|Year : 2018 | Volume
| Issue : 2 | Page : 708-715
Prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate
Lamiaa G El-Hamrawya1, Nagwa N Hegazy2, Samah M. I. El-Halawany3
1 Department of Neuropsychiatric, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Faculty of Medicine, Menoufia University; El-May Healthcare Center, Shibin El-Kom Health Administration, Menoufia, Egypt
|Date of Submission||16-Feb-2017|
|Date of Acceptance||02-May-2017|
|Date of Web Publication||27-Aug-2018|
Samah M. I. El-Halawany
El-May Healthcare Center, Shibin El-Kom Health Administration Shibin El-Kom, Menoufia
Source of Support: None, Conflict of Interest: None
The aim of the study was to estimate the prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate and to identify the risk factors among the healthcare providers.
Depression is common in medical students and residents; physicians have a rate of depression similar to that in the population. Poor mental health among nurses and doctors hinder professional performance and lowers the quality of the care provided by them.
Patient and methods
This was cross-sectional study which was conducted in Shibin El-Kom city including all doctors and nurses at teaching hospitals in Shibin El-Kom and Shibin El-Kom primary healthcare center (PHCC). The total number of doctors were 961 and nurses were 685. Socioeconomic Scale and Patient Health Questionnaire 9 were collected.
The prevalence of depressive symptoms among all participants of the PHCC (71.4%) was higher than tertiary healthcare hospital (THCH) (59%). The prevalence of depressive symptoms among the doctors of the PHCC (73.8%) was higher than THCH (58.8%), and the prevalence among nurses of the PHCC (68.6%) was higher than THCH (45.4%).
The prevalence of depressive symptoms was high among healthcare providers; to face this problem, there should be programs aiming at improving the mental health of healthcare provider's. Such programs should focus on the optimal financial, social, practical, and healthy lifestyle needed for better human health.
Keywords: depressive disorder, nurses, physicians, prevalence, risk factors
|How to cite this article:|
El-Hamrawya LG, Hegazy NN, El-Halawany SM. Prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate. Menoufia Med J 2018;31:708-15
|How to cite this URL:|
El-Hamrawya LG, Hegazy NN, El-Halawany SM. Prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate. Menoufia Med J [serial online] 2018 [cited 2019 Jul 20];31:708-15. Available from: http://www.mmj.eg.net/text.asp?2018/31/2/708/239773
| Introduction|| |
Depression can lead to significant emotional distress or impairment in social life, home life, and work. Both depression and substance disorders have been identified as major risk factors for the high rate of suicides among physicians, with more than 90% of those physicians who suicide having a history of mood disorder and/or substance abuse . In a systematic review from 15 countries, seven European, four Asian, and four Middle East countries, the overall pooled prevalence of depressive symptoms was 28.8% among physicians. The prevalence estimates ranged from 20.9 to 43.2% according to the instrument used and increased every calendar year . In a systematic review of dysfunctional psychological responses among intensive care unit nurse's prevalence of depression, conducted in USA (four), Germany (one), Greece (three), and one each in Japan, Nigeria, France, Eastern Taiwan, and Turkey, it was found that 12% of the nurses suffer from depression .
Depression is a common mental disorder affecting both sexes in any age group. A study for estimating the global burden of disease has shown depressive disorders to be the second leading cause of disability all over the world .
Several social factors cause depression such as low socioeconomic status, unemployment, long working hours, loneliness and lack of social support, and alcohol and substance abuse either as a consequence and/or a risk factor of depression. Sex differences in the prevalence of depression, with a higher morbidity for women than men, due to hormonal imbalance, which can be associated to menstruation, childbirth, and menopause or due to factors associated with social roles . The aim of the study was to estimate the prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate and to identify the risk factors among them.
| Patients and Methods|| |
The study was a cross-sectional one which was carried out in two places in Shibin El-Kom city in Menoufia governorate, Shibin El-Kom teaching hospital representing the tertiary healthcare level and Shibin El-Kom family healthcare center representing the primary healthcare level. Secondary healthcare level was discarded due to unavailability of time for participants in the private sectors such as clinics and private hospital. The study was conducted in the time frame of 11 months starting from (1st of February 2016 to the end of December 2016). The study sample was systematic cluster random sampling which included all doctors and nurses from both facilities. There was a total of 1646 participants. The total number of doctors were 961 (832 physicians, 56 dentists, 52 pharmacists, 21 physiotherapists). The total number of nurses were 685 (570 nurse and 115 specialized nurse). The participants numbers were 1646 from 1674, the response rate was 97.9%. The participants were divided into two groups of doctors and nurses, who were divided into subgroups: physicians, dentists, pharmacists, physiotherapists, specialized nurses, and nurses. Socioeconomic Scale (SES) Questionnaire  and Patient Health Questionnaire 9 (PHQ9)  were collected.
