Factors related to the probability of suffering mental health problems in emergency care professionals

Cruz, Silvia Portero de la; Cruz, Jesús Cebrino; Cabrera, Javier Herruzo; Abellán, Manuel Vaquero

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Revista Latino-Americana de Enfermagem

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Original Article • Rev Lat Am Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.3079-3144 copy

Factors related to the probability of suffering mental health problems in emergency care professionals

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

to evaluate the influence of burnout and coping strategies used by health professionals of the hospital emergency service on their mental health status and to determine sociodemographic and labor characteristics.

Method:

descriptive cross-sectional study in a sample of 235 nursing professionals and physicians who worked in four hospital emergency services. The Maslach Burnout Inventory, the General Health Questionnaire and the Inventario Breve de Afrontamiento-cope 28 were used as data collection instruments and specific and original questionnaires of sociodemographic and labor variables. Descriptive, quantitative and multivariate statistics were applied.

Results:

the dimension of depersonalization, avoidance-centered coping and being a physician were related to the presence of somatic symptoms, anxiety, social dysfunction and depression. Increased professional experience was associated with greater social dysfunction among health personnel and increased number of patients was related to depressive symptoms among health professionals.

Conclusions:

the dimensions of emotional exhaustion and depersonalization, avoidance-centered coping, being a physician and a daily smoker increase the risk of a psychiatric case. The practice of daily physical exercise is a protective factor.

Descriptors:
Adaptation Psychological; Burnout Professional; Nursing; Occupational Health; Mental Health; Emergency Service Hospital

Variable		Frequency (Percentage) n=235
Sex
	Male	56 (23.8)
	Female	179 (76.2)
Daily physical exercise
	Yes	128 (54.5)
	No	107 (45.5)
Daily consumption of tobacco
	Yes	115 (48.9)
	No	120 (51.1)
Professional category
	Physician	64 (27.2)
	Nurse	171 (72.8)
Type of contract
	Fixed	156 (66.4)
	Provisional	58 (24.7)
	Eventual	21 (8.9)
Emotional exhaustion
	High	46 (19.6)
	Average	131 (55.7)
	Low	58 (24.7)
Depersonalization
	High	115 (48.9)
	Average	42 (17.9)
	Low	78 (33.2)
Personal fulfillment
	High	129 (54.9)
	Average	45 (19.1)
	Low	61 (26)
Psychiatric case
	Yes	76 (32.3)
	No	159 (67.7)
Variable		Mean (Standard deviation)
Time of work (years)		12 (9.4)
Professional experience (years)		22.7 (8.7)
Patients seen daily		102.4 (63.2)
Maslach Burnout Inventory
	Emotional exhaustion (points)	17.4 (11.3)
	Depersonalization (points)	8.7 (6.1)
	Personal achievement (points)	37.9 (8.4)
General Health Questionnaire
	Somatic symptoms	2.4 (2)
	Anxiety	2.5 (1.9)
Social dysfunction		2.3 (1.8)
	Depression	2 (2)
Inventario breve de afrontamiento - COPE 28
	Problem-centered coping (points)	1.5 (0.5)
	Emotion-centered coping (points)	1.3 (0.4)
	Avoidance-centered coping (points)	1.1 (0.5)

