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Anxiety and depression levels among multidisciplinary health residents

Authors:

Abstract

Objective to assess symptoms of anxiety and depression of professionals of Multidisciplinary Health Residence Programs. Methods this is a cross-sectional study, performed with fifty professionals, using three instruments: one for socioeconomic and demographic data, and the Beck’s Anxiety and Depression Scale. Results predominance of females (92.0%), average age 26 years old, single (88.0%), family income from two to five salaries (56.0%) satisfied with the work (82.0%) and thought about quitting the program (56.0%) showed anxiety (50.0%) and depression (28.0%). Conclusion there was an association between anxiety and depression in multidisciplinary residents, which points to the need for rethinking strategies for identifying these symptoms and control of stress factors for the promotion of mental health.
Received: Feb. 5th 2016; Accepted: Mar. 14th 2016. Rev Rene. 2016 May-June; 17(3):372-7.
DOI: 10.15253/2175-6783.2016000300010
www.revistarene.ufc.br
Original Article
372
Anxiety and depression levels among multidisciplinary health
residents*

Daniela Salvagni Rotta1, Maria Helena Pinto1, Luciano Garcia Lourenção1, Priscila Regina Teixeira1, Elizangela
Gianini Gonsalez1, Claudia Eli Gazetta1
Objective: to assess symptoms of anxiety and depression of professionals of Multidisciplinary Health Residence
Programs. Methods:
one for socioeconomic and demographic data, and the Beck’s Anxiety and Depression Scale. Results:
         
              
anxiety (50.0%) and depression (28.0%). Conclusion:
in multidisciplinary residents, which points to the need for rethinking strategies for identifying these symptoms
and control of stress factors for the promotion of mental health.
Descriptors: Health Personnel; Internship and Residency; Anxiety; Depression.
Objetivo:            
   Métodos:       

Resultados: predominância do sexo feminino (92,0%), idade média 26 anos, solteiros (88,0%), renda familiar
                
(56,0%), apresentaram ansiedade (50,0%) e depressão (28,0%). Conclusão:   


Descritores: 
1Faculdade de Medicina de São José do Rio Preto. São José do Rio Preto, SP, Brazil.


Rev Rene. 2016 May-June; 17(3):372-7.
Anxiety and depression levels among multidisciplinary health residents
373
Introduction
The Multidisciplinary Health Residence


     


undergraduate(1). It is a post-graduation modality
lato sensu   
supervision, full-time and is as an effective way of
development and specialization in health care, and
     
community, promoting partnerships among managers,
workers and users, aiming a collective training in
  
the user integrity(2-3). Thus, this program allows the
exchange of knowledge among the various specialties
     
      
the service in contact with users and communities,
integrating theory and practice(1).
With the admission into the residence program,
changes occur in the professional and individual life of
the individual. Many move to other cities to attend the
program, separate from families and friends and need
a fast adaption to the new reality. Several suffer from
anxieties, tensions of lifestyle change and the working
environment and fail to create effective strategies
      

the development of anxiety and depression(4).

formation process in the context of residence, mainly
in specialties, shows that professionals are affected
       

user(5).
Residents may feel incompetent and worthless
       
     
        
environmental factor triggering disorders(6), such
 
professionals(7).
Considering the changes in daily life and stress

in the Multidisciplinary Health Residence, this study
aimed to assess symptoms of anxiety and depression
of professionals of Multidisciplinary Health Residence
Programs.
Methods
This is a cross-sectional study, population-
     
the Multidisciplinary Health Residence Programs of
an educational institution in the interior of São Paulo,
Brazil state in 2013, who agreed to participate in
 
     
different areas. They excluded those who were distant
from the professional activities for any reason during
the period of data collection.
The data collection was performed with three
    
       
age, gender, marital status, professional category,
        
       
Beck Anxiety Inventory measures the severity of the
     

     
(8), and the Beck
Depression Scale and the Beck Depression Inventory,
       
related to depressive symptoms such as hopelessness,
       
punished, physical symptoms such as fatigue, weight
(9).
Demographic and socioeconomic data
characterized the study population. Depression
      
Rotta DS, Pinto MH, Lourenção LG, Teixeira PR, Gonsalez EG, Gazetta CE
Rev Rene. 2016 May-June; 17(3):372-7.
374
according to instruments data and categorized in
    
