Occupational stress

Work-related stress among physicians

Dr Faisal Al Hadad

Consultant of Family Medicine & Occupational Health

PSMMC

Definition

"Stress" is the adverse reaction people have to excessive pressures or other types of demand placed on them

Adverse effects of stress at work

Physical effects: Coronary heart disease Musculoskeletal disorders Peptic ulcer disease

Psychosocial effects: Mental illness Social behaviour and interpersonal relations impairment Sexual behaviour impairment Maladaptive behaviours such as smoking and drinking.

Contd;

Organizational effects: High turnover among employees Absenteeism Poor time keeping Impaired work performance and productivity An increase in client complaints An increase in employee compensation claims

Stress in health professionals

The work is demanding

The work is characterized by high degree of responsibility

Health professionals are exposed to both emotional and physical risk.

Karasek’s Job Strain model

LOW STRAIN ACTIVE

HIGH STRAINPASSIVE

Job Demands

Low High

Low

High

Job Decision Latitude (Skill

use + Decision authority)

Active Learning,

Motivation to Develop New

Behavior Patterns

Risk of A Psychological

Strain and Physical Illness

B

A

Work-related stress in PHC physicians and hospital physicians in PSMMC

Dr. Faisal Al Hadad (Corresponding Author)

Prof. Jon Ayres, Head of IOEM, University of Birmingham

Prof. Adel Mishriky, Preventive Medicine Department, PSMMC

Methodology

Sample Size:

92 PHC physicians and 92 hospital physicians

The participants were selected randomly

Questionnaire:

Socio-demographic data

The Reeder Stress Inventory and the HSE’s Stress Indicator Tool.

Methodology

The HSE’s Stress Indicator Tool Domains:

Positive Control Role Change Peer support Managers' support

Negative Demands Relationships

Methodology

The survey was anonymous.

Questionnaires were distributed manually to the study participants.

The participants were informed through the questionnaire about the purpose of the study and that their participation was voluntary.

Data were collected over the first two weeks of May 2009, checked manually for completeness and stored confidentially.

Results (Socio-demographic data)

95.7% of PHC physicians and 92.4% of hospital physicians completed the questionnaires.

67.7% of the respondents physicians were male

The mean age of the respondents was 40.6 years.

64.2% of the respondents were specialists and 35.8% were consultants.

The hospital group were significantly more likely to be male, unmarried and current smokers.

Reeder scale scores

Question

Group (mean±SD)

p-valuePHC (n=88)

Hospital (n=85)

"In general, I am usually tense or nervous"2.61±0.732.62±0.720.965

"There is a great deal of nervous strain connected to my daily activities"

2.89±0.883.21±0.960.019

"My daily activities are extremely trying and stressful"

2.88±0.873.48±0.98<0.001

"At the end of the day I am completely exhausted"

3.27±1.043.68±1.050.012

Total2.94±0.413.28±0.490.001*

Domain

Group (mean±SD)

p-valuePHC

(n=88)Hospital (n=85)

Demands2.98±0.553.14±0.550.081

Relationships1.16±0.321.31±0.320.004

Control3.08±0.763.09±0.740.901

Role2.60±0.452.60±0.470.912

Change1.10±0.331.17±0.360.189

Peers’ support1.85±0.371.81±0.410.496

Managers' support2.00±0.572.05±0.580.403

Total scores for the Stress Indicator Tool domains

Domain

Age

p-value <30(n=28)

30-(n=106)

50-(n=39)

Mean±SDMean±SDMean±SD

Reeder3.30±0.643.15±0.652.83±0.760.021

Control2.94±0.782.94±0.693.58±0.66<0.001

Demands3.16±0.513.11±0.522.85±0.630.019

Role2.47±0.502.55±0.462.82±0.32<0.001

Change1.13±0.291.10±0.351.24±0.350.060

Peers’ support1.85±0.361.79±0.401.93±0.360.168

Relationships1.30±0.191.24±0.351.16±0.330.132

Managers' support2.11±0.531.95±0.582.15±0.570.150

Relation between Reeder Scale and Stress Indicator Tool domains and the respondents’ age

Relation between Reeder Scale and Stress Indicator Tool domains and the respondents’ gender

Domain

Gender

MannWhitney

Testp-value

Male(n=117)

Female(n=56)

Mean±SDMean±SD

Reeder 3.103±0.7243.107±0.6100.0260.872

Control3.160±0.7642.925±0.6892.5460.111

Demands3.026±0.5563.130±0.5430.9880.320

Role2.611±0.4522.568±0.4760.1770.674

Change1.166±0.3541.070±0.3133.8240.051

Peers’ support1.830±0.4021.832±0.3690.0140.906

Relationships1.234±0.3241.232±0.3300.0220.882

Managers' support2.054±0.5931.957±0.5301.5240.217

Relation between Reeder Scale and Stress Indicator Tool domains and the respondents’ job title

