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A sample of paediatric residents' loneliness-anxiety-depression-burnout and job satisfaction with probable affecting factors.

Byline: Nazan Karaoglu Sevgi Pekcan Yasemin Durduran Haluk Mergen Dursun Odabasi and Rahmi Ors

Abstract

Objective: To assess levels of anxiety depression loneliness burnout and job satisfaction among paediatric

Residents and how they influence each other.

Methods: The cross-sectional study was conducted at Necmettin Erbakan University Meram and Konya Meram Education and Research Hospital Turkey from January to June 2011 and comprised paediatric Residents and their counterparts from other departments who formed the control group. While maintaining confidentiality a questionnaire was used to collect data that had elements of the University of California Los Angeles Loneliness Scale Hospital Anxiety and Depression Scale Maslach Burnout Inventory and Minnesota Job Satisfaction Questionnaire. SPSS version 13 was used for statistical analysis.

Results: Overall there were 74 Residents in the study; 43(58%) working with the paediatrics department and 31(42%) in the control group. Overall mean age was 27.602.25 years. Residents who were not satisfied with the city they were living in with their professional career and who would not choose the same career given a second chance were feeling more lonely and had higher loneliness scores (pless than 0.05). In contrast anxiety among female Residents who were unsatisfied with their professional career and working conditions was significantly high (pless than 0.05). Positive correlation was detected between the burnout levels of Residents and their anxiety depression and loneliness scores (r=0.74; r=0.65; r=0.36). In terms of intrinsic extrinsic and total job satisfaction there was an obvious negative correlation (r=-0.57; r=-0.54; r=-0.61).

Conclusion: Working conditions and professional liability were the main factors affecting the Residents. Informed decision and career willingness may help them feel better.

Keywords: Loneliness Anxiety Depression Burnout Job satisfaction Paediatric Residency. (JPMA 65: 183; 2015) Introduction

It is known that medical profession puts pressure on physicians from the beginning of education years.1-3 This leads to anxiety depression loneliness and burnout in physicians and affects their psychological well-being job and life satisfaction. Personal facts like successes and expectations; professional facts like work environment and conditions; social facts like status and prestige contribute to job and life satisfaction.4-7 Loneliness which is defined as the perception of one's social relations at under-expected levels also triggers negatively biological stressors.8-10 Life satisfaction is closely related to loneliness depression and suicidal attempts.811 In addition feelings about job is related to both physical and psychological well-being.51213 Job satisfaction is a positive feeling achieved when expectations are met.14

Contrary to job satisfaction the burnout is a negatively affecting process a response to chronic feelings and personal stresses about job. The burnout has three dimensions: emotional burnout depersonalisation and decrease in success. It shows itself as the loss of wish energy idealism and aim.15-18 It could be influenced by conditions environment job satisfaction personal factors and income.12161719-23 Burnout is generally expresses itself in idealistic and highly motivated persons. Such people have high expectations of their profession and profound and long-term sustenance of such feelings results in stress alienation anxiety and depression.

Medical education accepts idealistic and motivated students by selection and motivates them for the true diagnosis and treatment during all their practice years. Naturally the stress and anxiety levels of the physicians become high. In more than half of the family physicians in a study anxiety was found over the cut-off level.25 The irony is that the wellness the mood in other words the psychological health of the physician deteriorates. There have been a number of studies in this regard done with family physicians general practitioners obstetricians gynaecologists and psychiatrists.25-7121617 Also there have been such studies involving Residents and Lecturers but there are very few studies analysing the mood working conditions and their correlations in paediatrics residents.14 In these studies mainly depression was analysed but other parameters were not touched altogether.

In this study we planned to analyse the anxiety depression loneliness burnout and job satisfaction levels in paediatrics Residents and to compare their interactions with the Residents of other departments.

Subjects and Methods

The cross-sectional study was conducted at Necmettin Erbakan University Meram and Ministry of Health's Konya Meram Education and Research Hospital Turkey from January to June 2011 and comprised paediatric Residents and their counterparts from other departments who formed the control group.

All the Residents were randomly selected from among those who were present at the time of the study and volunteered to take part after giving verbal consent. While maintaining confidentiality a questionnaire was used to collect data that had elements of the University of California Los Angeles (UCLA) Loneliness Scale Hospital Anxiety and Depression Scale (HADS) Maslach Burnout Inventory (MBI) and Minnesota Job Satisfaction Questionnaire (MJBQ). All the subjects filled the questionnaire by themselves. In case the questionnaire was not fully filled it was excluded from the study. However partially filled demographic sections were included.