    

The data analysis was performed using
Statistical Package for Social Sciences program, version
      

to 0.05.
      -
ments contained in the national and international
standards, regulatory of research involving human

Results
Fifty professionals from different categories,
most nurses participated in the study (30.0%).
 

an average of 24.5 years old (SD ± 2.6 years) and CI
95% from 23.8 to 25.3 years old; singles and family

It is noteworthy that most of the professionals
       


Residents showed symptoms of anxiety
associated or not with depression (50.0%); as well
     
     

      
     
 
     


      

and depression (p<0.001).
Table 1     
satisfaction characteristics of professionals enrolled
in the Multidisciplinary Residence Program
Variables
Population
Satisfied with the
program
Thought about
quitting
Yes No Ye s No
n (%)n (%)n (%)n (%)n (%)
Professional category
Nursing 15 (30.0) 12 (29.3) 3 (33.3) 10 (35.7) 5 (22.7)
Nutrition 9 (18.0) 8 (19.5) 1 (11.1) 3 (10.7) 6 (27.3)
Occupational Therapy 7 (14.0) 3 (7.3) 4 (44.4) 7 (25.0) -
Physiotherapy 5 (10.0) 5 (12.2) - 1 (3.6) 4 (18.2)
Psychology 4 (8.0) 3 (7.3) 1 (11.1) 2 (7.1) 2 (9.1)
Speech Therapy 3 (6.0) 3 (7.3) - 2 (7.1) 1 (4.5)
Biological Sciences 2 (4.0) 2 (4.9) - - 2 (9.1)
Pharmacy 2 (4.0) 2 (4.9) - 1 (3.6) 1 (4.5)
Odontology 2 (4.0) 2 (4.9) - 2 (7.1) -
Veterinary Medicine 1 (2.0) 1 (2.4) - - 1 (4.5)
Gender
Female 46 (92.0) 37 (90.2) 9 (100.0) 27 (96.4) 19 (86.4)
Male 4 (8.0) 4 (9.8) - 1 (3.6) 3 (13.6)
Age group (years)
20 – 25 38 (76.0) 31 (75.6) 7 (77.8) 22 (78.6) 16 (72.7)
26 - 30 10 (20.0) 10 (24.4) 2 (22.2) 6 (21.4) 6 (27.3)
Minimum age 21 21 22 21 23
Maximum age 35 33 35 35 29
Middle age 24.5

24.6

24,0

24.1

24.6

Marital status
Single 44 (88.0) 36 (87.8) 8 (88.9) 25 (89.3) 9 (86.4)
Married 05 (10.0) 5 (12.2) - 2 (7.1) 3 (13.6)
Other 1 (2.0) - 1 (11.1) 1 (3.6) -
Family income*
2 - 05 28 (56.0) 21 (51.2) 7 (77.8) 19 (67.9) 9 (40.9)
6 – 10 13 (26.0) 12 (29.3) 1 (11.1) 6 (21.4) 7 (31.8)
> 10 9 (18.0) 8 (19.5) 1 (11.1) 3 (10.7) 6 (27.3)
*
Rev Rene. 2016 May-June; 17(3):372-7.
Anxiety and depression levels among multidisciplinary health residents
375
Table 2 
for professionals enrolled in the Multidisciplinary
Health Residence Program
Variables
Depression
Total
Absence
n (%)
Light
n (%)
Moderate
n (%)
Serious
n (%)
Anxiety
 21 (42.0) 3 (6.0) 1 (1.0) - 25 (50.0)
Light 9 (18.0) 1 (2.0) 1 (2.0) - 11 (22.0)
Moderate 6 (12.0) 5 (10.0) - - 11 (22.0)
Serious - - 2 (4.0) 1 (2.0) 3 (6.0)
Total 36 (72.0) 9 (18.0) 4 (8.0) 1 (2.0) 50 (100.0)
 0.240 -0.122 -0.133 0.485 0.072
P value 0.059 * * <0.001 0.420
CI 95% -0.009-0.489 -0.397-0.153 -0.368-0.102 0.247-0.722-0.102-0.245

Discussion
The female prevalence in this study was also
demonstrated in a University Hospital in Spain, where
38.5% of the sample was composed of nurses(5).
      
