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| SHORT COMMUNICATION |
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| Year : 2010 | Volume
: 54
| Issue : 4 | Page : 219-223 |
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Prevalence of stress among resident doctors working in Medical Colleges of Delhi
NK Saini1, Sandeep Agrawal2, SK Bhasin3, MS Bhatia4, AK Sharma3
1 Reader, Department of Community Medicine, University College of Medical Sciences, New Delhi, India
2 Junior Resident, Department of Community Medicine, University College of Medical Sciences, New Delhi, India
3 Professor, Department of Community Medicine, University College of Medical Sciences, New Delhi, India
4 Professor, Department of Psychiatry, University College of Medical Sciences, New Delhi, India
| Date of Web Publication | 3-Mar-2011 |
Correspondence Address:
N K Saini
Reader, Department of Community Medicine, University College of Medical Sciences, New Delhi - 110 095
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-557X.77266
 Abstract | | |
The present cross-sectional study was conducted from November 2007 to December 2008 in four medical colleges and associated hospitals of Delhi. Study subjects comprised 930 resident doctors. The overall prevalence of stress was found to be 32.8% in resident doctors from all colleges. Out of 930 resident doctors, 165 (17.7%) had mild stress, 113 (12.2%) had moderate stress, and 27 (2.9%) were severely stressed. Important reasons of stress as perceived by the study subjects included long duty hours, departmental academic activities, financial constraints, family and emotional problems in the decreasing order of preference. Important factors significantly associated with stress-included existence of children, year of residency, type of department, and presence or absence of job satisfaction, having close friends, spending time with family/friends, and place of graduation. In the multivariate model, year of residency, giving time to family and or friends, having close friends during residency, job satisfaction, and state of graduation came out as predictors of stress. Keywords: Prevalence, Resident doctors, Stress
How to cite this article:
Saini N K, Agrawal S, Bhasin S K, Bhatia M S, Sharma A K. Prevalence of stress among resident doctors working in Medical Colleges of Delhi. Indian J Public Health 2010;54:219-23 |
How to cite this URL:
Saini N K, Agrawal S, Bhasin S K, Bhatia M S, Sharma A K. Prevalence of stress among resident doctors working in Medical Colleges of Delhi. Indian J Public Health [serial online] 2010 [cited 2023 Mar 30];54:219-23. Available from: https://www.ijph.in/text.asp?2010/54/4/219/77266 |
Stress is usual and normal part of our daily lives. It is a normal physical reaction to an internal or external pressure that is placed on a person's system. Stress becomes a problem when one feels overwhelmed by its challenges. Extended periods of stress can cause destructive changes in the body such as depression, heart disease, cancer, stroke, ulcers, back pain, headaches, raised blood pressure, indigestion, and a variety of other problems. [1]
Out of many groups who are affected by such emotional states and disorders, doctors especially the resident doctors comprise an important group because of the unique environment in which they work. [2],[3] Factors like excessive working hours, sleep deprivation, and repeated exposure to emotionally charged situations play an important role in causing stress in this group. In addition lack of job security, family and personal problems aggravate the stress. These residents have a very little experience, but they are expected to be proficient clinicians, educationists, researchers, and administrators.
Due to the nature of their professions, the mental health of doctors is not only of concern to them, but also is of concern to the greater society served by them. [4] In India, some studies have been done on stress in medical students, but practically very few studies have been done to assess the emotional disturbances in resident doctors. Hence, this study was planned to find the prevalence of stress and the factors associated with these emotional disorders in resident doctors working in medical colleges and associated hospitals of Delhi.
The study was cross sectional in design. The data collection was carried out between November 2007 and December 2008. The study area of the present study was four medical colleges and associated hospitals of Delhi. The study population comprised all the resident doctors (junior and senior residents) working in four medical colleges and associated hospitals of Delhi.
