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      Prevalence of Anxiety and Depressive Symptoms and Related Risk Factors among Physicians in China: A Cross-Sectional Study

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          Abstract

          Background

          Physicians’ poor mental health not only hinders their professional performance and affects the quality of healthcare provided but also adversely affects patients’ health outcomes. Few studies in China have evaluated the mental health of physicians. The purposes of this study are to quantify Chinese physicians’ anxiety and depressive symptoms as well as evaluate associated risk factors.

          Methods

          In our study, 2641 physicians working in public hospitals in Shenzhen in southern China were recruited and interviewed by using a structured questionnaire along with validated scales testing anxiety and depressive symptoms. Multivariable logistic regression models were used to identify risk factors for anxiety and depressive symptoms.

          Results

          An estimated 25.67% of physicians had anxiety symptoms, 28.13% had depressive symptoms, and 19.01% had both anxiety and depressive symptoms. More than 10% of the participants often experienced workplace violence and 63.17% sometimes encountered it. Among our study population, anxiety and depressive symptoms were associated with poor self-reported physical health, frequent workplace violence, lengthy working hours (more than 60 hours a week), frequent night shifts (twice or more per week), and lack of regular physical exercise.

          Conclusions

          Our study demonstrates that anxiety and depressive symptoms are common among physicians in China, and the doctor-patient relationship issue is particularly stressful. Interventions implemented to minimize workload, improve doctor-patient relationships, and assist physicians in developing healthier lifestyles are essential to combat anxiety and depressive symptoms among physicians, which may improve their professional performance.

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          Most cited references35

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          A SELF-RATING DEPRESSION SCALE.

          W W Zung (1965)
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            Effect of reducing interns' weekly work hours on sleep and attentional failures.

            Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures among first-year residents (postgraduate year 1) during a traditional rotation schedule that included extended work shifts and during an intervention schedule that limited scheduled work hours to 16 or fewer consecutive hours. Twenty interns were studied during two three-week rotations in intensive care units, each during both the traditional and the intervention schedule. Subjects completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98). Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P<0.001), slept 5.8 hours per week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of attentional failures while working during on-call nights (P=0.02) on the intervention schedule as compared with the traditional schedule. Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours. Copyright 2004 Massachusetts Medical Society.
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              The relationship between job stress, burnout and clinical depression.

              The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                22 July 2014
                : 9
                : 7
                : e103242
                Affiliations
                [1 ]Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
                [2 ]Shenzhen Health Education and Promotion Center, Shenzhen, Guangdong, P. R. China
                [3 ]Department of Occupational Health, Laiwu Municipal Center for Disease Control and Prevention, Laiwu, Shandong, P. R. China
                [4 ]National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
                University of Missouri Kansas City School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: GAY RSZ YQC ZXL. Analyzed the data: YHG TGH WC XYT XXY. Wrote the paper: YHG TGH HHD.

                Article
                PONE-D-13-49798
                10.1371/journal.pone.0103242
                4106870
                25050618
                5af5185f-7ed6-40b4-84c1-e592b82efdf4
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 December 2013
                : 30 June 2014
                Page count
                Pages: 7
                Funding
                This project was funded by the Shenzhen Health Education and Promotion Center. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Medicine and Health Sciences
                Epidemiology
                Health Care
                Health Care Providers
                Medical Doctors
                Physicians
                Mental Health and Psychiatry
                Anxiety Disorders
                Mood Disorders
                Public and Occupational Health
                Occupational and Industrial Medicine
                Research and Analysis Methods
                Research Design
                Survey Research
                Survey Methods
                Clinical Research Design
                Cross-Sectional Studies

                Uncategorized
                Uncategorized

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