      Santa Catarina
       
of the students were female(10-11)  
      
is related to the structure of health teams, composed
     
(12-13).
       
      
Federal University of Rio Grande do Sul, which showed

years old(13), and the Federal University of Pernambuco,
whose professionals average age was 27 years old(12).
Regarding marital status, the Federal University
of Pernambuco and the Federal University of Santa
Maria showed percentages of single professionals
       
and 81.1%, respectively)(12,14). It is assumed that the
prevalence of singles among the studied professionals
        
professionals and recent graduates.
A study with professionals in a university


      
desire to learn and gain experience could make young
people evaluate positive aspects of the work(15).
Anxiety and depression levels among
 
health trainees in Malaysia, which showed anxious
participants (60.7%), slightly anxious (13.5%),
moderately anxious (28.1%) and extremely anxious
(15.7%)(2). There was the prevalence of female
workers (60.6%), single (80.8%) with a mean age of
26.1 years old(2).
On the other hand, a Pakistani study performed
with medical students showed lower symptoms
of anxiety and depression(11), showing that the
student-medical transition is an exhausting process
       
University of Toronto, identifying the anxiety levels at

end of the course, when trust and familiarity with the
(7).
      
reports, poor relationships with colleagues and
superiors are among the factors that cause anxiety(2).
In Norway, exploring personality traits among
professional trainees associated with symptoms of
anxiety, depression and work stress reports during
     
of stress at work was positively correlated with the
       
of symptoms of anxiety higher than depression. It
was also noted that the female trainees experienced
greater work stress levels than men(16).
There are evidences that working and routine
      
to the levels of anxiety and depression (50.0%
and 28.0%, respectively), as the workload of the
Rotta DS, Pinto MH, Lourenção LG, Teixeira PR, Gonsalez EG, Gazetta CE
Rev Rene. 2016 May-June; 17(3):372-7.
376
Multidisciplinary Health Residence programs is
60 hours per week, lasting 24 months, a period in
which professionals develop theoretical and practical
activities. It is understood also that this step of the
training process is one of the most stressful stages


    
different specialties, relationship with family and

    

sectors and institutions(6).
It is also noted that anxiety is typical of every
profession, and therefore, the evaluation of the stressor
and the way of coping or adaptation to the stressor
are individual, depending on the work process and
teaching-learning that accompanies the existential
       
 
    
     
the limits of their personal and professional
identity, teamwork, interpersonal relationships and

care(14).
       

of multidisciplinary health residents, which can
      
        
      
     
residents. To make this assessment more effective,
  
factors related to other contexts, such as the causes of
dissatisfaction and the reasons that lead professionals

was the study performance in just one training center,
limiting the analysis of the results.
Conclusion
Most residents of this study were women,
       
    
       
      
depression, suggesting the need for greater attention
to professionals as well as the implementation of
actions aimed at the welfare of this population, with

control of stress factors and mental health promotion,


Acknowledgements
To the Medicine Faculty of São José do Rio
Preto for funding this study, through the Scholarship

