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Study on stress and psychological well being among medical professionals.

INTRODUCTION

A step forward towards 21st centaury where goal oriented work with perfection is expected, the demand of family and society stretches the daily routine. One wants to attend all in short duration of time. Fulfilling all the demands and expectation ultimately leads to ill health and stress. Health care practitioners are expected to give selfless services, continual devotion to need of others and are expected to give medical care in all types of environment. Stress has become one of the major life style problem caused specially changes in nature of work, breakdown in traditional family structure and many features of contemporarily urban environment. Stress is an inevitable part of our personal and professional lives. When poorly managed, stress will accumulate to levels that become injurious to our health and well-being. Continuous exposure to stressful events may lead to different outcomes including health problems like anxiety, loss of sleep, and disturbed relationship with the family etc. According to Willcock, Daly, Tennant and Allard (2004) medical practitioners are at higher risk of mental illness and more susceptible to "three-D"- Depression, Drink and Drugs Stress levels in health professionals have been shown to be high in many countries and in most staff groups. This creates a personal cost to the individuals concerned, a financial cost to the organizations in terms of absence, early retirement and complaints, and a health cost to patients in terms of the risk of poorer quality care that is received by patients from stressed or dissatisfied staff. At a time when health organizations worldwide are striving to reduce costs and to increase quality, addressing the psychological well-being o f their staff has necessarily raised high on their priorities. Health Professionals reports stresses on the latest research from around the world on the causes o f stress in health professionals and on ways to intervene to reduce stress levels. It considers wider issues such as burn-out, teamwork, training and counseling services and investigates the effectiveness of both organizational and individual interventions.

Nowadays life is going more stressful, especially among health care professionals. To increase the efficiency and effectiveness of health care delivery, this study among the health care professionals would be a great help.

Researchers have indicated that a certain degree of stress in necessary to motivate a person to perform well, while stress beyond the optimal level can lead to failure, unhappiness, and economic loss.

"Stress is essentially reflected by the rate of all wear and tear caused by life"Hans Selye,1956

Selye in 1946 first time used the term stress. Stress is a word derived from Latin word 'stingere' which means to 'draw tight' it is a kind of the force which pushes physical or psychological factor beyond its range of stability, producing a strain with the individual.

Selyes's concept of General Adaptation Syndrome (GAS) explains the stress phenomenon. This model put forward that general Physiological response is produced in three stages- Alarm stage, Resistance stage, Exhaustion.

Girdano, Everly and Dusk (1993) states, Stress is the body reacting. It is psycho-physiological (mind-body) arousal that can fatigue body systems to the point of malfunction and disease. According to Wheaton(1996) Stress can be looked as a process in which external and internal stimuli, forces or system interact, where triggers activate a response system may lead to exhaustion and vulnerability.

'Psychological stress refers to a relationship with the environment that the person appraises as significant for his or her well being and in which the demands tax or exceed available coping resources' (Lazarus and Folkman 1986, p. 63).

Causes of stress-

Desai (1999) classified stressors in to three major categories-

Physiological Causes- The physiological category includes genetic and congenital factors, life experience, biological rhythms, sleep, posture, diet, fatigue, muscular tension and disease of adaptation.

Psychological Causes- Psychological Causes comprised of nine elements- perception, emotion, situation, experience, sensation, decisions, memory, motivation, cognition and appraisal.

Environmental Causes- Those factors which originate from the environment like ambient environment, physical events, psychological subsystem, physiological subsystem, social and biotic events.

Doctors- consistently experiencing high intensity of work, conflicting time demands, and heavy professional responsibility, physical and social resources are deficient, and there is the ever-present threat of medico-legal action. Often doctors have limited power to alter the conditions under which they work.

There are a large number of external pressures also like innate professional responsibilities of doctors, increased clinical workload due to insufficient staffing and resources in the health system, lack of control over work-life balance, professional, social and geographical isolation, the requirement for ongoing medical education, the demands of keeping pace with rapid developments in medical technology and knowledge, changes in the administration and regulations in the health system, and community expectations.

Interaction with patients and their families, which often involve dealing with suffering and death in emotionally charged clinical situations, can drain the "reserves" of the doctors with repercussions on their personal lives. Such experiences are in addition to the pressures experienced outside the workplace such as relationship and financial problems.

Ryff(1995) suggested a multidimensional model of psychological well-being that comprises six distinct dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance that supposedly vary in meaningful ways by personal characteristics including age.

Shin and Johnson (1978) have defined well-being form of happiness as "a global assessment of a person's quality of life according to his own chosen criteria" (p. 478).

Subjective Well-Being (SWB) was defined by Deiner (2009) as the general evaluation of one's quality of life. The concept has been conceptualized as the three components: (1) a cognitive appraisal that one's life was good (life satisfaction); (2) experiencing positive levels of pleasant emotions; (3) experiencing relatively low levels of negative moods.