All available doctors and nurses at Shibin El-Kom city in Menoufia governorate.
Persons who gave their approval to participate in the study.
Patients who were already diagnosed with psychiatric or mental disorders or chronic illness diseases.
Patients who were absent at the time of data collection (like sick leave, etc.) or refused to complete the questionnaire form.
All participants of the study were volunteers. Oral consents were granted by all participants in the study after illustration of purposes of this study they were encouraged to give full informed consent to participate. It was emphasized that all data collected were strictly confidential and the data were used for scientific purposes only and they have the right to withdraw from the study at any time. The Menoufia Faculty of Medicine Committee for Medical Research Ethics reviewed and formally approved the study.
A review of the current and past literatures on depressive symptoms among doctors and nurses was performed.
Three preliminary visits to the teaching hospital and the primary healthcare unit of Shibin El-Kom were conducted to obtain basic information about the environment of the research and to obtain approval from authorities to carry out the research.
This phase lasted from 1st of February till the end of March 2016. It was performed on 10 physicians and nurses who work at the two facilities included in the study. To evaluate the adequacy and the relevance of the validated study tools 'questionnaire sheets' and determine the time needed for filling every part of the questionnaires. Explore the potential obstacles and difficulties that confront the execution and flow of work.
Feedback of the pilot study
The following were done: Some useful modification was done in the questionnaire format and more feasible time for execution was constructed. The language of some questions of the questionnaire was modified to be understandable by the participants and their acquaintances. Each questionnaire takes on the average about 10 min. All patients were interviewed using a predesigned questionnaire: SES  PHQ9 . The participants were interviewed and gave consent for the questionnaire. The sampling method was systematic cluster random sampling. The total score of SES  was calculated and the cut-off points to be used for SES classification are where a high level was indicated as at least 70%, a medium level as 40 to less than 70%, and a low level as less than 40%. To assess depression prevalence among the study participants using a predesigned questionnaire PHQ9 , which consisted of 10 questions, each question rated on a four-point scale ranging from 0 to 3 according to the frequency of occurrence was used. The interpretation of the total score was as follows: The cut-off scores that the PHQ9 depends on interpretation: score 0–4 normal, 5–9 minimal depressive symptoms, 10–14 major depression, mild severity (minor depression), 15–19 major depression, moderate severity 20 or higher major depression, extreme depression.
Data were collected, tabulated, and statistically analyzed using an IBM personal computer with statistical package for the social science (SPSS, version 20) (SPSS, version 20; SPSS Inc., Chicago, Illinois, USA) and Epi Info 2000 programs Epi Info 2000 programs; IBM, Armonk, New York), where the following statistics were applied.
In descriptive statistics quantitative data were presented in the form of mean, SD, range, and qualitative data were presented in the form of numbers and percentages.
χ2 was used to study the association between two qualitative variables.
Student's t-test is a test used for comparison between two groups having quantitative parametric variables while Mann–Whitney test is a test of significance used for the comparison between two groups not normally distributed having quantitative variables.
Fisher's exact test for 2 × 2 tables when the expected cell count of more than 25% of cases was less than 5.
P value of greater than 0.05 was considered not statistically significant.
P value of less than or equal to 0.05 was considered statistically significant.
P value of less than or equal to 0.001 was considered statistically highly significant.
