Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals

Objectives This study aimed to analyse and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties. Methods 435 German hospital residents in medical training working in 6 different medical specialties participated in a cross-sectional survey study. Physicians were asked about their working conditions and aspects of mental health and work ability. The Copenhagen Psychosocial Questionnaire, the Work Ability Index, the ICD-10 Symptom Rating and the Perceived Stress Questionnaire were used to measure working conditions, mental health and work ability. Results Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anaesthesiologists. Significant associations between physicians’ working conditions, occupational distress and mental health-related aspects are illustrated. Conclusions Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians' health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians' health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimisation and work process improvements should be focused by hospital management.

[1]  S. Siva,et al.  Ten-year results of quality assurance in radiotherapy chart round , 2013, BMC Health Services Research.

[2]  J. Bortz,et al.  Forschungsmethoden und Evaluation für Human- und Sozialwissenschaftler , 2006 .

[3]  David A. Groneberg,et al.  General and visceral surgery practice in German hospitals: a real-time work analysis on surgeons’ work flow , 2009, Langenbeck's Archives of Surgery.

[4]  A. Marchand,et al.  Occupation, work organisation conditions and the development of chronic psychological distress. , 2011, Work.

[5]  Lin Naing,et al.  Working conditions, self-perceived stress, anxiety, depression and quality of life: A structural equation modelling approach , 2008, BMC public health.

[6]  Leslie B. Hammer,et al.  Clarifying work-family intervention processes: the roles of work-family conflict and family-supportive supervisor behaviors. , 2011, The Journal of applied psychology.

[7]  Harald Hannerz,et al.  The Copenhagen Psychosocial Questionnaire--a tool for the assessment and improvement of the psychosocial work environment. , 2005, Scandinavian journal of work, environment & health.

[8]  A. Bakker,et al.  The job demands-resources model of burnout. , 2001, The Journal of applied psychology.

[9]  Anne Grönlund.  More Control, Less Conflict? Job Demand–Control, Gender and Work–Family Conflict , 2007 .

[10]  James W. Smither,et al.  DOES PERFORMANCE IMPROVE FOLLOWING MULTISOURCE FEEDBACK? A THEORETICAL MODEL, META‐ANALYSIS, AND REVIEW OF EMPIRICAL FINDINGS , 2005 .

[11]  A. Bakker,et al.  Job demands, job resources, and their relationship with burnout and engagement: a multi‐sample study , 2004 .

[12]  A. Nienhaus,et al.  Hospital physicians’ work stressors in different medical specialities: a statistical group comparison , 2015, Journal of Occupational Medicine and Toxicology.

[13]  B. Klapp,et al.  Pediatricians’ working conditions in German hospitals: a real-time task analysis , 2010, European Journal of Pediatrics.

[14]  Evangelia Demerouti,et al.  Work-family interface from a life and career stage perspective: the role of demands and resources. , 2012, International journal of psychology : Journal international de psychologie.

[15]  Work ability of employees in changing social services and health care organizations in Finland , 2012, International journal of occupational medicine and environmental health.

[16]  J. Siegrist.  [Effort-reward imbalance at work and depression: current research evidence]. , 2013, Der Nervenarzt.

[17]  R. Klaghofer,et al.  Work stress and reduced health in young physicians: prospective evidence from Swiss residents , 2008, International archives of occupational and environmental health.

[18]  J. Berbegal‐Mirabent,et al.  Antecedents of employee job satisfaction: Do they matter? , 2016 .

[19]  L. Dyrbye,et al.  Physician satisfaction and burnout at different career stages. , 2013, Mayo Clinic proceedings.

[20]  S. Levenstein,et al.  Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. , 1993, Journal of psychosomatic research.

[21]  N. Sevdalis,et al.  Relationships of Multitasking, Physicians’ Strain, and Performance: An Observational Study in Ward Physicians , 2012, Journal of patient safety.