The first section of the questionnaire included socio- demographic information and had 23 questions seeking among other things the name of the department presence of night shifts duration of residency work environment effective factors in career preference feelings of the subject at that time presence of a known psychiatric disorder etc.

The second section comprised the UCLA Loneliness Scale which was validated in Turkish by Demir.2627 The UCLA is a Likert type scale which has 10 straight and10 reverse items. Minimum and maximum possible scores are in between 20 and 80. A high score is estimated to be the indicator of loneliness. The internal consistency Cronbach coefficient was reported as 0.96 which was found to be 0.87 in our study.

The third section was based on HADS that had 14 items: 7 for anxiety and 7 for depression.28 Odd numbered questions were for anxiety; even numbered for depression. In its Turkish validity and reliability study the cut-off levels for depression and anxiety were 7 and 10 respectively.29 The minimum and maximum scores of the two sub-scales are 0 to 21. In our study the internal consistency coefficient Cronbach was 0.89.

The fourth section used MBI which consisted of 22 items.30 Burnout was investigated in three sub-scales: emotional burnout depersonalisation and decrease in personal accomplishment. Originally it is a seven-grade Likert scale but the Turkish version of the scale was transformed to five in which 0 represented 'never' and 4 represented 'always'.1831 Emotional burnout sub-scale included 8 items (1st 2nd 3rd 6th 8th 13th 16th and 20th items) concerning fatigue weariness and decrease in emotional energy. Depersonalisation sub-scale consisted of 6 items (5th 10th 11th 15th 21st and 22nd items) which described the lack of emotion in oneself during serving and giving care. Decrease in personal accomplishment sub-scale included 8 items (4th 7th 9th 12nd 14th 17th 18th and 19th items) reflecting the emotion of proficiency and success. High scores of emotional burnout and depersonalisation and low scores of personal accomplishment meant burnout.

In our study the scale's Cronbach was 0.63.

The fifth section was the Turkish adaptation of MJSQ which was an assessment tool for job satisfaction.3233 It consisted of 20 items concerning internal (1st 2nd 3rd 4th 7th 8th 9th 10th 11st 15th 16th 20th) external (5th 6th 12nd 13rd 14th 17th 18th 19th) and general job satisfaction. General satisfaction is calculated by the division of total scores by 20; internal satisfaction score by 12 and external satisfaction score by 8. For every item there were 5 choices between 1'not at all' and 5'very satisfied'. There were no reverse items. Minimum and maximum scores were between 20 and 100 points. The Cronbach of the scale in our study was 0.88.

SPSS version 13 was used for statistical analysis. While frequency and percentage were used for demographic data chi-square and Fishers's exact test were used for the comparison of categorical variables. Mean scores were analysed by student-t test in dichotomous groups with normal distribution and by Mann-Whitney-U test in non- normal distribution. In multiple groups one-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used. Normal distribution of variables was determined with Kolmogorov-Smirnov test. Significance was accepted when p value was lower than 0.05.

Results

Overall there were 74 Residents in the study;43(58%) working with the paediatrics department and 31(42%) in the control group. The 43 paediatrics Residents represented 79% of the total 54 available in the two study

Table-1: Subjects' Characteristics.

###n###%

Institution and Departments They Work

Meram Medical Faculty Paediatrics###26###35.1

Meram Medical Faculty Other Departments###31###41.9

Ministry of Health Meram Education and Research Hospital Paediatrics###17###23

Age###27.602.25

Gender

###Male###30###40.5

###Female###44###59.5

Marital status

Single###46###62.2

Married###28###37.8

Period Elapsed in Residency###8 months (median; interquartile range=23.75)###Min=1month. Max=60 months

Monthly Number of Shifts###10 shifts (median; interquartile range=6)###Min=0. Max=15

Number of Patients They Look in Every Shift###40 patients (median; interquartile range=36.25)###Min=0.0; Max=250

Number of Patients They Follow in Clinic###15 patients (median; interquartile range=1550)###Min=0.0; Max=90

Economic status

Good###15###20.3

Moderate###52###70.3

Bad###7###9.4

Satisfaction with f the City (n=73)