| Results|| |
The sociodemographic data of the whole studied sample showed that the majority of the studied sample was women in the primary healthcare center (PHCC) and the tertiary healthcare hospital (THCH) (83.2 and 70.9%, respectively). The mean age of the studied sample was about 35.5 ± 9.37 years. The majority of the studied group were married in both PHCC and THCH (90.9 and 80.3%, respectively). More than half of the studied sample (54.5 and 58.6%, respectively) were doctors (physicians and paramedical) in the PHCC and in the THCH 54.8% of them were pharmacists and dentists in PHCC, while 48%) of them were residents in THCH. The majority of the studied nurses were titled as a nurse. More than half of the studied sample were of high socioeconomic standard (57.1 and 59.2, respectively). The mean of experience years in doctors were 8.79 ± 6.09 in PHCC and 6.85 ± 5.69 in THCH. The mean of experience years in nurses were 20.43 ± 9.91 in PHCC and 21.45 ± 9.71 in THCH. The mean of working hours in doctors were 40.38 ± 14.62 in PHCC and 47.66 ± 19.95 in THCH. The mean working hours in nurses were 42.23 ± 9.93 in PHCC and 40.69 ± 9.0 in THCH. The mean of patients seen per day by doctors were 24.29 ± 17.60 in PHCC and 31.19 ± 38.42 in THCH. The mean patients seen per day by nurses were 30.69 ± 53.07 in PHCC and 31.19 ± 38.42 in THCH [Table 1]. All participants were either of high or medium socioeconomic standard level with high standard percentages of PHCC and THCH (57.1 and 59.2%, respectively). Socioeconomic standard was of no statistical significance in relation to depressive symptoms [Table 2]. The prevalence of depressive symptoms among all participants of the PHCC (71.4%) was higher than THCH (59%), with the highest percentage in PHCC and THCH (39 and 42.7%, respectively) having minor depression. The prevalence of depressive symptoms among doctors of the PHCC (73.8%) was higher than THCH (58.8%). With the highest percentage in PHCC (35.7%) having major depression and in THCH (40.2%) having minor depression. There was a statistical significance in the grades of depression. The prevalence of depressive symptoms among nurses of the PHCC (68.6%) was higher than THCH (45.4%), with highest percentage in PHCC (28.5%) having minimal symptoms of depression and in THCH (46.3%) having minor depression [Table 3].
|Table 1: Sociodemographic characteristics of the nurses among the studied sample (n=1646)|
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|Table 3: Prevalence of depressive symptoms among the studied sample (all participants-doctors-nurses) using Patient Health Questionnaire 9|
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Factors affecting depressive symptoms among doctors with statistical significance are women sex (65.4%), married (63.8%), income not enough, and unpaid loans and not enough and big loans (100%), postgraduate degree (64.4%), assigned doctors (69%) [Table 4], while factors affecting depressive symptoms for nurses with statistical significance are women sex 60.8%), mean age (42.72 years), not enough and small loan income (88.6%), college degree (65.3%), nurses (62.5%), have mean years of experience (22.22), mean working hours per week (41.52), and dealing with patients per day of a mean (36.57) [Table 5].
|Table 4: Factors affecting prevalence of depressive symptoms among doctors only using Patient Health Questionnaire 9|
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|Table 5: Factors affecting depressive symptoms among nurses using Patient Health Questionnaire 9|
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| Discussion|| |
The current study results are agreed by Alkhazrajy et al.  (in Baghdad), Wang et al.  (in China), Liezel  (in Cape Town), and Abdulghani  (in Saudi Arabia), where the prevalence of depressive symptoms was 70.25, 65.3, 55, and 47%, respectively. The mental health of the current study's physicians was more affected than that in some other countries. For example, the prevalence of depressive symptoms among physicians by Schwenk et al.  (in USA), Myers and Gabbard  (in USA), Wada et al.  (in Japan), Shen et al.  (in China), Atif et al.  (in Pakistan), and Bernburg et al.  (in Germany) were 11.3, 20, 8.8, 31.7, 25.8, and 17%, respectively. The relatively poor mental health status among physicians in Egypt may be because of numerous reasons. The workload of physicians in Egypt increases with the growing population, inadequate number of physicians and physician's income in Egypt is lower than that of physicians in many foreign countries, thus here doctor gets low income despite the workload leading to the higher prevalence of depressive symptoms in the study results.
While the prevalence of depressive symptoms among nurses of the PHCC (68.6%) was higher than THCH (45.4%). This was agreed by Welsh , where the prevalence of depressive symptoms in female medical-surgical hospital nurses estimated that the prevalence rate was 56% among nurses. Meanwhile it was disagreed by several studies, for example Abbas et al.  in the Kingdom of Saudi Arabia; Letvak et al.  in the USA; Mehrabi and Ghazavi  in Iran; Schmidt et al.  in Brazil 2011; and Stathopoulou et al.  in Greece that 25, 18, 18.8, 24.2, 24.4, and 23.9%, respectively, had depressive symptoms which is a much lower prevalence than the current study. This may due to the use of different tools, difference in culture, working hours, income, and due to work responsibilities.
Regarding the factors affecting depressive symptoms among doctors, age was not significant in the current study; this was confirmed by some studies by Becker et al. , Fahrenkopf et al. , and Hainer and Palesch , who reported that doctors' age did not appear to be related with depressive symptoms.
