Is Longer Working Time Associated with Depression and Mental Well-being in Resident and Young Doctors?
DOI:
https://doi.org/10.26911/thejhpm.2024.09.02.11Abstract
Background: Long working hours are known to have a negative impact on health. This study aims to explore the association between long working hours on depression and mental well-being with a nationally representative sample.
Subjects and Method: A cross-sectional study was conducted on 176 resident doctors and young doctors in Indonesia via Google Forms from November 2022 to July 2023. Depression and mental well-being were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the World Health Organization's five-item Well-Being Index (WHO-5). The correlation between working hours (< 12 hours and ≥ 12 hours on weekdays) and depression was analyzed using multiple linear regression, while the interrelation between working hours and mental well-being applied multiple logistic regression.
Results: A total of 53 (30.11%) resident doctors and junior doctors worked ≥ 12 hours on weekdays. Multiple linear regression analysis revealed that individuals with work duration ≥ 12 hours had a probability of experiencing depression 1.93 units higher than those who worked < 12 hours (b= 1.93; 95% CI= 0.35 to 3.51; p= 0.017). The multiple logistic regression model shows that individuals with work periods of ≥ 12 hours are 2.69 times more at risk of having poor mental well-being than those who work < 12 hours (OR= 2.69; 95% CI= 1.26 to 5.74; p= 0.010).
Conclusion: Working too long is significantly associated with the development of depressive symptoms and poor mental well-being. Management of working hours for resident doctors and young doctors is essential for maintaining physical and psychological health in order to improve the quality of care.
Keywords: long working hours, depression, mental well-being
References
Accreditation Council for Graduate Medical Education (2017). ACGME common program requirements section VI with background and intent.
Aksoy O, Bann D, Fluharty ME, Nandi A (2022). Religiosity and mental well-being among members of majority and minority religions: findings from understanding society: the UK house-hold longitudinal study. Am J Epide-miol. 191(1): 20–30. doi: 10.1093/aje-/kwab133.
Alothman OM, Alotaibi YM, Alayed SI, Alda-khil SK, Alshehri MA (2020). Prev-alence of depression among resident doctors in King Fahad Medical City, Riyadh, Saudi Arabia. Int J Pharm Res Allied Sci. 9(3): 81–86.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. Fifth Edition. Washington, DC: American Psychiatric Association. doi: 10.1176/appi.-books.9780890425596.
Assari S, Caldwell CH (2018). High risk of pepression in high income African American boys. J Racial Ethn Health Disparities. 5(4): 808–819. doi: 10.-1007/s40615-017-0426-1.
Barman P, Saha A, Dakua M, Roy A (2022). Does the intensity of religiosity and spirituality in later life improve mental well-being? evidence from India. J Relig Spiritual Aging (Preprint). doi: 10.1080/15528030.2022.2100560.
Binder M, Coad A (2013). “I’m afraid I have bad news for you…” estimating the impact of different health impairments on subjective well-being. Soc sci med. 87: 155–167. doi: 10.1016/j.socsci-med.2013.03.025.
Bondagji D, Fakeerh M, Alwafi H, Khan AA (2022). The effects of long working hours on mental health among resident physicians in Saudi Arabia. Psychol Res Behav Manag. 15: 1545–1557. doi: 10.2147/PRBM.S370642.
Brody DJ, Pratt LA, Hughes JP (2018). Prevalence of depression among adults aged 20 and over: United States, 2013-2016. NCHS data br. 1–8. https://-www.cdc.gov/nchs/data/databriefs/-db303_table.pdf#3. (Accessed: 29 July 2023).
Bugaj TJ, Krug K, Rentschler A, Nikendei C, Szecsenyi J, Schwill S (2020). Mental health of postgraduate trainees in primary care: a cross-sectional study. BMC Fam Pract. 21. https://doi.org/-10.1186/S12875-020-01199-6.
Castillo M (2015). The 3 pillars of health. AJNR Am J Neuroradiol. 36(1): 1–2. https://doi.org/10.3174/ajnr.A4025.
Chand SP, Arif H (2022). Depression. Stat-Pearls. StatPearls Publishing. https://-www.ncbi.nlm.nih.gov/books/NBK430847/. (Accessed: 22 May 2022).
Dewan Perwakilan Rakyat Republik Indone-sia (2021). Rancangan Undang-Undang tentang Pendidikan Kedok-teran. Jakarta.
Dian CN (2020). Validitas dan reliabilitas the patient health questionnare (PHQ-9) versi Bahasa Indonesia. Universitas Sumatera Utara.
