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ORIGINAL ARTICLE

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Anesthesiologists work-related exhaustion:


Acomparison study with other hospital employees
Waleed Riad, Afaf Mansour1,
Ashraf Moussa2

A B S T R A C T

Department of Anesthesia,
KingKhaled Eye Specialist Hospital,
2
King Faisal Specialist Hospital and
Research Centre, Riyadh, Kingdom
of Saudi Arabia, 1Department of
Psychiatry, College of Medicine,
Alexandria University, Egypt

Address for correspondence:


Dr. Waleed Riad,
Department of Anaesthesia,
King Khaled Eye Specialist Hospital,
P.O. Box 7191, Riyadh 11462,
Kingdom of Saudi Arabia.
E-mail: waleed_riad@yahoo.com

Background: Anesthesia is a demanding occupation due to long working hours,


sustained vigilance, unpredictability of stressful situation, fear of litigation, competence,
and production pressure. Work-related exhaustion can lead to several physical and
psychological symptoms and delay decision making. The aim of this study was to
evaluate how different work conditions affect personnel exhaustion by studying a sample
of anesthesiologists comparing them with ophthalmologists and ancillary hospital staff
Methods: One hundred fifty persons divided into three equal groups (50 each) were
invited to participate in this study. Subjects were asked to answer two self report
questionnaires: The Multidimensional Fatigue Inventory (MFI-20) and General Health
Questionnaire (GHQ-12) which used to assess work related exhaustion and mental
health, respectively. Results: Multidimensional Fatigue Inventory scale (MFI 20) and
General Health Questionnaire (GHQ 12) were significantly higher in anesthesiologists
than in other groups (P=0.001). Different aspects of work-related exhaustion showed
that general, physical and mental fatigue were significantly higher in anesthesiologists
(P=0.002 and 0.001, respectively). Reduced activity and reduced motivation were
also higher in anesthesiologists compare to the other groups (P=0.005 and 0.001,
respectively). Conclusion: Work-related exhaustion under the current study is more
obvious among anesthesiologists. Ophthalmologist and ancillary hospital employees
felt that they had less stress at their work.
Key words: Anesthesia, exhaustion, psychological distress

INTRODUCTION
Anesthesia is a demanding occupation due to long working
hours, sustained vigilance, unpredictability of stressful
situation, fear of litigation, competence and production
pressure.[1] Fatigue encompasses a decreased ability to
perform physical work and/or cognitive functions. It can be
caused by excessive time spent on a task, circadian factors
and sleep deprivation. It also correlates with a persons
motivation and emotional status.[2]
Work-related stress can also occurs when coping with jobrelated stressor results in imbalance between the demands
made on an individual, and the individuals ability to
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DOI:
10.4103/1658-354X.84095

Vol. 5, Issue 3, July-September 2011

meet that demand.[2] Adverse effects of persistent stress


include: Physical illness such as hypertension, emotional
deterioration manifested by chronic anxiety, depression,
labile personality, drugs or chemical substance abuse
and absenteeism.[3] It had been documented that sleepy,
exhausted anesthesiologists tend to have longer response
latencies and greater variability in appropriateness of their
responses.[3]
The aim of this cross-sectional study was to investigate
how different work conditions affect personnel exhaustion
by studying a sample of anesthesiologists comparing them
with ophthalmologists and ancillary hospital staff working
at the same facility.
METHODS
After approval of the local research and human ethics
Committees and a written informed consent from the
participant. A self-reporting questionnaire for assessment
of socio-demographic factors and validated scales for
fatigue and general health were used. Anonymity was
completely preserved. None of the studied participants
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Riad, et al.: Work-related exhaustion in anesthesia

