Burnout en los médicos de familia de Cataluña durante la quinta ola de la pandemia COVID-19 / Burnout among Catalan family doctors during the fifth wave of the COVID-19 pandemic

Objetivo: la pandemia de la COVID-19 ha tenido un impacto psicológico en los profesionales sanitarios, a menudo manifestándose como burnout. Nuestro objetivo fue estimar la prevalencia del burnout en médicas y médicos de familia de Cataluña durante la pandemia e identificar factores sociodemográficos, laborales y de salud mental asociados.Métodos: estudio descriptivo transversal basado en una encuesta online realizada entre junio y julio de 2021. Se invitó a participar a los 4.700 socios y socias de la Societat Catalana de Medicina Familiar i Comunitària (CAMFiC) y se obtuvo un 11% de respuesta (n = 522).Medidas principales: Maslach Burnout Inventory, con tres dimensiones: agotamiento emocional, despersonalización y realización personal. Análisis bivariante y regresión logística múltiple (variable dependiente: nivel elevado de afectación para cada dimensión de burnout).Resultados: el 67,5% de encuestados presentó niveles altos de agotamiento emocional, el 42,7% de despersonalización y el 29,9% de niveles bajos de realización personal. La prevalencia de agotamiento emocional elevado fue mayor entre las mujeres y los expuestos a pacientes con COVID-19. La edad y años de antigüedad laboral se asoció de forma inversa a agotamiento emocional y despersonalización alta. En el análisis multivariante, la depresión se asoció a despersonalización alta y realización personal baja, la ansiedad a agotamiento emocional alto, y el estrés a las tres dimensiones.Conclusiones: después de 1 año de pandemia, existen niveles elevados de burnout en los médicos y médicas de familia, particularmente en la dimensión de agotamiento emocional. Son necesarias medidas organizativas para proteger la salud mental de las/los profesionales.(AU)

Aim: the COVID-19 pandemic has had a psychological impact on health professionals, often manifesting as burnout. Our purpose was to estimate the prevalence of burnout in family doctors in Catalonia during the pandemic and to identify associated sociodemographic, occupational and mental health factors.Methods: cross-sectional descriptive study based on an online survey conducted June-July 2021. The 4700 members of the Catalan Society of Family and Community Medicine were invited to take part. An 11% response was obtained (n=522).Primary endpoints: Maslach Burnout Inventory, with three dimensions: emotional exhaustion, depersonalization and personal accomplishment. Bivariate analysis and multiple logistic regression (dependent variable: high level of affectation for each area dimension of burnout).Results: a total of 67.5%, 42.7% and 29.9% of respondents presented high levels of emotional exhaustion, depersonalization and low sense of personal accomplishment, respectively. The prevalence of high emotional exhaustion was higher among women and those exposed to COVID-19 patients. Age and seniority were inversely associated with emotional exhaustion and high depersonalization. Multivariate analysis revealed that depression was associated with high depersonalization and low personal accomplishment, anxiety with high emotional exhaustion, and stress with all three areas.Conclusions: One year after onset of the pandemic, we detected high levels of burnout in family doctors, particularly in terms of emotional exhaustion. Organizational measures are necessary to protect the mental health of professionals.(AU)

Gender differences in GPs' strategies for coping with the stress of the COVID-19 pandemic in Catalonia: A cross-sectional study.

BACKGROUND: The Covid-19 pandemic has increased stress levels in GPs, who have resorted to different coping strategies to deal with this crisis. Gender differences in coping styles may be contributing factors in the development of psychological distress. OBJECTIVES: To identify differences by gender and by stress level in coping strategies of GPs during the Covid-19 pandemic. METHODS: A cross-sectional, web-based survey conducted with GPs in Catalonia (Spain), in June-July 2021. via the institution's email distribution list, all GPs members of the Catalan Society of Family and Community Medicine were invited to complete a survey assessing sociodemographic, health and work-related characteristics, experienced stress (Stress scale of the Depression, Anxiety and Stress Scales-DASS 21) and the frequency of use of a range of coping strategies (Brief-COPE) classified as problem-focused, emotion-focused and avoidant strategies, some of which are adaptive and others maladaptive. We compared the scores of each strategy by gender and stress level using Student's t-test. RESULTS: Of 4739 members, 522 GPs participated in the study (response rate 11%; 79.1% women; mean age = 46.9 years, SD = 10.5). Of these, 41.9% reported moderate-severe stress levels. The most common coping strategies were acceptance, active coping, planning, positive reframing and venting. More frequently than men, women resorted to emotional and instrumental support, venting, distraction and self-blame, whereas men used acceptance and humour more commonly than women. Moderate-severe stress levels were associated with non-adaptive coping, with increased use of avoidance strategies, self-blame, religion and venting, and decreased use of positive reframing and acceptance. CONCLUSION: The most common coping strategies were adaptive and differed by gender. However, highly stressful situations caused maladaptive strategies to emerge.

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10.

