Department of Surgery, Duke University, Durham, North Carolina.
School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
J Surg Res. 2020 Nov;255:536-548. doi: 10.1016/j.jss.2020.04.038. Epub 2020 Jul 5.
Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment.
A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory.
There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006).
Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.
外科医生面临倦怠和抑郁的风险，这可能导致医疗错误、效率低下、精疲力竭、冲突和自杀。撒哈拉以南非洲地区存在重大挑战，可能会增加倦怠和抑郁的发生率，但尚未有正式评估确定特定于这种环境的压力源。
向东、中、南部非洲外科医生学院（COSECSA）的所有成员分发了一份调查。使用经过验证的措施评估倦怠、抑郁和压力源：医务人员倦怠量表、患者健康问卷（PHQ）9 项和霍姆斯-拉赫生活压力量表。
共有 131 名参与者（98 名非洲和 33 名非非洲外科医生）。中度至重度抑郁的发生率为 48%（n=63），倦怠的发生率高达 38%（n=48）。在婚姻状况、子女数量、实践中的合作伙伴或时间分配方面，非洲和非非洲外科医生之间没有显著差异。更多的非洲外科医生经历了孩子的出生（18%比 3%，P=0.04），但工作场所冲突较少（7.1%比 10.7%，P=0.045）。非洲外科医生更一致地认为他们对他人有积极影响（P=0.008），喜欢与患者合作（P=0.009），并且更满意（P=0.04）。对于所有外科医生，增加 PHQ-9 抑郁的预测因素是严重的职业冲突（P=0.02）、难以获得儿童保育（P=0.04）和种族歧视（P=0.003）。在 Maslach 模型中，倦怠的预测因素是难以获得儿童保育（P=0.05）和基于性别的晋升被拒绝（P=0.006）。
在东、中、南部非洲地区执业的外科医生中，倦怠和抑郁的发生率很高。尽管面临重大挑战，非洲外科医生对工作的看法往往更为积极。通过关注工作条件、晋升机会平等、工作场所冲突管理、儿童保育支持和增加执业外科医生的数量，可以改善倦怠和抑郁状况。
