ABSTRACT
Abstract: Introduction: Emergency medicine is a relatively new medical specialty in Brazil, approved just in 2016. Residency training programs have been implemented ever since. The emergency environment is known to represent a death-and-life tension on the professional team, culminating with high rates of mental illness in this population. The Covid-19 pandemic seems to be affecting these rates of depression, anxiety, and burnout in health professionals. Objective: To assess the symptoms of burnout, depression, and anxiety in Brazilian medical residents of Emergency Medicine during the Covid-19 pandemic and compare the residents' beliefs regarding clinical practice related to Covid-19 patients. Methods: A quantitative study was conducted with a convenience sample of volunteer medical residents from an anonymous online survey, available during April 2020. This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout; the Patient Health Questionnaire (PHQ-9) to measure depression; and the General Anxiety Disorders (GAD-7) to measure generalized anxiety disorder. This study also developed a Covid-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices related to Covid-19 patients. Results: The survey consisted of 63 respondents, about 26,35% of emergency medicine residents in Brazil. Only 39.6% residents felt safe while working with Covid-19 patients. Mild depressive symptoms were found in 68.2% of the residents, followed by anxiety symptoms in 50.7% and burnout in 54.0% overall. About 12% of the residents do nothing about their mental health status, while some prefer to talk with family or friends (36.1%) and discuss with their team support (24.3%) when they need mental health care. Conclusion: Emergency medicine residents have high rates of mental illness and it could get worse when submitted to stressful and unknown situations, such as the Covid-19 pandemic. Initiatives should be made to improve these physicians' mental health status. It is proposed that health institutions pay medical supervisors a closer and more unique look at physicians in training. A mentoring program proposal is an opportunity to reflect on technical and personal improvements for medical residents.
Resumo: Introdução: Medicina de emergência é uma especialidade relativamente nova no Brasil, aprovada apenas em 2016, e programas de treinamento em residência têm sido instituídos desde então. O ambiente da emergência é conhecido por representar uma tensão entre vida e morte nos profissionais, o que culmina em altos índices de adoecimento mental nessa população. A pandemia da Covid-19 aparenta estar influenciando nas taxas de depressão, ansiedade e burnout de profissionais de saúde. Objetivo: Este estudo teve como objetivos avaliar os sintomas de burnout, depressão e ansiedade em residentes de medicina de emergência brasileiros durante a pandemia da Covid-19 e comparar as crenças deles sobre a prática clínica relacionada aos pacientes com a doença. Método: Um estudo quantitativo foi realizado com uma amostra conveniente de médicos residentes voluntários, por meio de uma pesquisa on-line anônima disponível durante o mês de abril de 2020. Esta investigação coletou informações sociodemográficas e utilizou as seguintes escalas: Oldenburg Burnout Inventory (OLBI) para mensurar burnout, Patient Health Questionnaire (PHQ-9) para mensurar depressão e General Anxiety Disorders (GAD-7) para mensurar transtorno de ansiedade generalizada. Neste estudo, também foi desenvolvido um Questionário sobre o Impacto da Covid-19 (CIQ-19) para acessar as crenças e práticas clínicas relacionadas aos pacientes com Covid-19. Resultado: A pesquisa foi composta de 63 voluntários, aproximadamente 26,35% dos residentes em medicina de emergência no Brasil. Apenas 39,6% dos residentes se sentiram seguros enquanto trabalhavam com pacientes com Covid-19. Encontraram-se sintomas leves de depressão em 68,2%, seguidos de sintomas de ansiedade em 50,7% e burnout em 54,0%. Aproximadamente 12% dos residentes não fazem nada relação à própria saúde mental, alguns preferem conversar com familiares e amigos (36,1%), e outros discutem com a equipe de suporte (24,3%) quando precisam de atendimento. Conclusão: Os residentes de medicina de emergência possuem altos índices de adoecimento mental, e isso pode piorar quando submetidos a situações estressantes e desconhecidas, como a pandemia da Covid-19. Iniciativas devem ser tomadas para melhorar a saúde mental desses médicos. Propõe-se que as instituições de saúde ofereçam aos supervisores médicos uma visão mais próxima e exclusiva sobre os médicos em treinamento. A proposta de um programa de mentoria é uma oportunidade de refletir sobre melhorias técnicas e pessoais para médicos residentes.
