J.O. Adeolu1, O.B. Yussuf2 and O.A. Popoola1
- Department of Community Medicine, University College Hospital, Ibadan
- Department of Epidemiology and Medical Statistics, College of Medicine, Ibadan.
Introduction: Doctors respond differently to their complex work environment, some find it stimulating while others find it stressful. This study aimed to assess the prevalence and correlates of stress among junior doctors in a teaching hospital in Southwest Nigeria.
Methodology: A descriptive cross sectional survey of all junior doctors employed at the University College Hospital, Ibadan was carried out. Information was collected with a structured pretested questionnaire from 253 doctors. Descriptive statistics were generated. T-test, chi square and logistic regression analyses were conducted using SPSS version 16. Statistical significance was set at 5%.
Results: Mean age of respondents was 29.9 (±4.1) years, 61.3% were males, 59% had spent less than 5 years in medical practice, and 34.8% were married. Majority (79.4%) were resident doctors. Prevalence of stress, job dissatisfaction and poor mental health were 31.6%, 15.4% and 9.9% respectively. Age, gender, years of medical practice, religion, ethnicity and marital status were not significantly associated with job stress (p>0.05). Doctors who were stressed were more likely to be dissatisfied with their jobs (OR=2.33; CI=1.08-4.04) and to have poor mental health (OR=3.82; CI=1.47-9.95) than those who were not stressed.
Conclusion: The prevalence of stress in this study is high, and job dissatisfaction and poor mental health have been implicated as determinants of stress. As such, there should be an improvement in doctors’ welfare, health care facilities and delivery.
Keywords: Doctors, Job stress, Job satisfaction, Mental health.
Dr. J.O. Adeolu
Department of Community Medicine,
University College Hospital,
Stress as a term came into use from engineering and other physical sciences. These sciences consider stress to involve an application of enough force to an object or system to distort its original structure. The term has been defined in different ways because of the complex nature of stress itself. Seyle in 1936 first coined the word stress and described it as the nonspecific response of the body to any demand for change.1 Job stress has, however been defined by Centres for Disease Control (CDC) as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker.2
There is good evidence to show that doctors are at higher risk of stress than the general population because being a doctor is physically and emotionally demanding.3 The modern medical workplace is a complex environment, and doctors respond differently to it, some finding it stimulating and exciting, whereas others become stressed and burned out from the heavy workload.4 The medical workplace provides an environment where new skills are continually being learned, both as a result of medical knowledge evolving and because a doctor’s work changes, in part due to career development and progression through different jobs.4 The medical training process may be promoting an unhealthy lifestyle.5 While going through training, physicians are pushed to endure sleep deprivation, which can result in both cognitive impairment and emotional fragility. In addition, during both medical school and residency, physicians become introduced to the medical mentality of distancing from patients, taking on more and more work without complaint, and learning to compartmentalize feelings.5 The culture of medicine is one in which perfectionism and “workaholic standards” rule the day and many practice settings reward long hours and self-neglect.5 Physicians are encouraged to disregard themselves and deny their own needs. The process of medical education may enhance development of defence mechanisms that make it difficult to ask for help.5 Sources of stress for doctors include night calls, long hours of work, monotony of the job, less time for leisure, poor pay, poor working condition, etc.3
There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Job stress has been associated with poor mental and physical health.6, 7 Physicians under stress are more likely to treat patients poorly, both medically and psychologically and are also more prone to make errors of judgment.8 Doctors have higher degree of psychological morbidity, 9 suicidal tendencies and depression than the general population.10
There is dearth of documented research on the sources of stress among doctors in Nigeria. Eliciting the prevalence and causes of stress among UCH doctors will help in establishing intervention.