Anesthesiologists work-related exhaustion: A comparison study with other hospital employees.

BACKGROUND: Anesthesia is a demanding occupation due to long working hours, sustained vigilance, unpredictability of stressful situation, fear of litigation, competence, and production pressure. Work-related exhaustion can lead to several physical and psychological symptoms and delay decision making. The aim of this study was to evaluate how different work conditions affect personnel exhaustion by studying a sample of anesthesiologists comparing them with ophthalmologists and ancillary hospital staff
METHODS: One hundred fifty persons divided into three equal groups (50 each) were invited to participate in this study. Subjects were asked to answer two self report questionnaires: The Multidimensional Fatigue Inventory (MFI-20) and General Health Questionnaire (GHQ-12) which used to assess work related exhaustion and mental health, respectively.
RESULTS: Multidimensional Fatigue Inventory scale (MFI 20) and General Health Questionnaire (GHQ 12) were significantly higher in anesthesiologists than in other groups (P = 0.001). Different aspects of work-related exhaustion showed that general, physical and mental fatigue were significantly higher in anesthesiologists (P = 0.002 and 0.001, respectively). Reduced activity and reduced motivation were also higher in anesthesiologists compare to the other groups (P = 0.005 and 0.001, respectively).
CONCLUSION: Work-related exhaustion under the current study is more obvious among anesthesiologists. Ophthalmologist and ancillary hospital employees felt that they had less stress at their work.

INTRODUCTION

Anesthesia is a demanding occupation due to long working hours, sustained vigilance, unpredictability of stressful situation, fear of litigation, competence and production pressure.[1] Fatigue encompasses a decreased ability to perform physical work and/or cognitive functions. It can be caused by excessive time spent on a task, circadian factors and sleep deprivation. It also correlates with a person's motivation and emotional status.[2]

Work-related stress can also occurs when coping with job-related stressor results in imbalance between the demands made on an individual, and the individual's ability to meet that demand.[2] Adverse effects of persistent stress include: Physical illness such as hypertension, emotional deterioration manifested by chronic anxiety, depression, labile personality, drugs or chemical substance abuse and absenteeism.[3] It had been documented that sleepy, exhausted anesthesiologists tend to have longer response latencies and greater variability in appropriateness of their responses.[3]

The aim of this cross-sectional study was to investigate how different work conditions affect personnel exhaustion by studying a sample of anesthesiologists comparing them with ophthalmologists and ancillary hospital staff working at the same facility.

METHODS

After approval of the local research and human ethics Committees and a written informed consent from the participant. A self-reporting questionnaire for assessment of socio-demographic factors and validated scales for fatigue and general health were used. Anonymity was completely preserved. None of the studied participants had a history of neither neurological nor psychiatric disorders or taking any medication that affects nervous system.

Work related exhaustion and mental health were measured by validated instruments which are Multidimensional Fatigue Inventory Scale (MFI 20) and General Health Questionnaire (GHQ12) respectively. The Multidimensional Fatigue Inventory (MFI 20)[4] is a multidimensional test designed to measure five aspects of fatigue that include general, physical, reduced motivation, reduced activity and mental fatigue. Each aspect contains four items, it is a 5 point scale ranging from strongly agrees (5) to totally disagree (0). The sum score of each aspect ranges from 0 to 20 and hence the total fatigue (TF) ranges from 0 to 80. Participants were instructed to indicate how they felt in the last month prior to the questionnaire day. The scale does not contain any somatic items, designed to provide a complete description of the fatigue experience. The higher the scores the higher the degree of exhaustion, more concentration problems, reduced motivation and/or low level of activity.