Dimitriu A, Newsom R (2023). Depression and Sleep. https://www.sleepfounda-tion.org/mental-health/depression-andsleep.(Accessed: 23 July 2023).
Dreger S, Gerlinger T, Bolte G (2016). Gender inequalities in mental well-being in 26 European countries: do welfare regimes matter?. Eur J Public Health. 26(5): 872–876. https://doi.-org/10.1093/eurpub/ckw074.
Elias A, Brown AD (2022). The role of inter-generational family stories in mental health and wellbeing. Front Psychol. 13. https://doi.org/10.3389/fpsyg.20-22.927795.
Fang Y, Lodi S, Hughes TM, Frank E, Sen S, Bohnert ASB (2022). Work hours and depression in U.S. first-year physi-cians. N Engl J Med. 387(16). doi: 10.-1056/NEJMc2210365.
Fresna RH, Atikah SN, Salsabila MM, Pusparini PW, Purnasari RH, Anisa R, Oktaviyani F, et al. (2021). Gender differences in mental health responses of health workers during the Covid-19 pandemic: a systematic review with meta-analysis. J Health Policy Mana-ge. 06(02): 130–138. https://doi.org/-10.26911/thejhpm.2021.06.02.05.
Funkhouser CJ, Kaiser AJE, Alqueza KL, Carrillo VL, Hoffman LMK, Nabb CB, Auerbach RP, et al. (2021). Depression risk factors and affect dynamics: an experience sampling study. J Psychiatr Res. 135: 68–75. doi: 10.1016/j.jpsy-chires.2021.01.007.
Goodman SH, Gotlib IH (1999). Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev. 106(3): 458–490. doi: 10.1037/0033-295X.-106.3.458.
Gorham LS, Sadeghi N, Eisner L, Taigman J, Haynes K, Qi K, Camp CC, et al. (2022). Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling. J Child Psychol Psychiatry. 63(8): 939–947. doi: 10.1111/jcpp.13547.
Grundström J, Konttinen H, Berg N, Kiviruusu O (2021). Associations between relationship status and mental well-being in differentlLife phases from young to middle adulthood. SSM Popul Health. 14. https://doi.org/10.1016/j.ssmph.2021.100774.
Hameed TK, Masuadi E, Al Asmary NA, Al-Anzi FG, Al Dubayee MS (2018). A study of resident duty hours and burnout in a sample of Saudi residents. BMC Med Educ. 18(1). https://doi.-org/10.1186/s12909018-1300-5.
Hsu T-L, Barrett AE (2020). The association between marital status and psychological well-being: variation across negative and positive dimensions. SAGE Open. 41(11). https://doi.org/-10.1177/0192513X209101.
Jiang Y, Jiang T, Xu Li-T, Ding L (2022). Relationship of depression and sleep quality, diseases and general characteristics. World J Psychiatry. 12(5): 722–738. doi: 10.5498/WJP.V12.I5.-722.
Joules N, Williams DM, Thompson AW (2014). Depression in resident physicians: a systematic review. Open J Depress. 3: 89–100. doi: 10.4236/-ojd.2014.33013.
Kalmbach DA, Arnedt JT, Song PX, Guille C, Sen S (2017). Sleep disturbance and short sleep as risk factors for depression and perceived medical errors in first-year residents. Sleep. 40(3). doi: 10.1093/sleep/zsw073.
Kementerian Riset, Teknologi, dan Pendidikan Tinggi Republik Indonesia (2015). Peraturan Menteri Riset, Teknologi, dan Pendidikan Tinggi Republik Indonesia Nomor 44 Tahun 2015 tentang Standar Nasional Pendidikan Tinggi. Jakarta.
Koenig HG (2012). Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. 2012. 1–33. https://doi.org/10.5402/2012/-278730.
Kovacs M, Devlin B, Pollock M, Mukerji P (1997). A controlled family history study of childhood-onset depressive disorder. Arch Gen Psychiatry. 54(7): 613. doi: 10.1001/archpsyc.1997.0183-0190033004.
Kumar FDS, Vaingankar JA, Sambasivam R, Abdin E, Jeyagurunathan A, Seow E, Picco L, et al. (2019). Marital status and positive mental health of psychiatric outpatients. Ann Acad Med Singap. 48(12): 429–434. https://pub-med.ncbi.nlm.nih.gov/32112067/.
Li Z, Dai J, Wu N, Jia Y, Gao J, Fu H (2019). Effect of long working hours on depression and mental well-being among employees in Shanghai: the role of having leisure hobbies. Int J Environ Res Public Health. 16(24). doi: 10.3390/ijerph16244980.
