Advertisement

Academic Psychiatry

, Volume 33, Issue 4, pp 296–301 | Cite as

Burnout, Perceived Stress, and Depression Among Cardiology Residents in Argentina

  • Silvina V. Waldman
  • Juan Cruz Lopez Diez
  • Hernán Cohen Arazi
  • Bruno Linetzky
  • Salvador Guinjoan
  • Hugo Grancelli
Original Article

Abstract

Objective

Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes.

Methods

The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory.

Results

One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but non-medical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group.

Conclusion

Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.

Keywords

Depressive Symptom Academic Psychiatry Emotional Exhaustion Personal Accomplishment Medical Resident 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Prins JT, Gazendam-Donofrio SM, Tubben BJ, et al: Burnout in medical residents: a review. Med Educ 2007; 41: 788–800PubMedCrossRefGoogle Scholar
  2. 2.
    Thomas NK: Resident burnout. JAMA 2004; 292: 2880–2889PubMedCrossRefGoogle Scholar
  3. 3.
    Lockley SW, Cronin JW, Evans EE, et al, The Harvard Work Hours, Health and Safety Group: Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med 2004; 351: 1829–1837PubMedCrossRefGoogle Scholar
  4. 4.
    Stecker T: Well-being in an academic environment. Med Educ 2004; 38: 465–478PubMedCrossRefGoogle Scholar
  5. 5.
    Moffat K, McConnachie A, Ross S, Morrison J: First-year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004; 38: 482–491PubMedCrossRefGoogle Scholar
  6. 6.
    Finkelstein C, Brownstein A, Scott C, et al: Anxiety and stress reduction in medical education: an intervention. Med Educ 2007; 41: 258–264PubMedCrossRefGoogle Scholar
  7. 7.
    Levey RE: Sources of stress for residents and recommendations for programs to assist them. Acad Med 2001; 76: 142–150PubMedCrossRefGoogle Scholar
  8. 8.
    Shapiro S, Shapiro D, Schwartz G: Stress management in medical education: a review of literature. Acad Med 2000; 75: 748–759PubMedCrossRefGoogle Scholar
  9. 9.
    Purdy RR, Lemkau JP, Rafferty JP, et al: Resident physicians in family practice: who’s burned out and who knows? Fam Med 1987; 19: 203–208PubMedGoogle Scholar
  10. 10.
    Martini S, Arfken CL, Churchill A, et al: Burnout comparison among residents in different medical specialties. Acad Psychiatry 2004; 28: 240–242PubMedCrossRefGoogle Scholar
  11. 11.
    Woodside JR, Miller MN, Floyd MR, et al: Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry 2008; 32: 13–19PubMedCrossRefGoogle Scholar
  12. 12.
    Shanafelt TD, Bradley KA, Wipf JE, et al: Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002; 136: 358–367PubMedCrossRefGoogle Scholar
  13. 13.
    Nyssen AS, Hansez I, Baele P, et al: Occupational stress and burnout in anesthesia. Br J Anaesth 2003; 90: 333–337PubMedCrossRefGoogle Scholar
  14. 14.
    Biaggi P, Peter S, Ulich E: Stressors, emotional exhaustion, and aversion to patients in residents and chief residents—what can be done? Swiss Med Wkly 2003; 133: 339–346PubMedGoogle Scholar
  15. 15.
    Peterlini M, Tiberio IFLC, Saadeh A, et al: Anxiety and depression in the first year of medical residency training. Med Educ 2002; 36: 66–72PubMedCrossRefGoogle Scholar
  16. 16.
    Center C, Davis M, Detre T, et al: Confronting depression and suicide in physicians: a consensus statement. JAMA 2003; 289: 3161–3166PubMedCrossRefGoogle Scholar
  17. 17.
    Katz ED, Sharp L, Ferguson E: Depression among emergency medicine residents over an academic year. Acad Emerg Med 2006; 14: 476–478Google Scholar
  18. 18.
    Fahrenkopf AM, Sectish TC, Barger LK, et al: Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008; 336: 488–491PubMedCrossRefGoogle Scholar
  19. 19.
    Clark DC, Salazar-Grueso E, Gabler P, et al: Predictors of depression during the first 6 months of internship. Am J Psychiatry 1984; 141: 1095–1098PubMedGoogle Scholar
  20. 20.
    Hsu V, Marshal V: Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows. Am J Psychiatry 1987; 144: 1561–1566PubMedGoogle Scholar
  21. 21.
    Maslach C, Jackson SE, Leiter MP: Maslach Burnout Survey, 3rd ed. Palo Alto, Calif, Consulting Psychologist Press Inc, 1996Google Scholar
  22. 22.
    Maslach C: Burnout: The Cost of Caring. Cambridge, Mass, Malor Books, 2003Google Scholar
  23. 23.
    Gil-Monte PR: Validez factorial de la adaptación al español del Maslach Burnout Inventory-general survey. Salud pública Méx; 2002; 44: 33–40PubMedCrossRefGoogle Scholar
  24. 24.
    Rafferty JP, Lemkau JP, Purdy RR, et al: Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986; 42: 488–492PubMedCrossRefGoogle Scholar
  25. 25.
    Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983; 24: 385–396PubMedCrossRefGoogle Scholar
  26. 26.
    Herbert TB, Cohen S: Measurement issues in research on psychological stress, in Psychosocial Stress: Perspectives on Structure, Theory, Life Course, and Methods. Edited by Kaplan HB. New York, Academic Press, 1996Google Scholar
  27. 27.
    Cohen S: Contrasting the Hassle Scale and the Perceived Stress Scale. Am Psychol 1986; 41: 716–719CrossRefGoogle Scholar
  28. 28.
