Stress among doctors: A cross-sectional study in a tertiary care hospital, North India

INTRODUCTION

The modern medical workplace is a complex environment, and doctors respond differently to it, some finding it stimulating and exciting, whereas others become stressed and feel burnt-out from the heavy workload.^[1] Burnout is considered as a distinct state of psychological stress generated by the individual’s occupation and/or workplace and is identified as such in the World Health Organization’s International Classification of Diseases.^[2,3] The prevalence of burnout has been found to be as high as 75% among doctors.^[4]

Workplace stress affects the performance of the brain, including functions of work performance memory, concentration, and learning. Although small amount of stress can have positive effects by energizing people toward goals, excessive stress may seriously and negatively affect a person’s health and job performance. Hospitals are no exceptions; doctors are life savers, and if they come under stress, their efficiency is reduced, directly affecting the lives of a large number of people whom they treat. Stress may originate from personal and professional life of the person, affecting that person as a whole. Occupational stress occurs when job-related factors interact with individual factors, resulting in a change in the individual’s psychological and/or physiological state.^[5] Stress is closely related to the amount of psychosocial resources that are possessed or thought to be possessed to cope with the requirements of certain demanding situations.^[6] At an individual level, burnout among doctors has been associated with lower career satisfaction, higher absenteeism, greater probability of leaving the profession prematurely or choosing early retirement, and greater risk of experiencing difficulties in interpersonal relationships, such as with family and partners.^[7,8] All these factors affect the working capacity and efficiency of the health-care providers and thus have a deteriorating effect on the doctors, hospitals, and the patients. As stress among doctors is not taken into much consideration and often a neglected topic, so this study was planned with objectives of estimating the prevalence of stress among doctors in our region and to find the associated risk factors for the same.

MATERIALS AND METHODS

A cross-sectional study was conducted by including all the doctors from all the departments of a tertiary care institution. Complete enlistment procedure was followed for the enrolment of the participants which included junior residents, postgraduate residents, senior residents, consultants, professors, and head of the department. Out of the total list, 203 participants responded and included in this research work. However, those who were not available and did not consent to participate were excluded from the study.

RESULTS

In this study, a total of 203 participants were evaluated. Females (54.7%) outnumbered the males (45.3%). Mean age the participants was found to be 35.83 + 12.92 years. Mean of total number of years in the job was 9.8 years, however, mean years of present job were 3.2 years [Table 1].

More number of females were found in the non-clinical branches (included both pre-clinical and paraclinical branches); on the other side, males outnumbered the females in the clinical field [Figure 1].

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Figure 1:

Gender distribution according to department.

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In our study, median screen time of the study participants was found to be 3 h, with range of ½–12 h. Maximum participants (94.6%) claimed of not having any addiction habits followed by alcohol addiction (4.4%) and smoking (1%).

Stress levels were assessed using the PSS-10 on the basis of their past 1 month experience. Mean score was found 18.40 ± 5.4 with a range of 2–35. Majority (79.8%) of the participants were having moderate stress levels followed by low stress levels (13.8%) and high perceived stress was found in 6.4% of the medical professionals [Table 2].

Association of the mean stress scores with-in different demographic variables was calculated using unpaired t-test. Females showed higher stress levels, which were statistically significant with P < 0.05. However, department (clinical/ non-clinical) and marital status of the participants had no association with the stress levels [Table 3].

Association of the mean stress scores with age categories, designation, and addiction habits of the participants was calculated using the one-way ANOVA test. Statistical significant stress levels were found in the age category of 31–40 years of age (P = 0.04). This phase is settlement phase/ phase of establishment after the postgraduation, thus adding to the stress levels of the doctors. Post hoc Bonferroni test was run to find out the intergroup differences in the age categories. The age group of 51–60 years had statistically significant lower stress levels as compared to the age groups of 20–30 years and 31–40 years. However, no other age group showed such difference. The designation of the participants and addiction habits had no impact on the stress levels of the individuals [Table 4].

