The role of personality in stress, burnout and help-seeking. A ten-year longitudinal study among Norwegian medical students and early career physicians
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AbstractPrevious research has shown elevated levels of stress among physicians compared to the general population and other academics, and emotional pressure and demanding patient work are associated with mental health problems. Burnout impairs physician health and well-being and patient satisfaction and care, and has been pointed out as a major contributor to absenteeism and long sick leaves in physicians, thus affecting negatively health economics. Doctors tend to treat themselves and not seek help from others, thus reducing their chance of getting good treatment. There is a lack of studies with a longitudinal design that explore the development of physician stress, burnout and mental health problems through different phases of the career. The impact of personality dimensions in stress among doctors has been explored in a number of cross-sectional studies, but we lack knowledge on how personality dimensions interact in relation to stress.
Against this background, the present study explored the development of perceived stress, burnout and help-seeking among medical students and doctors in their early career. Predictors and concurrent explanatory variables of stress and burnout over time were explored. Are levels of perceived burnout among Norwegian physicians deviant from those in the general working population? The link between personality and experienced stress, burnout and help-seeking was put under scrutiny and the personality dimensions were explored: what role does the interplay between neuroticism, extraversion, and conscientiousness play in stress? Does conscientiousness moderate the stress related to neuroticism?
Materials and methods
The present thesis is based on two cohorts surveyed four times over 10 years by postal questionnaire. One cohort consisted of all the students at all four universities in Norway who started their medical education in 1993 (N = 379). The other cohort consisted of all the medical students at all the four universities in Norway who graduated in 1993 and 1994 (N = 522). Dependent variables were job stress, mental distress, work-home interference stress, burnout, and help-seeking for mental health problems in need of treatment. Personality was an ever-present predictor in all the papers of the study. Personality was assessed with dimensions of neuroticism, extraversion, and conscientiousness, but personality types were also used, based on dichotomization of the dimensions. Predictors also covered stressors, support, working conditions and autonomy. The longitudinal design enables the study of development of stress over time and also allows prediction over time to discover possible risk factors. A random sample of the general Norwegian working population (N = 1001) was used for comparison of burnout levels.
The level of perceived medical school stress was on a modest level of 2.5 on a scale from 1 to 5, and did not change from the third to the sixth year in the medical student cohort. Women reported higher level of overall perceived medical school stress than men. The level of emotional pressure, time pressure, fear of complaints, and work-home interference stress started off in internship at about 2.5 on a scale from 1-low to 5- high. The level of emotional pressure, time pressure and fear of complaints decreased from the fourth to the 9th postgraduate year, whereas the level of work-home interference stress increased in the same period. The level of emotional exhaustion was higher than amongst the general working population, and did not change significantly throughout the first eight postgraduate years. The level of treatment-needing mental health problems increased from the first to the fourth postgraduate year, from 11% to 17% with no subsequent augmentation of help-seeking.
The personality traits of neuroticism and conscientiousness predicted independently perceived medical school stress. Neuroticism, work-home interference and lack of colleague support predicted emotional exhaustion in an adjusted model. High levels of reality weakness were independently associated with low degree of help-seeking. As regards personality types, “Brooders”, with a combination of high neuroticism and high conscientiousness, were the most prone to report perceived stress, both in the medical curriculum and in the 1st postgraduate year. “Hedonists” on the other hand, with low neuroticism and low conscientiousness, were the least prone to report stress in the medical curriculum and in the 1st postgraduate year. Neuroticism, together with high or low conscientiousness, as well as low support, predicted stress related to balancing work and home life in young doctors.
Medical school stress persisted from mid-curriculum to the last year, stress related to demanding patient work declined, and stress related to the work-home interference increased in the first nine postgraduate years. Burnout levels were on a somewhat elevated level compared to the general working population. Male physicians compared were more burnt out than other male academic workers. A combination of high neuroticism and high conscientiousness is unfavourable with regard to stress, and reality weakness is associated with low help-seeking.
List of papers
I Røvik JO, Tyssen R, Gude T, Moum T, Ekeberg Ø, Vaglum P. Exploring the interplay between personality dimensions: A comparison of the typological and the dimensional approach in stress research. Personality and Individual Differences 2007;42:1255–66. doi:10.1016/j.paid.2006.10.004
II Tyssen R, Dolatowski FC, Røvik JO, Thorkildsen RF, Ekeberg Ø, Hem E, Gude T, Grønvold NT, Vaglum P. Personality traits and types predict medical school stress: a nationwide longitudinal study. Medical Education 2007; 41:781-7. doi:10.1111/j.1365-2923.2007.02802.x
III Røvik JO, Tyssen R, Hem E, Gude T, Ekeberg Ø, Moum T, Vaglum P. Job Stress in Young Doctors, with Emphasis on the Work-Home Interface. A Nine-Year Nationwide and Longitudinal Study of Course and Predictors. Industrial Health 2007; 45: 661-70. http://www.jniosh.go.jp/old/niih/en/indu_hel/index.html
IV Røvik JO, Tyssen R, Hem E, Gude T, Falkum, E, Ekeberg Ø, Vaglum P. Emotional Exhaustion among Early Career Physicians: A nationwide nineyear longitudinal and comparison study of levels and predictors. Submitted.
V Tyssen R, Røvik JO, Vaglum P, Grønvold NT, Ekeberg Ø. Help-seeking for mental health problems among young physicians: is it the most ill that seeks help? Soc Psychiatry Psychiatr Epidemiol 2004;39:989-93. doi:10.1007/s00127-004-0831-8