[22]  B. Klapp,et al.  Observation and analysis of junior OB/GYNs’ workflow in German hospitals , 2010, Archives of Gynecology and Obstetrics.

[23]  E. Demerouti,et al.  Factors Associated with Mental Health Status of Medical Residents: A Model-Guided Study , 2015, Journal of Clinical Psychology in Medical Settings.

[24]  Florina Spânu,et al.  Job demands, burnout, and engagement among nurses: A multi-level analysis of ORCAB data investigating the moderating effect of teamwork , 2015, Burnout research.

[25]  L. Sell.  Predicting long-term sickness absence and early retirement pension from self-reported work ability , 2009, International archives of occupational and environmental health.

[26]  J. Siegrist,et al.  Psychosocial stress among hospital doctors in surgical fields: results of a nationwide survey in Germany. , 2010, Deutsches Arzteblatt international.

[27]  L. Baker,et al.  Job satisfaction and motivation among physicians in academic medical centers: insights from a cross-national study. , 2008, Journal of health politics, policy and law.

[28]  Erasmus Mc,et al.  The effects of work-related and individual factors on the Work Ability Index: a systematic review , 2008, Occupational and Environmental Medicine.

[29]  J. Johnson,et al.  Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. , 1988, American journal of public health.

[30]  J. Bauer,et al.  Disstress in der Chirurgie – Eine Untersuchung in deutschen Krankenhäusern , 2014, Zentralblatt für Chirurgie.

[31]  S. Patten,et al.  Three job-related stress models and depression: a population-based study , 2012, Social Psychiatry and Psychiatric Epidemiology.

[32]  Hwan-Cheol Kim,et al.  Psychosocial factors and psychological well-being: a study from a nationally representative sample of Korean workers , 2015, Industrial health.

[33]  Judith K Sluiter,et al.  The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study , 2012, BMC Health Services Research.

[34]  A. Nakagawa,et al.  Mental health of Japanese psychiatrists: the relationship among level of occupational stress, satisfaction and depressive symptoms , 2015, BMC Research Notes.

[35]  H. Hasselhorn,et al.  The Copenhagen Psychosocial Questionnaire in Germany: From the validation of the instrument to the formation of a job-specific database of psychosocial factors at work , 2010, Scandinavian journal of public health.

[36]  W. Söllner,et al.  [Development of the "ICD-10-Symptom-Rating"(ISR) questionnaire]. , 2008, Zeitschrift fur Psychosomatische Medizin und Psychotherapie.

[37]  M. Weigl,et al.  Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians , 2015, European Journal of Pediatrics.

[38]  K. Wilhelm,et al.  Secrets to psychological success: Why older doctors might have lower psychological distress and burnout than younger doctors , 2009, Aging & mental health.

[39]  C. Higgins,et al.  Work-Family Conflict , 1994 .

[40]  J. Siegrist,et al.  Die ärztliche Rolle im Wandel , 2012, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz.

[41]  M. Weigl,et al.  Working conditions and effort–reward imbalance of German physicians in Sweden respective Germany: a comparative study , 2015, International Archives of Occupational and Environmental Health.

[42]  Bryan Rodgers,et al.  Job strain, job insecurity, and health: rethinking the relationship. , 2004, Journal of occupational health psychology.

[43]  D. Ganster,et al.  Impact of family-supportive work variables on work-family conflict and strain: A control perspective. , 1995 .

[44]  C. Guille,et al.  Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. , 2015, JAMA.

[45]  A. Müller,et al.  Associations of psychosocial working conditions and working time characteristics with somatic complaints in German resident physicians , 2016, International Archives of Occupational and Environmental Health.

[46]  A. Marchand,et al.  Psychological distress in the workforce: a multilevel and longitudinal analysis of the case of regulated occupations in Canada , 2014, BMC Public Health.

[47]  Robert Karasek,et al.  Job decision latitude and mental strain: Implications for job redesign , 1979 .