Collaborations
      
analysis and interpretation of data and writing of the

writing of the article, relevant critical review of the
  

      
of data, and with the relevant critical review of the
intellectual content.
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 
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... Estudos brasileiros mostram uma prevalência de 30,0% a 50,0% de ansiedade e de 25,0% a 30,5% de depressão em profissionais de saúde, evidenciando se tratar de um importante problema de saúde pública (Rotta et al., 2016;Gonsalez et al., 2017;Lourenção et al., 2017;Garcia Junior et al., 2018;Lourenção, 2018;Moura et al., 2018;Sampaio et al., 2020). Esses estudos apontam ainda que fatores como pressão no ambiente de trabalho, sono desregulado, sexo e estado civil estão associados ao desenvolvimento da ansiedade, enquanto o setor de trabalho, tipo de vínculo, cargo, idade e a cor estão associados ao desenvolvimento da depressão. ...
... Os níveis de ansiedade encontrados nesse estudo foram inferiores ao observados em estudos com profissionais de enfermagem, gestores de Unidades de Saúde da Família, residentes médicos de pediatria e residentes multiprofissionais de saúde brasileiros (Rotta et al., 2016;Lourenção et al., 2017;Lourenção, 2018;Julio et al., 2021), evidenciando que os profissionais da APS avaliados se encontram sob condições laborais menos estressoras, pois a ansiedade compreende uma resposta do organismo a situações de estresse e, geralmente, causa sintomas como perda de concentração, inquietação e distúrbios do sono, entre outros (Barbosa et al., 2020). ...
... Por outro lado, os níveis de depressão foram superiores aos observados em estudos com médicos da ESF e com residentes multiprofissionais de saúde (Rotta et al., 2016;Garcia Junior et al., 2018) e inferiores aos apresentados por gestores de Unidades de Saúde da Família, residentes médicos de pediatria e profissionais de enfermagem da APS (Bertussi, 2017;Lourenção et al., 2017;Lourenção, 2018;Julio et al., 2021). Essa diferença do nível de depressão dos profissionais desse estudo em relação ao apontado em outros estudos é coerente com a literatura, que aponta uma variação de 15,4% a 40,5% na prevalência de estresse entre profissionais da saúde (Corrêa & Rodrigues, 2017) e, comumente, é superior à prevalência estimada de estresse para a população geral, que, de acordo com a Organização Mundial de Saúde, é de 5,8% no Brasil e 5,9% nos Estados Unidos (World Health Organization, 2017). ...
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Resumo Introdução A atualização da Política Nacional de Atenção Básica em Saúde, em 2017, trouxe importantes retrocessos para o sistema de saúde brasileiro, dificultando a atuação profissional e favorecendo o adoecimento psíquico dos trabalhadores. Objetivo Avaliar a prevalência de ansiedade e depressão em trabalhadores da atenção primária à saúde. Método Estudo transversal, realizado em 2017, em um município de grande porte do interior paulista. Foram avaliados 173 profissionais das equipes da Atenção Primária à Saúde, utilizando um questionário com variáveis sociodemográficas e profissionais; o Inventário de Ansiedade de Beck (BAI); e o Inventário de Depressão de Beck (BDI-II). Resultados A ansiedade esteve presente em 45,3% dos profissionais, sendo 25,0% com ansiedade leve, 9,9% com ansiedade moderada e 10,5% com ansiedade grave. A depressão esteve presente 41,0% dos profissionais, sendo 28,9% com depressão leve e 12,1% com depressão moderada. Houve maior prevalência de ansiedade (17,3%) e de depressão (28,3%) entre Agentes Comunitários de Saúde e menor prevalência de ansiedade (1,2%) e de depressão (0,6%) entre médicos. Conclusão Há uma prevalência elevada de ansiedade e depressão em profissionais da Atenção Primária em Saúde, especialmente em agentes comunitários de saúde. Os gestores municipais devem implementar medidas de atenção à saúde dos trabalhadores, bem como garantir condições de trabalho favoráveis, para evitar o adoecimento dos profissionais.
... Los principales estresores fueron: falta de perspectivas de crecimiento profesional (2,9; ±1,3); forma de distribución de las tareas (2,7; ±1,0); formación profesional deficiente (2,7; ±1,2); tiempo insuficiente para realizar el trabajo (2,6; ±1,2). El modo de afrontamiento con mayor puntuación fue el centrado en el problema (3,75), seguido de la búsqueda de apoyo social (3,17). Conclusión: las presiones del entorno laboral en Atención Primaria favorecen el desarrollo del estrés por parte de los médicos. ...
... Health professionals are subject to situations that can trigger stress, such as excessive workloads, incomplete teams, and inadequate working conditions for meeting the demand for services. Such conditions can favor physical and mental illness in health care workers, triggering a chronic picture of stress and leading to the development of burnout syndrome [1][2][3]. ...