There appeared to be a positive relation between depression and increasing working hours and number of patients. The current study results revealed that doctors that have not enough income with small loans are more likely to have depression compared with those having enough income and savings. This was contradicted by the studies by Hainer and Palesch  and Alkhazrajy et al.  which showed no significant association between depression and monthly income. A positive relation between depression and working hours appeared. This was agreed by Defoe et al. , and Firth-Cozens and Cording  stated that doctors with working hours of more than 46 per week were highly vulnerable to develop psychological disorders. which was also confirmed by the studies by Gong et al. , Virtanen and Kivimäki , Bannai and Tamakoshi , the results of which revealed that physicians who work at least 60 h/week or who work night shifts twice or more per week were at greater risk of experiencing depressive symptoms. The current study has shown women to be more depressive than men. This was agreed by Levine and Bryant , Goebert et al. , Sen et al. , and Erdur et al.  who reported women to be at a greater risk to have depression. Moreover, married doctors are more likely to be depressed than single doctors. This was disagreed by several studies such as those by Gu et al. , Alkhazrajy et al. , Becker et al. , Fahrenkopf et al. , and Hainer and Palesch , who have found that sex and marital status have no significant variations in depression among the resident doctors.
Regarding factors affecting depressive symptoms in nurses there appeared to be a positive relation between depression and working hours and the number of patients. This was agreed upon by Boya et al.  study which reported that depression is significantly correlated with both night work and overtime work, while there was a contradiction by Abbas et al. , and Schmidt et al. , who reported no statistical significance between both overtime work and night shift and the manifestations of depression. Single nurses are less likely to have depressive symptoms than those whom are married. This was agreed by Halvani et al. , Ohida et al. , and Ardekani et al. , who have reported that married nurses had more severe depression than single ones. However, that was disagreed by Josling  as there was no relationship between marital status and depression, which does not match with the results of this study; this is possibly due to the lower number of single people than married people and due to the cultural dissimilarities in other countries. Nurses who do not have enough income with unpaid loan are more likely to have depression compared with those who have enough income and savings. This was agreed upon the study conducted by Akhtar-Danesh and Landeen  which reported that low income increases the prevalence of depressive symptoms among nurses as against the study by Reis et al. , reporting no relation of income and depressive symptoms.
| Conclusion|| |
The revalence of depressive symptoms was high among doctors and nurses; to face this problem, there should be a program aiming at improving the mental health of the healthcare provider. Such programs should focus on the optimal financial, social, practical, and healthy life needed for better human health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hampton T. Experts address risk of physician suicide. JAMA 2005; 294
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, di Angelantonio E, Sen S. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA 2015; 314
Karanikola M, Giannakopoulou M, Mpouzika M, Kaite CP, Tsiaousis GZ, Papathanassoglou ED. Dysfunctional psychological responses among Intensive Care Unit nurses: a systematic review of the literature. Rev Esc Enfer USP 2015; 49
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al.
Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382
Salk RH, Petersen JL, Abramson LY, Hyde JS. The contemporary face of gender differences and similarities in depression throughout adolescence: development and chronicity. J Affect Disord 2016; 205
Fahmy SI, Nofal LM, Shehata SF, El Kady HM, Ibrahim HK. Updating indicators for scaling the socioeconomic level of families for health research. J Egypt Public Health Assoc 2015; 90
Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002; 32
Alkhazrajy, Lujain Anwar; Sabah, Sadik; Abed, SM Hassan. Prevalence of depressive symptoms among primary health care providers in Baghdad. Int J Health Psychol Res 2014; 2
Wang JN, Sun W, Chi TS, Wu H, Wang L. Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health 2010; 83
Liezel R. The prevalence of burnout and depression among medical doctors working in the Cape Town metropole community health care clinics and district hospitals of the provincial government of the Western Cape: a cross-sectional study [PhD thesis]. Stellenbosch: Stellenbosch University; 2011.
Abdulghani HM. Stress and depression among medical students: a cross sectional study at a medical college in Saudi Arabia. Pak J Med Sci 2008; 24
Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry 2008; 69
Myers MF, Gabbard GO. The physician as patient: a clinical handbook for mental health professionals. Washington, DC, USA: American Psychiatric Pub; 2009.
Wada K, Yoshikawa T, Goto T, Hirai A, Matsushima E, Nakashima Y, et al.
