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ABSTRACT: BACKGROUND: Burnout and job satisfaction in psychiatrists has been an area of considerable interest. Longitudinal studies on the subject are lacking, rendering it difficult to establish whether burnout changes with time or whether low job satisfaction may predict high burnout with time in psychiatrists. AIMS: This longitudinal study of burnout and job satisfaction in a cohort of New Zealand psychiatrists was conducted to examine if initial scores on the Job Diagnostic Survey (JDS) predicted scores on the Maslach Burnout Inventory (MBI) three years later and vice versa. METHODS: Three questionnaires (a socio-demographic questionnaire, the JDS and the MBI) were sent to all registered psychiatrists in 2008, which included all those who had participated in a study three years earlier. Scores on these three questionnaires were compared for those who had participated in both studies. RESULTS: The overall number of psychiatrists reporting a high level of emotional exhaustion (EE) did not change across the two phases. The number of psychiatrists reporting high levels of depersonalization (DP) increased from 31 (13%) to 45 (20.2%); the mean DP score for the cohort significantly increased by 17.5% (p < .01). Those reporting reduced personal accomplishment (PA) increased from 90 (37.7%) to 98 (43.9%); the mean PA score for the cohort significantly reduced by 14.5% (p < .001). Low scores on skill variety, task Identity, and feedback of the JDS were significantly correlated with high EE scores three years later, whereas low scores on skill variety were significantly correlated with high scores on DP, and low scores on task significance and feedback were correlated with low scores on PA three years later. CONCLUSIONS: Paying attention to aspects of job satisfaction may assist us in developing specific interventions for psychiatrists who may score high on different dimensions of burnout.
International Journal of Social Psychiatry 04/2012; · 1.15 Impact Factor
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ABSTRACT: Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion.
A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents.
Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work; working long hours; an aggressive administrative environment; and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries.
Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously.
International Journal of Social Psychiatry 03/2011; 57(2):166-79. · 1.15 Impact Factor
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ABSTRACT: To ascertain the presence, and describe the pattern and extent, of restrictive care practices in the treatment of mental health inpatients in a rural New Zealand unit.
Retrospective data was anonymously extracted from patient records at Rotorua Hospital (Rotorua, New Zealand). Data sets were compiled from 300 consecutive patient admissions between January 2000 and December 2001. The demographic and diagnostic characteristics extracted were gender, age, ethnicity (Măori or non-Măori classification only), primary diagnosis, length of hospital stay, seclusion, medication on discharge, dosage of antipsychotic medication if given, referral to psychotherapy, voluntary/involuntary status on admission, and readmission rates.
After controlling for other clinical variables, ethnicity was not associated with specific diagnoses, increased use of seclusion, and involuntary status on admission or higher readmission rates. Măori patients were more likely to receive antipsychotic medication and at higher doses than non-Măori. Măori were less likely to be referred to psychotherapy services and had shorter lengths of stay.
There was no evidence of widespread restrictive care practices against Măori, although the disparities in antipsychotic prescription and psychotherapy referral suggest some restrictive care practices do exist. The use of specialist cultural teams in general mental health services may prevent restrictive care practices.
Social Psychiatry and Psychiatric Epidemiology 06/2008; 43(5):387-91. · 2.70 Impact Factor
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ABSTRACT: We aimed to elucidate causative and protective factors associated with burnout in New Zealand psychiatrists, to identify signs and symptoms of the burnout syndrome, and to identify any difference in the perspectives of psychiatrists who scored high versus low on the emotional exhaustion (EE) subscale of the Maslach Burnout Inventory (MBI).
Twelve participants were randomly selected, six from each group of psychiatrists (high versus low EE). A face-to-face interview based on a semi-structured questionnaire was carried out with each participant. The interviews were recorded and transcribed verbatim. The transcriptions were manually analysed by two independent reviewers using a grounded theory approach for qualitative analysis.
Major features of burnout were changes in appearance, behaviour and mood. Causes of burnout identified were external, internal and interpersonal factors, and changing work environment. Protective factors associated with burnout included supportive relationships, extracurricular activities, variety in one's work, a positive attitude towards one's work and high job satisfaction.
A preliminary profile of the burnout syndrome was established and has a potential role in the prevention of burnout in psychiatrists. Causative factors associated with burnout were identified and supported previous findings. Novel factors protective against burnout were suggested and require further investigation. No differences were apparent between the two subgroups of psychiatrists (high versus low EE).
Australasian Psychiatry 11/2007; 15(5):417-21. · 0.86 Impact Factor
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ABSTRACT: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population.
In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures.
The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.
This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.