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Objetivo: Avaliar os níveis de estresse ocupacional e as estratégias de enfrentamento entre médicos da Atenção Primária à Saúde. Materiais e Métodos: Estudo transversal, realizado com médicos das Unidades de Atenção Primária à Saúde de um município brasileiro de grande porte. Para a coleta dos dados utilizou-se um instrumento elaborado pelos pesquisadores, contendo variáveis sociodemográficas e profissionais; a Escala de Estresse no Trabalho e a Escala de Modos de Enfrentamento de Problemas. Os dados foram analisados em função do cálculo dos escores adequados às escalas, com tratamento estatístico apropriado, considerando-se nível de significância de 5%. Resultados: Houve predomínio do sexo feminino (59,4%), jornada de 40 horas semanais (59,4%) e tempo mediano de atuação na Atenção Primária de sete anos. Oito profissionais (25,0%) apresentaram escores compatíveis com estresse importante (>2,5). Os principais estressores foram: falta de perspectivas de crescimento na carreira (2,9; ±1,3); forma de distribuição das tarefas (2,7; ±1,0); deficiência nos treinamentos profissionais (2,7; ±1,2); tempo insuficiente para realizar o trabalho (2,6; ±1,2). O modo de enfrentamento com maior escore foi o focalizado no problema (3,75), seguido da busca por suporte social (3,17). Conclusão: As pressões do ambiente laboral na Atenção Primária favorecem o desenvolvimento de estresse pelos médicos. O desequilíbrio emocional direciona a estratégia de enfrentamento dos profissionais, reforçando a necessidade de se criar um ambiente laboral acolhedor, com equipes coesas, integradas e bem geridas, capazes de compartilhar emoções e engajadas em promover o apoio social.
... O desgaste psicológico inerente à atuação na Estratégia Saúde da Família exige grande equilíbrio emocional dos profissionais de enfermagem e leva, muitas vezes, ao surgimento de quadros crônicos, que podem evoluir para o estresse ocupacional, aumentando o risco de desenvolver ansiedade, o que leva a um estado de desmotivação e aumenta a probabilidade da manifestação da Síndrome de Burnout (3) . ...
... As variáveis sociodemográficas e profissionais foram utilizadas para caracterizar a população do estudo. Seguindo as recomendações dos instrumentos, uma psicóloga realizou o cálculo dos níveis de ansiedade e depressão, categorizando-os em ausência de ansiedade ou depressão, ansiedade ou depressão leve, ansiedade ou depressão moderada e ansiedade ou depressão grave (3) . ...
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Objetivo: analisar os níveis de ansiedade, depressão e work engagement em profissionais de enfermagem da Atenção Primária à Saúde. Métodos: estudo transversal, descritivo e correlacional com profissionais de enfermagem das Unidades de Saúde da Família. Utilizaram-se: o Inventário de Ansiedade de Beck; o Inventário de Depressão de Beck; e a Utrecht Work Engagement Scale. Resultados: observaram--se destaques para ansiedade moderada entre enfermeiros e ansiedade leve para auxiliares/técnicos de enfermagem; e para depressão leve entre enfermeiros e auxiliares/técnicos de enfermagem. Ansiedade e depressão se correlacionaram positiva e moderadamente (r:0,562; p=0,000). Os profissionais apresentaram níveis altos de work engagement. Conclusão: evidenciaram-se níveis importantes de ansiedade e depressão presentes entre profissionais com indicação de avanço para níveis que comprometem a saúde e a qualidade de vida. Apesar do comprometimento na saúde mental, os profissionais se mostram dispostos para o trabalho e com importante capacidade de resiliência.
... Nevertheless, the environment of complex care units involves the daily coexistence of health professionals and sick people in risky situations, which requires high technical and scientific knowledge to meet their needs in a timely manner. Moreover, the constant presence of death and mourning companions, anxiety about work, rigid and often inflexible routines can increase work suffering [12][13][14][15]. ...
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The aim was to evaluate levels of compassion fatigue in nursing professionals working in complex care units of a Brazilian university hospital. A cross-sectional, descriptive, and correlational study was carried out with nursing workers from complex care units of a University Hospital. Data were collected in the second half of 2019, in the pre-pandemic period of COVID-19, using the Brazilian version of the Professional Quality of Life Scale (ProQoL-BR). A total of 146 individuals partici-pated, including 41 (28.1%) nurses, 92 (63.0%) nursing technicians and 13 (8.9%) nursing assis-tants. It was observed that 26.1% presented high level of compassion satisfaction. For 17.5% there was level of burnout and 49.7%, medium level of burnout; and 22.0% with high and 46.1% with medium level of secondary traumatic stress. Twenty-eight (19.2%) professionals had compassion fatigue, of which 16 (57.1%) were nursing technicians. There is a high percentage of professionals with medium and high rates of burnout and secondary traumatic stress, a fact that is reinforced by the presence of compassion fatigue in almost one fifth of the studied individuals. These results highlights how much the health of these workers can be affected by living with traumatic patient experiences.