There were very few studies available to determine the prevalence of stress in resident doctors. No such studies were available from India. To calculate the sample size, the lowest reported prevalence of depression (among depression, anxiety and stress) from several studies which was found to be approximately 10%, was taken, as this study was a part of the study to find out stress, anxiety, and depression among the residents. Allowing an error of 20%, the range of prevalence becomes 8-12%. Therefore, detecting a prevalence of >12% was considered to be statistically significant. The required sample size for this study (calculated using Epi Info 2000 software), considering the significance level at 5% and 80% power of the study, was calculated to be 843. Assuming a 10% non-response rate, the required sample size was 927. Since all four Medical Colleges were located in the same city and nature of work was almost similar, so we assumed that there was no design effect. Out of five medical colleges in Delhi, four medical colleges and associated hospitals, i.e. Maulana Azad Medical College and Loknayak Hospital, Lady Hardinge Medical College and Sucheta Kriplani Hospital,Vardhman Mahavir Medical College and Safdarjung Hospital and University College of Medical Sciences, and Guru Tegh Bahadur Hospital, were included in the study. The fifth medical college AIIMS was not included in the study since it is a referral institute and its working environment was considered quite different from the other medical colleges and associated hospitals.
A written permission was obtained from the Dean/Principal/Medical Superintendent of the respective colleges and hospitals prior to conducting the study. A list containing the names of all the residents and departments where they were working was obtained separately from each of the four medical colleges included in the study. The final list included 1600 residents from four medical colleges. Out of these, 450 (28%) residents each, were from UCMS and MAMC, 400 (25%) residents from LHMC, and 300 (19%) from Safdarjung hospital. Using the population proportionate sampling technique, the individual college's study population was calculated from total study sample size of 927 (260 each were to be studied from UCMS and MAMC, 232 from LHMC and 176 from SAFDARJUNG). The residents were randomly approached in each college till the required sample size was achieved in each college.
Non-academic junior residents (who were not pursuing any two or three year post graduation course), residents who could not be contacted after three attempts, who were on leave for 2 or more than 2 days in 7 days preceding the date of interview, and if a resident had filled a similar questionnaire in past 8 weeks, were not included in the study.
The residents selected for the study were contacted by the investigator personally. A written consent was taken and the respondent was counseled to provide correct information. The proforma containing information about socio-demographic and other factors was filled by the investigator on the spot. A study tool used in this study comprised a standard self-administered questionnaire DASS [5],[6] (Depression Anxiety Stress Scale), to elicit the presence of stress, anxiety, and depression in the study population. The self-administered questionnaire DASS was handed over to the respondents and was collected on the next visit. The response rate came out to be 77.5% in this study.
The DASS is a 42-item self-report instrument designed to measure the three related negative emotional states of depression, anxiety, and stress. It has 14 items each on stress, anxiety, and depression. Each item has to be rated by a four-point rating scale. The rating scale is as follows: 0 (did not apply to me at all), 1 (applied to me to some degree, or some of the time), 2 (applied to me to a considerable degree, or a good part of time), and 3 (applied to me very much, or most of the time). The final scoring is done by adding 14 items each of stress, anxiety, and depression and subsequently each of stress, anxiety, and depression are categorized as normal, mild, moderate, severe, and extremely severe. For stress score of 0-14 is normal, 15-18 is mild stress, 19-25 moderate, 26-33 severe and >34 is very severe stress.
All the scales of DASS have been shown to have high internal consistency. [5],[6] It is suitable for screening adolescents and adults. In addition, a pre-tested semi-open ended and self-prepared questionnaire was used in study for getting socio-demographic details and identifying the factors and their association with stress, anxiety, and depression.
The results being presented here pertain to stress. The results relating to anxiety and depression will be presented separately.
The data thus collected were transferred to a computer-based spreadsheet using Microsoft Excel Software and analysis was done on the SPSS software version 12. Appropriate statistical tests (including Chi-square test and logistic regression) were applied.
Of 930 study subjects (resident doctors), 495 were males and 935 females. The age of the resident doctors ranged between 24 and 39 years with a mean age of 27.5 ± 2.3 years. Of them, 175 (18.8%), 642 (69%), 111 (11.9%) and 2 (90.2%) belonged to ≤25, 26-30, 31-35 and 36-40 years, respectively.
The overall prevalence of stress was found to be 32.8% (305) in resident doctors from all colleges. Out of 930 resident doctors, 165 (17.7%) had mild stress, 113 (12.2%) had moderate stress, and 27 (2.9%) were severely stressed [Table 1].
When residents were asked for the most common reasons of stress in residency (multiple responses), it was found that nearly half (50.6%) of residents responded that duty hours was the most common cause followed by academic activities of the department (37%). Finance (23%), family (11%), and emotions (11%) were other reasons found.
[Table 2] depicts the various factors associated with stress among resident doctors. As can be seen from the table, 54.6% first year residents were stressed in comparison to 24.2% and 24.1% of second- and third-year residents, respectively. Nearly 30.7% of the senior resident doctors were found to be in some sort of stress. The difference in stress levels according to the year of residency was found to be statistically significant (P=0.00).
