Stress, depression and burnout among hospital physicians in Rijeka, Croatia.

BACKGROUND: Six years of recent ongoing economic and structural crisis in Croatia have brought to a significant decrease of socioeconomic standard in our country, and had an important impact on the health care system. In this background we examined the prevalence of depression and burnout and their association with work stressors. SUBJECTS AND METHODS: Cross sectional survey was conducted with self reported questionnaires in 459 hospital physicians in Rijeka, Croatia. Physicians were divided into three groups: surgical, nonsurgical and diagnostic group. Socio-demographic and work-related characteristics questionnaire, Occupational Stress Assessment Questionnaire (OSAQ), Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and Beck Depression Inventory II (BDI-II) were used. Sperman correlation and logistic regression were calculated to rank association between stressors at work with depression and burnout syndrome. RESULTS: Response rate was 62.3%, (286/459). Every fifth doctor experienced all examined stressors in the workplace as stressful. The prevalence of moderate and severe depression was 12.2%. High levels of emotional exhaustion were 43.6%, depersonalization 33.5%, and lack of personal accomplishment 49.1%. There was no statistical difference in surgical, nonsurgical and diagnostic groups in depression and all domains of MBI-HSS. Almost all stressors were correlated with depression and burnout syndrome. Most of the perceived stressors were significant predictors of burnout syndrome and depression. CONCLUSIONS: High levels of burnout domain compared to overall results from similar studies from other countries, placed the results in our sample on the higher end of the range, while results for depression after adjustment with lower cutoff point would be similar to those usually found in research literature. Our study showed that burnout is highly prevalent among Croatian physicians. Target interventions at the workplace should be considered as one of the strategies to reduce negative impact of work stress on physicians' mental health.

Risk behaviors for getting HIV infection among the Croatian men who have sex with men in 2007.

This survey was conducted with the aim of obtaining the information on the sexual risk behavior of Croatian men who have sex with men (MSM) two years after the first research. There was total of 820 respondents recruited at seven frequent meeting places of Croatian MSM in Zagreb and Rijeka, as well as one gay-oriented web-site. The overall response rate was 17.6% which is 1.4 percentage point less than it was two years ago. The rate of condom use during last anal intercourse was 53.2% and 69% of those who used a lubricant had chosen a correct water-based product which is increase of 15% comparing to the last research. Only 27% of those who had also had sex with women (MSM/MSW) during last 12 months regularly used protection. The results of this research suggest that there are trends in declining of some risk behaviors among Croatian MSM but there is a lot of space for focused and effective prevention activities on increasing the risk perception and reducing risk behaviors.

Seroprevalence of blood-borne infections and population sizes estimates in a population of injecting drug users in Croatia.

Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system. The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated IDUs population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level.