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Burnout in physicians

Lee YY, Medford AR, Halim AS

J R Coll Physicians Edinb, 2015;45(2):104-7.
PMID: 26181523 DOI: 10.4997/JRCPE.2015.203

Increasing numbers of doctors are experiencing burnout now more than ever before and the worrying part is that what we see is just the tip of the iceberg. Burnout, a state of mental exhaustion caused by the doctor's professional life, is characterised by emotional exhaustion, depersonalisation and a reduced sense of accomplishment or success. Burnout has been largely ignored or under-recognised previously. This paper provides a perspective on burnout among doctors, including an overview of symptoms, the scale of the problem, the implications and causes of burnout and, finally, a strategic framework to provide a basis for managing it. Most importantly, professional bodies are urged to start taking steps to help troubled doctors. Medical Colleges should provide essential assistance, support and guidance as well as ensuring fair management and promotion policies.

Matched MeSH terms: Workload/psychology
Fulltext Doctors' Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences

Mohd Fauzi MF, Mohd Yusoff H, Muhamad Robat R, Mat Saruan NA, Ismail KI, Mohd Haris AF

Int J Environ Res Public Health, 2020 10 08;17(19).
PMID: 33050004 DOI: 10.3390/ijerph17197340

The COVID-19 pandemic potentially increases doctors' work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors' fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = -0.53), chronic fatigue (adj. b = -0.53), depression (adj. b = -0.14), anxiety (adj. b = -0.11), and stress (adj. b = -0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = -0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

Matched MeSH terms: Workload/psychology
Influence of job demands and job control on work-life balance among Taiwanese nurses

Ng LP, Chen IC, Ng HF, Lin BY, Kuar LS

J Nurs Manag, 2017 Sep;25(6):438-448.
PMID: 28419626 DOI: 10.1111/jonm.12482

AIM: This study investigated the extent to which the job demands and job control of nurses were related to their work-life balance.
BACKGROUND: The inability to achieve work-life balance is one of the major reasons for the declining retention rate among nurses. Job demands and job control are two major work domain factors that can have a significant influence on the work-life balance of nurses.
METHOD: The study measured the job demands, job control and work-life balance of 2040 nurses in eight private hospitals in Taiwan in 2013.
RESULTS: Job demands and job control significantly predicted all the dimensions of work-life balance. Job demands increased the level of work-life imbalance among nurses. While job control showed positive effects on work/personal life enhancement, it was found to increase both work interference with personal life and personal life interference with work.
CONCLUSION: Reducing the level of job demands (particularly for psychological demands) between family and career development and maintaining a proper level of job control are essential to the work-life balance of nurses.
IMPLICATIONS FOR NURSING MANAGEMENT: Flexible work practices and team-based management could be considered by nursing management to lessen job demand pressure and to facilitate job engagement and participation among nurses, thus promoting a better balance between work and personal life.

Matched MeSH terms: Workload/psychology
Connotations of psychological and physiological health in the psychosocial work environment: An industrial context

Javaid MU, Bano S, Mirza MZ, Isha ASN, Nadeem S, Jawaid A, et al.

Work, 2019;64(3):551-561.
PMID: 31658088 DOI: 10.3233/WOR-193016

BACKGROUND: Psychological conditions are experiences of the conscious and unconscious elements of the work context, which revolve around workers' perceptions of feeling either engaged or disengaged with the assigned tasks. In the psychosocial work environment of hazardous industries like petrochemicals where production lasts twenty-four hours a day and continues seven-days-a-week, a psychologically available worker is extremely important. Psychological availability refers to when workers who are physically, emotionally and psychologically engaged at the moment of performing tasks.
OBJECTIVE: The broad objective of this study was to investigate the direct and indirect effects of behavioral factors on the psychological and physiological health of workers.
METHODS: The latest, second generation technique, which is structural equation modeling, is used to identify the relationships between behavioral antecedents and health outcomes. A total of 277 technical workers participated, aged between 20 and 49 and were healthy in all aspects.
RESULTS: The study results showed quantitative demands, emotional demands, work-family conflict, and job insecurity were significantly associated with both psychological (stress) and physiological (Body Mass Index) factors. The social support of colleagues produced mixed findings with direct and indirect paths. Stress also significantly mediates the psychosocial factors and burnout of the workers.
CONCLUSION: The study concluded that workers were physically available, but they experienced distractions as members of social systems, affecting their physiological and psychological health.

Matched MeSH terms: Workload/psychology
Fulltext Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia

Al-Dubai SA, Ganasegeran K, Perianayagam W, Rampal KG

ScientificWorldJournal, 2013;2013:137620.
PMID: 24367238 DOI: 10.1155/2013/137620

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was "fear of making mistakes." Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies. Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life-the poetry of the common place, of the common man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief.SirWilliam Osler, Aphorisms from the Student Life (Aequanimitas, 1952).

