Subjective Assessment of Stress and its Relationship with Neuroendocrine Mechanisms of its Development in Obstetricians-Gynecologists against the Background of Professional Burnout

Mikhail Yu. Kuzmin, Darya P. Tyumentseva, Maria A. Rashidova, Leonid F. Sholokhov, Anait Yu. Marianian

 
International Journal of Biomedicine. 2021;11(4):551-557.
DOI: 10.21103/Article11(4)_OA25
Originally published December 10, 2021

Abstract: 

The purpose of this сase-control study was to investigate the factors of subjective assessment of stress and their relationship with neuroendocrine mechanisms of its development in obstetricians-gynecologists against the background of professional burnout.
Methods and Results: A total of 96 physicians and nurses from the different clinics specializing in both obstetrics and gynecology were surveyed. The Russian versions of MBI, BDI, SF-12, FFMQ, MAAS, and Coping strategies (the Ways of Coping Checklist) were applied. Blood serum/plasma was tested on the concentration of hormones (DHEA-C and TSH), melatonin, serotonin, and dopamine. Saliva cortisol was also estimated. In the present study, 43.75% of the physicians and nurses showed a high degree of burnout, which was comparable to that among physicians and nurses in other studies. Physicians and nurses with a high degree of burnout had more expressed coping strategies like Confrontive coping, Distancing, Self-controlling, Seeking social support and Escape-avoidance. Also, they have more expressed level of depressive manifestations. We found significant correlations between some factors of subjective assessment of stress (like coping and mindfulness) and neuroendocrine biomarkers.  Adaptive coping like Planful problem-solving correlated negatively with the level of melatonin, and subscales of the mindfulness questionnaire were correlated negatively with levels of some biomarkers. Thus, we concluded that coping strategies and mindfulness could theoretically contribute to a decrease in the secretion of several hormones.
Conclusion: Physicians and nurses with a low degree of burnout have a greater level of mindfulness and a lower level of some maladaptive coping strategies – Confrontive coping, Distancing, Escape-avoidance. Our results focus on the predictive role of these factors of subjective assessment of stress, in particular, Confrontive coping and mindfulness, in burnout syndrome. The present data confirm that there are some psychological and physiological aspects related to stress in the medical profession.

