Nazia Nazir  ( Department of Psychiatry, Government General Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )
Hafiz Amjad Hussain  ( Department of Medicine, DHQ Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )
Umair Ahmed  ( Department of Medicine, Allied Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )
Ahmad Ayaz Sabri  ( Department of Medical, Government General Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )
Nazir Ahmad  ( Department of Medical, Government General Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )
Amna Gulam Rasool  ( Department of Psychiatry, Government General Hospital, Faisalabad Medical University, Faisalabad, Pakistan. )

Objective: To analyse the prevalence of stress among doctors serving at various public and private hospitals.

Methods: The cross-sectional study was conducted at four public and private hospitals in Faisalabad, Pakistan, from July to December 2019, and comprised doctors with at least one year of professional service. Data was collected using the Perceived Stress Scale Questionnaire and was analysed using SPSS 20.

Results: Of the 162 respondents, 87(53.7%) were males and 75(46.3%) were females. The females had significantly higher (p<0.05) perceived stress scores compared to the males. Age, number of years in job, and number of children had negative correlation with stress scores (p<0.05). Stress was significantly low in doctors who managed to usually get time-out for relaxation (p<0.01) and in those doing private practice (p<0.05). The effect of doctor's marital status, type of specialty and residence was not significant (p>0.05).

Conclusion: Younger doctors, particularly females, in their early career were found to have higher perceived stress scores compared to their senior colleagues with more children and well-established private practice.

Keywords: Psychological stress, Occupational stress, Life stress, Mental suffering. (JPMA 71: 1424; 2021)

DOI: https://doi.org/10.47391/JPMA.232

 

Introduction

 

A doctor's job is hectic and stressful. Patient care, particularly in government hospitals, requires vigilant and efficient decision-making and prompt action which is further crucial due to high number of critical patients present at these hospitals. Stress level negatively affects efficiency and decision power which is directly hazardous for patient care.¹ Doctors are exposed to significant levels of stress during their jobs.²

High stress levels among doctors may result in aggressive attitude towards patients, poor decision-making and medical errors.³

The healthcare landscape is changing rapidly and so is the practice of medicine. In this technology-oriented era, new models of medical care are being introduced regularly to overcome the shortcomings in the existing models of care.⁴

Almost all doctors face stress owing to various factors, which affect the physical and mental health of doctors who face psychiatric issues, like anxiety disorders, depressive illnesses, adjustment disorders and even substance abuse.⁵ Psychiatric illnesses among doctors are usually ignored not only by the common folks, but also by the doctors themselves.⁶ In this scenario, gender may play a role in the experience of stress.⁷ Females have to face a variety of more stressors, like gender discrimination, stereotyping, marriage-work balance and social stigma.⁸

Another study shows that women find workplace significantly more stressful than men.⁹

Also, studies have correlated age with perception of stress; some reporting a negative correlation,¹⁰ while others found the difference non-significant.¹¹

The current study was conducted to measure the level of perceived stress and its association with various factors, such as gender, age, number of years in job, number of children, time for relaxation and private practice among doctors.

 

Subjects and Methods

 

After approval from the institutional ethical review committee (ERC), the cross-sectional study was conducted from July to December 2019 in Faisalabad, Pakistan, and comprised doctors working at Allied Hospital, Divisional Headquarter (DHQ) Hospital, Government General Hospital and the Independent Hospital. All the four hospitals experience high patient load not only from Faisalabad, but also from nearby towns and cities, including Sargodha, Jhang, Toba Tek Singh, Samundari and Chiniot. The study sample was raised using convenience sampling technique from among doctors of either gender in service for at least one year. House officers and doctors serving on administrative posts were excluded.

The sample size was calculated in the light of literature¹² using online sample calculator¹³ with confidence level 95%, margin of error 5%, population proportion 50%, and population size 277.

After taking informed consent, data was collected using Perceived Stress Scale (PSS-14) that has 7 positively-stated and 7 negatively-stated items which are scored on a five-point Likert scale. The score is calculated by reverse coding the negatively-stated items and then summing up the scores of all the 14 items, with final score ranging from 0 to 56. Higher scores indicate higher levels of perceived stress. The instrument was not intended by its developers¹⁴ (Cohen, Kamarck & Mermelstein 1983) as a diagnostic tool, and, hence, there is no cut-off score.

Data was analysed using SPSS 20. One-way analysis of variance (ANOVA) was used for the comparison of all group means.

 

Results

 

Of the 162 respondents, 87(53.7%) were males and 75(46.3%) were females. Doctors responses to all the 14 items were noted (Table-1).

 

 

The overall mean PSS score was 26.09±8.141.

The females had significantly higher (p<0.05) perceived stress scores compared to the males. Age, number of years in job, and number of children had negative correlation with stress scores (p<0.05). Stress was significantly low in doctors who managed to usually get time-out for relaxation (p<0.01) and in those doing private practice (p<0.05). The effect of doctor's marital status, type of specialty and residence was not significant (p>0.05) (Table-2).

 

 

Discussion

 

The study found higher mean perceived stress score of 27.56 among female doctors compared to their male colleagues 24.82. The finding is in line with previous studies.^15-17

Conflict between professional responsibilities and social expectations related to home-life has been conjectured as one of the possible reasons of higher stress level among females.¹⁸

In the current study, stress among younger doctors was significantly higher compared to their older colleagues. A study in Indian hospitals showed higher stress levels among senior doctors.¹⁸ However, the study linked their higher stress levels with administrative responsibilities in addition to their clinical duties. In the current study, doctors having additional administrative responsibilities were excluded. Our results in this regard are in agreement with a study done in African hospitals which showed lower stress levels among senior doctors compared to their junior counterparts.¹⁹

Our study did not show any significant difference in the stress levels of married and unmarried doctors, but the African study showed higher stress among single doctors compared to their married counterparts.¹⁹

Although a study among German hospitals found significant difference in stress levels among different medical specialties,²⁰ no significant difference was found in the current study.

The stress among doctors who had their private practice in addition to their government job was significantly lower compared to those with no private practice in the current study. It may be conjectured that private practice is not only a means of keeping oneself too busy to think about stressful issues, but it also reduces financial worries due to increased income, resulting in lower stress levels.

The results also indicated that those doctors who usually spare time for relaxation also had low stress.

 

Conclusion

 

Female doctors had higher perceived stress compared to their male colleagues. Doctors' age, number of years in service, number of children, private practice and time-out for relaxation showed a negative association with perceived stress. No significant association was observed of doctors' marital status, type of residence and specialty with the perceived stress score.

 

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

 

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