Occupational stress in consultants in accident and emergency medicine: a national survey of levels of stress at work

Abstract

Objective: To assess levels of occupational stress in UK accident and emergency (A&E) consultants. Method: Postal survey of complete enumeration of UK consultants. Main outcome measures: GHQ-12 and SCL-D, and respondents' reported perceptions of stressors. Results: Of 371 valid respondents (78%), 21 declined to participate. Of the remaining 350, 154 (44.4%) had GHQ-12 scores over the threshold for distress, which is much higher than found in other studies of doctors. Levels of depression as measured by the SCL-D at 18% (n=63) were slightly higher than other groups. Thirty four (10%) reported suicidal ideation. Women had significantly higher SCL-D scores than men (U=6604, p<0.01). Respondents were highly satisfied with A&E as a specialty. Protective factors found in other occupational groups did not apply. Only one demographic or work related factor; number of hours reportedly worked during previous week by respondents in full time posts (median=57, interquartile range=57), significantly correlated with either stress outcome measure (GHQ-12 scores) (ρ=0.126, p<0.03). Logistic regression modelling revealed "being overstretched" (OR=1.18), "effect of hours (OR=0.82) and stress (OR=1.58) on family life", and "lack of recognition" (OR=1.32) were significant predictors of GHQ identified caseness, while "the effect of stress on family life" (OR=1.53), low prestige of specialty (OR=1.20), and "dealing with management" (OR=1.28) predicted SCL-D scores. Conclusion: There are high levels of psychological distress among doctors working in A&E compared with other groups of doctors. There is likely to be an effect on staff morale and career longevity. Interventions to improve the working lives of A&E consultants are required, in particular a reduction in hours worked.O ccupational stress is a recognised problem in health care workers. Doctors are considered to be at particular risk, 1 with suicide rates among medical practitioners higher than in similar professional groups.2 3 Stress can lead to serious ill health, 4 affect career longevity, and cause personal distress.Accident and emergency (A&E) is an evolving specialty in the UK where consultants face particular challenges such as unpredictable workload, high patient attendances, limited resources, repeated exposure to traumatic events, potentially violent situations, and critical decision making often based on incomplete information. Studies of other groups of doctors show psychological morbidity levels of between 21% and 28%, 1 5 6 although one small scale study reported a level of 46%.7 Studies of distress in North American emergency physicians show mixed results. There are reports of high levels of burnout and stress, 8 but others have reported lower levels similar to those of UK studies. 9 An international study of emergency physicians reported high levels of stress and depression among UK A&E consultants compared with those from other countries, 10 although overall levels were not high. 11The last major study of UK based A&E consultants was based on data gathered in ...

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