Keywords: 
obstetricians-gynecologists • stress • professional burnout • biomarkers
References: 
  1. Maslach C, Jackson SE. The measurement of experienced burnout. Journal of Organizational Behavior. 1981;2:99-113. doi: 10.1002/job.4030020205.
  2. Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, Souza T, Gonçalves AK. Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One. 2018 Nov 12;13(11):e0206840. doi: 10.1371/journal.pone.0206840. 
  3. Ofei-Dodoo S, Irwin G, Kuhlmann Z, Kellerman R, Wright-Haviland S, Dreiling M. Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators. Kans J Med. 2019 Feb 26;12(1):11-16. 
  4. Govardhan LM, Pinelli V, Schnatz PF. Burnout, depression and job satisfaction in obstetrics and gynecology residents. Conn Med. 2012 Aug;76(7):389-95.
  5. Smith RP. Burnout in Obstetricians and Gynecologists. Clin Obstet Gynecol. 2019 Sep;62(3):405-412. doi: 10.1097/GRF.0000000000000441.
  6. Watanabe N, Horikoshi M, Shinmei I, Oe Y, Narisawa T, Kumachi M, Matsuoka Y, Hamazaki K, Furukawa TA. Brief mindfulness-based stress management program for a better mental state in working populations - Happy Nurse Project: A randomized controlled trial✰✰. J Affect Disord. 2019 May 15;251:186-194. doi: 10.1016/j.jad.2019.03.067. 
  7. Romani M, Ashkar K. Burnout among physicians. Libyan J Med. 2014 Jan;9(1):23556. doi: 10.3402/ljm.v9.23556. 
  8. Toker S, Biron M. Job burnout and depression: unraveling their temporal relationship and considering the role of physical activity. J Appl Psychol. 2012 May;97(3):699-710. doi: 10.1037/a0026914. 
  9. Gabbe SG, Hagan Vetter M, Nguyen MC, Moffatt-Bruce S, Fowler JM. Changes in the burnout profile of chairs of academic departments of obstetrics and gynecology over the past 15 years. Am J Obstet Gynecol. 2018 Sep;219(3):303.e1-303.e6. doi: 10.1016/j.ajog.2018.06.012. 
  10. Iorga M, Socolov V, Muraru D, Dirtu C, Soponaru C, Ilea C, Socolov DG. Factors Influencing Burnout Syndrome in Obstetrics and Gynecology Physicians. Biomed Res Int. 2017;2017:9318534. doi: 10.1155/2017/9318534. 
  11. Zivin K, Brower KJ, Sen S, Brownlee RM, Gold KJ. Relationship Between Faculty Characteristics and Emotional Exhaustion in a Large Academic Medical Center. J Occup Environ Med. 2020 Aug;62(8):611-617. doi: 10.1097/JOM.0000000000001898. 
  12. Dunne PJ, Lynch J, Prihodova L, O'Leary C, Ghoreyshi A, Basdeo SA, Cox DJ, Breen R, Sheikhi A, Carroll Á, Walsh C, McMahon G, White B. Burnout in the emergency department: Randomized controlled trial of an attention-based training program. J Integr Med. 2019 May;17(3):173-180. doi: 10.1016/j.joim.2019.03.009. 
  13. Lebares CC, Hershberger AO, Guvva EV, Desai A, Mitchell J, Shen W, Reilly LM, Delucchi KL, O'Sullivan PS, Ascher NL, Harris HW. Feasibility of Formal Mindfulness-Based Stress-Resilience Training Among Surgery Interns: A Randomized Clinical Trial. JAMA Surg. 2018 Oct 1;153(10):e182734. doi: 10.1001/jamasurg.2018.2734. 
  14. Rees C, Craigie M, Slatyer S, Heritage B, Harvey C, Brough P, Hegney D. Mindful Self-Care and Resiliency (MSCR): protocol for a pilot trial of a brief mindfulness intervention to promote occupational resilience in rural general practitioners. BMJ Open. 2018 Jun 30;8(6):e021027. doi: 10.1136/bmjopen-2017-021027.
  15. Deneva T, Ianakiev Y, Keskinova D. Burnout Syndrome in Physicians-Psychological Assessment and Biomarker Research. Medicina (Kaunas). 2019 May 24;55(5):209. doi: 10.3390/medicina55050209
  16. Kolesnikova LI, Darenskaya MA, Grebenkina LA, Sholokhov LF, Semenova NV, Osipova EV, Kolesnikov SL. [INDICATORS OF PITUITARY-THYROID SYSTEM AND LIPID METABOLISM IN REPRESENTATIVES OF BURYAT ETHNOS AND EUROPEOIDS]. Zh Evol Biokhim Fiziol. 2016 Jul;52(4):270-274. [Article in Russian].
  17. Kolesnikova LI, Popova AS, Sinitskiy AI, Kozochkin DA, Gornostaeva AB. [Content of cortisol in cord blood for various impairments of adaptation in newborns]. Vestnik Rossijskoj Akademii Medicinskih Nauk. 2013;68(12):41-43. [Article in Russian].
  18. Madaeva IM, Berdina ON, Sholokhov LF, Semenova NV, Kolesnikova LI. Patofiziologicheskie aspekty funktsionirovaniia sistemy neĭroéndokrinnoĭ reguliatsii pri sindrome obstruktivnogo apnoé sna [Pathophysiological aspects of neuro-endocrine regulation system in patients with obstructive sleep apnea syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(4. Vyp. 2):55-59. doi: 10.17116/jnevro20181184255. [Article in Russian].
