Occupational Stress And Its Relationship To Depressive Symptoms And Anxiety Disorder Among Ophthalmologists In Shanghai

Occupational Stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capability, resources or needs of the worker. The stress can lead the body to have a physiological reaction, which can strain a person physically as well as mentally. Stress related disorders encompass a broad array of conditions, including psychological disorders:depression, and anxiety. It is also associated with various biological reactions that may lead ultimately to compromised health, such as cardiovascular disease. These conditions may lead to poor work performance, less work productivity and economic loss. Physicians, as a special occupational population, deal with a patient’s life, disease and process of death. Further more physicians have oppressive stress due to the urgent nature of clinical practice and difficulty of decision-making as opposed to those in other occupations. Particularly, excessive workload, discord with patients and their guardians could be primary stress factors for doctors. Unfortunately, mental disorders in doctors can lead to medical mistakes, malpractices and adversely affect their attitude towards patient care. Therefore, occupational stress among doctors could seriously affect the quality of lives of not only physicians but also the whole general population. Owing to an increasing impact of occupational stress of physicians, how to improve the doctor’s psychological conditions should become an accelerating social concern.Eye Diseases affect the quality of lives of patients significantly, and treatment expectations from patients are quite high. Combined with the wide variety of eye diseases and the complexity of ophthalmic operations, the training programs of ophthalmology take a long time. All of these conditions could lead ophthalmologists to face high occupational stress. As one of the most developed urban areas in China, average life expectancy in Shanghai ranks first in China. Moreover, many health system reform policies are implemented first in Shanghai. Therefore, physicians in Shanghai could be in high work demand. However few studies have investigated occupational stress among physicians in Shanghai, even fewer for ophthalmologists. The aim of this study is to explore the level of occupational stress and its relationship with depressive symptoms and anxiety among ophthalmologists in Shanghai.Part I Occupational Stress and its Factors among Ophthalmologists in ShanghaiObjectives:The purpose of this study was to examine the level of occupational stress and its related factors among ophthalmologists in Shanghai.Methods:This cross-sectional study was performed during the period of July-September2012. The study population comprised of812ophthalmologists, working in74hospitals in Shanghai, including Grade Ⅲ Eye Specialty Hospitals, Grade Ⅲ General Hospitals, Grade Ⅱ Hospitals, and Nongovernmental Hospitals. A questionnaire that comprised demographic factors, work conditions, occupational stress and stressors from clinical work was distributed to these doctors. Multivariate logistic regression was used to explore the factors related to occupational stress.Results:A total of739effective respondents became our subjects (effective response rate91.0%). Effort Reward Ratio (ERR) of ophthalmologists in Shanghai was0.66±0.42.15.3%doctors suffered from high occupational stress with high effort-low reward work condition (ERR>1). Junior doctors (years of experience≤5years) had significant higher level of occupational stress (ERR:0.70±0.41).19.3%junior doctors had effort-reward imbalance. Multivariate logistic analyses showed that working time over60hours every week (OR:1.94,95%CI:1.12-3.38), academic working time over10hours every week (OR:2.43,95%CI:1.45-4.09) were positively associated with effort-reward imbalance. Demand Control Ratio (D/C) among ophthalmologists was1.30±0.44, and72.5%doctors had high occupational stress with more work demand and less work autonomy. D/C in junior doctors was significantly higher than senior doctors (1.46±0.48vs.1.22±0.40), and83.5%junior doctors were in the occupational condition with higher demand and lower autonomy. Multivariate logistic analyses showed that "Not work as expected"(OR:9.15),"Not fixed working time"(OR:14.34),"Poor relationship with patients or guardians"(OR:7.21), "Negative influences of Media Misreport"(OR:4.97) were crucially associated with high occupational stress in junior doctors.Conclusions:Ophthalmologists probably have high occupational stress, and the work conditions for junior doctors are even worse, which need more social concern. Efficient interventions should be considered by health administrators aiming at improving the quality of Chinese doctors, specifically for juniors.Part Ⅱ. The relationship between occupational stress and depressive symptoms among ophthalmologists in ShanghaiObjectives:The purpose of this study was to explore the associations between occupational stress and depressive symptoms among ophthalmologists in Shanghai, analysis the impact of work-related factors and assessment factors of occupational stress on depressive symptoms.Methods:A cross-sectional study, which was performed during the period of July-September2012. The study population was ophthalmologists in Shanghai. The Chinese version of