Variable		SS^* * SS: Somatic symptoms; (points) n=235	A^† † A: Anxiety. (points) n=235	SD^‡ ‡ SD: Social dysfunction; (points) n=235	D^§ § D: Depression. (points) n=235	PC^\|\| \|\| PC: Psychiatric case; (points) n=235	No PC^\|\| \|\| PC: Psychiatric case; (points) n=235
Variable		r Pearson^¶ ¶ Direct regression: somatic symptoms = 0.1 + 2 × avoidance-centered coping; Somatic symptoms = 1.5 + 0.02 × patients seen daily; Anxiety = −0.1 + 2.3 × avoidance-centered coping; Anxiety = 1.4 + 0.02 × patients seen daily; Social dysfunction = 3.8-0.9 × problem-centered coping; Social dysfunction = −0.02 + 2 × avoidance-centered coping; Social dysfunction = 1.6 + 0.03 × work experience; Social dysfunction = 1.7 + 0.01 × patients seen daily; Depression = 3.1 - 0.7 × problem-centered coping; Depression = −0.8 + 2.5 × avoidance-centered coping; Depression = 0.8 + 0.02 × patients seen daily;	r Pearson^¶ ¶ Direct regression: somatic symptoms = 0.1 + 2 × avoidance-centered coping; Somatic symptoms = 1.5 + 0.02 × patients seen daily; Anxiety = −0.1 + 2.3 × avoidance-centered coping; Anxiety = 1.4 + 0.02 × patients seen daily; Social dysfunction = 3.8-0.9 × problem-centered coping; Social dysfunction = −0.02 + 2 × avoidance-centered coping; Social dysfunction = 1.6 + 0.03 × work experience; Social dysfunction = 1.7 + 0.01 × patients seen daily; Depression = 3.1 - 0.7 × problem-centered coping; Depression = −0.8 + 2.5 × avoidance-centered coping; Depression = 0.8 + 0.02 × patients seen daily;	r Pearson^¶ ¶ Direct regression: somatic symptoms = 0.1 + 2 × avoidance-centered coping; Somatic symptoms = 1.5 + 0.02 × patients seen daily; Anxiety = −0.1 + 2.3 × avoidance-centered coping; Anxiety = 1.4 + 0.02 × patients seen daily; Social dysfunction = 3.8-0.9 × problem-centered coping; Social dysfunction = −0.02 + 2 × avoidance-centered coping; Social dysfunction = 1.6 + 0.03 × work experience; Social dysfunction = 1.7 + 0.01 × patients seen daily; Depression = 3.1 - 0.7 × problem-centered coping; Depression = −0.8 + 2.5 × avoidance-centered coping; Depression = 0.8 + 0.02 × patients seen daily;	r Pearson^¶ ¶ Direct regression: somatic symptoms = 0.1 + 2 × avoidance-centered coping; Somatic symptoms = 1.5 + 0.02 × patients seen daily; Anxiety = −0.1 + 2.3 × avoidance-centered coping; Anxiety = 1.4 + 0.02 × patients seen daily; Social dysfunction = 3.8-0.9 × problem-centered coping; Social dysfunction = −0.02 + 2 × avoidance-centered coping; Social dysfunction = 1.6 + 0.03 × work experience; Social dysfunction = 1.7 + 0.01 × patients seen daily; Depression = 3.1 - 0.7 × problem-centered coping; Depression = −0.8 + 2.5 × avoidance-centered coping; Depression = 0.8 + 0.02 × patients seen daily;	Mean (Standard deviation)	Mean (Standard deviation)
EE^ EE: Emotional exhaustion; (points)		0.1	0.2	0.2^†† †† p value <0.001.	0.1	18.7(11.8)	15.1(10.1)^‡‡ ‡‡ p value <0.01;
DP^§§ §§ DP: Depersonalization; (points)		0.01	0.1	0.04	0.04	8.7 (5.9)	8.7 (6.6)
PF^\|\|\|\| \|\|\|\| PF: Personal fulfillment; (points)		0.03	-0.03	-0.03	0.1	37.8 (8.5)	38.1 (8.2)
PCC^¶¶ ¶¶ PCC: problem-centered coping; (points)		-0.1	-0.1	-0.3^†† †† p value <0.001.	-0.2^‡‡ ‡‡ p value <0.01;	1.5 (0.5)	1.6 (0.5)
ECC^* ***** ECC: emotion-centered coping; (points)		0.2	0.1	0.1	0.2	1.3 (0.4)	1.2 (0.4)
ACC^{†† †} †† † ACC: avoidance-centered coping; (points)		0.5^†† †† p value <0.001.	0.6^†† †† p value <0.001.	0.5^†† †† p value <0.001.	0.6^†† †† p value <0.001.	1.3 (0.4)	0.8 (0.3)
Age (years)		0.1	0.1	0.1	0.1	49.1 (7.3)	46.7 (8.9)^‡‡ ‡‡ p value <0.01;
Time of work (years)		-0.1	-0.04	-0.1	-0.1	11.5 (9.6)	13.1 (9.1)
Professional experience (years)		0.1	0.1	0.1^‡‡ ‡‡ p value <0.01;	0.1	23.3 (9)	21.4 (7.8)
Patients seen daily		0.2^†† †† p value <0.001.	0.3^†† †† p value <0.001.	0.2^†† †† p value <0.001.	0.3^†† †† p value <0.001.	55.8(23.2)	43.3 (248)
		Mean (Standard deviation)	Mean (Standard deviation)	Mean (Standard deviation)	Mean (Standard deviation)	n (%)	n (%)
Sex
	Male	2.2 (2)	2.2 (1.9)	2.1 (1.8)	2 (2)	34 (60.7)	22 (39.3)
	Female	2.5 (1.9)	2.6 (1.9)	2.4 (1.8)	2 (2)	120 (67)	59 (33)
Marital status
	Married	1.9 (1.9)	2.1(2.1)	1.9 (1.9)	1.4 (2)	27 (50.9)	26 (49.1)
	Single	2.5 (2)	2.6 (1.9)	2.4 (1.8)	2.1 (2)	98 (67.6)	47 (32.4)
	Separated/divorced	2.8 (1.9)	2.7 (1.7)	2.8 (1.6)	2.4 (1.9)	22 (81.5)	5 (18.5)
	Widowed	2.2 (2.2)	2.8 (2)	2.7 (2.2)	2.2 (1.9)	7 (7)	3 (30)
Daily physical exercise
	Yes	2 (1.8)	2.2 (2)	2 (1.8)	1.7 (2)	94 (73.4)	34 (26.6)
	No	2.7 (2)^†† †† p value <0.001.	2.7 (1.9)	2.6(1.8)^‡‡ ‡‡ p value <0.01;	2.3 (1.9)	60 (56.1)	47 (43.9)^‡‡ ‡‡ p value <0.01;
Daily consumption of tobacco
	Yes	2.6 (1.9)	2.6 (1.9)	2.4 (1.9)	2.3 (2)	83 (72.2)	32 (27.8)
	No	2.2 (2)	2.3 (2)	2.3 (1.8)	1.7 (1.9)	71 (59.2)	49 (40.8)^‡‡ ‡‡ p value <0.01;
Professional category
	Physician	2.9 (1.8)	3.3 (1.6)	2.9 (1.7)	2.9 (1.7)	54 (84.4)	10 (15.6)
	Nurse	2.2 (2)^†† †† p value <0.001.	2.2 (2)^†† †† p value <0.001.	2.1(1.8)^†† †† p value <0.001.	1.7 (2)^†† †† p value <0.001.	100 (58.5)	71 (41.5)^‡‡ ‡‡ p value <0.01;
Type of contract
	Fixed	2.5 (1.9)	2.6 (1.9)	2.5 (1.8)	2.1 (2)	106 (67.9)	50 (32.1)
	Provisional	2 (2.1)	1.9 (2)	1.9 (1.8)	1.7(2)^‡‡ ‡‡ p value <0.01; ^‡‡‡ ‡‡‡ Significance obtained by the analysis of variance and Scheffé's method for later comparisons: significant versus eventual difference	24 (52.2)	32 (47.8)
	Eventual	2.6(2.1)	3 (2.1)	2.3 (1.8)	2 (2)	14 (60.9)	9 (39.1)