... A amostra final foi composta por 50 residentes, com mediana de idade de 27 anos (IQ: 25-30 anos), sendo 80% (n=40; IC95%: 66,2-89,9) do sexo feminino. Resultados semelhantes são descritos na literatura, com um percentual de residentes do sexo feminino variando de 78,26% a 92% (ROTTA et al., 2016;CAVALCANTI et al., 2018;ROCHA et al., 2018;FELTRIN et al., 2019). Essa condição está ligada ao processo histórico e cultural da prática do cuidado realizado pelas mulheres, como sendo uma característica e qualidade feminina o cuidar da casa, da família e dos doentes, associada à intensificação da participação delas nas atividades econômicas nas últimas décadas, principalmente nos Brazilian Journal of Development, Curitiba, v.7, n.4, p. 33998-34016 apr 2021 serviços de saúde, onde é expressivo a presença da mão de obra feminina (MACÊDO et al., 2018;ROCHA;CASAROTTO;SCHMITT, 2018;SILVA et al., 2019). ...
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Este trabalho teve como objetivo compreender o significado, as vivências e a percepção dos residentes do Programa de Saúde Coletiva da Secretaria de Saúde do Recife (SESAU/Recife), quanto à qualidade de vida e atuação profissional durante a pandemia da COVID-19. Trata-se de pesquisa qualitativa, realizada com coleta de dados através de formulário on-line e roteiro semiestruturado, e a utilização da análise de conteúdo de Bardin. Os dados mostram que qualidade de vida foi compreendida pelos residentes como um conjunto de direitos sociais que envolve a satisfação de necessidades básicas e que proporciona bem-estar. Ademais, que a formação profissional foi comprometida devido o cenário da COVID-19. Conclui-se que as sensações e vivências relatadas pelos residentes vão de encontro a um espaço favorável de formação e trabalho.
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Descrever a ocorrência da depressão relacionada ao trabalho no interior de Minas Gerais e investigar a associação entre depressão relacionada ao trabalho e sexo, idade, situação no mercado de trabalho, tempo de trabalho na ocupação e a categoria da ocupação. Estudo retrospectivo, descritivo e quantitativo, com análise de todas as notificações de depressão relacionadas ao trabalho acompanhadas em um serviço público de saúde do trabalhador, no período de janeiro de 2013 a dezembro de 2019. Os dados coletados foram armazenados em planilhas do Excel, em dupla entrada com checagem. Para a análise dos dados, utilizou-se o programa Bioestat 5.0 e para as variáveis categóricas utilizou-se o teste Qui-quadrado (α= 0,05). Houve um predomínio do sexo feminino. Encontrou-se associação da depressão grave com o sexo feminino, com a situação no mercado de trabalho e com a faixa etária. Não houve associação da doença à categoria profissional. Faz-se necessário investir em estratégias de promoção e proteção da saúde mental no ambiente de trabalho, sobretudo entre as mulheres que tendem a ter jornadas de trabalho no âmbito profissional e familiar.
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to analyze the influence of gender and age on the quality of the professional lives of health care professionals at a university hospital. a total of 546 professionals completed a general questionnaire that measured sociodemographic variables and evaluated job satisfaction using a scale adopted from the NTP 394 Job Satisfaction scale and translated into Spanish. overall, 77.2% of the professionals surveyed were satisfied with the work they perform. With regards to gender, we found overwhelming evidence of the feminization of practically all health care professions included in the study, with higher levels of job satisfaction among women than men. Regarding age, 20-30-year-olds and professionals over 61 years old showed higher satisfaction levels than did middle-aged professionals. Higher levels of dissatisfaction were reported by professionals between 41 and 50 years old. we were able to detect the influence of gender and age on the level of job satisfaction, finding significant associations between job satisfaction and both of these variables. Generally, women expressed more satisfaction than men, and elderly professionals showed higher satisfaction compared to younger professionals. Management policies should focus on taking action to correct the conditions that produce dissatisfaction among certain groups of employees.
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Objective: To review the psychometric properties of the Beck Depression Inventory-II (BDI-II) as a self-report measure of depression in a variety of settings and populations. Methods: Relevant studies of the BDI-II were retrieved through a search of electronic databases, a hand search, and contact with authors. Retained studies (k = 118) were allocated into three groups: non-clinical, psychiatric/institutionalized, and medical samples. Results: The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high and substantial overlap with measures of depression and anxiety was reported. The criterion-based validity showed good sensitivity and specificity for detecting depression in comparison to the adopted gold standard. However, the cutoff score to screen for depression varied according to the type of sample. Factor analysis showed a robust dimension of general depression composed by two constructs: cognitive-affective and somatic-vegetative. Conclusions: The BDI-II is a relevant psychometric instrument, showing high reliability, capacity to discriminate between depressed and non-depressed subjects, and improved concurrent, content, and structural validity. Based on available psychometric evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity of depression, with broad applicability for research and clinical practice worldwide.