    Remor E: Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Span J of Psychol 2006; 9: 86–93Google Scholar
  29. 29.
    Gonzalez Ramirez MT, Landero Hernandez R: Factor structure of the Perceived Stress Scale (PSS) in a sample from Mexico. Span JPsychol 2007; 10: 199–206Google Scholar
  30. 30.
    Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory-II. San Antonio, Tex, Psychological Corporation, 1996Google Scholar
  31. 31.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision. Washington, DC, American Psychiatric Association, 2000Google Scholar
  32. 32.
    Richaud de Minzi MC, Sacchi C: Adaptatión del inventario de la depresión de Beck a sujetos Argentinos normales. Revista Iberoamericana de Diagnóstico y Evaluation Psicológica 2001; 12: 11–17Google Scholar
  33. 33.
    Barger LK, Cade BE, Ayas NT, et al: Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005; 352: 125–134PubMedCrossRefGoogle Scholar
  34. 34.
    Fletcher KE, Davis SQ, Underwood W, et al: Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004; 141: 851–857PubMedCrossRefGoogle Scholar
  35. 35.
    Landrigan CP, Rothschild JM, Cronin JW, et al: Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 2004; 351: 1838–1848PubMedCrossRefGoogle Scholar
  36. 36.
    Rollinson DC, Rathlev NK, Moss M, et al: The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study. Ann Emerg Med 2003; 41: 400–406PubMedCrossRefGoogle Scholar
  37. 37.
    Puddester D: The Canadian Medical Association’s policy on physician health and well-being. West J Med 2001; 174: 5–7PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Leiter MP, Maslach C: Areas of work life: a structured approach to organizational predictors of job burnout, in Research in Occupational Stress and Well-Being. Edited by Perrewe PL, Ganster DC. Oxford, Elsevier, 2004; 3: 91–134Google Scholar
  39. 39.
    Maslach C, Schaufeli WB, Leiter MP: Job burnout. Annu Rev of Psychol 2001; 52: 397–422CrossRefGoogle Scholar
  40. 40.
    Accreditation Council for Graduate Medical Education. Report of the ACGME Work Group on Resident Duty Hours, 2008. Available at http://www.acgme.org/acWebsite/dutyHours/ACGMEApprovedSpecialtySpecificDutyHourLanguage_AS_ED_01_16_2008.pdf
  41. 41.
    Dola C, Nelson L, Lauterbach J, et al: Eighty hour work reform: faculty and resident perceptions. Am J Obstet Gynecol 2006; 195: 1450–1456PubMedCrossRefGoogle Scholar
  42. 42.
    Myers JS, Bellini LM, Morris JB, et al: Internal medicine and general surgery residents’ attitudes about the ACGME duty hours regulations: a multicenter study. Acad Med 2006; 81: 1052–1058PubMedCrossRefGoogle Scholar
  43. 43.
    Kusuma SK, Mehta S, Sirkin M, et al: Measuring the attitudes and impact of the eighty-hour workweek rules on orthopedic surgery residents. J Bone Joint Surg Am 2007; 89: 679–685PubMedCrossRefGoogle Scholar
  44. 44.
    Schenarts PJ, Anderson Schenarts KD, Rotondo MF: Myths and realities of the 80-hour work week. Curr Surg 2006; 63: 269–274PubMedCrossRefGoogle Scholar
  45. 45.
    Hutter MM, Kellogg KC, Ferguson CM, et al: The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 2006; 243: 864–671PubMedCrossRefGoogle Scholar
  46. 46.
    Karamanoukian RL, Ku JK, DeLaRosa J, et al: The effects of restricted work hours on clinical training. Am Surg 2006; 72: 19–21PubMedGoogle Scholar
  47. 47.
    Martini S, Arfken CL, Balon R: Comparison of burnout among medical residents before and after the implementation of work hours limits. Acad Psychiatry 2006; 30: 352–355PubMedCrossRefGoogle Scholar
  48. 48.
    Gelfand DV, Podnos YD, Carmichael JC, et al: Effect of the 80-hour workweek on resident burnout. Arch Surg 2004; 139: 933–938PubMedCrossRefGoogle Scholar
  49. 49.
    Gopal R, Glasheen JJ, Miyoshi TJ, et al: Burnout and internal medicine resident work hour restrictions. Arch Intern Med 2005; 165: 2595–2600PubMedCrossRefGoogle Scholar
  50. 50.
    Rosen IM, Gimotty PA, Shea JA, et al: Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med 2006; 81: 82–85PubMedCrossRefGoogle Scholar
  51. 51.
    Stamp T, Termuhlen P, Miller S, et al: Before and after resident work hour limitations: an objective assessment of the well-being of surgical residents. Curr Surg 2005; 62: 117–121PubMedCrossRefGoogle Scholar
  52. 52.
    Girard DE, Choi D, Dickey J, et al: A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center. BMC Med Educ 2006; 6: 36–41PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Hendin H, Maltsberger JT, Hass AP: A physician’s suicide. Am J Psychiatry 2003; 160: 2094–2097PubMedCrossRefGoogle Scholar
  54. 54.
    Center C, Davis M, Detre T, et al: Confronting depression and suicide in physicians: a consensus statement. JAMA 2003; 289: 3161–3166PubMedCrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2009

Authors and Affiliations

  • Silvina V. Waldman
    • 1
    • 2
  • Juan Cruz Lopez Diez
    • 2
  • Hernán Cohen Arazi
    • 1
  • Bruno Linetzky
    • 2
  • Salvador Guinjoan
    • 3
  • Hugo Grancelli
    • 1
  1. 1.CardiologyFundación para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI)Buenos AiresArgentina
  2. 2.CardiologyCONARECBuenos AiresArgentina
  3. 3.Neurology and PsychiatryFLENIBuenos AiresArgentina

Personalised recommendations