Variable		Somatic symptoms^* * Coefficient of determination adjusted for the subscale of somatic symptoms = 23.8%, F = 25.4, p <0.001;				Anxiety^† † Coefficient of determination adjusted for the anxiety subscale = 34.9%, F = 21.9, p<0.001;
		Gross estimate		Adjusted estimate^‡ ‡ Adjustment variables: age and sex;		Gross estimate		Adjusted estimate^‡ ‡ Adjustment variables: age and sex;
		Coef ß	P-value	Coef ß	P-value	Coef ß	P-value	Coef ß	P-value
EE^§ § EE: Emotional exhaustion; (points)		0.02	0.1			0.03	0.1
DP^\|\| \|\| DP: Depersonalization; (points)		0.1	0.03	0.02	0.01	0.01	0.02	0.1	0.01
PF^¶ ¶ PF: Personal fulfillment; (points)		-0.04	0.9			-0.2	0.2
PCC^ PCC: problem-centered coping; (points)		-0.3	0.2			-0.2	0.4
ECC^†† †† ECC: emotion-centered coping; (points)		0.2	0.6			-0.4	0.2
ACC^‡‡ ‡‡ ACC: avoidance-centered coping (points)		1.9	0.001	2	0.0001	2.3	0.002	2	0.001
Age (years)		0.03	0.2			-0.3	0.7
Time of work (years)		0.6	0.7			-0.4	0.1
Professional experience (years)		0.02	0.2			0.01	0.5
Patients seen daily		0.2	0.4			0.2	0.1
Sex
	Female	1 (Ref.)	0.7			1 (Ref.)	0.4
	Male	0.1	0.7			0.2	0.4
Marital status
	Married	1 (Ref.)				1 (Ref.)
	Single	0.3	0.3			0.3	0.8
	Separated/divorced	0.8	0.9			0.1	0.8
	Widowed	0.6	0.3			0.6	0.4
Daily physical exercise
	Yes	1 (Ref.)				1 (Ref.)
	No	0.7	0.1			0.3	0.1
Daily consumption of tobacco
	Yes	1 (Ref.)				1(Ref.)
	No	0.3	0.2			0.2	0.4
Professional category
	Physician	0.4		0.3		0.8		0.7
	Nurse	(1 Ref.)	0.01	(1 Ref.)	0.02	(1 Ref.)	0.01	(1 Ref.)	0.001
Type of contract
	Fixed	1 (Ref.)				1 (Ref.)
	Provisional	0.2	0.3			0.4	0.2
	Eventual	0.3	0.5			0.7	0.1

