Health Professional Wellbeing

Although stress, depression and anxiety are the second most prevalent work related illnesses, these actually caused more loss of work days than the most prevalent work related illnesses, musculo-skeletal disorders. For example, each sufferer of a musculo-skeletal disorder took an average of 19.4 days off work, whereas the average sufferer of stress, depression and anxiety took an average 29.2 days off in the same 12-month period. This translates to 12.3 million working days lost for musculo-skeletal disorders whereas 13.4 million working days or 0.6 days per worker were lost due to stress, depression or anxiety made worse or brought on by work.

Dr Ramesh Manocha

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Research from the Australian Primary Health Care Research Institute (APHCRI) has found that 64% of GPs have faced violence ranging from verbal abuse to murder in the past year.

The findings have sparked an investigation by the Austrlain Goverment into the matter, including an online survey which will open in four weeks. The survey is expected to take around 10 minutes to complete, and will be organised by the APHCRI.

The APHCRI’s lead research Professor Rhian Parker says the issue must be more thoughroly investigated. “Often GPs, when they’re assaulted, don’t make a huge deal of it – but it’s significant and we need to find out how much it is going on,” she said.

From the Medical Observer.

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It has been suggested that stress management intervention (SMI) studies tend to attract people with lower levels of stress thereby further increasing measurement error. This can impact on the likelihood of the trial demonstrating the true benefits of the tested intervention since the “subclinical” population effectively dilutes the measurable effects of the SMI. In fact this reasoning has been used to explain why many studies of meditation, behaviour therapies and SMIs, when comparing two or more different approaches to stress management, often demonstrate equivalence of outcome.

Dr Ramesh Manocha

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A systematic review of studies exploring stress in doctors and dentists by Rutter et al. (2002) found that teaching doctors and dentists experience less stress then their non-teaching counterparts. The review analysed seven studies and found evidence to suggest that a teaching role mitigated stress in doctors and dentists, with the authors suggesting several mechanism for the effect including lessend isolation, increased self-esteem and added interest in patients as a source of teaching opportunities. The authors emphasised that more research is neccesary to confirm and explain their findings.

The study can be found at Interscience.

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This Saturday, October the 10th, will be World Mental Health Day. Organised by the World Federation for Mental Health, it is a global initiative aimed at promoting mental health. Conducted at a grassroots level, this year’s World Mental Health Day will focus on the topic of mental health in primary care, emphasising the importance of integrating mental healthcare into primary healthcare systems.

“The theme of this year’s campaign is intended to draw worldwide attention to the growing body of knowledge on integration which emphasizes the benefits of enhancing overall health and promoting mental health by integrating healthcare services. World Mental Health Day 2009 aims to provide consumers, families, and advocacy associations around the world with accessible information on this topic.”

World Mental Health Day coincides with the Australian Psychological Society’s National Psychology Week.

More information can be found at the World Federation for Mental Health site.

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In order to develop an understanding of the potential efficacy of meditation as an stress management intervention (SMI) directed at stress and especially work stress, the evidence in the peer-reviewed literature was reviewed. Computer databases, including MEDLINE, PsycINFO, CINAHL, EMBASE, Current Contents and Biological Reports were consulted. I also searched the Internet, hardcopy reports and other sources of “grey literature”. Search terms included “stress”, “work”, “occupational”, “job”, “strain”, “meditation”, “stress management”, “psychotherapy”, “behaviour therapy”, “relaxation” and combinations of these terms. Of the 12 controlled studies found, 8 were described as RCTs and 4 as NRTs. The NRTs all compared meditation to either a waiting list or non-intervention control group, so it is not surprising that they all reported substantial positive effects of meditation. Such a design cannot however exclude the impact of non-specific effects such as placebo and spontaneous improvement and so were excluded from this review.

Of the 8 studies describing themselves as RCTs, those of Winzelberg and Peters clearly reported using a strategy that cannot be described as acceptable random allocation. Moreover, Peters used self-report questionnaires that had not been validated. They were re-classified as NRTs and excluded from this review.

The remaining 6 RCTs involved comparison with a number of different controls. Two used more than one control, simultaneously giving rise to 8 comparisons. The authors universally concluded that meditation was effective as an SMI.

Dr Ramesh Manocha

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A Japanese study by Kanai-Pak et al. found that 56% of nursing staff surveyed scored high on burnout, with 60% being dissatisfied with their jobs. The survey of almost 6,000 nurses discussed issues facing nurses in Japan including the young nursing population and the low retention rate of qualified nurses, and concluded that work environment was the greatest challenge facing Japanese nursing staff. The authors suggested improved relationships between nurses and physicians and within the nursing staff would greatly reduce burnout.

The study can be found at www.ncbi.nlm.nih.gov.

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A Spanish study by Camps et al. (2008) found that 8 per cent of medical oncologists are suffering from high levels of burnout. The survey of 200 oncologists also found that 21 per cent of the sample showed high levels of exhaustion. The results were consistent with previous international research examining oncologists.

The authors describe the specialty as having its own unique stresses, as it involves much management of pain and death, which often leads to the internalising of painful emotions.

The authors recommend an increase in education to teach oncologists how to manage their emotions, and the establishment of support groups to help oncologists manage stress and burnout.

The study can be found here.

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The stress construct is founded on a core set of operational notions. These include:

• Karasek’s (1979) idea of “demand-control imbalance” or “job strain”; jobs are stressful if they combine high demands with a lack of ability to control the situation. In other words, the perception of low control is put forward as the main source of work stress. There is data that indicates a relationship between low control and poor health outcomes.

• Siegrist’s (1996) idea of “effort-reward imbalance”; the demands of a job, and the coping capacity that is required to do it become stressful if the rewards, whether they be remuneration, job satisfaction, status or other, are not reciprocally matched.

• Johnson’s (1988) idea of “support”; having the right tools and infrastructure for the job and supportive relationships in the workplace.

Dr Ramesh Manocha

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