ABSTRACT
ABSTRACT BACKGROUND: 2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic. OBJECTIVE: To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties. DESIGN AND SETTING: Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020. METHODS: This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients. RESULTS: The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties. CONCLUSION: Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.
Subject(s)
Humans , COVID-19 , Internship and Residency , Anxiety/epidemiology , Brazil/epidemiology , Mental Health , Cross-Sectional Studies , Surveys and Questionnaires , Depression/diagnosis , Depression/epidemiology , Pandemics , SARS-CoV-2ABSTRACT
OBJECTIVES: This study aims to assess the symptoms of burnout, depression, and anxiety in Brazilian medical residents during the COVID-19 pandemic and to compare residents' beliefs and clinical practices related to COVID-19 patients among all six years of medical residency training in Brazil. METHODS: A quantitative study was conducted in April 2020 with a convenience sample of medical resident volunteers from an anonymous online survey. This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression, and the General Anxiety Disorders (GAD-7) to measure generalized anxiety disorder. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices related to COVID-19 patients. RESULTS: Our sample comprised 3071 respondents. Depressive symptoms were the most common among second-year residents (70.5%), followed by anxiety symptoms (56.0%) and burnout (55.2%) among fourth-year residents. We also observed burnout symptoms (55.1%) among second-year residents. CONCLUSION: The COVID-19 pandemic increased the risk of mental illnesses in some years of residency. Our study could not conclude the reasons why the incidence varies among levels of physician training. Final year medical residents have avoided seeing COVID-19 patients.
Subject(s)
Humans , COVID-19 , Internship and Residency , Brazil/epidemiology , Mental Health , Surveys and Questionnaires , Pandemics , SARS-CoV-2ABSTRACT
Insight é um atributo amplamente investigado na psiquiatria clínica, principalmente nos ramos das psicoses e neuroses, para avaliar: a percepção do paciente sobre si mesmo, a compreensão de sua doença, o entendimento de necessidade de tratamento e a relação entre sua doença em seu contexto psicossocial. A anorexia nervosa é uma das doenças com maior índice de morbimortalidade dentro dos distúrbios psiquiátricos, sendo que um dos maiores fatores de risco para o início e progressão da doença é a percepção distorcida do paciente sobre o seu próprio corpo. A pesquisa tem como foco analisar o funcionamento do insight atrelado à anorexia nervosa a partir da visão do médico psiquiatra. Trata-se de uma pesquisa exploratória de abordagem qualitativa com a utilização de entrevistas semiestruturadas realizadas com oito psiquiatras matriculados no CRM/SC na região do Vale do Itajaí no ano de 2017. Foi utilizada para análise dos dados a perspectiva da "análise do conteúdo". A anorexia nervosa, por ser uma doença multifatorial que engloba todo o contexto psicossocial, econômico e familiar, deve contar com um tratamento multiprofissional voltado para os déficits que acompanham a patologia e a história da pessoa. Considera-se o insight como um mecanismo necessário à prática profissional dos médicos psiquiatras. Apesar do conceito de insight ser reconhecido no meio acadêmico e profissional médico, permanece um assunto com pouca profundidade e discussão. De tal modo, deve-se destacar a necessidade de outras pesquisas, pois o assunto tem importância para que se possa oportunizar melhores prognósticos e tratamentos e qualificação profissional.
Insight is an attribute widely investigated in clinical psychiatry, mainly in the branches of psychoses and neuroses, to evaluate: the patient's perception of himself, the understanding of his illness, the understanding of the need for treatment and the relation between his illness in psychosocial context. Anorexia nervosa is one of the diseases with the highest morbidity and mortality rate within psychiatric disorders, and one of the major risk factors for the onset and progression of the disease is a distorted perception in the patient's of their own body. The research focuses on the functioning of the insight linked to anorexia nervosa from the perspective of the psychiatrist. This is an exploratory qualitative approach with the use of semi-structured interviews with eight psychiatrists enrolled in the CRM/SC in the Vale do Itajaí region in the year 2017. The "content analysis" perspective was used to analyze the data. Because anorexia nervosa is a multifactorial disease that encompasses the whole psychosocial, economic and family context, it must have a multi-professional treatment focused on the deficits that accompany the pathology and history of the person. Insight is considered as a necessary mechanism for the practice of psychiatrists. Although the concept of insight is recognized in academia and medical settings, it still remains a subject with little depth and discussion. Therefore, it is necessary to highlight the need for other researches, because the subject in matter is important so that better prognoses, treatments and professional qualifications can be provided.