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High levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation. Medical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper's Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25. Extroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = -.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52). Certain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.
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It is generally understood that trainees experience periods of heightened stress during first year residency, yet there is little information on variations in stress and well-being over the transition period or those factors that contribute to these variations. This qualitative study explored the trajectory of well-being described by first year residents in the context of challenges, supports and adaptations over time. In-depth interviews were conducted face-to-face with 17 first year residents at the University of Toronto. Participants drew a graph of their well-being over the course of their first year and described critical periods of challenge and adaptation. Interviews were audio-taped and transcribed. Results were organized into a thematic analysis using NVivo software. Residents described a pattern of well-being that varied in accordance with changes in rotations. Well-being increased when residents perceived high levels of team support, felt competent and experienced valued learning opportunities. Well-being decreased with low team support, heavy work demands, few learning opportunities and poor orientations. Anxiety and excitement in the beginning of the year gave way to heightened confidence but increased fatigue and apathy towards the year's end. Residents used a number of cognitive, behavioural and self-care strategies to cope with transitional challenges. Residents experienced a pattern of highly fluctuating well-being that coincided with changes in rotations. Residents' well-being varied according to levels of supervisor and colleague support, learning opportunities, and work demands. Residents' well-being may be improved by program interventions that facilitate better team and supervisory supports, maintain optimal service to learning ratios, establish effective fatigue and risk management systems, offer wellness support services and integrate skills based resiliency training into the curriculum.
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The Beck Depression Inventory (BDI) is used worldwide for detecting depressive symptoms. This questionnaire has been revised (1996) to match the DSM-IV criteria for a major depressive episode. We assessed the reliability and the validity of the Brazilian Portuguese version of the BDI-II for non-clinical adults. The questionnaire was applied to 60 college students on two occasions. Afterwards, 182 community-dwelling adults completed the BDI-II, the Self-Report Questionnaire, and the K10 Scale. Trained psychiatrists performed face-to-face interviews with the respondents using the Structured Clinical Interview (SCID-I), the Montgomery-Åsberg Depression Scale, and the Hamilton Anxiety Scale. Descriptive analysis, signal detection analysis (Receiver Operating Characteristics), correlation analysis, and discriminant function analysis were performed to investigate the psychometric properties of the BDI-II. The intraclass correlation coefficient of the BDI-II was 0.89, and the Cronbach's alpha coefficient of internal consistency was 0.93. Taking the SCID as the gold standard, the cut-off point of 10/11 was the best threshold for detecting depression, yielding a sensitivity of 70% and a specificity of 87%. The concurrent validity (a correlation of 0.63-0.93 with scales applied simultaneously) and the predictive ability of the severity level (over 65% correct classification) were acceptable. The BDI-II is reliable and valid for measuring depressive symptomatology among Portuguese-speaking Brazilian non-clinical populations.
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Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An in-vestigative, descriptive, analytical, longitu-dinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, trans-lated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonal-ization; 18.8% showed impaired commit-ment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric In-tensive Care. Age and specialty area were positively correlated with Personal Accom-plishment. One of the Residents was iden-tified with changes in three subscales of the Maslach Burnout Inventory, thus character-ized as a Burnout Syndrome patient. Nurs-ing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers. KEY WORDS Nursing. Burnout, professional. Occupational health. RESUMEN Los Enfermeros Residentes pueden experi-mentar desgaste físico y emocional deriva-do del trabajo cotidiano de la Residencia de Enfermería. El objetivo de este estudio fue determinar la incidencia del Burnout en re-sidentes de enfermería. Se realizó un estu-dio exploratorio, descriptivo, analítico y longi-tudinal-prospectivo con 16 Residentes, en el período de dos años. Se utilizó el Maslach Burnout Inventory traducido y validado para Brasil y un instrumento de datos sociodemo-gráficos/ocupacionales. 