Not at All Unsatisfied- Unsatisfied###21###28.7

Indecisive###15###20.5

Satisfied-Very Satisfied###37###47.7

Satisfaction with the Job

Not at All Unsatisfied- Unsatisfied###16###21.6

Indecisive###27###36.5

Satisfied-Very Satisfied###31###41.9

Satisfaction with the Working conditions

Not at All Unsatisfied- Unsatisfied###46###62.1

Indecisive###13###17.6

Satisfied-Very Satisfied###15###20.3

Reason To Be a Physician

Not Just Wanted###5###9

Individual Reasons###21###37.5

Environmental Reasons###16###28.5

Economic Reasons###14###25

If I Could Have One More Chance I Would Select Medicine Again

Never- Probably###22###29.8

Not sure###25###33.8

Mostly probably-Absolutely yes###27###36.5

If I Could Have One More Chance I Would Select ... Residency Again

Never- probably###21###28.4

Not sure###21###28.4

High probable-Absolutely yes###32###43.2

With Whom you Share Work Related Problems

Family###35###47.3

Colleagues###33###44.6

Administrators###3###4.1

Nobody###3###4.1

Do you think you Got Initiative in Vocational Subjects

Yes###20###27.4

No###53###72.6

Do you think you are Successful in your Job

Never-Sometimes###13###17.6

###J Pak Med Assoc

A sample of paediatric residents' loneliness-anxiety-depression-burnout and job satisfaction with probable affecting factors###186

Not Sure###22###29.7

Usually-Always###39###52.7

Do you feel Loneliness

Never###4###5.4

Sometimes###52###70.3

Not sure###5###6.8

Usually###13###17.6

Do you Go Late to Work

Never###16###21.6

Sometimes###52###70.3

Not sure###2###2.7

Usually###4###5.4

Did you Get any Problems because of forgetting your responsibilities

Never###9###12.2

Sometimes###53###71.6

Not sure###6###8.1

Usually###6###8.1

Total###74

Table-2: Comparison of UCLA HADS MBI and MJSQ scores in respect to the questions and items of the first section of the questionnaire.

###Anxiety###Depression###UCLA###Internal###External###Total###Emotional###Depersonalization Personal

###Satisfaction###Satisfaction###Satisfaction###Burnout###Success

Gender

Male###8.564.18###8.063.72###35.9010.06###3.520.62###3.060.80###3.340.61###24.267.05###16.163.63###28.063.95

Female###10.344.23###8.114.70###35.9510.25###3.310.46###2.720.71###3.070.52###25.705.49###15.543.06###27.093.17

p###0.07###0.96###0.98###0.12###0.05###0.05###0.32###0.43###0.24

Marital Status

Single###9.174.33###7.894.42###36.5410.55###3.480.53###3.080.74###3.320.56###24.416.02###15.323.18###28.193.56

Married###10.354.14###8.424.15###34.929.42###3.080.74###2.490.66###2.950.53###26.286.34###16.573.40###26.323.16

p###0.25###0.6###0.5###0.09###0.0001###0.0001###0.2###0.11###0.02

Period Elapsed in Residency

0-8 month###9.284.41###8.134.21###37.1811.12###3.510.50###3.030.76###3.320.51###24.425.90###15.212.99###27.443.68

reater than 8 month###9.974.15###8.054.45###34.618.88###3.280.55###2.670.73###3.030.60###25.866.43###16.413.53###27.523.39

p###0.49###0.94###0.27###0.06###0.04###0.03###0.31###0.11###0.92

Monthly Number of Shifts

0-10 shift###9.664.44###7.644.61###36.269.76###3.310.58###2.730.79###3.070.61###25.906.37###16.353.60###26.903.70

reater than 10 shift###9.564.11###8.683.86###35.5010.69###3..520.46###3.030.69###3.320.49###24.095.82###15.062.74###28.253.15

p###0.91###0.3###0.75###0.1###0.09###0.06###0.21###0.09###0.1

Patient Number In every Shift

0-40 patients###8.974.42###7.684.27###36.1810.60###3.480.46###3.020.70###3.300.49###24.185.67###15.133.11###27.563.62

reater than 40 patients###10.703.95###8.884.56###34.558.91###3.260.63###2.550.78###2.970.65###26.926.00###16.743.49###27.703.33

p###0.1###0.26###0.5###0.09###0.01###0.02###0.07###0.04###0.87

Patient Number Followed In Clinic

0-15 patients###9.054.06###7.943.91###37.0511.07###3.490.49###2.980.64###3.280.49###24.896.06###15.262.78###27.283.50

reater than 15 patients###9.874.25###8.004.55###33.938.31###3.330.57###2.710.85###3.080.62###25.096.11###16.363.78###27.963.50

p###0.4###0.95###0.19###0.21###0.12###0.12###0.89###0.16###0.41

Economic Status

Good###8.804.03###6.133.54###33.267.60###3.390.52###3.060.76###3.260.59###23.666.72###15.604.10###28.533.64

Moderate###10.154.28###8.614.41###35.9210.40###3.370.52###2.790.74###3.140.56###25.766.09###15.903.02###27.193.48