The entire 19 departments where residents were working were divided into two broad categories of clinical and non-clinical departments. This category-wise prevalence of stress was found to be statistically significant (P=0.045).
Stress was more prevalent in residents who were not satisfied with their job, who did not have close friends in their residency training as compared to those residents who had close friends, who were not able to spend time with their family/friends, and who had done their graduation from outside Delhi [Table 2]. Out of 503 married residents, 161 had children and 342 were without children. Stress was present in 44% of residents who were having children in comparison to 25% of residents who were not having children. This difference was found to be statistically significant (P=0.000).
All those variables that were significant (P< 0.05) on univariate analysis were considered for the multivariate logistic regression. The stepwise logistic regression technique was used to carry out the analysis. In the multivariate model, the association of stress with year of residency, giving time to family/friends, having close friends during residency, and state of graduation was shown to be statistically significant.
The overall prevalence rate of stress among resident doctors was found to be 32.8%. Pinto et al. in their study among residents and consultants in Goa Medical College reported 80% prevalence of stress. [7] Another study by Supe [8] reported 73% prevalence of stress among medical students conducted in medical students of Mumbai pursuing MBBS. One of the reasons for low prevalence of stress in our study might be the difference in the tools used to assess the stress. Also, our study was questionnaire based and the results depended on voluntary provision of correct information by the study subjects.
Cohen et al. reported a stress prevalence of 34% among resident doctors in Canada. [9] In 2004, Sargent et al.[10] in their study in USA in 2004 also reported 33% stress among resident doctors. These findings were similar to the findings of the present study. However, the geographical settings as well as the working atmosphere of the resident doctors were totally different in these studies.
Similar to our findings, some other studies [7],[8],[11] also reported almost same factors as the precipitating reasons for stress. We found a significantly high prevalence of stress in residents who were having children (44%) in comparison to those who were not having children (25%). This may be due to the extra role overload and increased family responsibility among those residents who have children. Sharma et al. in their study done on doctors in India in 2005 also described role overload in doctors that caused stress among them. [12]
In our study, it was seen that first-year residents had the highest prevalence of stress. This can be explained by the view that the first-year residents have a new level of role responsibility, increased workload (being the most junior resident of the hospital) in addition to education, and patient care activities. Schneider et al. in their study in 1993 in first year residents found a significant amount of anxiety and depression. [13]
A significant difference in stress between clinical and non-clinical departments might be due to extended duty hours, increased workload, and dealing with patient-related issues like managing relatives of patients in emergency situations, trauma cases, deaths, etc.
Further analysis revealed that overall about 60% residents in our study were satisfied with their job and wanted to pursue in the same profession. Comparable findings were also reported by Madaan et al.[11] and Cohen et al.,[9] respectively. Patient-related issues were associated with increased stress among resident doctors as was also revealed by other studies. [14]
Overall, 63.7% of residents were having close friends in their residency training. The prevalence of stress (42.7%) was significantly more in residents who did not have close friends in their residency training as compared to those residents who had close friends. Revicki et al.[15] in their study also reported that support of peers and work group reduced stress among the residents.
Residents who were not spending time with family and or friends were two times more likely to be in stress than residents whom were spending more time to the family and or friends. Earle et al.[16] also found in their study that 43.7% of residents turned to their family and or friends in hour of their need to relive stress. This finding can be explained by the fact that family and friends are the top-most supports in one's life and provide the social and mental security to a person.
Stress was found to be significantly more in residents who did their graduation from outside the Delhi. This can be explained by the adaptive demands faced by a resident in a new place which include relocation to another area, mastery of a new organizational system, change in living atmosphere, separation from the families and or friends, and lack of social life.
As it was a questionnaire-based study, the response made by the residents may not be true information. Since the data were collected over a period of 1 year and the sample included both the residents of pre-exam time and post-exam time, who did not have similar mental state, it could have influenced the findings of the study. Proportionate sampling was not applied in selecting residents working in clinical and non-clinical departments and the stress levels may differ between the two groups, so the results may not reflect the true prevalence of stress in entire resident doctors' population. Non-respondents in the study could have also affected the results.
There is also lack of studies using multivariate technique (logistic regression) for finding the risk factors for stress in resident doctors. Thus, more studies with appropriate methodology need to be conducted.
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[Table 1], [Table 2]
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