A simplified measure of burnout symptoms among paramedics - an exploratory analysis of a Hungarian sample.

BACKGROUND: Burnout is still one of the leading mental health problems. According to research results over the past decades, healthcare workers, including paramedics, are considered a high-risk group. In concordance with these results, the available resources need to prioritize monitoring paramedics' mental health. METHODS: In our study, we investigated whether the available test batteries measuring burnout could be reduced while maintaining their effectiveness. We reduced the 21-item Burnout Measurement and the 8-item version of the Psychosomatic Symptom Scale using the data of 727 Hungarian paramedics. We selected the top four items of the questionnaires that were significantly correlated with the original Burnout Measure Index and the Psychosomatic Scale Index. The classification efficiency of the shortened list of items was based on the initial risk categories of the Burnout Measure and its sensitivity was analyzed using Binary Logistic regression and ROC curves. We then used Two-Step Cluster Analysis to test the ability of the shortened Burnout Measure Index to develop new risk categories. The reliability indicators were also explored. RESULTS: The results show that the Burnout Measurement can be reduced to 4 items with a classification efficiency of 93.5% in determining the level of burnout. The 5-item reduction of the Psychosomatic Symptom Scale can classify subjects to the appropriate intervention level for burnout with an efficiency of 81.6%. The ROC analysis suggests that the shortened questionnaires have an excellent separative ability to discriminate between the initial risk groups. Three new risk categories were also identified as a result of the cluster analysis. CONCLUSION: The shortened scales may be proven effective in resource management, which could significantly quicken the assessment of burnout in the future. The abbreviated scale is also suitable for classifying subjects into risk categories. However, further research is needed to see whether the shortened scales can be used as a diagnostic tool.

Psychological immune competency predicts burnout syndrome among the high-risk healthcare staff: A cross-sectional study.

BACKGROUND: Burnout and psychological immune competency have not been investigated together among employees of high-risk specializations such as emergency medicine, intensive care or surgery. AIM: In this study we aim to examine the prevalence of burnout among high-risk clinical staff and explore whether the strength of psychological immune competency predict burnout. DESIGN: A cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the participants (n = 216). Nurses (n = 145) and physicians (n = 71) from emergency medicine, intensive care and surgery departments participated in the study. METHOD: Burnout syndrome was measured using the Maslach Burnout Inventory, while psychological immune competency was measured using the Psychological Immune Competency Questionnaire. The data collection started in June of 2018 and was finished in March of 2019. RESULTS: Participants with higher psychological immune competency reported lower levels of burnout: emotional exhaustion (r = -0.478; p < 0.001), depersonalization (r = -0.459; p < 0.001) and personal accomplishment (r = 0.543; p < 0.001). Multiple linear stepwise regression analysis revealed the psychological immune competency to be a stable predictor of burnout on all three scales. CONCLUSION: Psychological immune competency shows a strong relationship with scales of burnout syndrome and as such should be further examined due to development of successful intervention and prevention programs.

Adaptation and psychometric evaluation of Hungarian version of the Fear of COVID-19 Scale.

BACKGROUND: COVID-19 pandemic has had a global major healthcare, social and economic impact. In present study we aim to adapt the Fear of COVID-19 Scale to Hungarian. MATERIALS AND METHODS: Forward-backward translation method was used to translate the English version of the scale to Hungarian. Participants were a convenience sample of 2175 university students and employees. The study was conducted between January 18th and February 12th 2021. The test battery included Hungarian versions of Fear of COVID-19 scale, short Beck Depression Inventory (BDI-H) and State-Trait Anxiety Inventory (STAI). RESULTS: The scale showed one-factor structure, the loadings on the factor were significant and strong (from .47 to .84). Internal consistency was very good (α = .84). Construct validity for the Fear of COVID-19 Scale was supported by significant and positive correlations with STAI (r = 0.402; p < 0.001) and BDI-H (r = 0.270; p < 0.001). CONCLUSION: The Hungarian version of Fear of COVID-19 Scale is a reliable and valid tool in assessing fear of coronavirus.

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis.

OBJECTIVE: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.

[Depression screening in the pregnancy care. Results from the area of Békéscsaba]. / Depressziószurés a várandósgondozásban. Eredmények Békéscsaba körzetébol.