Bad###7.424.27###8.424.31###41.7111.49###3.580.74###2.940.92###3.320.67###23.425.44###15.423.90###27.423.64

P###0.2###0.14###0.19###0.65###0.46###0.62###0.38###0.9###0.43

Satisfaction with f the City (n=73)

Not at all us.+ unsatisfied 10.284.51###8.383.69###40.8510.82###3.500.42###2.970.54###3.290.42###25.716.62###16.092.96###26.233.50

Indecisive###9.534.77###8.334.68###33.939.92###3.270.46###2.970.77###3.150.49###24.205.72###14.263.12###27.262.91

Satisfied-Very satisfied###9.214.02###7.784.60###34.189.09###3.400.62###2.750.87###3.140.68###25.106.27###16.293.47###28.243.66

P###0.66###0.85###0.03###0.44###0.48###0.61###0.77###0.12###0.11

Satisfaction with the Job

Not at all us.+ unsatisfied 13.623.55 10.564.91 41.068.09###3.030.47###2.340.69###2.750.53###30.314.82###17.123.96###25.932.88

Indecisive###10.183.29###8.223.93 36.4810.56###3.270.43###2.750.72###3.060.46###25.924.01###16.373.17###27.0332.05

Satisfied-Very satisfied###7.063.62###6.703.79###32.809.73###3.700.51###3.220.66###3.510.50###21.746.34###14.612.69###28.673.86

P###0.0001###0.01###0.02###0.0001###0.0001###0.0001###0.0001###0.02###0.02

Satisfaction with the Working conditions

Not at all us.+ unsatisfied 10.783.96###8.934.21###35.919.52###3.180.48###2.540.70###2.930.51###27.155.90###16.673.39###27.433.02

Indecisive###9.924.00###8.923.98 40.0011.52###3.610.41###3.000.43###3.370.30###25.535.48###15.382.53###26.382.90

Satisfied-Very satisfied###5.803.27###4.803.38###32.469.99###3.890.39###3.610.64###3.780.41###18.535.08###13.462.41###28.605.05

P###0.0001###0.0001###0.14###0.0001###0.0001###0.0001###0.0001###0.0001###0.25

If I Could Have One More Chance I Would Select Medicine Again

Never- Probably###11.274.46 10.184.23 40.3111.18###3.200.50###2.760.83###3.020.56###26.686.62###16.544.12###26.593.40

Not sure###9.364.33###7.284.68###31.648.92###3.400.61###2.720.79###3.130.63###25.966.64###15.923.46###27.523.90

High Probable-Yes###8.513.76###7.143.47###36.338.83###3.560.45###3.070.65###3.360.49###23.074.85###15.072.18###28.183.18

P###0.07###0.02###0.01###0.06###0.19###0.09###0.08###0.29###0.29

Do you think you are Successful in your Job

Never-Sometimes###11.464.99 10.465.04 39.9211.62###3.170.60###2.460.84###2.880.66###27.466.80###15.763.00###26.844.54

Not sure###9.724.80###8.185.08 36.5910.70###3.270.53###2.730.71###3.050.52###26.317.25###26.543.55###26.543.55

Usually-Always###8.943.58###7.253.26###34.239.03###3.540.49###3.070.71###0.350.52###23.664.95###28.233.01###28.233.01

P###0.18###0.06###0.2###0.04###0.02###0.01###0.08###0.47###0.15

Do you feel Loneliness

Never-Sometimes###9.214.34###7.924.25###34.169.70###3.400.53###2.850.73###3.180.55###24.575.92###15.282.99###27.713.32

Not sure###11.801.78 10.423.84 42.406.14###2.800.44###2.321.03###2.610.61###30.005.38###19.403.43###25.002.34

Usually-Always###10.534.44###7.924.76 41.0710.78###3.600.48###3.120.74###3.410.53###25.617.03###16.613.73###27.464.46

P###0.3###0.47###0.02###0.01###0.13###0.02###0.16###0.01###0.25

TOTAL###9.624.27###8.094.3###35.9310.1###3.400.54###2.860.76###3.180.57###25.126.17###15.793.30###27.483.51

Table-3: Comparison of UCLA HADS MBI and MJSQ scores of Subjects and Controls.