17,2% de los Resi-dentes mostraron valores elevados en Ago-tamiento Emocional y Despersonalización, respectivamente; 18,8% compromiso en In-competencia/falta de Realización Profesio-nal, entre estos, 75% pertenecían a las espe-cialidades de Emergencias, Unidad de Tera-pia Intensiva de Adultos y Pediátrica. Edad y especialidad se correlacionaron positivamen-te con Incompetencia/falta de Realización Profesional. Se identificó a un Residente de Enfermería con alteración en las tres sub-es-calas del Maslach Burnout Inventory, caracte-rizándoselo como portador de Síndrome de Burnout. Los Residentes de Enfermería po-seen perfiles de sufrimiento. Conocer tales factores puede minimizar los transtornos de salud de dichos trabajadores.
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Context: North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. Objectives: The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. Methods: A systematic review was conducted using search terms encompassing psychological distress amongst medical students. OvidSP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; PsycINFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. Results: The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Conclusions: Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students.
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Introduction: Anxiety among house officers may impair functioning and health care delivery. This study aimed to determine the association between anxiety among house officers at Universiti Kebangsaan Malaysia Medical Center, sociodemographic and work-related factors. Methods: A cross-sectional study using the self-rated and validated Malay Depressive Anxiety and Stress Scale 21, the General Stressor Questionnaire and a sociodemographic questionnaire. Results: Of the 89 house officers, 60.7% were anxious. Multivariate logistic analysis showed work-related challenges, performance pressure (odds ratio [OR] = 9.000, 95% confidence interval [CI] = 1.812-44.705), poor relationship with supervisors (OR = 5.212, 95% CI = 2.033-3.365), poor relationship with colleagues (OR = 4.642, 95% CI = 1.816-11.866), bureaucratic constraints (OR = 3.810, 95% CI = 1.541-9.415) and poor job prospects (OR = 3.745, 95% CI = 1.505-9.321) strongly associated with anxiety. Family-related stressors were less significant (OR = 1.800, 95% CI = 0.760-4.266) unless they were work related (work-family conflicts [OR = 8.253, 95% CI = 2.652-25.684]). Discussion: Almost two-thirds of this cohort reported work-related anxiety symptoms. Administrators need to address these mental health needs early. The subsequent improvement in communication skills, conflict resolution and anxiety reduction will result in short- and long-term benefits towards the young doctors's mental health. The cascading impact on these individuals, thus empowered, will be good work-life balance, improved patient care and safety, a satisfying medical career whilst contributing maximally to the country's health care.
Article
To determine the frequency of anxiety and depression among medical students of Wah Medical College and their associations with sociodemographic and educational characteristics if any. Cross-sectional survey. Wah Medical College, from September 2007 to March 2008. A sample of 279 students was included in the study after excluding first year medical students because they were admitted for less than 6 months. A self administered Encounter Form was administered. Sociodemographic and educational characteristics included age, gender, birth order, number of siblings, monthly income, monthly expenditure on education, academic performance in professional examination, past medical and past psychiatric history, substance abuse and family history of psychiatric illness. Beck depression inventory and beck anxiety inventory were used to assess the level of depression and anxiety. The chi-square test was applied at 5% level of significance to determine associated factors for anxiety and depression respectively. The mean age of students was 21.4+/-1.41 years with female preponderance i.e. 202 (72.4%). Anxiety was present in 133 (47.7%) students and depression in 98 (35.1%) students. Both were found concomitantly in 68 (24.37%) students. Age (p=0.013), gender (p=0.016), examination criteria dissatisfaction (p=0.002) and overburden with test schedule (p=0.002) were significantly associated with depression. Anxiety was significantly associated with gender (p=0.007), birth order (p=0.049), year of study (p=0.001), examination criteria dissatisfaction (p=0.010) and overburden with test schedule (p=0.006). One third of students were found to have anxiety and depression which was associated with the sociodemographic and educational factors as stated above.
Interprofessional education in health: concepts and practices. Cad FNEPAS
  • N A Batista
Batista NA. Interprofessional education in health: concepts and practices. Cad FNEPAS [Internet].