International Journal of Social Psychiatry 08/2007; 53(4):306-16. · 1.15 Impact Factor
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ABSTRACT: In this paper, we report the results of our study aimed at a systematic analysis of the circadian phenotypes of fruit flies Drosophila melanogaster selected for early and late adult emergence, in light of the "morning and evening oscillator" (M and E) model for circadian clocks. We monitored adult emergence and activity/rest rhythms in these flies under light/dark (LD) cycles with short (8:16 h), normal (12:12 h) and long (16:8 h) photoperiods, as well as under constant darkness (DD). Across all the three LD cycles, the early populations displayed a morning phenotype with peak of emergence and activity occurring earlier than the controls and greater anticipation to "lights-on" and weak anticipation to "lights-off", while the late populations showed an evening phenotype with peak of emergence and activity occurring later than the controls and greater anticipation to lights-off and weak anticipation to lights-on. The gate of adult emergence and duration of activity in the early populations was narrower than the controls, while those of the late populations were wider than the controls. In addition, the circadian periodicities of adult emergence and activity/rest rhythms of the early flies were significantly shorter than the controls, while those of the late flies were significantly longer than the controls. In summary, the circadian phenotypes indicate that the early populations have evolved a dominant M oscillator, while the late populations have evolved a dominant E oscillator, thus providing an empirical support for the M and E model in Drosophila.
Journal of Insect Physiology 05/2007; 53(4):332-42. · 2.24 Impact Factor
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ABSTRACT: To investigate whether circadian clocks in fruit flies Drosophila melanogaster evolve as a consequence of selection on the timing of adult emergence, we raised four replicate populations each of early (early(1..4)) and late (late(1..4)) emerging flies by selecting for adults that emerged during the morning and the evening hours. We estimated the percentage of flies that emerged during the two selection windows to evaluate the direct response to selection, and the circadian phenotypes of adult emergence and locomotor activity rhythms under light/dark (LD) and constant darkness (DD) to assess the correlated response to selection. After 55 generations, the percentage of flies emerging during the morning window increased in the early populations, but decreased in the late populations. The percentage of flies emerging during the evening window increased in the late populations, but decreased in the early populations. The time course and waveform of emergence and locomotor activity rhythms of the selected populations diverged from each other as well as from the controls. Further, the circadian periodicity of the early populations was significantly shorter than the controls, while that of the late populations was significantly longer than the controls. The light-induced phase response curve of the selected populations differed significantly within groups as well as from the controls. Such modifications in the circadian phenotypes of the selected populations due to heritable changes in genetic architecture, in response to imposed selection pressure, suggest that the circadian clocks underlying emergence and locomotor activity rhythms in D. melanogaster evolve as a correlated response to selection on the timing of adult emergence.
Journal of Experimental Biology 04/2007; 210(Pt 5):906-18. · 3.00 Impact Factor
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ABSTRACT: The prosecution of psychiatric inpatients for violent acts remains controversial but is increasingly considered as a management option for a minority of patients. Most of the literature so far has been based in North America. This study in a rural New Zealand psychiatric unit was undertaken to explore the rates, reasons and outcomes of referring psychiatric inpatients to the police for possible prosecution of violent acts committed while in hospital.
Data were extracted retrospectively from the log of ward incident forms of the inpatient unit for the 24 months between July 2002 and June 2004 inclusive. Any incident fitting an operationalized definition of physical or verbal aggression was included in this study. The type, time, location and persons involved in each incident were recorded. Case files of all patients were used to extract information on diagnosis, treatment and further details of the incident. The details and outcome of each incident was individually verified with the local police department.
Data were available for 31 incidents. There were three cases of assault by three patients that resulted in police involvement, and one patient was convicted. Brief histories and descriptions of the incidents are provided.
Despite an increasing awareness that prosecution of patients for violent acts is an option for psychiatric staff, such referrals to the police and subsequent convictions remain rare. In the absence of clear national policies, individual hospitals must be proactive in formulating flexible policies to address such incidents on a case by case basis.
Australasian Psychiatry 10/2006; 14(3):251-5. · 0.86 Impact Factor
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ABSTRACT: To explore possible contributing or mitigating factors for burnout in New Zealand psychiatrists as well as future research directions in this area.
A selective review of the literature pertaining to burnout and reports regarding New Zealand's medical workforce.
Possible factors contributing to burnout in New Zealand psychiatrists include rapid changes in the country's health system, the challenge of recruiting and retaining psychiatrists, poor distribution of staff and funds and difficulties in psychiatric training. Potential protective factors against burnout include lifestyle factors, long experience in psychiatry, proposed long lengths of career in New Zealand and potentially positive changes in the health system. Research challenges include subject recruitment, the lack of exploration of personal protective factors and completing longitudinal studies.