###Mean Rank###Mann-Whitney U###Total N=74 MeanSD###Minimum###Maximum###P

Anxiety###484###9.624.27###2###20###0.045

Paediatrics n=43###41.74

Other Departments n=31###31.61

Depression###557.5###8.094.30###0###20###0.231

Paediatrics n=43###40.03

Other Departments n=31###33.98

UCLA###617.5###35.9310.10###20###64###0.591

Paediatrics n=43###38.64

Other Departments n=31###35.92

Internal Satisfaction###466.5###40.826.51###27###56###0.028

Paediatrics n=43###32.85

Other Departments n=31###43.95

External Satisfaction###582###22.906.12###10###36###0.354

Paediatrics n=43###35.53

Other Departments n=31###40.23

Total Satisfaction###507###63.7211.52###37###91###0.08

Paediatrics n=43###33.79

Other Departments n=31###42.65

Emotional Burnout###490.5###25.126.17###10###39###0.053

Paediatrics n=43###41.59

###J Pak Med Assoc

A sample of paediatric residents' loneliness-anxiety-depression-burnout and job satisfaction with probable affecting factors###188

Other Departments n=31###31.82

Depersonalization###498.5###15.793.30###10###24###0.064

Paediatrics n=43###35.53

Other Departments n=31###40.23

Personal Accomplishment###544.5###27.483.51###20###38###0.179

Paediatrics n=43###40.34

Other Departments n=31###33.56

PMann-Whitney U test

UCLA: University of California Los AngelesLoneliness Scale

HADS: Hospital Anxiety and Depression Scale

MBI: Maslach Burnout Inventory

MJSQ: Minnesota Job Satisfaction Questionnaire.

Table-4: Mean UCLA HADS MBI and MJSQ scores of Subjects in the Ministry of Health Education and Research Hospital and the Meram Faculty of Medicine.

###Paediatrics Residents###Other###p

###n=43###n=31

###(Meram Ministry of Health)

###n=26###n=17

Anxiety###10.444.14###(10.114.51###10.94 3.57)###8.484.25###0.12

Depression###8.604.34###(8.304.77###9.05 3.68)###7.384.22###0.42

UCLA###36.309.68###(34.6910.70###38.76 7.52)###35.4110.80###0.41

Internal Satisfaction###39.486.58###(38.465.83###41.05 7.49)###42.676.05###0.04

External Satisfaction###22.326.24###(21.195.97###24.05 6.42)###23.705.96###0.2

Total Satisfaction###61.8112.13###(59.6511.24###65.11 13.01)###66.3810.21###0.07

Emotional Burnout###26.066.64###(25.537.08###26.88 6.00)###23.805.27###0.23

Depersonalization###16.393.50###(15.962.84###17.05 3.32)###14.962.84###0.1

Personal Accomplishment###28.023.39###(28.193.12###27.76 3.86)###26.743.60###0.28

PKruskal Wallis test

UCLA: University of California Los AngelesLoneliness Scale

HADS: Hospital Anxiety and Depression Scale

MBI: Maslach Burnout Inventory

MJSQ: Minnesota Job Satisfaction Questionnaire.

sites. Of the total study population 44(59.5%) were females and 30(40.5%) were males. The overall mean age was 27.602.25 years. The length of residency was 1 to 60 months (median=8 months; interquartile range [IQR] =23.75) (Table-1).

UCLA scores were high in Residents who were not satisfied with the city and the career they chose who were feeling alone frequently and who would not like to select the same career if they were given a second chance (pless than 0.05). Anxiety score was high in female Residents who were unhappy with the career and working conditions (pless than 0.07) (Table-2).

In comparison of the four scales the paediatrics Residents had significantly low internal satisfaction scores compared with the controls (p=0.03) (Table-3).

Only internal satisfaction of Residents working in the Ministry of Health Education and Research Hospital was significantly higher than the Residents working in Meram Faculty of Medicine (p=0.04) (Table-4). In relation to questions about professional attitudes responsibilities and related outcomes there were no significant differences in all the four scores (pgreater than 0.05).

Negative correlations were found between working time and internal satisfaction (r=-0.25) external satisfaction (r=-0.29) and total satisfaction (r=-0.30). Positive correlations were found between emotional burnout level of the Residents and anxiety depression and UCLA scores (r=0.74; r=0.65; r=0.36respectively) and negative correlations were found for internal external and total job satisfaction (r=-0.57; r=-0.54; r=-0.61respectively).

Discussion

The stakes in the medical profession are high and so are the disappointments. Working conditions contribute in both positive and negative ways and may influence the overall outcome.171620 This study is important for targeting a special physician group which had graduated from medical school but was still getting education in a residency programme. Besides comparison between two groups of paediatrics Residents and with a control group also added to the significance of the study. Paediatrics residents were selected because of their hard tiring work schedule and academic curricula. Moreover the study compared loneliness anxiety depression burnout and job satisfaction as five main groups while they could be subjects of separate and different studies.