Furthermore,Bradshaw et al.(2007) defined well-being as "Play[ing] an active role in creating the well-being by balancing different factors, developing and making use of resources and responding to stress.

Susmita Halder and Akash Kumar Mahato (2013) researched on level of stress and well-being health care providers in Kolkata. The results revealed that stress is a "clearly problem" for 33% of nurses, 20% of paramedics and technicians and 13.3% of doctors.

According to Wall et al.(1997) a large sample of National Health Service workers in Britain were studied on high levels of minor psychiatric disorders among doctors, nurses, allied health professionals, and managers. The results reveled higher rates in health professional as compare to the general population.

With the view of above review of literature following objectives were formulated.

Objectives:

1. To investigate the pattern of stress among medical professionals.

2. To investigate the pattern of wellbeing medical professionals.

METHOD

Sample: The medical professionals (Allopathic and Ayurvedic, Homoeopathic) working in government hospitals or doing private practice or working in private hospitals were randomly selected for the study. Equal number of male and female (N=100 each) doctors participated in the study.

A total number of two hundred (N=200) male and female doctors practicing in Government and Private Clinic/Hospital of Bhopal city, located in Central India participated in the study. Equal number of Male Doctors and Female Doctors (N=100 each) were taken as sample.

Measures: In the course of study following measures were prepared & used in the study. A brief description of the measures are given below-

Stress: The stress questionnaire was developed during the course of study. The questionnaire consists of 47 items including five dimensions-1.patients, 2.Hospital/clinic, 3.Incentive, 4. Family and 5.self. A set of five point scale was used ranging from Never to Always.

Psychological Well Being Scale: The Ryff Scales of Psychological Well-Being is used. It consist of 42 items, the dimensions are Autonomy, Environmental mastery, Personal Growth, Positive Relations with others, Purpose in life, Self Acceptance.

Procedure: After finalization of the tools, data were collected for the main study, to investigate relationship among the variables. After due concern and permission from the competent authorities, a convenient time was fixed for data collection. After developing good rapport with them instructions were made clear. In the beginning the purpose of the study was explained to participants and they were assured that their responses will be kept confidential and will be used for academic purposes.

RESULT

Stress: The responses of the participants were given on dimensions of stress factors- Patient, hospital, Incentives, Family and Self were analyzed. Results of the scores depict that higher the score less is the stress and vice-versa.

Patient- Mean & Standard deviations of the scores obtained on patient dimension of stress factor shows that the effects of gender and effect of organization were not significant whereas the main effect of experience was significant F (1,192) = 51.93, p<.01. The pattern of results indicates that practitioners having higher experience showed less stress due to patient (M=20.25) as compared to less experienced participants (M=16.67). The interaction of gender x organization was significant F (1,192) = 11.71, p<.05. The pattern of result indicate that male medical practitioners of government organization were having low patient stress (M=19.74) as compared to practitioners working in private organizations (M=17.22).On the other hand female practitioner of government organization has more stress (M=18.00) as compared to female practitioners of private organization (M=18.88).

Hospital- Mean & standard deviations of scores indicates hospital dimension of stress factor shows the main effect experience was significant F(1,192)=12.05,p<.05. The pattern of results indicate that there was less stress between 10 years practitioners (M=40.57) as compared to less experienced practitioners (M=36.89).

Incentive-Mean and standard deviations on incentive dimension of stress factor are shows that the effect of gender was not significant but effect of experience F (1,192) = 19.91, p<.05 was significant. The mean scores indicate that senior practitioners get lower incentives(M=17.62) as compared to the less experienced one(M=15.17).The interactional effect of gender with organization was also found highly significant F (1,192) = 24.00, p<.05. Government practitioners had low level of incentive (M=17.04) as compared to private practitioners (M=15.75).

Family-Mean and standard deviation of scores on family dimension of stress performed. It is evident that main effect of experience was significant F (1,192) =22.14,p< .05.Mean scores indicate that more experience practitioners have less family stress(M=17.19)as compared to less experienced once (M=14.77). However effect of organization was significant F (1,192) =13.65, p<.05. Mean scores indicate that government practitioners have less family stress (M=16.93) as compared to private ones (M=15.03).The interaction of gender with organization F (1,192) =6.00, p<.05 was found significant. Mean of organization represents that male government practitioner scored lower (M= 17.58) as compare to private practitioners (M= 14.42). Similarly female government practitioners scored less (M=16.28) as compared with private female practitioners (M=15.64).