Given the current state of knowledge, it would be difficult to accurately know whether New Zealand psychiatrists were burnt out or satisfied with their work. Carefully designed studies would help to clarify this issue.
Australasian Psychiatry 04/2006; 14(1):20-3. · 0.86 Impact Factor
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ABSTRACT: Circadian clocks have been implicated in the regulation of pre-adult development of fruit flies Drosophila melanogaster. It is believed that faster clocks speed up development and slower clocks slow it down. We established three sets of D. melanogaster populations (early, control and late). The early and late populations were raised by selecting for flies that emerged either in the morning or in the evening under 12:12 hr light/dark (LD) cycles. After 75 generations of selection, the time course and waveform of the adult emergence and activity rhythms of the early and the late populations diverged from each other as well as from the controls. In this paper, we report the consequence of this selection on the rate of pre-adult development.
We assayed the pre-adult development time of the selected and control populations under 12:12 hr LD cycles and constant darkness (DD). Under LD cycles, the early populations develop faster than the controls, while the late populations develop slower than the controls. Although flies take longer to develop under DD than in LD, the relative differences between the mean development times of the selected and control populations remain unaltered in DD. In a separate experiment designed to investigate the effect of time of egg collection and experimental conditions on the duration of pre-adult stage, we assayed the development time of the selected and control populations by collecting eggs at different times of the day (morning and evening) and by assaying their pre-adult development time under constant light (LL), LD, and DD conditions. Irrespective of the time of egg collection and assay light regime, the late flies continue to develop slower than the early flies.
The results of our study clearly indicate that selection on the timing of adult emergence alters the rate of pre-adult development in D. melanogaster. The timing of egg collection as well as assay light regime does not have any measurable effect on the relative differences between the developmental rates of the early and the late flies. Taken together these results appear to suggest that pleiotropic effects of clock genes mediate correlated changes in the timing of adult emergence and the rate of pre-adult development in D. melanogaster.
BMC Developmental Biology 02/2006; 6:57. · 2.79 Impact Factor
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ABSTRACT: Abstract
Background
Circadian clocks have been implicated in the regulation of pre-adult development of fruit flies Drosophila melanogaster . It is believed that faster clocks speed up development and slower clocks slow it down. We established three sets of D. melanogaster populations ( early , control and late ). The early and late populations were raised by selecting for flies that emerged either in the morning or in the evening under 12:12 hr light/dark (LD) cycles. After 75 generations of selection, the time course and waveform of the adult emergence and activity rhythms of the early and the late populations diverged from each other as well as from the controls . In this paper, we report the consequence of this selection on the rate of pre-adult development.
Results
We assayed the pre-adult development time of the selected and control populations under 12:12 hr LD cycles and constant darkness (DD). Under LD cycles, the early populations develop faster than the controls , while the late populations develop slower than the controls . Although flies take longer to develop under DD than in LD, the relative differences between the mean development times of the selected and control populations remain unaltered in DD. In a separate experiment designed to investigate the effect of time of egg collection and experimental conditions on the duration of pre-adult stage, we assayed the development time of the selected and control populations by collecting eggs at different times of the day (morning and evening) and by assaying their pre-adult development time under constant light (LL), LD, and DD conditions. Irrespective of the time of egg collection and assay light regime, the late flies continue to develop slower than the early flies.
Conclusion
The results of our study clearly indicate that selection on the timing of adult emergence alters the rate of pre-adult development in D. melanogaster . The timing of egg collection as well as assay light regime does not have any measurable effect on the relative differences between the developmental rates of the early and the late flies. Taken together these results appear to suggest that pleiotropic effects of clock genes mediate correlated changes in the timing of adult emergence and the rate of pre-adult development in D. melanogaster .
BMC Developmental Biology. 01/2006;
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ABSTRACT: Dengue fever (DF) and Dengue hemorrhagic fever (DHF) are widespread in Southeast Asia. An outbreak of DF/DHF in Delhi in 2003 started during September, reached its peak in October-November, and lasted until early December. This study describes the clinical and laboratory data of the 185 cases of DF/DHF admitted to Lok Nayak Hospital, New Delhi. The mean age of the patients was 26 +/- 10 years. Fever was present in all the cases with an average duration of fever being 4.5 +/- 1.2 days with headache (61.6%), backache, (57.8%), vomiting (50.8%) and abdominal pain (21%) being the other presenting complaints. Hemorrhagic manifestations in the form of a positive tourniquet test (21%), gum bleeding and epistaxis (40%), hematemesis (22%), skin rashes (20%) and melena (14%) were also observed. Hepatomegaly and splenomegaly were observed in 10% and 5% of cases, respectively. Laboratory investigations revealed thrombocytopenia (with a platelet count of < 100,000/microl) in about 61.39% of cases, Leukopenia (WBC <3,000/mm2) and hemoconcentration (Hct >20% of expected for age and sex) were found in 68% and 52% of the cases, respectively. The mortality rate was 2.7%. Despite widespread measures taken to control outbreaks of DF, it caused major outbreaks. More stringent measures in the form of vector control, improved sanitation and health education are needed to decrease morbidity, mortality and health care costs caused by a preventable disease.
