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RESEARCH PRODUCT

The Mental Health of Primary Care Physicians in Rhineland-Palatinate, Germany

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description

Physicians are subject to intense occupational stress (e1– e3), and long-term stress harms their well-being. Health impairments such as high blood pressure (e4), burnout syndrome (e5, e6), depression (1– 3), and substance dependencies (e2, e7) have been linked to occupational stress. One established approach to the assessment of occupational stress is the so-called occupational gratification crisis model (4, 5), according to which stress arises when persistent hard work (effort) does not yield a corresponding gratification (reward). Another important component of this model is a personality-based tendency to devote excessive effort to work, to the individual’s own detriment (“overcommitment”). Physician surveys have revealed a high degree of stress according to this model (6, 7), as well as associations between stress and impaired mental health (2, 3, 8). Although occupational stress among physicians and its effects on physicians’ health have been thoroughly investigated in other countries, there have been no more than a few empirical studies to date on the situation among primary care physicians (PCPs) in Germany. All surveys of German PCPs until now have been inadequate in one (or both) of the following ways: The questions dealt exclusively with the quantity of work (working hours, number of patients), and no standardized instruments were applied for the assessment of subjective occupational stress (9); or else the relation of stress to the physicians’ health was not studied, at least not explicitly (10, 11, e8). Moreover, little attention has been devoted to the stress that physicians experience in their leisure time, which may be important, in view of the possibility of inadequate mental hygiene. Physicians’ health and mental health may also be influenced by personality traits such as resilience and the type D personality pattern. Emotional resilience is generally considered to be a protective factor against health impairments (e9– e11), while type D personality has been found to be a risk factor for various health problems (e12– e15). Type D persons readily fall into negative emotional states (“negative affectivity”), while also tending to suppress the expression of negative feelings (“social inhibition”) (12). We used standard instruments to study the effect of experienced stress and personality-related factors on the health of German PCPs. Our a priori expectations were that occupational stress, stress during leisure time, and the type D personality pattern would be positively associated with impaired mental health, while resilience would be negatively associated with impaired mental health.