had a history of neither neurological nor psychiatric


disorders or taking any medication that affects nervous
system.
Work related exhaustion and mental health were measured
by validated instruments which are Multidimensional
Fatigue Inventory Scale (MFI 20) and General Health
Questionnaire (GHQ12) respectively. The Multidimensional
Fatigue Inventory (MFI 20)[4] is a multidimensional test
designed to measure five aspects of fatigue that include
general, physical, reduced motivation, reduced activity
and mental fatigue. Each aspect contains four items, it is
a 5 point scale ranging from strongly agrees (5) to totally
disagree (0). The sum score of each aspect ranges from 0
to 20 and hence the total fatigue (TF) ranges from 0 to 80.
Participants were instructed to indicate how they felt in the
last month prior to the questionnaire day. The scale does not
contain any somatic items, designed to provide a complete
description of the fatigue experience. The higher the scores
the higher the degree of exhaustion, more concentration
problems, reduced motivation and/or low level of activity.
General Health Questionnaire (GHQ12)[5] developed by
Goldberg and it was used in the present work to assess
different aspects of mental health of the participants.
The most important reasons for using the (GHQ 12) are
its brevity, intelligibility, and its psychometric properties.[6]
The reliability coefficients for the General Health
Questionnaire ranged from 0.78 to 0.95.[6] The General
Health Questionnaire used in the present study includes
12 items; each item has the following 4 answer choices: Not
at all, no more than usual, more than usual, and much more
than usual, given a possible range of scores ranging from
0 to 12. Mental distress was considered if the participant
score four or higher.[7]

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Statistical analysis

The sample size calculation using G*Power 3.1.0 indicated


that 50 subjects are required per group in order to detect a
difference of 0.3 in the mean of total fatigue score between
the groups. The alpha error was set at 0.05 and Type II
error was set at 0.20. The results were analyzed using SPSS
version 14 (SPSS Inc., Chicago, IL, USA). Statistical analysis
had been done using Chi-square or one-way analysis of
variance (ANOVA) whatever appropriate. If ANOVA
Test was significant, Tukey HSD Multiple Comparisons
Test was used to compare different groups. For all tests
of significance, a P value of 0.05 was used as the level of
significance. Numerical data were expressed as a mean
value and standard deviation (SD) while categorical data
were expressed as number and percentages.
RESULTS
Demographic data are shown in [Table1], Ophthalmologists
were significantly older compared to the other groups
(P=0.001). There was no sex difference in the category
distribution (P=0.18). Percentage of married anesthesiologists
was significantly lower in comparison to ophthalmologist but
higher than hospital staff (P=0.005). Level of education was
significantly lower in hospital employee (P=0.001).
Both Multidimensional Fatigue Inventory scale (MFI 20) and
General Health Questionnaire (GHQ 12) were significantly
higher in anesthesiologists compare to other groups (P=0.001)
[Figure1]. Comparisons of different aspects of Fatigue
are shown in [Table2]. General, physical and mental fatigue
were significantly higher in anesthesiologists (P=0.002 and
0.001, respectively). Reduced activity and reduced motivation
were also higher in anesthesiologists compare to the other
groups (P=0.005 and 0.001, respectively).

Table1: Demographic data


Age (years)
Less than 30
More than 30
Sex
Male
Female
Marital status
Single
Married
Divorced
Widow
Education
<12 years
12-14 years
University
Postgraduate

Ophthalmologists
(n=50) (%)

Hospital employees
(n=50) (%)

Anesthesiologists
(n=50) (%)

P value

3 (6)
47 (94)

22 (44)
28(56)

10 (20)
40(80)

0.001

43 (86)
7 (14)

31 (62)
19 (38)

33 (66)
17 (34)

0.18

3 (6)
47 (94)
0 (0)
0 (0)

12 (24)
29 (58)
4 (14)
2 (4)

8 (16)
35 (70)
6 (12)
2 (2)

0 (0)
0 (0)
0 (0)
50 (100)

13 (26)
4 (8.3)
20 (40)
13 (26)

0 (0)
0 (0)
0 (0)
50 (100)

0.005

0.001

Data expressed as number (percentage) or mean value (SD)