The Southeast Asian journal of tropical medicine and public health 09/2005; 36(5):1174-8. · 0.60 Impact Factor
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ABSTRACT: This article reviews burnout in psychiatrists. A model of burnout is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout. Lastly, recommendations are made for future research.
We conducted a selective literature review to expand on two recent systematic reviews to examine the etiology, prevalence, and consequences of burnout in psychiatrists. We distinguish the effects of burnout, depression, and work-related stress.
An etiological model for the development of burnout in psychiatrists is described here in terms of an interaction between the predisposing, precipitating, and perpetuating factors.
Research is needed on the long-term effects of work-place stress on psychiatrists, to identify possible protective factors, and to utilize this information to inform the design of interventions that protect or mitigate the effects of work-place stress on psychiatrists.
The International Journal of Psychiatry in Medicine 02/2005; 35(4):405-16. · 1.03 Impact Factor
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ABSTRACT: Circadian clocks regulate physiological and behavioral processes in a wide variety of organisms, and any malfunction in these clocks can cause significant health problems. In this paper, we report the results of our study on the physiological consequences of circadian dysfunction (malfunctioning of circadian clocks) in two wild-type populations of fruit flies (Drosophila melanogaster). We assayed locomotor activity behavior and lifespan among adult flies kept under constant dark (DD) conditions of the laboratory, wherein they were categorized as rhythmic if their activity/rest schedules followed circadian (approximately 24 h) patterns, and as arrhythmic if their activity/rest schedules did not display any pattern. The rhythmic flies from both populations lived significantly longer than the arrhythmic ones. Based on these results, we conclude that circadian dysfunction is deleterious, and proper functioning of circadian clocks is essential for the physiological well being of D. melanogaster.
Chronobiology International 02/2005; 22(4):641-53. · 4.03 Impact Factor
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Australasian Psychiatry 01/2005; 12(4):401-3. · 0.86 Impact Factor
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ABSTRACT: Administrators' perceptions of significant factors that might affect the recruitment and retention of psychiatrists for New Zealand's public mental health Services have not been previously investigated.
A postal questionnaire was sent to managers of all 21 of New Zealand's mental health Services. The questionnaire requesting information about any difficulties managers experienced in recruiting and retaining psychiatrists, factors they thought attract psychiatrists to join and stay, reasons why psychiatrists left, strategies they had tried to alleviate any psychiatrist shortages, and their relative success.
Responses were received from 3 of 8 metropolitan Services and 8 of 13 non-metropolitan Services. Every service had experienced problems in recruiting and retaining psychiatrists over the past 5 years. New Zealand's general shortage of psychiatrists and limitations on recreational activities available in their area were reasons unanimously held to account for this. Factors unanimously identified as significant in influencing psychiatrists to join a mental health service were lifestyle, professional opportunities, functional multidisciplinary teams, and adequate staffing and training activities. Factors unanimously identified in retaining psychiatrists were levels of professional satisfaction, a reasonable on-call roster, functional multidisciplinary teams, adequate resources, and the ability to practise safely and within their area of expertise. There was no unanimity as to why psychiatrists would leave a service. Every service which attempted to assist psychiatrists with their relocation, and which found locums to cover so that they could take leave when they wanted, reported that these strategies had been wholly or partially successful in alleviating their psychiatrist shortage.
Administrators' perspectives (which are often different to those of psychiatrists) about factors affecting recruitment and retention are worth investigating.
The New Zealand medical journal 11/2004; 117(1204):U1122.
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ABSTRACT: New Zealand is suspected of sharing other countries' difficulties of having inadequate numbers of practising psychiatrists and attracting psychiatrists to work outside its main urban centres, but there is no contemporary data on the socio-demographic and professional practice profile of its psychiatrists. This paper highlights some interesting trends about New Zealand's psychiatric workforce.
