Research on the relationship between occupational burnout and depression of medical staff in medical institutions in Liaoning Province
Project leader: Wang Huiqiu
Research group member: Huang Chuanhao Gao Dejiang Sui Xiangjun
Project undertaking unit: Shenyang Anning Hospital
Scientific research results release platform: Liaoning Provincial Society of Social Sciences, Liaoning Provincial Law Society Labor Law Research Association, Liaoning Provincial Society Labor Society 3 (2022) Excellent scientific research results release conference, 2022-10-31, Liaoning. Shenyang
[Abstract] Purpose discusses the relationship between the exhaustion of occupational value, occupational emotional failure and depression of medical personnel under the COVID-19 pandemic. Method Using the questionnaire survey method, 643 medical staff from Liaoning Province were selected as the survey subjects, and a self-compiled natural situation questionnaire, burnout scale and PHQ-9 were used for the questionnaire survey. Results The scores of medical staff's burnout in each dimension are: emotional failure (M=10.16, SD=6.76); depersonalization (M=5.45, SD=5.19); and personal sense of accomplishment (M=11.29, SD=9.64). The depressed mood is: 44.6% of the subjects who scored 0-4 were not depressed; 25.2% of the subjects who scored 5-9 were likely to have mild depression; 22.9% of the subjects who scored 10-14 were likely to have moderate depression; 5.1% of the subjects who scored 15-19 were likely to have moderate depression; 20-27 were likely to have severe depression. Taking occupational emotional failure as the mediating variable, occupational value failure is independent variable , and depression is dependent variable, a structural equation model is established, and the model is well fitted (2=838.525, df=238, RMSEA=0.063, SRMR=0.053, TLI=0.948, CFI=0.955). Conclusion The depression emotional state of medical staff cannot be ignored under the COVID-19 pandemic. Medical staff’s burnout and depression emotional state can be intervened and regulated through multiple dimensions of individual, organization and society.
Keywords: medical staff; burnout; depression; intermediary model
Under the outbreak of the new crown epidemic in the past two years, medical staff have well explained to the people of the world "what is great love" and "what is the mission of saving lives and helping the wounded". The doctors have well implemented their vows "to seek happiness for patients, do their best to relieve human illnesses, help the perfection of health, maintain the holiness and honor of medical skills, save lives and help the wounded, and pursue them unyieldingly without giving up hardships." But it cannot be ignored that the work of medical staff is characterized by high risk, high pressure, large workload and unstable working and rest time [1]; in the face of diseases, medical staff often feel the helplessness of "seldom cured and always comforting", and these confusions also force medical staff to doubt their own sense of professional value.
A related survey shows that 44% of doctors feel burnout, 4% of doctors have had clinically diagnosed depressive disorder [2], and the condition of depression is more significant [3]. This study explores the relationship between the exhaustion of professional value, occupational emotional failure and depression in medical staff.
1 Objects and methods
1.1 Research methods
This study uses survey method , and data collection is carried out through the "Query Network", and questionnaires are distributed to medical staff in Liaoning. A total of 643 data are collected.
1.2 The age range of the subjects of the study
was 19-67 years old (M=48.85, SD=15.346); among them 186 males (28.93%) and 457 females (71.07%); the main survey group was Shenyang (73.52%) medical staff, of which 94.25% of the subjects were medical staff in public hospitals; among them, 74.65% of the subjects were employed in tertiary hospitals, , 20.37% of the subjects worked in secondary hospitals, and the others worked in first-level hospitals; the working years ranged from 0-45 years (M=16.41, SD=12.638 ); among them, senior professional titles account for 28.77%, intermediate professional titles account for 31.57%, junior professional titles account for 36.39%; among the subjects, there were 27 college leaders and 136 middle-level cadres; the subjects had postgraduate students and above, accounting for 16.49% of the total number of people surveyed, 62.36% of the bachelor's degree, and 16.17% of the college degree; the subjects had a monthly income of more than 10,000 yuan, and the majority of the subjects had a monthly income of 5,000-8,000 yuan accounted for 50% of the total number; they were very satisfied with their income, 31.42% were relatively satisfied, 36.55% felt average, and 20.22% were dissatisfied with their income or were very dissatisfied with their income.