Saudi Journal of Anaesthesia

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Riad, et al.: Work-related exhaustion in anesthesia


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Table2: Subitems of fatigue questionnaire


Ophthalmologists
(n=50)

Hospital employees
(n=50)

Anesthesiologists
(n=50)

P value

4.38 (3.1)*
4.37 (3.2)*
3.58 (2.5)*
2.75 (2.3)*
4.28 (2.8)*

5.12 (2.7)*
4.46 (3.3)*
2.94 (2.7)*
2.88 (2.4)*
5.10 (2.7)*

10.06 (5.0)
9.28 (5.2)
7.31 (4.7)
5.90 (4.3)
9.60 (5.2)

0.002
0.001
0.005
0.001
0.001

General fatigue
Physical fatigue
Reduced activity
Reduced motivation
Mental fatigue

Data expressed as a mean value (SD), *Against anesthesiologist. *P value <0.05 against anesthesiologist

Higher score of work related exhaustion scale in


anesthesiologists could be attributed to the fact that they
usually work for long and intense duty periods, suffer
from loss of sleep, and develop mental, psychological and
physical stress.[2] Some indirect evidence links fatigue with
impaired medical decision making[13] and reduced patient
safety.[10] Unlike other specialists, anesthesiologists continue
to have on-call commitment until the age of retirement.
Frequent on-call showed strong positive correlation with
severe stress symptoms.[10]

Figure1: Total fatigue and General Health Questionnaire (*Against


anesthesiologist. Data expressed as a mean value while error bars represent
(SD), *P value <0.05 against anesthesiologist)

DISCUSSION
Our study showed that work related exhaustion as total
and different subtypes together with mental stress were
significantly higher in anesthesiologists compared to the
other two studied groups. Most of the currently studied
anesthesiologists were significantly younger than the
ophthalmologists. This was supported by previous work
of Nyssan and Hansez who proved that age correlated
negatively with fatigue symptoms, in their study younger
anesthesiologists showed higher rate of fatigue compared
to their older colleagues.[8] A previous work on general
Norwegian population reported weak correlation between
age and fatigue.[9]
No statistically significant gender differences were seen
either in anesthesiologists or the other two studied groups.
On the contrary Lindfors and colleagues proved that
women had higher stress symptoms including exhaustion
than men.[10] Another study found female anesthesiologists
feeling higher task related stressors at their work. [11]
A previous study concerning Portuguese anesthesiologists
had pointed out the conflicts between home and work
responsibilities as a major source of stress.[12] Loge and
colleague showed a strong positive correlation between
women and fatigue in Norwegian population. [9] The
difference could be attributed to the difference in the
culture and to the instrument used.
Vol. 5, Issue 3, July-September 2011

General Health Questionnaire (GHQ12) was significantly


higher in anesthesiologists when compared with the other
studied groups. In the same line with our results, Coomber
and colleagues showed that 20%-60% of doctors exhibiting
clinically important levels of mental distress at any one
time depending on their threshold for morbidity and the
specialty in which they work.[14] The work of Nyssen and
colleague found that 40% of the studied anesthesiologists
were suffering from high emotional exhaustion.[15] Many
researches had outlined the negative physiological and
psychological consequences of dysfunctional occupational
stress.[10,11] It affects cognitive performance, and makes one
prone to mental disorders such as depression.[10]
The results of our study are limited by the fact that working
conditions and subjective perception of working conditions
may change with national culture, hospital culture, and
departmental culture among others. Furthermore, the
multitude of additional stressors from family life was not
assessed in details.
In conclusion, work-related exhaustion under the current study
is more obvious among anesthesiologists. Ophthalmologist
and ancillary hospital employees feel less stress at their work.
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How to cite this article: Riad W, Mansour A, Moussa A.
Anesthesiologists work-related exhaustion: A comparison study
with other hospital employees. Saudi J Anaesth 2011;5:244-7.
Source of Support: Nil, Conflict of Interest: None declared.

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