A postal questionnaire was sent to all actively practising vocationally registered psychiatrists with a New Zealand mailing address requesting information about basic demographic data, professional training experiences, current professional status, practise intentions, why they chose to work where they do and what factors might influence them to leave for another region of New Zealand or overseas.
Of the 277 doctors on the vocational register for psychiatry, 159 responded, giving a response rate of 59.8%. Most psychiatrists were male (n = 102; 64.2%), European (n = 144; 90.6%), aged between 41 and 60 (69.2%), born overseas (n = 90; 56%), had English as their primary language (n = 142; 89.3%) and were in a long-term relationship with dependent children (n = 99; 62.3%). Nearly all (n = 149; 95%) did their psychiatry training in a metropolitan area and most (n = 108; 67.9%) held the Fellowship of the Royal Australian and New Zealand College of Psychiatry (FRANZCP). Most worked in a metropolitan area (n = 136; 85.5%) and either wholly or partly in the public sector (n = 145; 93%). Nearly one-quarter expected to retire over the next decade. Professional factors were rated more important as a reason for staying by metropolitan psychiatrists compared with their non-metropolitan counterparts (p < 0.001). Psychiatrists who did not have an FRANZCP (57%vs. 27%, p = 0.05), those who had spent more than 50% of their professional life in New Zealand (86%vs. 74%, p = 0.02) or those who had obtained their primary medical degree outside New Zealand were more likely to be in non-metropolitan areas (81%vs. 49%, p = 0.04). Metropolitan psychiatrists rated personal and social reasons more highly than non-metropolitan psychiatrists did for factors which might induce them to leave for another area, whereas professional development was ranked lower.
This is the first contemporary study of New Zealand's psychiatric workforce and it highlights some interesting trends and has significant implications for those concerned with the recruitment and retention of psychiatrists. Further investigation is suggested, as a more complete picture of New Zealand's specialist psychiatric workforce would be gained by including psychiatrists who are not vocationally registered.
Australian and New Zealand Journal of Psychiatry 07/2004; 38(7):547-53. · 2.93 Impact Factor
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ABSTRACT: In this paper, we report the results of our extensive study on eclosion rhythm of four independent populations of Drosophila melanogaster that were reared in constant light (LL) environment of the laboratory for more than 700 generations. The eclosion rhythm of these flies was assayed under LL, constant darkness (DD) and three periodic light-dark (LD) cycles (T20, T24, and T28). The percentage of vials from each population that exhibited circadian rhythm of eclosion in DD and in LL (intensity of approximately 100 lux) was about 90% and 18%, respectively. The mean free-running period (tau) of eclosion rhythm in DD was 22.85 +/- 0.87 h (mean +/- SD). Eclosion rhythm of these flies entrained to all the three periodic LD cycles, and the phase relationship (psi) of the peak of eclosion with respect to "lights-on" of the LD cycle was significantly different in the three periodic light regimes (T20, T24, and T28). The results thus clearly demonstrate that these flies have preserved the ability to exhibit circadian rhythm of eclosion and the ability to entrain to a wide range of periodic LD cycles even after being in an aperiodic environment for several hundred generations. This suggests that circadian clocks may have intrinsic adaptive value accrued perhaps from coordinating internal metabolic cycles in constant conditions, and that the entrainment mechanisms of circadian clocks are possibly an integral part of the clockwork.
Chronobiology International 12/2003; 20(6):977-87. · 4.03 Impact Factor
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Psychiatry and Clinical Neurosciences 05/2003; 57(2):235-6. · 2.13 Impact Factor
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ABSTRACT: Treatment programmes are largely hospital based in developing countries and yet research on factors predicting frequent re-hospitalisation remains scarce from them. This cross-sectional study of factors predictive of frequent re-hospitalisation explored whether factors reported from developed countries could apply to India.
Information was collected on four dimensions (socio-demographic, socio-cultural, treatment and illness variables) from 90 patients readmitted to a teaching psychiatric institute in India over a 3 month period. Patients were grouped into Frequently Re-hospitalised (FR) with three or more admissions to hospital in the last 18 months and Less Frequently Re-hospitalised (LFR) with two or fewer admissions in the last 18 months.
Support available for treatment, days spent in hospital and cost of treatment had a significant effect on whether the patient was more frequently hospitalised. The place of domicile tended to have an effect on the frequency of hospitalisation.
Factors predictive of frequent re-hospitalisation reported in this study differed from those in developed countries. The above variables identify high users of inpatient beds who may be targeted for specific interventions to reduce re-hospitalisation rates.
Social Psychiatry and Psychiatric Epidemiology 10/2002; 37(9):435-40. · 2.70 Impact Factor
