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      The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

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          Abstract

          Background

          We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability.

          Methods

          A questionnaire was sent to all (n = 958) hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD), anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item). The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to physicians with low complaint scores were calculated for each mental disorder.

          Results

          The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0–10), and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold for stress more likely to report their work ability as insufficient.

          Conclusions

          The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.

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          Most cited references27

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          Burnout and self-reported patient care in an internal medicine residency program.

          Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Cross-sectional study using an anonymous, mailed survey. University-based residency program in Seattle, Washington. 115 internal medicine residents. Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made...errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout--but not sex, depression, or at-risk alcohol use--was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
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            Effect of a comprehensive surgical safety system on patient outcomes.

            Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway. We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals. In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.).
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              Psychosocial work environment and mental health--a meta-analytic review.

              To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.
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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2012
                31 August 2012
                : 12
                : 292
                Affiliations
                [1 ]Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100, DE Amsterdam, the Netherlands
                Article
                1472-6963-12-292
                10.1186/1472-6963-12-292
                3459739
                22938170
                9ba0c24f-e297-419f-8e10-38c3410cefe4
                Copyright ©2012 Ruitenburg et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 July 2011
                : 26 July 2012
                Categories
                Research Article

                Health & Social care
                Health & Social care

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