Loneliness was 43% in a study at the same university and men were the loneliest.8 In our study there was no gender-based differences in terms of loneliness. In a previous study at the same university mean anxiety and depression scores were 7.663.21 and 5.773.4 respectively and male students were more depressive.4 Mean anxiety score was 9.624.27 mean depression score was 8.094.3 in this study and though the anxiety scores of female residents were higher than male residents the difference was not significant. In addition there was no difference between genders in respect to depression also.

Usually studies in this area determined that personal accomplishment job satisfaction and depersonalisation scores were higher in males and emotional burnout scores were higher in females.6 In the study we could not find any difference among internal external and total satisfaction emotional burnout depersonalisation and personal accomplishment in respect of gender. The majority of the subjects were satisfied with their jobs (78.4%) and nearly half of them would select medicine again if they could have one more chance. Residents who noted that they would never select medicine as a career if they could have one more chance to decide had high depression and loneliness scores which supports our claim.

Marital status job's requirements work environment shifts social status of the job length of service and personal characteristics are important for burnout and job satisfaction.1617 Job satisfaction of married physicians was reported to be higher.22 In a study with teaching staff emotional burnout was found to be more frequent among singles while depersonalisation was more frequent among married lecturers. Interestingly the latter were found to perceive themselves successful. Authors also noted a significant difference between elapsed time in the profession and emotional burnout depersonalisation and personal accomplishment scores. But some other studies found no relationship between marital status and emotional burnout.20 In our study there were no relationship between married and single Residents in terms of anxiety depression loneliness internal satisfaction emotional burnout and depersonalisation.

Single Residents had significantly high scores in external and total satisfaction and personal accomplishment perception. Having no marital responsibility allows them to concentrate better on their job than the married Residents and they could find more time for themselves and could cope with job problems more easily.

A study denoted that with age and length of service job satisfaction also increases because work-related thoughts perception and attitudes become healthier over time.

Contrary to these findings external and total satisfaction was significantly higher in residents of 0 to 8 months in our study. It could be related to a confidence that they were successful in the TUS medical specialty examination. The most challenging condition of Turkish medical training is to be a Resident via earning high scores at the national TUS exam which is a very very competitive one. However seniority and work experience could be seen as a valuable source against emotional burnout. In another study employees working 5 years and less had much more work-related tension than employees working greater and equal to 10 years.34 It noted an increase in work-related stress emotional burnout and depersonalisation and a decrease in depersonalisation and personal accomplishment with age. Authors reported that work-related tensions increase while job satisfaction decreases.

In our study number of shifts had no effect but when the number of patients became more than 40 during a shift external and total satisfaction of the Residents decreased and depersonalisation increased significantly. The Residents experienced difficulties uniquely during night shifts because number of patients in the clinic they give care to was found to be ineffective in their well-being.

In a study job satisfaction was found high among physicians who noted that the medical career was their own choice and thought that they did the 'right' thing. Again in the same study the job satisfaction of the physicians who had career goals and objectives was also high.22 Similarly in our study satisfaction with city career and working conditions were influencing the Residents. While Residents who were not satisfied with the city had only high UCLA loneliness score; Residents who were not satisfied with their professional career had high anxiety depression loneliness and emotional burnout and depersonalisation scores. In addition they had low internal external total satisfaction and personal accomplishment scores. In terms of working conditions those who were not satisfied with conditions had significantly high anxiety and depression scores and had significantly low internal external and total satisfaction scores.

Those Residents' emotional burnout and depersonalisation were apparent but there was no difference between personal accomplishments.

Burnout is a dangerous situation especially in professions requiring mutual human relationship. Emotional burnout is the feeling of being emotionally overloaded and the depletion of resources of the individual.151819 Physical burnout insomnia alcohol and drug abuse besides health and familial problems absenteeism decreased morale and desire could lessen job satisfaction and organisational loyalty. On the other hand use of initiative giving feedback rewarding social support providing of career development opportunities for individuals lessens emotional burnout.1819 In this study no difference was found in respect to anxiety depression loneliness burnout job satisfaction in Residents who didn't think they possess initiative who were late for work and who had problems because of forgetting their responsibilities. It can be related to the viewpoint of our Residents about seeing themselves still as a student who had limited responsibility.

We found that depersonalisation which is the most problematic dimension of burnout occurred when the number of patients was greater than 40 in a shift and especially in Residents who were not satisfied with their career and working conditions. Compared with other Residents it is important that paediatrics residents had higher depersonalisation scores but it was not significant. However paediatrics residents are not in close relationship with a sick child only but also with the family. The depersonalisation of these residents may make them inattentive to the needs of patients and their relatives. Similarly reduction of internal external total satisfaction burnout depersonalisation and personal accomplishment should be a warning for residency education. Trials to make more informed career choice and to ensure that it gets done will pre-empt the chance of producing unhappy and dissatisfied physicians.