Domain

Job title

MannWhitney

Testp-value

Specialist(n=111)

Consultant(n=62)

Mean±SDMean±SD

Reeder 3.12±0.6983.076±0.6730.4240.515

Control2.975±0.8023.279±0.5946.3210.012*

Demands3.086±0.5583.011±0.5440.8070.369

Role2.595±0.4712.602±0.4400.0360.850

Change1.121±0.3591.160±0.3130.5700.450

Peers’ support1.856±0.3991.785±0.3750.8000.371

Relationships1.232±0.3451.237±0.2880.1060.745


Relation between Reeder Scale and Stress Indicator Tool domains and the respondents’ marital status

Domain

Marital status

MannWhitney

Testp-value

Married(n=154)

Unmarried(n=19)

Mean±SDMean±SD

Reeder 3.110±0.6963.058±0.6310.1890.664

Control3.077±0.7423.142±0.8000.0010.981

Demands3.054±0.5613.105±0.4880.2470.619

Role2.608±0.4532.505±0.5060.6040.437

Change1.127±0.3421.200±0.3540.6190.432

Peers’ support1.811±0.3861.989±0.4032.4860.115

Relationships1.230±0.3191.263±0.3760.0100.920


Relation between Reeder Scale and Stress Indicator Tool domains and the respondents’ smoking status

Domain

Smoking Status

MannWhitney

Testp-value

Non-Smokers(n=135)

Current(n=19)

Mean±SDMean±SD

Reeder 3.069±0.6733.463±0.6355.6650.017*

Control3.084±0.7642.900±0.6632.0840.149

Demands3.058±0.5403.295±0.4224.2270.040*

Role2.573±0.4822.616±0.3850.0080.930

Change1.152±0.3271.037±0.4061.4610.227

Peers’ support1.816±0.3941.774±0.3910.2010.654

Relationships1.229±0.3281.311±0.3020.8520.356


Dependant FactorIndependent FactorBR2P-value

ReederGroup (reference: PHC)0.3220.172<0.001*

Smoking (reference: non)0.153

Marital status (reference: married)-0.363

ControlAge0.0270.232<0.001*

Reeder-0.275

DemandsReeder0.5090.395<0.001*

ChangeSex (reference: male)-0.1170.089

Age0.007

Smoking (reference: non)-0.091

Marital status (reference: married)0.157

Peer SupportMarital status (reference: married)0.1590.156<0.001*

Reeder-0.174

RelationshipsReeder0.2010.225<0.001*

Managers' SupportReeder-0.1460.0300.022*

Multiple linear regression

Conclusion

Hospital physicians were more stressed at work than PHC physicians

Hospital physicians had poorer relationships with their managers and colleagues.

Work stress among physicians decreased with increasing age.

Gender, marital status and job title had no significant effect on the level of work stress and the primary work stressors

Recommendations

Engagement of senior managers to commit to managing work related stress and the production of a stress policy.

The work stress attributed to organizational changes should be reduced by:

1- Providing physicians with information to enable them to understand the

reasons for proposed changes 2- Encouraging physicians to influence proposals 3- Ensuring that physicians are aware of timetables of changes and 4- Providing them with access to relevant support during such changes.

Recommendations

Physicians should be encouraged to support their colleagues, to make themselves aware of what support is available and how and when to access it.

Stress management training should be recommended to foster awareness and recognition of stressors and to teach appropriate stress reduction skills.

Whatever intervention is done, assessment of its impact would need to be undertaken after an appropriate time interval.

Thank you

Self-administered questionnaire

Advantages: It can be administered to a larger number of people with less

cost. The behavior of an interviewer will not directly influence the

subject's response to any one question.

Disadvantages: The language barrier because the native language of the

majority of physicians included in the study was not English. The subjective response of participants to questions.

“Hospital physicians are more stressed”

The more strained relationship between hospital physicians compared with PHC physicians.

The recent organizational changes introduced in FCM department which reduced the workload among PHC physicians in RMH significantly e.g. short booking system and recruitment of more PHC physicians.

The differences in the type of work and the work environment: -Hospital physicians tend to have more on-call duties and deal with more

emergency cases than PHC physicians. -Unlike PHC physicians, hospital physicians are involved in ward round

which is conducted on a daily basis to evaluate and manage their patients.

-Hospital physicians deal with more severely ill patients compared with PHC physicians. Caring for these patients and dealing with their families may cause emotional drain or exhaustion.

Health & Medicine

Occupational stress