on from medical school, or who are studying specialties not compatible with their skills and personalities, or who foster severe interpersonal problems on the job. Common effects of stress include anxiety, depression, obsessive-compulsive trends, hostility, and alcohol and substance abuse. To respond to the problems that these many stressors present to residents, the Accreditation Council for Graduate Medical Education (ACGME) requires that all post-medical-school medical training programs make assistance services available for all residents. The author outlines essential elements of an assistance program, states how important such problems can be in saving both residents and their institutions needless difficulties and costs, and presents important issues for the consideration of all involved in residents' training.
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Affiliation(s)
- R E Levey
- Department of Medicine, the University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
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