Variable		Social dysfunction^* * Coefficient of determination adjusted for the social dysfunction subscale = 36.7%, F = 23.6, p <0.001;				Depression^† † Coefficient of determination adjusted for the subscale of depression = 40.6%, F = 33.1, p <0.001;
		Gross estimate		Adjusted estimate^‡ ‡ Adjustment variables: age and sex;		Gross estimate		Adjusted estimate^‡ ‡ Adjustment variables: age and sex;
		Coef ß	P-value	Coef ß	P-value	Coef ß	P-value	Coef ß	P-value
AE^§ § EE: Emotional exhaustion; (points)		0.02	0.1			0.04	0.3
DP^\|\| \|\| DP: Depersonalization; (points)		0.1	0.2			0.1	0.1
PF^¶ ¶ PF: Personal fulfillment; (points)		-0.01	0.4			-0.1	0.6
PCC^ PCC: problem-centered coping; (points)		-1	0.001	-1	0.002	-0.8	0.5
ECC^†† †† ECC: emotion-centered coping; (points)		0.1	0.8			0.2	0.4
ACC^‡‡ ‡‡ ACC: avoidance-centered coping (points)		2	0.004	2	0.001	0.2	0.01	0.2	0.03
Age (years)		-0.02	0.2			-0.03	0.1
Time of work (years)		-0.02	0.2			-0.2	0.7
Professional experience (years)		0.3	0.04	0.5	0.04	0.03	0.1
Patients seen daily		0.3	0.3			0.32	0.01	0.4	0.04
Sex
	Female	1 (Ref.)	0.3			1 (Ref.)	0.4
	Male	0.2				0.2
Marital status
	Married	1 (Ref.)				1 (Ref.)
	Single	0.03	0.9			0.2	0.5
	Separated/divorced	0.1	0.9			0.4	0.5
	Widowed	0.4	0.3			0.4	0.3
Daily physical exercise
	Yes	0.4	0.1			0.4	0.1
	No	1 (Ref.)				1 (Ref.)
Daily consumption of tobacco
	Yes	1 (Ref.)				1 (Ref.)
	No	-0.1	0.03			-0.5	0.3
Professional category
	Physician	0.4		0.5		1.3		2.1
	Nurse	1 (Ref.)	0.02	(1 Ref.)	0.03	(1 Ref.)	0.01	(1 Ref.)	0.001
Type of contract
	Fixed	1 (Ref.)				1 (Ref.)
	Provisional	-0.2	0.4			0.02	0.9
	Eventual	0.2	0.5			0.2	0.6