Correlation of the mean stress scores was found non-significant both with the number of years in job (r = −0.067, P = 0.340) and screen time of the participants (r = 0.060, P = 0.392). However, many other factors in this study were found to be statistically significant in increasing the stress levels among doctors. Professional factors included emergency duties and intradepartmental working environment, which causes significant stress among the doctors. However, problems in the personal life such as staying away from the family, not able to give adequate time to their family life, any sickness in the family, lack of proper sleep and rest, and not having time to pursue their hobbies – all induces stress among the medical personnel [Table 5].

In the present study, listening to the music was found to be the most common stress reliever followed by exercise. However, multiple options were being used by the participants to overcome their stress [Figure 2]. Other stress relievers included –spiritual activities, watching TV, hobbies shopping, relaxation activities, and spending time with family members.

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Figure 2:

Stress relievers among participants.

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DISCUSSION

In the present study, a total of 203 participants were evaluated; majority being the females (54.7%). Maximum were in the age category of 20–30 years (47.3%) with mean age of 35.83 + 12.92 years. However, in other similar studies conducted in India, maximum participants were males and age group of 25–35 years was the most common age category.^[11-13]

In our study, stress levels were assessed using PSS-10 scale and mean stress scores were found 18.40 ± 5.4. Majority (79.8%) of the participants were having moderate stress levels. Statistically significant of the stress levels was found in female doctors (P = 0.009) and in the age category of 31–40 years (P = 0.04). Emergency duties, intradepartmental working environment, being away from family, not able to have proper personal and family time, and lack of sleep were the main factors to cause increased stress among doctors.

However, in a study conducted by Sathiya et al., stress levels of the doctors were compared with the nurses. This study concluded that higher stress levels were found in the doctors with mean scores of 18.35 (± 4.7). Inadequacies of staff and resources, sleep deprivation, confronting constant emotional assault, smoking, and physical suffering were found as important stressors. Gender was not associated with stress levels of the participants.^[12] In another conducted by Khoo et al. in Malaysia, taking pediatricians as the study participants, more emotional breakdown was found in the junior/fresher doctors with the main reason of stress to establish themselves in the field. Other sources of the stress “dealing with difficult parents” (80.2%), “feeling of inadequate knowledge to meet work demands” (72.6%), “crowded wards” (70.6%), “fear of medicolegal issues” (70.1%), and “dealing with acute intensive care children” (68.5%). Workplace factors such as unrealistic goals and disrespectful interactions with colleagues or subordinates were significantly associated with emotional exhaustion.^[14]

The stress levels were seen higher in the doctors those who were in the beginning phase of their careers. In a study conducted by Shriram et al., male medical interns showed higher levels of the PSS-10 scores as compared to female counterparts.^[15] In similar study conducted by Chatterjee in 2020, clinical interns showed maximum levels of the stress with mean scores of 20.4 ± 5.2 followed by house residents (17.5 ± 5.1).^[13] This showed that beginning of the career induces more stress to the health-care providers. Similar findings were seen in the studies conducted by Sahasrabuddhe et al.^[1] and Lorga et al.^[16] In other study, main stress factors were mentioned as heavy work load with long duty hours (48.3%), poor accommodation and food (32%), low stipend (41%), and lack of social and family life (22.8%).^[1] However, physical environment, work volume, poor pay, lack of appreciation, lack of support, opportunities, promotion, patient expectation, and deadline were the main stressors in the study conducted taking Iran doctors as the participants.^[17]

In our study, only 4.4% of participants claimed of having alcohol addiction followed by smoking habits. Similar findings of the vicious cycle of stress, alcohol, and smoking were seen in a study conducted by Sathiya et al. and Lorga et al.^[12,16] In our study, listening to the music was found to be stress reliever followed by majority of the participants. In a study conducted by Prasad et al., before and after stress evaluation were done in the doctors after the 6-week yoga and meditation program.^[18] It showed improvement in the inner content, happiness, confidence levels, patience, and reduced fatigue in the participants. In a systematic review, experts have emphasized on the support-based interventions to facilitate the development of the meaningful strategies for managing occupational stress in the longer term, to assist medical doctors in coping with work that is, by its nature, inherently challenging.^[19]

CONCLUSION

Moderate stress levels were found in this study, thus affecting the doctors in various ways. Proper rest and involvement into stress-relieving activities such as meditation and yoga and conducive working environment are the need of the hour for the burnout health-care providers.