Decrease in personal accomplishment represents reduction of proficiency and productivity of the individual. It is associated with impairment and depression in fulfilling the requirements of the job. Lack of social support and opportunities for individuals' self- development worsen this situation.15 Indeed in a study evaluating the relationship between job satisfaction and career vocational factors the right choice in choosing a career following regular publications were noted to be related with job satisfaction. The authors noted that job satisfaction increases when climbing to the high points of the career when the physicians think that they selected the right job and when there was an increasing interest in issues of the field.22 In a study pointing out that participation to post-graduation continuous medical education (CME) and having good communication with patients was important for avoiding work stress.

It also cited that family physicians in Canada had 64% job satisfaction besides a high stress and burnout.7 In a multi- centre study involving European family physicians burnout was related with personal issues increased workload low job satisfaction which even led to the desire of quitting the profession and take recourse to alcohol tobacco and drug usage.16

Loneliness impairs the capacity to cope with stress causing damage in the feelings of self-value and self- efficacy.10 In our study we found that Residents who said that they often or always felt themselves lonely had high loneliness scores contrary to their high internal and total satisfaction scores and low depersonalisation score. The perception of loneliness and social support self-efficacy and individualisation with the changing social structure could suggest that many physicians have different perceptions. We believe that this point needs to be investigated more in detail through further studies.

In one study where physicians of paediatrics internal medicine paediatrics subspecialty and internal medicine subspecialty participated work stress was found to be the lowest in paediatricians while burnout was found to be two times higher in paediatrics sub-specialty physicians than in paediatricians.14 This situation could be caused by the additional medical responsibilities upon educational responsibilities. Unfortunately in our study there was no comparison of specialists with general practitioners to let us make comments on the issue. However recent studies performed among specialists and general practitioners reported a general burnout and a decrease in job satisfaction among all practicing physicians. In our study we found no difference among other department's Residents and paediatrics Residents except internal satisfaction scores.

Conclusion

The study determined that the influence of working condition is not unique to paediatricians. Burnout and job satisfaction must be included in institutional social and health policy-making machineries and ways to cope with them must be taught. Though small in scale the study is indicative of current trends and what can be done in the future.

References

1. Hull SK DiLalla LF Dorsey JK. Prevalence of health-related behaviors among physicians and medical trainees. Acad Psychiatry 2008; 32:31-8.

2. Bugdayci R Kurt AO Sasmaz T Oner S. Mersin li'nde Pratisyen ve Uzman Hekimlerde Depresyon Sikligi ve Etkileyen FaktAlrler. Toplum Hekimligi BA1/4lteni 2007; 26: 32-6.

3. Alvi T Assad F Ramzan M Khan FA. Depression anxiety and their associated factors among medical students. J Coll Physicians Surg Pak 2010; 20: 122-6.

4. Nogueira-Martins LA Neto RF Macedo PCM Citero VA Mari JJ. The mental health of graduate students at the Federal University of SAPound o Paulo: a preliminary report. Braz J Med Biol Res 2004; 37: 1519-24.

5. Becker JL Milad MP Klock S. Burnout depression and career satisfaction: Cross-sectional study of obstetrics and gynecology residents. Am J Obstet Gynecol 2006; 195: 1444-9.

6. Woodside JR Miller MN Floyd MR McGowen KR Pfortmiller DT. Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry 2008; 32:13-9.

7. Lee FJ Stewart M Brown JB. Stress burnout and strategies for reducing them. What is the situation among Canadian family physicians Can Fam Physician 2008; 54:234-5.

8. Karaoglu N Avsaroglu S Deniz ME. Yalniz misin Selcuk Aniversitesi Algrencilerinde yalnizlik dA1/4zeyi ile ilgili bir calisma. Marmara Med J 2009;22: 19-26.

9. Steptoe A Owen N Kunz-Ebrecht SR Brydon L. Loneliness and neuroendocrine cardiovascular and inflammatory stres responses in middle-aged men and women. Psychoneuroendocrinol 2004; 29: 593-611.

10. NausheenB Gidron Y Gregg A Tissarchondou HS Peveler R. Loneliness social support and cardiovascular reactivity to laboratory stress. Stress 2007; 10: 37-44.