Variable^* * Dependent variable: presence/absence of probable psychiatric cases detected by the General Health Questionnaire (≤6 points: normal probability, no case and 7 points: probable psychiatric case);		Gross Odds Ratio (CI^† † Confidence interval; 95%)	P-value	Adjusted Odds Ratio ^‡ ‡ Adjustment variables: age and sex; ,^§ § Probability ratio test = 35.2, R2 of Nagelkerke = 0.6, Area under the ROC curve = 0.9, p <0.001; (CI^† † Confidence interval; 95%)	P-value
EE^\|\| \|\| EE: Emotional exhaustion; (points)		1.03 (1.01 – 1.06)	0.02	1.07 (1.02 – 1.11)	0.01
DP^¶ ¶ DP: Depersonalization; (points)		1.97 (1.92 – 1.99)	0.01	1.87 (1.80 – 1.94)	0.001
PF^ PF: Personal fulfillment; (points)		1.14 (0.95 – 1.23)	0.19
PCC^†† †† PCC: problem-centered coping; (points)		0.61 (0.34 – 1.06)	0.08
ECC^‡‡ ‡‡ ECC: emotion-centered coping; (points)		2.09 (0.98 – 4.44)	0.06
ACC^§§ §§ ACC: avoidance-centered coping (points)		3.98 (3.91 – 4.87)	0.01	4.37 (3.51 – 6.78)	0.001
Age (years)		1.04 (0.87 – 1.07)	0.17
Time of work (years)		0.98 (0.95 – 1)	0.20
Professional experience (years)		1.02 (0.99 – 1.06)	0.12
Patients seen daily		1.02 (0.95 – 1.03)	0.07
Sex
	Female	1.32 (0.71 – 2.45)	0.39
	Male	1 (Ref.)	0.39
Marital status
	Married	1 (Ref.)
	Single	0.28 (0.16 – 1.20)	0.33
	Separated/divorced	0.84 (0.67 – 2.35)	0.28
	Widowed	0.63 (0.24 – 1.51)	0.16
Daily physical exercise
	Yes	0.16 (0.10 – 0.74)		0.30 (0.22 – 0.44)
	No	1 (Ref.)	0.01	1 (Ref.)	0.01
Daily consumption of tobacco
	Yes	1.79 (1.03 – 3.09)	0.04	2.38 (1.14 – 5)	0.02
	No	1 (Ref.)	0.04	1 (Ref.)
Professional category
	Physician	1.26 (1.12 – 1.55)	0.01	1.30 (1.12 – 1.78)	0.01
	Nurse	1 (Ref.)		1 (Ref.)
Type of contract
	Fixed	1 (Ref.)
	Provisional	0.20 (0.12 – 1.43)	0.53
	Eventual	0.31 (0.25 – 1.05)	0.39

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Autor correspondente: Silvia Portero de la Cruz E-mail: n92pocrs@uco.es