Matched MeSH terms: Workload/psychology
Work and women's well-being: religion and age as moderators

Noor NM

J Relig Health, 2008 Dec;47(4):476-90.
PMID: 19093675

Religion has been found to moderate the stress-strain relationship. This moderator role, however, may be dependent on age. The present study tested for the three-way interaction between work experience, age, and religiosity in the prediction of women's well-being, and predicted that work experience and religiosity will combine additively in older women, while in younger women religiosity is predicted to moderate the relationship between work experience and well-being. In a sample of 389 married Malay Muslim women, results of the regression analyses showed significant three-way interactions between work experience, age, and religiosity in the prediction of well-being (measured by distress symptoms and life satisfaction). While in younger women the results were in line with the predictions made, in the older women, both additive and moderator effects of religiosity were observed, depending on the well-being measures used. These results are discussed in relation to the literature on work and family, with specific reference to women's age, religion, as well as the issue of stress-strain specificity.

Matched MeSH terms: Workload/psychology
Fulltext Validity and Reliability of Malay Version of the Job Content Questionnaire among Public Hospital Female Nurses in Malaysia

Amin NA, Quek KF, Oxley JA, Noah RM, Nordin R

Int J Occup Environ Med, 2015 10;6(4):232-42.
PMID: 26498051 DOI: 10.15171/ijoem.2015.632

BACKGROUND: The Job Content Questionnaire (M-JCQ) is an established self-reported instrument used across the world to measure the work dimensions based on the Karasek's demand-control-support model.
OBJECTIVE: To evaluate the psychometrics properties of the Malay version of M-JCQ among nurses in Malaysia.
METHODS: This cross-sectional study was carried out on nurses working in 4 public hospitals in Klang Valley area, Malaysia. M-JCQ was used to assess the perceived psychosocial stressors and physical demands of nurses at their workplaces. Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Cronbach's α values were used to estimate the reliability (internal consistency) of the M-JCQ.
RESULTS: EFA showed that 34 selected items were loaded in 4 factors. Except for psychological job demand (Cronbach's α 0.51), the remaining 3 α values for 3 subscales (job control, social support, and physical demand) were greater than 0.70, indicating acceptable internal consistency. However, an item was excluded due to poor item-total correlation (r<0.3). The final M-JCQ was consisted of 33 items.
CONCLUSION: The M-JCQ is a reliable and valid instrument to measure psychosocial and physical stressors in the workplace of public hospital nurses in Malaysia.

Matched MeSH terms: Workload/psychology
Fulltext Reliability and construct validity of the Malay version of the Job Content Questionnaire (JCQ) among secondary school teachers in Kota Bharu, Kelantan, Malaysia

Hadi AA, Naing NN, Daud A, Nordin R

Southeast Asian J Trop Med Public Health, 2006 Nov;37(6):1254-9.
PMID: 17333785

This study was conducted to assess the reliability and construct validity of the Malay version of Job Content Questionnaire (JCQ) among secondary school teachers in Kota Bharu, Kelantan. A total of 68 teachers consented to participate in the study and were administered the Malay version of JCQ. Reliability was determined using Cronbach's alpha for internal consistency whilst construct validity was assessed using factor analysis. The results indicated that Cronbach's alpha coefficients revealed decision latitude (0.75), psychological job demand (0.50) and social support (0.84). Factor analysis showed three meaningful common factors that could explain the construct of Karasek's demand-control-social support model. The study suggests the JCQ scales are reliable and valid tools for assessing job stress in school teachers.

Matched MeSH terms: Workload/psychology
Predictors of Work-Family Role Conflict and Its Impact on Professional Women in Medicine, Engineering, and Information Technology in Nigeria

Uzoigwe AG, Low WY, Noor SN

Asia Pac J Public Health, 2016 Oct;28(7):629-637.
PMID: 27637552 DOI: 10.1177/1010539516667782

This study examines work-family role conflict and the factors predicting it, with a sample of 173 professional women in engineering and information technology (IT) firms, including 2 hospitals-1 public and 1 private. Our findings show no significant difference in the level of work-family role conflict encountered by women across medicine, engineering, and IT, whereas hours of work, family responsibilities, job demand, and work role overload were significantly correlated with work-family role conflict. Multiple linear regression analysis indicates that only work role overload, family responsibilities, and hours of work significantly predicted 45.9% of work-family role conflict. This implies that working women are burdened by work demands, which invariably affects the work-family role conflict they experience and leads to deterioration of their occupational health. It is suggested that employers should create a flexible work schedule and establish family-friendly policies in the workplace to promote a healthy work-life balance for women in science careers.