Introduction: Pregnancy is usually desired, yet it has its own difficulties that can be overwhelming, thus depression might occur. The prevalence of this is 6.58-26.7% in the international literature and 6.5-17.9% in Hungarian studies. Aim: The aim was to analyze the data of the perinatal depression screening program of Békéscsaba which started in 2014. We wanted to study the pathological rate and the connection between demographic data and depression symptoms. Method: Until august 2019, 1708 women took part in the program. The screening is done by perinatal nurses: they explain the aims and hand over the Edinburgh Postnatal Depression Scale three times during pregnancy and once postpartum. They also suggest women in need to attend the psychological intervention as part of the screening. Results: The prevalence of the pathological questionnaires were 15.31%, 14.29%, 11.87%, and 12.68% at the four measuring occasions. In the whole sample, 18.27% of women had pathological score at least once. The depression scores of the four measurements correlated significantly with each other. Women who did not plan their pregnancies had higher level of depression in all four measurements. In the first trimester, women who were under 21 years old and/or were single had higher depression scores. In the second trimester, multipara women tended to have higher scores. Conclusion: The high prevalence and the constant level of depression emphasize the importance of the screening and psychological intervention, as previous studies found connection between depression and some perinatal complications. Some demographic factors can indicate more vulnerable women. Orv Hetil. 2020; 161(10): 374-381.

Associations Between Depression Symptoms, Psychological Intervention and Perinatal Complications.

Antenatal and postpartum depression has been associated with maternal, child and family-unit complications. Our aim was to assess the impact of a depression screening and intervention program on perinatal complications. This study included 2042 women. They were screened on the Edinburgh Postnatal Depression Scale (EPDS), three times during pregnancy and once after childbirth. If their EPDS score was above the cut-off score, psychological intervention was offered. Significant relationships were found between depression scores and perinatal complications, such as protracted cervical dilation, protracted descent, preeclampsia, intrauterine growth restriction, low birthweight and cesarean section. Depression scores were higher in the intervention group, compared to the non-intervention group, but decreased after the consultations. The cesarean section rate was significantly lower in the consultation group. A rapid screening process can provide an adequate tool to identify women who are more likely to have such complications due to depression.

[Investigation of the burnout syndrome among the employees of the Department of Surgery at the University of Szeged and comparison with the results of the Department of Emergency Medicine]. / A kiégésszindróma vizsgálata a Szegedi Tudományegyetem Sebészeti Klinikájának dolgozói körében és összehasonlítása a Sürgosségi Betegellátó Önálló Osztályon kapott eredményekkel.

Introduction: Examination of the burnout syndrome in various healthcare fields has paramount importance for a better understanding of the disorder as well as for the establishment of a suitable preventive and intervention program. The surgical departments' employees are at risk among healthcare workers, so it is our objective to further expand the knowledge on the characteristics of the burnout syndrome among the Hungarian surgical staff. Additionally, we compare the results obtained from the Department of Surgery at the University of Szeged with the results of the Department of Emergency Medicine. Aim: Aim of this study is to examine the burnout syndrome and its associations with different variables among the workers of the Department of Surgery at the University of Szeged, and to compare the data with a previous study conducted at the Department of Emergency Medicine at the University of Szeged. Method: Cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the staff. Burnout was measured using the Maslach Burnout Inventory, while psychological immune competence was measured using the Psychological Immune Competence Questionnaire. Results: Based on statistical analysis, the number of weekly working hours and the number of somatic symptoms have a negative impact on burnout, while the greater number of high-quality social relationships and the stronger psychological immune competence have proven to be protective factors. Comparing the Department of Surgery and Department of Emergency Medicine at the University of Szeged, we found a difference in the age of the workers, the number of years spent in the healthcare as well as the scores on the burnout depersonalization scale. Conclusions: The results obtained show further correlations and reveal protective and risk factors in burnout which can be a key to establishing preventive and intervention strategies. Orv Hetil. 2019; 160(20): 784-791.

[Investigation of the burnout syndrome among the employees of the Department of Emergency Medicine at the University of Szeged]. / A kiégésszindróma vizsgálata a Szegedi Tudományegyetem, Sürgosségi Betegellátó Önálló Osztály dolgozóinak körében.