1.3 Research tool
Natural Situation Survey Self-compiled natural situation questionnaire collecting relevant information of medical personnel, including 17 issues including gender, age, service life, hospital nature, income, etc.
Burnout Measurement This study used the MBI-GS scale [4] (Chinese version) compiled by Maslach, which included 15 items and three factors: the emotional failure scale (5 items); the depersonalization scale (4 items); the personal sense of accomplishment scale (6 items); the questionnaire was scored by Likert seven points, including: never, rarely, occasionally, frequently, frequently, very frequent, and daily, with scores of 0-6 points respectively, and the personal sense of accomplishment was scored in reverse. The higher the score, the higher the level of burnout. The project was analyzed for confirmatory factors, and the model was fitted well (2=388.816, df=84, RMSEA=0.075, SRMR=0.046, TLI=0.958, CFI=0.967), with factor loads of 0.704~0.931, and the internal consistency ɑ coefficients of the three dimensions were 0.929, 0.952, and 0.908, respectively. In this study, the depersonalized scale and the personal sense of accomplishment scale dimension were used as the participants’ scores for the occupational value of medical work, and the emotional failure scale dimension was used as the scores for the occupational emotional failure of medical staff.
Depression Emotion Measurement PHQ-9[5] is a 9-item self-evaluation tool prepared based on the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) as the standard for major depression disorders, which is easy to use in clinical practice. This scale has been translated into multiple languages, and it is used in different groups to show that it has good reliability and validity. It has become one of the preferred tools for screening depression in primary medical care abroad. The scale contains 9 items in total, and uses a 0-4-point scoring method, including: no, a few days, more than half of the time, almost every day. The higher the score, the higher the depression. After calculating the total score, 0-4 points indicate no depression; 5-9 points may have mild depression; 10-14 points may have moderate depression; 15-19 points may have moderate depression; 20-27 points may have severe depression. All items were analyzed in one-factor, the model was fitted well (2=99.712, df=21, RMSEA=0.076, SRMR=0.027, TLI=0.962, CFI=0.978), the factor load was 0.533~0.822, and the internal consistency ɑ coefficient was 0.895. This study used the scores from this scale as participants’ depression scores.
1.4 Statistical method
This study used SPSS18.0 for data management, descriptive statistics and related analysis, and used Mplus7.4 for confirmatory factor analysis and mediation model establishment.
2 Results
2.1 Descriptive statistical analysis of occupational burnout and depression of medical staff
After the reverse score of personal sense of accomplishment, the total scores of each dimension in the score of the occupational burnout questionnaire are as follows: emotional failure (M=10.16, SD=6.76); depersonalization (M=5.45, SD=5.19); personal sense of accomplishment (M=11.29, SD=9.64). 44.6% of the subjects who scored
0-4 without depression accounted for 44.6%; 25.2% of the subjects who scored 5-9 may have mild depression accounted for 22.9% of the subjects who scored 10-14 may have moderate depression accounted for 5.1% of the subjects who scored 15-19 may have moderate depression accounted for 2.2% of the subjects who scored 20-27 may have severe depression accounted for 2.2%.
2.2 Correlation analysis of occupational burnout and depression among medical staff
Correlation analysis of each dimension of depression and burnout, and the results obtained are shown in Table 2-1:
Table 2-1 Correlation analysis of depression and burnout among medical staff
variable | depressive emotions | emotional exhaustion | depersonalization | personal sense of achievement | |||||
dedepressive emotions | - | ||||||||
Emotional failure | - | - | |||||||
Depersonalization | - | ||||||||
Personal sense of accomplishment | - |
** indicates that it is significantly related to 0.01 level (bilaterally)
2.3 The structural equation model fitting test of medical staff's sense of burnout and depression
2.3.1 Common method deviation test
0 Since the research data are measured using the questionnaire method , confirmatory factor analysis is used to test the common method deviation problem, involving all the questions corresponding to the three research variables: depression, occupational value exhaustion, and occupational emotional failure, and the number of common factors is 1[6]. The results show that the model fit index is poor (2=5804.764, df=252, RMSEA=0.185, SRMR=0.157, TLI=0.545, CFI=0.585), indicating that there is no serious common method bias in the data in this study.