Association of depression and suicidal ideation with unreasonable patient demands and complaints among Japanese physicians: a national cross-sectional survey. Int J Behav Med 2011; 18:
Shen LL, Lao LM, Jiang SF, Yang H, Ren LM, Ying DG, Zhu SZ. A survey of anxiety and depression symptoms among primary-care physicians in China. Int J Psychiatry Med 2012; 44
Atif K, Khan HU, Ullah MZ, Shah FS, Latif A. Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan. Pak J Med Sci 2016; 32
Bernburg M, Vitzthum K, Groneberg DA, Mache S. Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals. BMJ Open 2016; 6
Welsh D. Predictors of depressive symptoms in female medical-surgical hospital nurses. Issues Ment Health Nurs 2009; 30
Abbas MA, Abu Zaid LZ, Hussaein M, Bakheet KH, Al Hamdan NA. Anxiety and depression among nursing staff at King Fahad Medical City, Kingdom of Saudi Arabia. J Am Sci 2012; 8
Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clin Nurse Spec 2012; 26
Mehrabi T, Ghazavi Z. Survey public health of woman nurses in hospitals of Isfahan University of Medical Science. J Health. 2005; 1
Schmidt DR, Dantas RA, Marziale MH. Anxiety and depression among nursing professionals who work in surgical units. Rev Esc Enfer USP 2011; 45
Stathopoulou H, Karanikola MN, Panagiotopoulou F, Papathanassoglou ED. Anxiety levels and related symptoms in emergency nursing personnel in Greece. J Emerg Nurs 2011; 37
Becker JL, Milad MP, Klock SC. Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents. Am J Obstet Gynecol 2006; 195
Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, et al.
Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008; 336
Hainer BL, Palesch Y. Symptoms of depression in residents: a South Carolina Family Practice Research Consortium study. Acad Med 1998; 73
Defoe DM, Power ML, Holzman GB, Carpentieri A, Schulkin J. Long hours and little sleep: work schedules of residents in obstetrics and gynecology. Obstet Gynecol 2001; 97
Firth-Cozens J, H Cording. “What matters more in patient care? Giving doctors shorter hours of work or a good night's sleep?.” 2004: 165–166.
Gong Y, Han T, Chen W, Dib HH, Yang G, Zhuang R, et al.
Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study. PLoS One 2014; 9
Virtanen M, Kivimäki M. Saved by the bell: does working too much increase the likelihood of depression?. Expert Rev Neurother 2012; 12
Bannai A, Tamakoshi A. The association between long working hours and health: a systematic review of epidemiological evidence. Scand J Work Environ Health 2014; 40
Levine RE, Bryant SG. The depressed physician: a different kind of impairment. Hosp Physician 2000; 36
Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al.
Depressive symptoms in medical students and residents: a multischool study. Acad Med 2009; 84
Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J, Guille C. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry 2010; 67
Erdur B, Ergin A, Turkcuer I, Parlak I, Ergin N, Boz B. A study of depression and anxiety among doctors working in emergency units in Denizli, Turkey. Emerg Med J 2006; 23
Gu A, Onyeama GM, Bakare MO, Igwe MN. Prevalence of depression among resident doctors in a teaching hospital, South East Nigeria. Int J Clin Psychiatry 2015; 3
Boya FÖ, Demiral Y, Ergör A, Akvardar Y, De Witte H. Effects of perceived job insecurity on perceived anxiety and depression in nurses. Ind Health 2008; 46
Halvani GH, Nodoushan IS, Hoboubati H, Nodoushan MS, Nodoushan RJ, Hajian N
Effect of shift work on the frequency of depression in nursing staff of Yazd University of Medical Sciences. J Comm Health Res 2012; 1
Ohida T, Kamal AM, Tomofumi SO, Ishii T, Uchiyama M, Minowa M, Nozaki S. Night-shift work related problems in young female nurses in Japan. J Occup Health 2001; 43
Ardekani ZZ, Kakooei H, Ayattollahi SM, Choobineh A, Seraji GN. Prevalence of mental disorders among shift work hospital nurses in Shiraz, Iran. Pak J Biol Sci 2008; 11
Akhtar-Danesh N, Landeen J. Relation between depression and sociodemographic factors. Int J Ment Health Syst 2007; 1
Reis EJ, Carvalho FM, Araújo TM, Porto LA, Silvany Neto AM. Job and mental disorders in teachers of the municipal network of Vitória da Conquest, Bahia, Brazil. Cad Saúde Pública 2005; 21
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]