[48]  Tuija Tammelin,et al.  Work ability index of young employees and their sickness absence during the following year. , 2006, Scandinavian journal of work, environment & health.

[49]  D. Bates,et al.  Effect of reducing interns' work hours on serious medical errors in intensive care units. , 2004, The New England journal of medicine.

[50]  David A Groneberg,et al.  Cardiologists' workflow in small to medium-sized German hospitals: an observational work analysis , 2011, Journal of cardiovascular medicine.

[51]  G. Bahn,et al.  A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties , 2016, Journal of Korean medical science.

[52]  V. Haines,et al.  The multilevel determinants of workers’ mental health: results from the SALVEO study , 2015, Social Psychiatry and Psychiatric Epidemiology.

[53]  Yonghua Hu,et al.  Prevalence of cardiovascular disease and risk factors in a rural district of Beijing, China: a population-based survey of 58,308 residents , 2012, BMC Public Health.

[54]  M. Nübling,et al.  Psychosocial workload and stress in the workers’ representative , 2012, BMC Public Health.

[55]  Furman S. McDonald,et al.  Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey , 2013, Journal of General Internal Medicine.

[56]  K. Kokko,et al.  Development trajectories of Finnish managers' work ability over a 10-year follow-up period. , 2009, Scandinavian journal of work, environment & health.

[57]  J. Sluiter,et al.  Physical job demands and related health complaints among surgeons , 2012, International Archives of Occupational and Environmental Health.

[58]  Krista L. Langkamer,et al.  Work and family satisfaction and conflict: a meta-analysis of cross-domain relations. , 2007, The Journal of applied psychology.

[59]  R. Arvey,et al.  Performance evaluation in work settings. , 1998, Annual review of psychology.

[60]  M. Hilton,et al.  Associations between psychological distress, workplace accidents, workplace failures and workplace successes , 2010, International archives of occupational and environmental health.

[61]  H. Yanai,et al.  The interrelationships between working conditions, job satisfaction, burnout and mental health among hospital physicians in Japan: a path analysis. , 2009, Industrial health.

[62]  S. Parker,et al.  Enhancing role breadth self-efficacy: the roles of job enrichment and other organizational interventions. , 1998, The Journal of applied psychology.

[63]  G Kecklund,et al.  Sleep disturbances, work stress and work hours: a cross-sectional study. , 2002, Journal of psychosomatic research.

[64]  Jean E. Wallace.  "Job Stress, Depression and Work-to-Family Conflict: A Test of the Strain and Buffer , 2006 .

[65]  B. Klapp,et al.  Surgeons’ work ability and performance in surgical care: relations between organisational predictors, work engagement and work ability , 2013, Langenbeck's Archives of Surgery.

[66]  Shelley E. Taylor.  Social Support: A Review , 2011 .

[67]  P. Neves,et al.  Abusive supervision, psychosomatic symptoms, and deviance: Can job autonomy make a difference? , 2016, Journal of occupational health psychology.

[68]  A. Bakker,et al.  Work-self balance: A longitudinal study on the effects of job demands and resources on personal functioning in Japanese working parents , 2013 .

[69]  T. Revenson,et al.  Handbook of Health Psychology , 2001 .

[70]  A. Burdorf,et al.  The importance of job control for workers with decreased work ability to remain productive at work , 2010, International archives of occupational and environmental health.

[71]  B. Klapp,et al.  An observational real-time study to analyze junior physicians' working hours in the field of gastroenterology. , 2009, Zeitschrift fur Gastroenterologie.

[72]  T. Loew,et al.  Entwicklung des Fragebogens »ICD-10-Symptom-Rating« (ISR) , 2008 .

[73]  J. Anthony,et al.  Physician substance use by medical specialty. , 1999, Journal of addictive diseases.

[74]  B. Klapp,et al.  Physicians' working conditions and job satisfaction: does hospital ownership in Germany make a difference? , 2009, BMC health services research.