2.3.2 Mediation model fitting test
According to the mediation effect testing process proposed by Wen Zhonglin and Ye Baojuan [7], first, a simple regression analysis model was established based on occupational value exhaustion as the independent variable and depression as the dependent variable. The results show that the model fits well (2=497.352, df=141, RMSEA=0.063, SRMR=0.046, TLI=0.953, CFI=0.961), and occupational value failure has a significant positive predictive effect on depression (β=0.831, p<0.001).>
uses occupational value exhaustion as the independent variable, occupational emotional exhaustion as the mediating variable, and depression as the dependent variable, and establishes a latent variable mediating model. The data fit is good (2=838.525, df=238, RMSEA=0.063, SRMR=0.053, TLI=0.948, CFI=0.955). As can be seen from Figure 2-1, occupational emotional exhaustion has a significant mediating effect between occupational value exhaustion and depression.
Figure 2-1 Path regression coefficient of the mediation model
Note: ＊＊p＜0.001
3 Discussion
From previous research results [8-9], medical staff's sense of occupational burnout is generally high, and its influencing factors are mainly high work pressure, lack of motivation, need to maintain a continuous sense of tension at work, and often feel frustration [10]; in addition to the pressure of work itself, personal factors of medical staff will also affect the degree of their sense of occupational burnout [11]; and organizational factors, such as interpersonal relationships, superior-subordinate relationships, and income situations, will also lead to differences in the sense of occupational burnout of medical staff [12]; finally, the society's expectations for medical staff are also invisible pressure on medical staff, such as conflicts in the relationship between doctors and patients [13].
Depression is the most important clinical symptom of depression disorder. Depression can be manifested as slow movements and inattention at work. These states will reduce the quality of work of medical staff and even cause the risk of medical accidents [14]. In this study, nearly half of the subjects did not have depression, but we cannot ignore that there are still many medical staff with mild to moderate depression, and a small number of subjects even have moderate and severe depression.It can be seen from the results of the relevant analysis that the burnout and depression levels of medical staff are positively correlated, that is, the higher the burnout, the higher the depression level.
In this study, we used occupational emotional exhaustion as the mediating variable to establish a relationship model between occupational value burnout and depression in medical staff. It can be seen from the model diagram that whether medical staff can effectively complete their work and their understanding of their work value will affect their work mood, and thus affect their own depression. Fundamentally speaking, if we try to relieve the depression of medical staff, we first need to let medical staff have a reasonable and positive understanding of their own work. The reason why medical staff have doubts or negative thoughts about their own work is mainly reflected in the following three aspects: 1. Questioning the significance and value of work; 2. There is no high sense of self-efficacy for completing work; 3. The work has not been recognized by the society or the organization.
Therefore, in view of the above research results, the following relevant suggestions are put forward from the personal, organizational and social aspects of medical staff [15]: For individuals, medical staff need to correctly understand their work responsibilities and improve their professional level as much as possible. Medical staff have higher work competence in order to have a higher sense of self-efficacy for their work; at the organizational level, 1. Hospitals of different levels only represent different places of work where medical workers work, and they cannot divide the importance of labor by the hospital level alone, 2. Standardize the preparation of medical systems, Really achieve " equal pay for equal work ", 3. Improve the welfare benefits of medical staff with junior professional titles, give them more room for growth, and standardize the promotion mechanism of the medical system ; from the social level, increase the social status of medical staff, continue to advocate the media to positively publicize the work of medical staff, increase the professional pride of medical staff, and improve the salary and benefits of medical staff, so that medical staff can experience the importance of this profession and the importance of society when compared with other professions.
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