Siegrist’s ERI questionnaire (C-ERI) and the Chinese Version of Karasek’s job content questionnaire (C-JCQ) were used to measure occupational stress, and the Chinese version Center for Epidemiological Survey Depression Scale (CES-D) was used to measure depressive symptoms. Logistic regression analysis was used to determined the associations between depressive symptoms and doctors’ occupational stress adjusting for age, gender, physical exercise, health status, sleep status and the relationship between doctors and patients.Results:A total of739effective respondents became our subjects (effective response rate91.0%). CES-D scores of ophthalmologists were13.12±10.01, and38.7%doctors suffered from depressive symptoms. High occupational stress associated significantly with doctors’depressive symptoms. The odds ratio (OR) of depressive symptoms in high occupational stress with effort-reward imbalance (Effort Reward Ratio, ERR>1) group was4.21(95%CI2.72-6.52) compared with ERR≤1group, adjusted for basic attributes. The adjusted OR of depressive symptoms in high occupational stress with more job demands and lower job autonomy (Demand Control Ratio, D/C>1) group was2.40(95%CI:1.64-3.52) compared with D/C<1group. Multivariate logistic analyses showed that lower work reward tertile (OR:2.4), higher over commitment tertile (OR:3.72), lower job autonomy (OR:1.66) were positively associated with depressive symptoms. CES-D scores of junior doctors were significantly higher than senior doctors, and51.2%juniors were in positive depressive symptoms. Poor relationship between doctors and patients influenced on depressive symptoms crucially (OR:2.13-3.59).Conclusions:Ophthalmologists in Shanghai are probably in high depressive level, which associate with their high occupational stress. Doctor-patients relationship plays an important role in depressive disorder. The depressive problem in junior doctor seems to be more serious. Management of Occupational stress is needed as a countermeasure against depressive symptoms among ophthalmologists.Part Ⅲ. The relationship between occupational stress and Anxiety among ophthalmologists in ShanghaiObjectives:The purpose of this study was to explore the associations between occupational stress and anxiety among ophthalmologists in Shanghai, analysis the impact of work-related factors and assessment factors of occupational stress on anxiety.Methods:A cross-sectional study, which was performed during the period of July-September2012. The study population was ophthalmologists in Shanghai. The Chinese version of Siegrist’s ERI questionnaire (C-ERI) and the Chinese Version of Karasek’s job content questionnaire (C-JCQ) were used to measure occupational stress, and the Self Rating Anxiety Scale (SAS) was used to measure anxiety. Logistic regression analysis was used to determined the associations between anxiety and doctors’occupational stress adjusting for age, gender, physical exercise, health status, sleep status and the relationship between doctors and patients.Results:A total of739effective respondents became our subjects (effective response rate91.0%). SAS standard scores of ophthalmologists were44.11+9.51, and25.0%doctors suffered from anxiety. High occupational stress associated significantly with doctors’anxiety. The odds ratio (OR) of anxiety in high occupational stress with effort-reward imbalance (Effort Reward Ratio, ERR>1) group was3.96(95%CI2.59-6.05) compared with ERR≤1group, adjusted for basic attributes. The adjusted OR of anxiety in high occupational stress with more job demands and lower job autonomy (Demand Control Ratio, D/C>1) group was2.34(95%CI:1.51-3.63) compared with D/C≤1group. Multivariate logistic analyses showed that middle over commitment tertile (OR:2.44), higher over commitment tertile (OR:3.94) were positively associated with anxiety. SAS standard scores of junior doctors were significantly higher than senior doctors, and31.4%juniors were in anxiety. Poor relationship between doctors and patients influenced on depressive symptoms crucially (OR:2.54-2.66).Conclusions:Ophthalmologists in Shanghai are probably in high anxiety level, which associate with their high occupational stress. Doctor-patients relationship plays an important role in anxiety. The anxiety problem in junior doctor seems to be more serious. Management of Occupational stress is needed as a countermeasure against anxiety among ophthalmologists.Conclusions1. Ophthalmologists probably have high occupational stress, and the work conditions for junior doctors are even worse, which need more social concern.2. Long working hours and long academic working hours increase the risk of occupational stress among ophthalmologists.3. Ophthalmologists in Shanghai are probably in high depressive level, which associate with their high occupational stress.4. Low work reward, high over commitment and low job autonomy increase the risk of depressive symptoms in ophthalmologists.5. Over commitment associates crucially with ophthalmologists’anxiety.6. The depressive and anxiety problems in junior doctor seem to be more serious.7. Doctor-patients relationship plays an important role in ophthalmologists’ depressive symptoms and anxiety.8. Efficient interventions should be considered by health administrators aiming at improving the occupational stress against depressive symptoms and anxiety among ophthalmologists.