Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study.

BACKGROUND: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. OBJECTIVE: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. METHODS: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55% women) submitted self-collected hair samples for cortisol analysis. RESULTS: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. CONCLUSIONS: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics.

Beliefs about stress moderate the association between COVID-19-related work demands and burnout symptoms in physicians.

The present study set out to investigate the role of different stress beliefs (positive and negative beliefs about stress, as well as perceived control) on the association between central COVID-19-related work demands and burnout symptoms in physicians during the second lockdown of the SARS-CoV-2 pandemic. N = 154 practicing physicians (mean [SD] age = 37.21 [9.43] years]; 57.14% female) participated in our cross-sectional German-wide online survey and answered questions about sociodemographic factors, their current work situation, their stress beliefs, and their current burnout symptoms. Moderation analyses revealed significant interaction effects between stress beliefs and specific COVID-19-related work demands on the prediction of burnout symptoms, most consistent with respect to perceived control. Positive believes about stress and its controllability were cross-sectional associated with reduced, negative believes about stress however with enhanced associations between COVID-19-related work demands and burnout symptoms. This finding indicates, if confirmed by longitudinal research, the potential of the usage of stress beliefs in prevention programs for physicians in order to mitigating negative effects of chronic stress.

The moderating effect of cortisol and dehydroepiandrosterone on the relation between sleep and depression or burnout.

For poor sleep quality (SQ) as well as major depressive disorder (MDD) and burnout, a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been identified. Although poor SQ is often reported as an early symptom of MDD or burnout, it is not clear whether HPA axis-related hormones can influence the association between SQ and MDD or burnout. This manuscript addresses this question by examining HPA axis-related hormones as potential moderators influencing the association between SQ and MDD or burnout. In the fourth annual examination wave of the Dresden Burnout Study, we measured general SQ (including sleep duration and efficiency), depressive and burnout symptoms, and obtained hair samples for quantification of long-term integrated steroid concentrations (cortisol [hC], cortisone [hCn], dehydroepiandrosterone [hDHEA]) from 462 participants (67% female). Data on SQ, depressive and burnout symptoms were available from 342 participants from the preceding examination wave (average time span between examinations 13.2 months). Cross-sectional analyses showed that the negative association between sleep duration and depressive symptoms was buffered by higher levels of hC, and hCn, whereas the negative association between sleep duration and burnout symptoms was buffered by higher levels of hDHEA. The negative association between sleep efficiency and burnout symptoms was intensified by higher levels of hC and hC/hCn ratio and the negative association between general SQ and burnout symptoms was intensified by higher levels of hC/hCn ratio. With regard to longitudinal data, a significant interaction effect between sleep duration and hC/hCn ratio could be detected for burnout symptoms. Our results suggest opposed moderation effects of hair glucocorticoids on the association between SQ and depressive or burnout symptoms. This points toward opposed glucocorticoid receptor functioning in depression and burnout. To fully elucidate the negative consequences of poor SQ on MDD and burnout, the complex underlying mechanisms of action including HPA axis-related hormones need to be investigated in MDD and burnout separately.

Sleep disturbances in major depressive and burnout syndrome: A longitudinal analysis.

Sleep quality (SQ) is considered to be a critical variable in major depressive syndrome (MD) as well as in burnout syndrome (B). Thus far, no study examined the differential influence of these syndromes on SQ. MD and B have been assessed in 4,415 participants at baseline and in 1,396 participants at follow-up based on the Patient Health Questionnaire-9 (PHQ-9) and the Maslach Burnout Inventory-General Survey (MBI-GS). The Pittsburgh Sleep Quality Index was used to measure SQ. Based on the PHQ-9 and MBI-GS at baseline assessment, participants were divided into four groups: a control group, a MD group, a B group, and a comorbid group suffering from MD and B. Multiple regression analyses showed that all groups demonstrate significantly worse SQ than the control group, while individuals with MD showed a lower SQ compared to individuals with B. The comorbid group showed the lowest SQ. Longitudinal analyses showed a significant bidirectional association between major depressive symptoms and SQ, whereas burnout symptoms were predictive for SQ but not vice versa. The study indicates differences between MD and B with regard to SQ, suggesting worse SQ in more severely burdened groups. Major depressive symptoms are bidirectionally linked to SQ, whereas burnout symptoms are only suggested a risk factor for impaired SQ.

Thinking Against Burnout? An Individual's Tendency to Engage in and Enjoy Thinking as a Potential Resilience Factor of Burnout Symptoms and Burnout-Related Impairment in Executive Functioning.

The personality trait need for cognition (NFC) refers to individual differences in the tendency to engage in and enjoy cognitive endeavors. In today's working world, which is characterized by increasing cognitive demands, NFC may contribute to resilience against work-related stress and burnout symptoms. We investigated this question in a large population-wide sample of 4,134 individuals (Study 1) and in a sample of 125 students (Study 2). NFC was consistently negatively related to the burnout facets emotional exhaustion and reduced personal efficacy of the Maslach burnout inventory and explained up to 10% additional variance in burnout symptoms over and above the five-factor model of personality. In the student sample, where stress factors are mainly cognitive in nature, NFC was the most relevant predictor. In this sample, we additionally investigated whether NFC might be a relevant moderator of the inconsistently found associations between burnout and impairments in cognitive functioning. The participants conducted three cognitive tasks (number-letter task, two-back task, and Go/NoGo task) that measure the executive functions switching, updating, and response inhibition, respectively. While burnout was slightly negatively related to working memory performance, NFC did not moderate the relationship between burnout and executive control which could be traced back to the young and healthy sample used to examine this research question. All in all, our results clearly suggest that NFC may be an important individual difference factor contributing to the resilience against burnout, especially if stress factors are cognitive in nature.

Reduced self-regulation mirrors the distorting effects of burnout symptomatology on task difficulty perception during an inhibition task.

Burnout, a pathological consequence of chronic work stress, shows an increasing incidence rate in industrialized countries. Previous findings indicate that burnout may be linked to a detachment of the negative association between subjectively appraised task demand and cognitive performance, which is typically seen in healthy individuals. The present study sought to confirm this relationship and to investigate whether this dissociation is mirrored in a biological marker of self-regulation, i.e., resting vagally mediated heart rate variability (HRV). A heterogeneous sample (N = 65) of working adults (M age = 43.3, SD = 10; 23.1 % male) with varying degrees of burnout symptomatology completed three cognitive tasks (2-back, number-letter, and go/nogo) to assess different domains of executive functioning (updating, set-shifting, and inhibition), and respective demand ratings. Additionally, vagally mediated HRV at rest, operationalized as the root-mean square differences of successive R-R intervals (RMSSD), was recorded. Burnout symptomatology moderated the association between subjective task difficulty and performance parameters of the go/nogo task, such that higher burnout scores were associated with reductions in the naturally occurring negative association between self-rated task demand and response inhibition. Intriguingly, this pattern was mirrored when replacing burnout with HRV. These findings suggest that burnout symptomatology, and individual differences in self-regulatory capacities (indexed by resting HRV), may alter one's capacity for accurate task evaluation, a mechanism which could potentially underlie the dissociation between self-rated cognitive function and actual performance among individuals experiencing burnout.