INTRODUCTION: Burnout has been described as a growing problem amongst healthcare workers. Emergency department staffs experience the burden of stress day by day, yet only a few studies have examined their burnout. AIM: In this study we wanted to investigate the burnout and its relations to other variables amongst the employees of the Department of Emergency Medicine in Szeged. METHOD: Cross-sectional design utilizing a self-administered questionnaire was used to collect data from the staff of the Department. Burnout was measured using the Maslach Burnout Inventory. RESULTS: Burnout is considerably prevalent among the workers of the Emergency Department, especially nurses and physicians. The study found negative relation between burnout and age, number of children, number of years in the healthcare system, number of physical symptoms, social support and psychological immune system. Being single was a risk factor. CONCLUSIONS: The risks and protective factors found to be associated with burnout in this study might help to set up institutional prevention and intervention strategies. Orv Hetil. 2018; 159(3): 113-118.

A more rational, theory-driven approach to analysing the factor structure of the Edinburgh Postnatal Depression Scale.

We endeavoured to analyze the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) during a screening programme in Hungary, using exploratory (EFA) and confirmatory factor analysis (CFA), testing both previously published models and newly developed theory-driven ones, after a critical analysis of the literature. Between April 2011 and January 2015, a sample of 2967 pregnant women (between 12th and 30th weeks of gestation) and 714 women 6 weeks after delivery completed the Hungarian version of the EPDS in South-East Hungary. EFAs suggested unidimensionality in both samples. 33 out of 42 previously published models showed good and 6 acceptable fit with our antepartum data in CFAs, whilst 10 of them showed good and 28 acceptable fit in our postpartum sample. Using multiple fit indices, our theory-driven anhedonia (items 1,2) - anxiety (items 4,5) - low mood (items 8,9) model provided the best fit in the antepartum sample. In the postpartum sample, our theory-driven models were again among the best performing models, including an anhedonia and an anxiety factor together with either a low mood or a suicidal risk factor (items 3,6,10). The EPDS showed moderate within- and between-culture invariability, although this would also need to be re-examined with a theory-driven approach.

[The risk factors of mood changing during the perinatal period]. / A hangulati állapot alakulásának kockázati tényezoi a perinatalis idoszakban.

INTRODUCTION: The screening of perinatal depression was introduced in Szeged in April 2011. AIM: Our aim was to assess the extent of perinatal mood changing and to explore the risk factors of it. METHOD: Perinatal nurses gave the Edinburgh Postnatal Depression Scale to the 3849 participants four times. RESULTS: In the first trimester were the highest average scores (3.74) and pathological rate (10.8%) compared to the other measurement occasions. There was a positive correlation between the scores of the measurement occasions. The higher average scores related to the epidural anesthesia almost significantly, but significantly to the low birth weight, unplanned pregnancies, younger and older age, single marital status and multiparity of the participant. CONCLUSIONS: Even the first trimester is sensitive to pathological mood changes, which besides with other factors could be risk factors to postpartum depression. To avoid this it is important to continue the screening and provide adequate help. Orv. Hetil., 2017, 158(4), 139-146.

Non-medical determinants of cesarean section in a medically dominated maternity system.

OBJECTIVE: To assess the contribution of non-medical factors to actual mode of delivery in a setting with high cesarean rates. DESIGN: Follow-up survey. SETTING: University department of obstetrics and gynecology. SAMPLE: Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid-pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. METHODS: Structured questionnaire completed in gestational weeks 18-22. Information on subsequent delivery was obtained from patient files and through personal contact. MAIN OUTCOME MEASURES: Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio-demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. RESULTS: The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one-third (two-fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. CONCLUSIONS: The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non-medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role.

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary.

BACKGROUND: the purpose of the study was to assess the validity of the 10-item Edinburgh Postnatal Depression Scale (EPDS) in screening for postnatal depression (PND) in Hungary. METHODS: between July 2010 and March 2011, a sample of 266 women attending a routine check-up at six weeks post partum completed the newly translated Hungarian version of the EPDS at the Department of Obstetrics and Gynecology, University of Szeged, Hungary, and underwent clinical assessments based on the Structured Clinical Interview for DSM-IV disorders (SCID-I). FINDINGS: eight (3.0%) of the mothers were diagnosed with major postnatal depression, and 36 (13.5%) with minor depression on the basis of the SCID. Internal consistency of the Hungarian version of the EPDS was satisfactory (Cronbach α coefficients ≥0.727). The best cut-off for major depression was 12/13, with a sensitivity of 100.0%, and a specificity of 97.7%. The area under the ROC curve was found significant for combined (major+minor) depression as well and at a cut-off of 7/8 indicated a sensitivity of 72.7% and a specificity of 86.0%. A factor analysis suggested multidimensionality with two factors (anxiety and depression). CONCLUSIONS: the EPDS showed good validity in the postnatal period in a clinical sample in Hungary.