Lin H, Lin E, Auditore S, Fanning J (2016). A narrative review of high-quality literature on the effects of resident duty hours reforms. Acad Med. 91(1): 140–150. https://doi.org/10.1097/ACM.-0000000000000937.
Lye M-S, Tey Y-Y, Tor Y-S, Shahabudin AF, Ibrahim N, Ling K-H, Stanslas J, et al. (2020). Predictors of recurrence of major depressive disorder. PLoS One. 15(3): e0230363. https://doi.org/10.-1371/journal.pone.0230363.
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S (2015). Prevalence of depression and depressive symptoms among resident physicians a systematic review and meta-analysis. J Am Med Assoc. 314(22): 2373–2383. https://-doi.org/10.1001/JAMA.2015.15845.
Maurice S, Beaton J, Ng V (2011). Family matters: does this mean the end of the 24-hour on-call shift for Canadian residents?. Can Fam Physician. 57(5): e192–e193. https://www.ncbi.nlm.-nih.gov/pmc/articles/PMC3093608/pdf/0570e192.pdf.
McGrath JJ, Wray NR, Pedersen CB, Mortensen PB, Greve AN, Petersen L (2014). The association between family history of mental disorders and general cognitive ability. Transl Psychiatry. 4(7): e412. https://doi.org/10.1038/T-P.2014.60.
Melo MCA, Das Chagas Medeiros F, De Bruin VMS, Santana JAP, Lima AB, De Francesco Daher E (2016). Sleep quality among psychiatry residents. Can J Psychiatry. 61(1): 44–49. https:-//doi.org/10.1177/07-06743715620410.
Mirza W, Mirza AM, Saleem MS, Chacko PP, Ali M, Tarar MN, Babar A, et al. (2018). Well-being assessment of medical professionals in progressive levels of training: derived from the WHO-5 well-being index. Curēus. 10(12): e3790. https://doi.org/10-.7759/cureus.3790.
Moeller A, Webber J, Epstein I (2016). Resident duty hour modification affects perceptions in medical education, general wellness, and ability to provide patient care. BMC Med Educ. 16: 175. https://doi.org/10.1186/s12909-016-0703-4.
Moss E, Willoughby BJ (2018). Associations between beliefs about marriage and life satisfaction: the moderating role of relationship status and gender. J Fam Stud. 24(3): 274–290. https://doi.org/10.1080-/13229400.2016.1187658.
Murti B (2016). Prinsip dan metode riset epidemiologi. Fourth Edition. Surakarta.
National Steering Committee on Resident Duty Hours (2013). Fatigue, risk and excellence: towards a pan-Canadian consensus on resident duty hours.
FRCPC.https://www.royalcollege.ca/rcsite/educational-initiatives/resident-duty-hours-e (Accessed: 29 March 2022).
Ogawa R, Seo E, Maeno T, Ito M, Sanuki M, Maeno T (2018). The relationship between long working hours and depression among first-year residents in Japan. BMC Med Educ. 18(1). https://doi.org/10.1186/s12909-018-1171-9.
Omani-Samani R, Maroufizadeh S, Almasi-Hashiani A, Sepidarkish M, Amini P (2019). The WHO-5 well-being index: a validation study in people with infertility. Iran J Public Health. 48(11): 2058–2064. https://doi.org/10.1850-2/ijph.v48i11.3525.
Organisation for Economic Cooperation and Development (2006). OECD glossary of statistical terms - marital status definition. https://stats.oecd.org/-glossary/detail.asp?ID=1597. (Accessed: 22 May 2022).
Organisation for Economic Cooperation and Development (2020). Average annual hours worked. OECD iLibrary. https://doi.org/https://doi.org/10.1787/data-00303-en.
Patel V, Burns JK, Dhingra M, Tarver L, Kohrt BA, Lund C (2018). Income inequality and depression: a systematic review and meta‐analysis of the association and a scoping review of mechanisms. World Psychiatry. 17(1): 76–89. https://doi.org/10.1002/wps.-20492.
Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Grunze H, et al. (2018). Multigenerational transmission of liability to psychiatric illness in offspring of parents with bipolar disorder. Bipolar Disord (Preprint). https://doi.org/10.1111/bdi.12668.
Pundati TM, Tamtomo D, Sulaeman ES (2018). Motivation, competence, workload, and their association with nurse performance in Dr. Arif Zaenudin Hospital, Surakarta. J Health Policy Manage. 3(2): 63–70. https://doi.org/10.26911/thejhpm.-2018.03.02.01.