11. Swami V Chamorro-Premuzic T Sinniah D Maniam T Kannan K Stanistreet D et.al. General health mediates the relationship between loneliness life satisfaction and depression. A study with Malaysian medical students. Soc Psych Psych Epid 2007; 42: 161-6.

12. Bressi C Porcellana M Gambini O Madia L Muffatti R Peirone A et al. Burnout among Pschiatrists in Milan: a multicenter survey. Psychiatr Serv 2009; 60: 985-8.

13. Pines AM Kanner AD. Nurses' burnout: lack of positive conditions and presence of negative conditions as two independent sources of stress. J Psychosoc Nurs Ment Health Serv 1982; 20: 30-5.

14. Shugerman R Linzer M Nelson K Douglas J Williams R. Paediatric Generalists and Subspecialists: Determinants of Career Satisfaction. Paediatrics 2001; 108 ; e40.

15. Maslach C Schaufeli WB Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397-422.

16. Soler JK Yaman H Esteva M Dobbs F Asenova RS Katic M et al. Burnout in European family doctors: the EGPRN study. Fam Pract 2008;25:245-65.

17. Putnik K Houkes I. Work related characteristics work-home and home-work interference and burnout among primary healthcare physicians: A gender perspective in a Serbian context. BMC Public Health 2011; 11: 716.

18. Capri B. TA1/4kenmislik Allceginin TA1/4rkce uyarlamasi: gecerlik ve gA1/4venirlik calismasi. Mersin Aniversitesi Egitim FakA1/4ltesi Dergisi 2006; 2: 62-77.

19. Schaufeli WB Bakker AB Van Rhenen W. How Changes in Job Demands and Resources Predict Burnout Work Engagement and Sickness Absenteeism. J. Organiz. Behav 2009; 30:893-917.

20. YA1/4rA1/4r S. Ogrenilmis gA1/4clA1/4lA1/4k kidem ve medeni durumun duygusal tA1/4kenmedeki rolA1/4: kaynaklarin korunmasi teorisi kapsaminda bir analiz. AtatA1/4rk Aniversitesi Iktisadi ve Idari Bilimler Dergisi 2011; 25:107-26.

21. Ataoglu A cmeli C Ozcetin A. Hekimlerde mesleki is doyumu. Abant Izzet Baysal Aniversitesi Tip FakA1/4ltesi Dergisi 2000; 2; 17-34.

22. Sevimli F Iscan OF. Bireysel ve is ortamina ait etkenler acisindan is doyumu. Ege Acad Review 2005; 5: 55-64.

23. Sutherland JV Cooper CL. Job stress satisfaction and mental health among general practitioners before and after introduction of a new contract. BMJ 1992; 304: 1545-8.

24. Pines AM. Treating career burnout: A psychodynamic existential perspective. J Clin Psychol 2000; 56: 633-42.

25. Karaoglu N Bulut S Baydar A Carelli F. Aile hekimlerinde durumluk ve sA1/4rekli anksiyete dA1/4zeyi: Bir vaka kontrol calismasi. TA1/4rkiye Aile Hekimligi Dergisi 2009; 13: 119-26.

26. Russell D Peplau LA Cutrona CE. The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. J Pers Soc Psychol 1980; 39: 472-80.

27. Demir A. UCLA Yalnizlik Allceginin gecerlik ve gA1/4venirliligi. Psikoloji Dergisi 1989; 7: 14-8.

28. Zigmond AS Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70.

29. Aydemir O. Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. TA1/4rk Psikiyatr Derg 1997; 8: 280-7.

30. Maslach C Jackson SE. The measurement of experienced burnout. J Occup Behaviour 1981; 2: 99-113.

31. Ergin C. Doktor ve hemsirelerde tA1/4kenmislik ve Maslach Allceginin uyarlanmasi. VII. Ulusal Psikoloji Kongresi Bilimsel Calismalari. Bayraktar R Dag (EditAlrler). Ankara: TA1/4rk Psikologlar Dernegi Yayini 1993; pp 143-54.

32. Weiss DJ Dawis RV England GW Lofguist LH. Manual for the Minnesota Satisfaction Questionnaire. Minnesota studies in vocational rehabilitation. Industrial Relations Center Minneapolis University of Minnesota; 1967.

33. Baycan AF. Analysis of several affects of job satisfaction between different occupational groups (thesis). Bogazici university institue of social science 1985.

34. SA1/4nter AT Canbaz S Dabak S Oz H Peksen Y. Pratisyen hekimlerde tA1/4kenmislik ise bagli gerginlik ve is doyumu dA1/4zeyleri. Genel Tip Derg 2006;16:9-14.
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Publication:Journal of Pakistan Medical Association
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Date:Feb 28, 2015
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