  19. Semenova NV, Madaeva IM, Kolesnikova LI. Rol' melatonina kak komponenta antioksidantnoĭ zashchity pri insomnii v perimenopauze [The role of melatonin as a component of the antioxidant defense system in perimenopausal women with insomnia]. Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(7):7-13. doi: 10.17116/jnevro20191190717. [Article in Russian].
  20. Tsou MT, Pai TP, Chiang TM, Huang WH, Lin HM, Lee SC. Burnout and metabolic syndrome among different departments of medical center nurses in Taiwan-Cross-sectional study and biomarker research. J Occup Health. 2021 Jan;63(1):e12188. doi: 10.1002/1348-9585.12188.
  21. Lennartsson AK, Theorell T, Kushnir MM, Jonsdottir IH. Changes in DHEA-s levels during the first year of treatment in patients with clinical burnout are related to health development. Biol Psychol. 2016 Oct;120:28-34. doi: 10.1016/j.biopsycho.2016.08.003.
  22. Luthar SS, Curlee A, Tye SJ, Engelman JC, Stonnington CM. Fostering Resilience among Mothers under Stress: "Authentic Connections Groups" for Medical Professionals. Womens Health Issues. 2017 May-Jun;27(3):382-390. doi: 10.1016/j.whi.2017.02.007.
  23. Danhof-Pont MB, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. J Psychosom Res. 2011 Jun;70(6):505-24. doi: 10.1016/j.jpsychores.2010.10.012.
  24. Banasiewicz J, Zaręba K, Rozenek H, Ciebiera M, Jakiel G, Chylińska J, Owczarek K. Adaptive capacity of midwives participating in pregnancy termination procedures: Polish experience. Health Psychol Open. 2020 Dec 9;7(2):2055102920973229. doi: 10.1177/2055102920973229. 
  25. O'Dowd E, O'Connor P, Lydon S, Mongan O, Connolly F, Diskin C, McLoughlin A, Rabbitt L, McVicker L, Reid-McDermott B, Byrne D. Stress, coping, and psychological resilience among physicians. BMC Health Serv Res. 2018 Sep 21;18(1):730. doi: 10.1186/s12913-018-3541-8.
  26. Winkel AF, Honart AW, Robinson A, Jones AA, Squires A. Thriving in scrubs: a qualitative study of resident resilience. Reprod Health. 2018 Mar 27;15(1):53. doi: 10.1186/s12978-018-0489-4.
  27. Vodopyanova NE, Starchenkova ES. [Burnout syndrome]. Saint-Petersburg: Peter; 2008. [In Russian].
  28. Atalyan AV, Kolesnikova LI, Kolesnikov SI, Grjibovski AM, Suturina LV. Research electronic data capture (redcap) for building and managing databases for populationbased biomedical studies. Human Ecology. 2019; 2. 52–59. doi: 10.33396/1728-0869-2019-2-52-59
  29. Vasserman LI, Iovlev BV, Isaeva ER, Trifonova EA., Shchelkova OY.  [Methods for psychological diagnosis of coping strategies in stressful and problematic situations for the individual]. Saint-Petersburg: St. Petersburg Psychoneurological Institute named after V. M. Bekhterev; 2008. [In Russian].
  30. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JM. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008 Sep;15(3):329-42. doi: 10.1177/1073191107313003. 
  31. Carlson LE, Brown KW. Validation of the Mindful Attention Awareness Scale in a cancer population. J Psychosom Res. 2005 Jan;58(1):29-33. doi: 10.1016/j.jpsychores.2004.04.366. 
  32. De la Fuente-Solana EI, Suleiman-Martos N, Pradas-Hernández L, Gomez-Urquiza JL, Cañadas-De la Fuente GA, Albendín-García L. Prevalence, Related Factors, and Levels of Burnout Syndrome Among Nurses Working in Gynecology and Obstetrics Services: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Jul 19;16(14):2585. doi: 10.3390/ijerph16142585.
  33. Białek K, Sadowski M. Level of stress and strategies used to cope with stress by physicians working in intensive care units. Anaesthesiol Intensive Ther. 2019;51(5):361-369. doi: 10.5114/ait.2019.90473. 
  34. Cullati S, Cheval B, Schmidt RE, Agoritsas T, Chopard P, Courvoisier DS. Self-Rated Health and Sick Leave among Nurses and Physicians: The Role of Regret and Coping Strategies in Difficult Care-Related Situations. Front Psychol. 2017 Apr 20;8:623. doi: 10.3389/fpsyg.2017.00623. 
  35. Lee-Winn AE, Townsend L, Reinblatt SP, Mendelson T. Associations of neuroticism-impulsivity and coping with binge eating in a nationally representative sample of adolescents in the United States. Eat Behav. 2016 Aug;22:133-140. doi: 10.1016/j.eatbeh.2016.06.009.
  36. Stein NL, Leventhal B, Trabasso TR. Psychological and Biological Approaches to Emotion. 1st Edition. New York; 1990.

Download Article
Received September 28, 2021.
Accepted November 3, 2021.
©2021 International Medical Research and Development Corporation.