General Health Questionnaire (GHQ12)[5] developed by Goldberg and it was used in the present work to assess different aspects of mental health of the participants. The most important reasons for using the (GHQ 12) are its brevity, intelligibility, and its psychometric properties.[6] The reliability coefficients for the General Health Questionnaire ranged from 0.78 to 0.95.[6] The General Health Questionnaire used in the present study includes 12 items; each item has the following 4 answer choices: Not at all, no more than usual, more than usual, and much more than usual, given a possible range of scores ranging from 0 to 12. Mental distress was considered if the participant score four or higher.[7]

Statistical analysis

The sample size calculation using G*Power 3.1.0 indicated that 50 subjects are required per group in order to detect a difference of 0.3 in the mean of total fatigue score between the groups. The alpha error was set at 0.05 and Type II error was set at 0.20. The results were analyzed using SPSS version 14 (SPSS Inc., Chicago, IL, USA). Statistical analysis had been done using Chi-square or one-way analysis of variance (ANOVA) whatever appropriate. If ANOVA Test was significant, Tukey HSD Multiple Comparisons Test was used to compare different groups. For all tests of significance, a P value of 0.05 was used as the level of significance. Numerical data were expressed as a mean value and standard deviation (SD) while categorical data were expressed as number and percentages.

RESULTS

Demographic data are shown in [Table 1], Ophthalmologists were significantly older compared to the other groups (P = 0.001). There was no sex difference in the category distribution (P = 0.18). Percentage of married anesthesiologists was significantly lower in comparison to ophthalmologist but higher than hospital staff (P = 0.005). Level of education was significantly lower in hospital employee (P = 0.001).

Table 1

Demographic data

Both Multidimensional Fatigue Inventory scale (MFI 20) and General Health Questionnaire (GHQ 12) were significantly higher in anesthesiologists compare to other groups (P = 0.001) [Figure 1]. Comparisons of different aspects of Fatigue are shown in [Table 2]. General, physical and mental fatigue were significantly higher in anesthesiologists (P = 0.002 and 0.001, respectively). Reduced activity and reduced motivation were also higher in anesthesiologists compare to the other groups (P = 0.005 and 0.001, respectively).

Figure 1

Total fatigue and General Health Questionnaire (*Against anesthesiologist. Data expressed as a mean value while error bars represent (SD), *P value <0.05 against anesthesiologist)

Table 2

Subitems of fatigue questionnaire

DISCUSSION

Our study showed that work related exhaustion as total and different subtypes together with mental stress were significantly higher in anesthesiologists compared to the other two studied groups. Most of the currently studied anesthesiologists were significantly younger than the ophthalmologists. This was supported by previous work of Nyssan and Hansez who proved that age correlated negatively with fatigue symptoms, in their study younger anesthesiologists showed higher rate of fatigue compared to their older colleagues.[8] A previous work on general Norwegian population reported weak correlation between age and fatigue.[9]

No statistically significant gender differences were seen either in anesthesiologists or the other two studied groups. On the contrary Lindfors and colleagues proved that women had higher stress symptoms including exhaustion than men.[10] Another study found female anesthesiologists feeling higher task related stressors at their work.[11] A previous study concerning Portuguese anesthesiologists had pointed out the conflicts between home and work responsibilities as a major source of stress.[12] Loge and colleague showed a strong positive correlation between women and fatigue in Norwegian population.[9] The difference could be attributed to the difference in the culture and to the instrument used.

Higher score of work related exhaustion scale in anesthesiologists could be attributed to the fact that they usually work for long and intense duty periods, suffer from loss of sleep, and develop mental, psychological and physical stress.[2] Some indirect evidence links fatigue with impaired medical decision making[13] and reduced patient safety.[10] Unlike other specialists, anesthesiologists continue to have on-call commitment until the age of retirement. Frequent on-call showed strong positive correlation with severe stress symptoms.[10]

General Health Questionnaire (GHQ12) was significantly higher in anesthesiologists when compared with the other studied groups. In the same line with our results, Coomber and colleagues showed that 20%-60% of doctors exhibiting clinically important levels of mental distress at any one time depending on their threshold for morbidity and the specialty in which they work.[14] The work of Nyssen and colleague found that 40% of the studied anesthesiologists were suffering from high emotional exhaustion.[15] Many researches had outlined the negative physiological and psychological consequences of dysfunctional occupational stress.[1011] It affects cognitive performance, and makes one prone to mental disorders such as depression.[10]

The results of our study are limited by the fact that working conditions and subjective perception of working conditions may change with national culture, hospital culture, and departmental culture among others. Furthermore, the multitude of additional stressors from family life was not assessed in details.

In conclusion, work-related exhaustion under the current study is more obvious among anesthesiologists. Ophthalmologist and ancillary hospital employees feel less stress at their work.