Self (Norms, Values & Belief)-Mean and standard deviations indicating self dimension of stress shows that the main effect of experience F (1,192) =22.45, p<.05was found significant. The mean scores indicate that more experienced have less stress (M=47.46) as compared to junior practitioners (M=42.12). The interaction of gender with organization was highly significant F (1,192) = 20.96, p<.05. The pattern of mean scores show that male medical professionals of government organization scored less (M=49.50) as compared to private practitioners (M=42.58) on self dimension. Whereas female professionals of private organization scored less (M=45.24) as compared government professionals (M=41.84).

Total Stress The total result indicated the effect of experience contributed significantly for stress experience (1,192) =33.56, p<.01.The pattern of results indicated that more experienced participants were less stressed (M=143.09)as compared to the less experienced participants (M=125.62).

Similarly effect of organization also contributed significantly for stress experience, F (1,192) = 3.86, p<.01. The pattern of results indicated that the participants working in government organization noted less stress (M=137.32) as compared to participants belonged to private organization (M=131.39).The interaction of gender with experience was also obtained significant F (1,192) = 8.65, p<.01. The result reflects that higher experience male participants (M=140.88) experienced less stress as compared to less experienced participants (M=132.28). Similarly the female participants of higher experience tenure (M=145.30) indicated less stress as compared to less experience female participants (M=118.96).

The interaction of gender with organization was significant, F (1,192) = 19.25, p<.01. The pattern of scores indicates that male participants of government organizations showed less stress (M=146.16) as compared to private organization male participants (M=127.00), however, the female participants of private organization displayed less stress (M=135.78) as compared to female participants (M=128.48) of government organizations.

Similarly interaction of experience with organization was significant F (1,192) = 4.18, p<.05.

The pattern of results hint that more experienced participants of government organization observed less stress (M=149.14) as compared to more experienced participants of private organization (M=137.04).
                            Sum of          Mean
Source                      Squares    df   Square     F       Sig.

Gender                        990.125    1    990.125   2.178  .142
Experiences                 15260.045    1  15260.045  33.568  .000
Organization                 1758.245    1   1758.245   3.868  .051
gender x experiences         3933.845    1   3933.845   8.654  .004
gender x organization        8751.645    1   8751.645  19.252  .000
experiences x organization   1903.445    1   1903.445   4.187  .042
gender x experiences x       5460.125    1   5460.125  12.011  .001
organization
Error                       87282.320  192    454.595


The interaction of gender with organization was significant, F (1,192)=19.25,p<01. The pattern of scores indicated that male participants of government organizations showed less stress (M=146.16) as compared to male participants of private organization (M127.00), however, the female participants of private organization displayed less stress (M=135.78) as compared to female participants (M=128.48) of government organization.

Psychological Wellbeing:

Autonomy: Mean and standard deviation on autonomy and the summary of ANOVA performed on the score on autonomy show the effect of gender is statistically not significant. The main effect of organization F (1,192) =8.75, p<.05 was highly significant. The interaction effect of gender with organization was not significant. The pattern of result indicate that on the psychological wellbeing factor government organization practitioners scored higher (M=23.86) as compared to private practitioners (M=22.70) on autonomy dimension.

Environmental Mastery: mean and standard deviation on environmental mastery are show results that reveal the effect of gender is not significant but the effect of organization was significant F (1,192) =5.86, p<.05 on the environmental mastery dimension. The interaction of gender with organization was statistically not significant. The pattern of result reflect that medical practitioners from government organization scored higher (M=22.19) as compared to private practitioners (M=21.18) on the environmental mastery dimension of psychological wellbeing.

Personal Growth: Mean and standard deviation indicating personal growth shows that effect of gender and organization were observed statistically not significant. Whereas interaction of gender with organization F (1,192) =12.12, p<.05is found to be significant. On the other hand pattern of result shows government organization scored higher (M=22.65) as compare to private organization (M=21.89).

Positive Relations: The results indicate that the main effect of gender and organization was not significant. The interaction of gender with organization was also not significant. The pattern of results reveal that medical practitioners working in government organization (M=23.10) and private organization (M=23.09) displayed marginal difference on the dimension of positive relation of psychological wellbeing.

Purpose in life: The effect of gender and organization on purpose in life dimension was not significant, It was observed that the interaction of gender with organization is also statistically non significant. It reflects that medical practitioners of government organization scored higher (M=22.05) as compared to practitioners of private organization (M=21.94).

Self-acceptance: The Means and standard deviations of scores of gender and also main effect of organization indicated on self acceptance dimension of psychological wellbeing factor are not significant. The interaction effect of gender with organization was highly significant F (1,168) =29.76, p<.05.The pattern of result indicate that on the dimension of self acceptance of psychological wellbeing the government & private organization showed marginal difference (M=23.19) and (M=23.13) respectively.

