Front-line physicians stressed and anxious at work and home
New study reports moderate to severe stress levels in ER doctors during the frenetic early phase of COVID-19 pandemic
July 21, 2020
Science Daily/University of California - San Francisco
Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to a new analysis led by UC San Francisco.
In the first known study to assess stress levels of U.S. physicians during the coronavirus pandemic, doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.
"Occupational exposure has changed the vast majority of physicians' behavior at both work and home," said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF. "At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line."
The results, which appear July 21, 2020, in Academic Emergency Medicine, found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.
Lack of PPE was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.
But the survey also showed clear-cut ways of mitigating anxiety:
Improve access to PPE;
Increase availability of rapid turnaround testing;
Clearly communicate COVID-19 protocol changes;
Assure access to self-testing and personal leave for front line providers.
The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.
The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana and New Jersey. Researchers noted that the majority of study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. But the study found that median levels of anxiety in the California sites were similar to those in the New Orleans and Camden sites, which were experiencing surges at the time.
"This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally," Rodriguez said. "Some of our findings may be intuitive, but this research provides a critical early template for the design and implementation of interventions that will address the mental health needs of emergency physicians in the COVID-19 pandemic era."
The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the ER, and possible development of long-term post-traumatic stress.
https://www.sciencedaily.com/releases/2020/07/200721084205.htm
Feeling burned out? The contributors could be more related to depression than you think
April 29, 2020
Science Daily/Medical University of South Carolina
Researchers found that similar factors cause both medical intern burnout and depression. These findings can be used to identify and treat burnout as well as mitigate the risk of burnout by modifying workplace factors.
An article published in the Journal of General Internal Medicine looks at the relationship between burnout and depressive symptoms in medical interns.
The article is authored by Constance Guille, M.D., an associate professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, and Lisa Rotenstein, M.D., an internal medicine resident at Harvard Medical School/Brigham and Women's Hospital, among others.
According to Rotenstein, these findings help correct a long-held misconception about burnout and depression.
"There is a long-standing thought that burnout is associated with workplace factors and that depressive symptoms are associated with workplace factors but also heavily influenced by personal factors," explained Rotenstein. "We found that the factors that drive burnout are much more closely related to the factors that drive depressive symptoms than previously realized."
In this study, Rotenstein and Guille uncover that there is substantial overlap between the factors that predict burnout and depressive symptoms. The study surveyed 1,552 medical interns entering residency programs at 68 different institutions about depressive symptoms, emotional exhaustion and depersonalization, as well as about potential contributing factors. Depressive symptoms were measured by a standard 9-item Patient Health Questionnaire, while emotional exhaustion and depersonalization were measured with a 9-item abbreviated Maslach Burnout Inventory. Workload and learning environment satisfaction were assessed with a standardized instrument. Personal factors assessed included age, gender, ethnicity, relationship status, sexual orientation, parenting status, specialty, self-reported history of depression, early life stress and neuroticism score.
The study found significant overlap between factors that contribute to depressive symptoms and those that contribute to burnout, with about two-thirds of variance in both depressive symptoms and burnout attributable to personal factors, and one-third of the variance in these measures attributable to workplace factors.
With more than 142 definitions circulating in the literature, the definition of burnout has historically been unclear. This lack of clear definition has led to highly variable rates of burnout being reported among medical interns, residents and attending physicians. In contrast, depressive symptoms are well-defined and have been clinically validated. The results of this study suggest that assessing for depressive symptoms may be a validated, standardized alternative to assessing for burnout among medical personnel. They also underscore that interventions that help address burnout may be effective in addressing depressive symptoms and vice versa. Examples of such interventions include leveraging resources such as scribes to address documentation burdens, time banking for physician service and resources such as childcare to take stress off those physicians with familial obligations.
For Guille, the takeaway message from this study is clear.
"Previous to this work, depression and burnout were conceptualized as separate entities with different factors contributing to these outcomes," explained Guille. "This work suggests there is substantial overlap between both workplace and personal factors that contribute to an increase in both depressive symptoms and burnout."
https://www.sciencedaily.com/releases/2020/04/200429105914.htm
Burnout linked with irregular heartbeat
January 14, 2020
Science Daily/European Society of Cardiology
Feeling excessively tired, devoid of energy, demoralised, and irritable? You may have burnout, a syndrome associated with a potentially deadly heart rhythm disturbance. That's the conclusion of a large study published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
"Vital exhaustion, commonly referred to as burnout syndrome, is typically caused by prolonged and profound stress at work or home," said study author Dr. Parveen K. Garg of the University of Southern California in Los Angeles. "It differs from depression, which is characterised by low mood, guilt, and poor self-esteem. The results of our study further establish the harm that can be caused in people who suffer from exhaustion that goes unchecked."
Atrial fibrillation is the most common form of heart arrhythmia. It is estimated that 17 million people in Europe and 10 million people in the US will have this condition by next year, increasing their risk for heart attack, stroke, and death. Yet, what causes atrial fibrillation is not fully understood.
Psychological distress has been suggested as a risk factor for atrial fibrillation, but previous studies showed mixed results. In addition, until now, the specific association between vital exhaustion and atrial fibrillation had not been evaluated.
The researchers in this study surveyed more than 11,000 individuals for the presence of vital exhaustion, anger, antidepressant use, and poor social support. They then followed them over a period of nearly 25 years for the development of atrial fibrillation.
Participants with the highest levels of vital exhaustion were at a 20% higher risk of developing atrial fibrillation over the course of follow-up compared to those with little to no evidence of vital exhaustion.
While further study is needed to better understand the observed relationship, Dr. Garg noted that two mechanisms are likely at play. "Vital exhaustion is associated with increased inflammation and heightened activation of the body's physiologic stress response," he said. "When these two things are chronically triggered that can have serious and damaging effects on the heart tissue, which could then eventually lead to the development of this arrhythmia."
No connections were found between anger, antidepressant use, or poor social support and development of atrial fibrillation. "The findings for anger and social support are consistent with prior research but two previous studies did find a significant association between antidepressant use and an increased risk of atrial fibrillation. Clearly, more work still needs to be done," said Dr. Garg.
Further research is also needed to identify concrete actions for doctors to help patients with exhaustion, said Dr. Garg.
He concluded: "It is already known that exhaustion increases one's risk for cardiovascular disease, including heart attack and stroke. We now report that it may also increase one's risk for developing atrial fibrillation, a potentially serious cardiac arrhythmia. The importance of avoiding exhaustion through careful attention to -- and management of -- personal stress levels as a way to help preserve overall cardiovascular health cannot be overstated."
https://www.sciencedaily.com/releases/2020/01/200114173108.htm