Women's antenatal preferences for delivery route in a setting with high cesarean section rates and a medically dominated maternity system.

OBJECTIVE: To assess birth preferences in a sample of Hungarian pregnant women and identify determinants of ambivalence or clear choices for cesarean section throughout pregnancy. DESIGN: Follow-up two-point questionnaire survey. SETTING: University Department of Obstetrics and Gynecology in Hungary. SAMPLE: A total of 413 women with singleton pregnancies where there was no awareness of medical contradictions to vaginal delivery, attending for routine ultrasound examination in mid-pregnancy from November 2011 to March 2012. METHODS: Questionnaires completed in mid- and late pregnancy (gestational weeks 18-22 and 35-37) including the Wijma Delivery Expectancy/Experience Questionnaire A. MAIN OUTCOME MEASURES: Prevalence of women preferring cesarean section or being uncertain about what delivery route to choose, in case they had the choice; their demographic characteristics, attitudes toward birth issues and their Wijma Delivery Expectancy/Experience Questionnaire A scores, compared with women consistent in their preference for vaginal delivery. RESULTS: Of the 413 respondents, 365 (88.4%) were consistent in their preference for vaginal delivery. In logistic regression models the important contributors to describing preferences for cesarean section or uncertain preferences were previous cesarean section and maternal belief that cesarean section is more beneficial than vaginal delivery. CONCLUSIONS: The majority of pregnant women preferred vaginal delivery to cesarean section. Neither a higher Wijma Delivery Expectancy/Experience Questionnaire A score nor sociodemographic differences were important determinants of a preference for cesarean section or for an uncertain preference. On the other hand, previous cesarean section and certain preconceived maternal attitudes towards delivery were characteristic for these women.

The Edinburgh Postnatal Depression Scale: translation and antepartum validation for a Hungarian sample.

OBJECTIVE: the Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument routinely used during the peripartum period for the identification of depression. The purpose of the study was to assess the validity of the 10-item EPDS in screening for antepartum depression (APD) in Hungary. DESIGN: validation study carried out between July and December 2010. SETTING: Department of Obstetrics and Gynecology, University of Szeged, Hungary. PARTICIPANTS: 219 women attending a routine check-up at 12 weeks antepartum. INTERVENTIONS: participants completed the newly translated Hungarian version of the EPDS and underwent a clinical assessment with the Structured Clinical Interview for DSM-IV disorders (SCID-I). MEASUREMENT AND FINDINGS: seven (3.2%) of the mothers were diagnosed with major antepartum depression and 15 persons (6.85%) with minor depression on the basis of the SCID. Internal consistency of the EPDS was satisfactory (Cronbach α coefficients ≥0.728). The best cut-off on the Hungarian version of the EPDS for major depression was 8/9, with a sensitivity of 71.4%, and a specificity of 91.5%. The area under the ROC curve was found significant for combined depression as well and at a cut-off of 6/7 indicated a sensitivity of 81.8% and a specificity of 83.2%. KEY CONCLUSIONS: the EPDS showed acceptable validity despite a considerable scatter in the total scores in our sample. IMPLICATION FOR PRACTICE: the EPDS is a reliable instrument for the screening of depressive disorders, especially major depressive disorder in early pregnancy among Hungarian women.

Obstetric and psychosocial risk factors for depressive symptoms during pregnancy.

We aimed to determine the psychosocial and obstetric correlates of depressive symptomatology during pregnancy in South-Eastern Hungary. A total of 1719 women were screened for depression in four counties in 2006 and 2007, based on a Leverton Questionnaire (LQ) score of ≥12 at 14-24 weeks of gestation. The LQ scores indicated a probable depressive illness (PDI) in 17.2% of the study group. The best predictors in a multiple regression analysis were history of major depression (adjusted odds ratio [AOR]=3.23), and major life events (AOR=2.43). A perceived lack of social support from partner (AOR=1.79) and lack of support by family (AOR=1.23) were also significant determinants. Lack of planning of pregnancy (AOR=1.12) and a history of unfavourable obstetric outcome (AOR=1.42) also seem to predispose to PDI. Overall, psychosocial factors appeared important in the prediction of PDI, whereas economic features did not.