DISCUSSION

Present study was aimed to examine the role of gender, and nature of job on perceived stress and psychological wellbeing. It was assumed that participants associated with government establishment or private establishment will differ in the perception of stress and well being. In the present study equal numbers of male and female medical professionals were selected for participation in the study due to difference in perceived social and psychological context, these participants developed their views differently.

They organize and perceived the things in different manner. Thus the present study is exploratory in nature. Medical professionals face a variety of problems during their work; these problems come from variety of sources. It is perceived that the nature of work setting government and private may also contributed number of challenges of medical practitioners. Scarcity of resources, pressure to attend more patients within a time limit, other administrative responsibilities hamper the performance. Besides non availability of sufficient time for the family, availability of sufficient honorarium and reward are the common factors which influence the commitment and hindrance in medical professionals' in indicative manner. Similarly, lack of autonomy, lack of participation in decision making, bureaucratic hindrance and maximizing the profit for the organization are the challenges to the medical professionals.

Perceived stress was assessed on the basis of five dimensions namely-patient, hospital, incentive family, and self. ANOVA was applied on these dimensions separately. The findings of the study indicated that male and female participants almost perceived the problems coming from patient equally. Usually patients and attendants ask variety of questions for their satisfaction. Sometimes these queries become problematic for medical professionals, irrespective of gender.

It was observed that male participants working in government establishment indicated lowest stress as compared to participants working in private sector, where as reversed trend was observed for female practitioners working in private establishment indicate less stress as compared to female professionals of government sector. For the hospital dimension perceived stress findings of the study indicated that Competition among colleagues, leg pulling, poor arrangements at work place, personal feeling about the job, not having required support, lack of information at work place are the common perceived concern of stress Another factor responsible for stress was reported by the professionals was incentive or rewards. The professionals of government sector indicated the less amount of stress as compared to professionals of private organizations. It appears that professionals of government sector gets salary and opportunity for private consultation, due to this their financial requirements are met. The similar conditions are not available for the private practitioners. Thus they live in uncertainty and demonstrate higher stress.

Family was another source that produced stress. Present research indicated that a verity of problems are faced by the professionals and interfere their family life. Similarly the professionals of private organization displayed higher stress as compared to professionals of government organization. The high stressed professionals complain that they were not able to spend qualitative time with family members, fail to attend family functions, not able to spend holidays with family members and their family life is disturbed by frequent emergency calls. These problems affect the life of professionals more working in private organization as compared to government organization. The other problems related to self, norms, values and belief are also responsible for occurrence of stress among the participants. It was noticed that female participants were more worried about these problems as compared to male participants. It appears that due to socialization pattern and lack of real life exposure female professionals become more sensitive and develops more stress as compared to their male counterparts.

In psychological wellbeing participants feelings were also studied A close look on the result obtained on autonomy dimension indicated that participants from government organization enjoyed better autonomy as compared to participants belonging to private sector. It was also observed that interaction of gender with organization jointly influence the perception of autonomy. It was observed that experienced male participants working in private organization enjoyed better autonomy than government sector participants. Participants from government sector and more experienced male participants were observed to enjoy higher autonomy which reflects that they are able to resist social pressure to thin and act in certain ways and evaluate self by personal standards. On the other hand female working in private organization were observed to have less autonomy which shows they rely on others for making important judgment and decisions.

The interaction of gender and organization indicated significant impact on personal growth, a close look on the result supported that male participants working in government sector evince that the high personal growth as compared to the participants of private sector. Which means they observe them self as growing and expanding and are open to new experiences whereas the revers observation was noted for the female participants. The participants of private organization gave higher importance to purpose in life as compared to participants of government organization. Interestingly it was also noted that female participants of private organization perceived them self in more positive way as compared to government participants. On the other hand the male participants of government organization indicated positive response about self as compared to male participants of private organization.

Conclusion: The present study thus suggests that the setting in which medical professionals work is important determinant of stress. Nowadays life is going more stressful, especially among health care professionals because of numerous causes - patient, incentive, working hours and others. To increase the efficiency and effectiveness of health care delivery, policy makers should think to reorganize these factors. It was observed that probably the sense of security of job perceived by professionals at government organization enjoy better mental health as compared to private organizations. Similarly male participants in comparison to female participants enjoy better mental health. However in private hospitals the reverse trend was observed.

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Rajendra Singh (*) and Reena Singh (**)

(*) Department of Community Medicine, Govt. SDJH Medical College, Azamgarh-276128, (**) Post Doctoral Fellow, ICSSR, Department of Psychology, Barkatullah University,Bhopal,India

Received: December 15, 2017

Revised: February 09, 2018

Accepted: April 19, 2018
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Author:Singh, Rajendra; Singh, Reena
Publication:Indian Journal of Community Psychology
Date:Sep 1, 2018
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