Matched MeSH terms: Workload/psychology
Occupational pressure-targeting organisational factors to ameliorate occupational dysfunction

Loh SY, Than W, Quek KF

J Occup Rehabil, 2011 Dec;21(4):493-500.
PMID: 21365305 DOI: 10.1007/s10926-011-9287-3

INTRODUCTION: Chronic pressure at work has debilitating impact on healthcare employers (e.g. reduced productivity, high costs, poor patient care) and on female healthcare employees (e.g. sickness, dysfunction). This paper highlights relationship at work as the key occupational source of work-stress which is organisational in nature.
METHODS: A cross-sectional study (n = 230) was conducted using the Pressure Management Inventory on several female dominated health professions within a large public hospital. Analysis of variance was used to show relationship between sources and outcome of pressure. Linear regressions were used to predict which sources of pressure (IV) was linked to the outcomes of occupational pressure (DV).
RESULTS: The number one source of occupational pressure is relationships at work (i.e. with supervisors), and not workload. 'Relationship' is also the key predictor of several negative outcomes of pressure at work. Analysis of variance showed significant differences in two sources of pressures, i.e. Workload (P = 0.04) and Home-work balance (P = 0.03).
CONCLUSION: This paper provides insights into the occupational pressure of women health professionals by highlighting the organisational sources of pressure and the implications for preventing occupational dysfunction secondary to stress at work.

Matched MeSH terms: Workload/psychology
Fulltext Working conditions, self-perceived stress, anxiety, depression and quality of life: a structural equation modelling approach

Rusli BN, Edimansyah BA, Naing L

BMC Public Health, 2008 Feb 06;8:48.
PMID: 18254966 DOI: 10.1186/1471-2458-8-48

BACKGROUND: The relationships between working conditions [job demand, job control and social support]; stress, anxiety, and depression; and perceived quality of life factors [physical health, psychological wellbeing, social relationships and environmental conditions] were assessed using a sample of 698 male automotive assembly workers in Malaysia.
METHODS: The validated Malay version of the Job Content Questionnaire (JCQ), Depression Anxiety Stress Scales (DASS) and the World Health Organization Quality of Life-Brief (WHOQOL-BREF) were used. A structural equation modelling (SEM) analysis was applied to test the structural relationships of the model using AMOS version 6.0, with the maximum likelihood ratio as the method of estimation.
RESULTS: The results of the SEM supported the hypothesized structural model (chi2 = 22.801, df = 19, p = 0.246). The final model shows that social support (JCQ) was directly related to all 4 factors of the WHOQOL-BREF and inversely related to depression and stress (DASS). Job demand (JCQ) was directly related to stress (DASS) and inversely related to the environmental conditions (WHOQOL-BREF). Job control (JCQ) was directly related to social relationships (WHOQOL-BREF). Stress (DASS) was directly related to anxiety and depression (DASS) and inversely related to physical health, environment conditions and social relationships (WHOQOL-BREF). Anxiety (DASS) was directly related to depression (DASS) and inversely related to physical health (WHOQOL-BREF). Depression (DASS) was inversely related to the psychological wellbeing (WHOQOL-BREF). Finally, stress, anxiety and depression (DASS) mediate the relationships between job demand and social support (JCQ) to the 4 factors of WHOQOL-BREF.
CONCLUSION: These findings suggest that higher social support increases the self-reported quality of life of these workers. Higher job control increases the social relationships, whilst higher job demand increases the self-perceived stress and decreases the self-perceived quality of life related to environmental factors. The mediating role of depression, anxiety and stress on the relationship between working conditions and perceived quality of life in automotive workers should be taken into account in managing stress amongst these workers.

Matched MeSH terms: Workload/psychology*
Risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) hospitals in Kelantan

Aziah BD, Rusli BN, Winn T, Naing L, Tengku MA

Southeast Asian J Trop Med Public Health, 2004 Jun;35(2):468-75.
PMID: 15691158

A cross-sectional study was conducted to determine the risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan, between September 2001 and February 2002. One hundred and two laboratory technicians from HUSM and 79 from KKM Hospitals were selected and 84 (82.4%) from HUSM and 71 (89.9%) from KKM Hospitals were recruited as study subjects. Data were collected by self-administered questionnaire using the validated Malay version of the Job Content Questionnaire (JCQ), originally developed by Robert Karasek. The results indicated significant associations between the risk factors of job-related depression, and low social support, and high psychological demands (OR 3.0, 95% CI 1.1-8.8) in laboratory technicians in HUSM. However, for laboratory technicians in KKM Hospitals, the significant association was between job-related depression, and low social support and low decision authority (OR 9.7, 95% CI 1.1-91.1). Low social support was highly associated with job-related depression in laboratory technicians in HUSM and KKM Hospitals. We, therefore, conclude that low social support positively predicted depression in laboratory technicians in HUSM and KKM Hospitals. In addition, high psychological demands also significantly predicted depression in laboratory technicians in HUSM; however, for laboratory technicians in KKM Hospitals, low decision authority was the significant predictor of depression.

Matched MeSH terms: Workload/psychology

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