Stress and psychiatric disorder in healthcare professionals and hospital staff

Background Previous studies of stress in healthcare staff have indicated a probable high prevalence of distress. Whether this distress can be attribut ed to the stressful nature of the work situation is not clear. No previous study has used a detailed interview method to ascertain the link between st ress in and outside of work and anxiety and depressive disorders. Methods Doctors, nurses, and administrative and ancillary staff were screen ed using the general health questionnaire (GHQ). High scorers (GHQ>4) and m atched individuals with low GHQ scores were interviewed by means of the cli nical interview Schedule to ascertain definite anxiety and depressive disor ders (cases). Cases and controls, matched for age, sex, and occupational gr oup were interviewed with the life events and difficulties schedule classif ication and an objective measure of work stress to find out the amount of s tress at work and outside of work. Sociodemographic and stress variables we re entered into a logistic-regression analysis to find out. the variables a ssociated with anxiety and depressive disorders. Findings 64 cases and 64 controls were matched. Cases and controls did not differ on demographic variables but cases were less likely to have a confid ant (odds ratio 0.09 [95% CI 0.01-0.79]) and more likely to have had a prev ious episode of psychiatric disorder (3.07 [1.10-8.57]). Cases and controls worked similar hours and had similar responsibility but cases had a greate r:number of objective stressful situations both in and out of work (severe event or substantial difficulty in and out of work-45 cases vs 18 controls 6.05 [2.81-13.00], p<0.001; severe chronic difficulty outside of work-27 vs 8, 5.12 [2.09-12.46], p<0.001). Cases had significantly more objective wor k problems than controls (median 6 vs 4, z=3.81, p<0.001). The logistic-reg ression analyses indicated that even after the effects of personal vulnerab ility to psychiatric disorder and ongoing social stress outside of work had been taken into account, stressful situations at work contributed to anxie ty and depressive disorders. Interpretation Both stress at work and outside of work contribute to the an xiety and depressive disorders experienced by healthcare staff. Our finding s suggest that the best way to decrease the prevalence of these disorders i s individual treatment, which may focus on personal difficulties outside of work, combined with organisational attempts to reduce work stress. The lat ter may involve more assistance for staff who have a conflict between their managerial role and clinical role.