Ramadianto AS, Kusumadewi I, Agiananda F, Raharjanti NW (2022). Symptoms of depression and anxiety in Indonesian medical students: association with coping strategy and resilience. BMC Psychiatry. 22: 92. https://-doi.org/10.1186/s12888-022-03745-1.
Riecher-Rössler A (2017). Sex and gender differences in mental disorders. Lancet Psychiatry. 4(1): 8–9. https://doi.org/10.1016/S2215-0366(16)30348-0.
Sarfika R, Malini H, Putri DE, Buanasari A, Abdullah KL, Freska W (2021). Factors influencing depression among Indonesians during the COVID-19 outbreak. Nurse Media J Nurs. 11(3): 380–388. https://doi.org/10.14710/-nmjn.v11i3.36783.
Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S (2021). Improving sleep quality leads to better mental health: a meta-analysis of randomised controlled trials. Sleep Med Rev. 60. https://doi.org/10.1016/j.smrv.2021.101556.
Siregar A (2018). Perbedaan gender dalam perilaku penemuan informasi akade-mis di kalangan mahasiswa FISIP Universitas Airlangga. Surabaya.
Smith TB, McCullough ME, Poll J (2003). Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psy-chol Bull. 129(4): 614–636. https://-doi.org/10.1037/0033-2909.129.4.6-14.
Soemantri D, Greviana N, Findyartini A, Azzahra TB, Suryoadji KA, Mustika R, Felaza E (2021). “To obey or not to obey” - medical students’ response towards professional dilemmas in a hierarchical and collectivist culture. PLoS One. 16(12). htt-ps://doi.org/https://doi.org/10.1371/journal.pone.0261828.
Solano P, Ustulin M, Pizzorno E, Vichi M, Pompili M, Serafini G, Amore M (2016). A google-based approach for monitoring suicide risk. Psychiatry Res. 246: 581–586. https://doi.org/-10.1016/J.PSYCHRES.2016.10.030.
Statista (2021). Average weekly working hours in Indonesia in 2019 and 2020, by gender. Statista Research Depart-ment. https://www.statista.com/sta-tistics/1251483/indonesia-average-working-hours-per-week-by-gender/. (Accessed: 25 March 2022).
Steel P, Schmidt J, Shultz J (2008). Refining the relationship between personality and subjective well-being. Psychol Bull. 134(1): 138–161. https://doi.org/10.1037/0033-290-9.134.1.138.
Stepko B (2021). Why are women more at risk for depression?. AARP. https://-www.aarp.org/health/conditions-treatments/info-2021/depression-in-women.html. (Accessed: 23 July 2023).
Sullivan PF, Neale MC, Kendler KS (2000). Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry. 157(10): 1552–1562. https://doi.org/10.1176/appi.ajp.157.10.1552.
Syrén SM, Kokko K, Pulkkinen L, Pehkonen J (2020). Income and mental well-being: personality traits as moderators. J Happiness Stud. 21: 547–571. https://doi.org/10.1007/S10902-019-00076-z.
Tan Z, Shi F, Zhang H, Li N, Xu Y, Liang Y (2018). Household income, income inequality, and health-related quality of life measured by the EQ-5D in Shaanxi, China: a cross-sectional study. Int J Equity Health. 17: 1–10. https://doi.org/https://doi.org-/10.1186/s12939-018-0745-9.
Temple J (2014). Resident duty hours around the globe: where are we now?. BMC Med Educ. 14(S1): S8. https://doi.org/10.1186/1472-6920-14-S1-S8.
Ulya Z, Sulistyono A, Novianto WT (2018). Implementation of Community Mental Health Service in Malang, East Java. J Health Policy Manage. 3(2): 108–113. https://doi.org/10.26911/-thejhpm.2018.03.02.07.
Wilson S, Vaidyanathan U, Miller MB, Mc-Gue M, Iacono WG (2014). Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent Course?. Dev Psychopathol. 26(0): 1477–1493. https://doi.org/10.1017/S0954579414001151.
Wink P, Dillon M, Larsen B (2005). Religion as moderator of the depression-health connection: findings from a longitudinal study. Res Aging. 27(2): 197220. https://doi.org/10.1177/0164027504270483.
World Health Organization (2018). Mental health: strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mentalhealthstrengthening-our-response. (Accessed: 30 April 2022).
Zhao L, Han G, Zhao Y, Jin Y, Ge T, Yang W, Cui R, et al. (2020). Gender differences in depression: evidence from genetics. Front Genet. 11. https://doi.org/10.-3389/fgene.2020.562316.