Background: Depression has a high prevalence among European countries. Several instruments have been designed to assess its symptoms in different populations. The Hopkins Symptom Checklist 25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use. There are short versions of this scale that could be useful in Primary Care (PC) settings, but their psychometric properties are unknown. Aim: To assess in PC patients the psychometric properties and diagnostic accuracy of the Spanish version of the HSCL-10 and the HSCL-5 consisting of 10 and 5 items, respectively. Methods: A multicenter, cross-sectional study was carried out at six PC centers in Spain. The HSCL-25 was administered to outpatients aged 45-75 who also participated in the structured Composite International Diagnostic Interview (CIDI). HSCL-10 and HSCL-5 were assessed and compared to HSCL-25 regarding total score correlation, internal consistency, and criterion validity against the gold-standard CIDI. This is a methodological study from a secondary data analysis and the primary data has been previously published. Results: Out of 790 patients, 767 completed the HSCL-25 and 736 the CIDI interview (96.0%). Cronbach's Alpha was 0.84 for HSCL-10 and 0.77 for HSCL-5. The known-group method and confirmatory factor analysis were acceptable for the establishment of construct validity. Sensitivity was 79.7% (CI95%, 67.7-88.0%) for HSCL-10, and 78.0% (CI95%, 65.9-86.6%) for HSCL-5, whereas specificity was 83% (CI95%, 80.0-85.7%) for HSCL-10, and 72.8% (CI95%, 69.3-76.0%) for HSCL-5. Area under the curve against CIDI was 0.88 (CI95%, 0.84-0.92%) for HSCL-10, and 0.85 (CI95%, 0.81-0.89%) for HSCL-5. Optimum cutoff point calculated with Youden Index was 1.90 for the HSCL-10 and 1.80 for the HSCL-5. Conclusion: HSCL-10 and HSCL-5 are reliable and valid tools to detect depression symptoms and can be used in PC settings.

Nine Forward-Backward Translations of the Hopkins Symptom Checklist-25 With Cultural Checks.

Introduction: The Hopkins Symptom Checklist-25 (HSCL-25) is an effective, reliable, and ergonomic tool that can be used for depression diagnosis and monitoring in daily practice. To allow its broad use by family practice physicians (FPs), it was translated from English into nine European languages (Greek, Polish, Bulgarian, Croatian, Catalan, Galician, Spanish, Italian, and French) and the translation homogeneity was confirmed. This study describes this process. Methods: First, two translators (an academic translator and an FP researcher) were recruited for the forward translation (FT). A panel of English-speaking FPs that included at least 15 experts (researchers, teachers, and practitioners) was organized in each country to finalize the FT using a Delphi procedure. Results: One or two Delphi procedure rounds were sufficient for each translation. Then, a different translator, who did not know the original version of the HSCL-25, performed a backward translation in English. An expert panel of linguists compared the two English versions. Differences were listed and a multicultural consensus group determined whether they were due to linguistic problems or to cultural differences. All versions underwent cultural check. Conclusion: All nine translations were finalized without altering the original meaning.

Validation and Psychometric Properties of the Spanish Version of the Hopkins Symptom Checklist-25 Scale for Depression Detection in Primary Care.

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach's alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86-0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1-95.1%) and specificity was 76.7% (CI 95%, 73.3-79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

Burnout y malestar psicológico en los residentes de Medicina Familiar y Comunitaria / Burnout and psychological distress among trainee General Practitioners

OBJETIVO: Estimar la prevalencia de burnout y malestar psicológico de los médicos residentes de Medicina Familiar y Comunitaria (MFyC) de dos unidades docentes y determinar su relación con el año de residencia, los estilos de vida y las condiciones laborales. DISEÑO: Estudio transversal. Emplazamiento: Atención Primaria. Participantes: Se realizaron encuestas presenciales a los residentes de dos unidades docentes (n = 278), incluyendo a todos los residentes de la muestra. El porcentaje de respuesta fue del 76,9%. MEDICIONES PRINCIPALES: Prevalencia de burnout mediante la escala Maslach Burnout Inventory (MBI) y prevalencia de malestar psicológico mediante la escala General Health Questionnaire-12 (GHQ-12). También variables sobre estilos de vida, organización laboral y consumo de drogas. RESULTADOS: El 72% de los participantes son mujeres. La prevalencia de burnout es del 33,8% (IC 95% 27,0-40,6), siendo del 25,6% (IC 95% 19,5-31,7) el agotamiento emocional, 37,9% (IC 95% 31,0-44,7) la despersonalización y 52,9% (IC 95% 45,9-59,9) la baja realización personal. La prevalencia aumenta de forma significativa en todas las dimensiones a partir del segundo año de residencia, excepto en la realización personal. La prevalencia de malestar emocional es del 40,4% (IC 95% 33,5-47,3), sin diferencias significativas según año de residencia. De los residentes con malestar psicológico, el 50,0% presenta también burnout, mientras que este porcentaje es del 22,1% entre los que no presentan malestar psicológico. CONCLUSIONES: La prevalencia de malestar emocional y de burnout (especialmente en baja realización personal) es elevada en los residentes de Medicina Familiar y Comunitaria. Esta es superior a la descrita en estudios previos para otros colectivos de profesionales de la salud y se debe tener en cuenta para desarrollar medidas preventivas

OBJECTIVE: To estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions. DESIGN: Cross-sectional study. LOCATION: Primary Care. PARTICIPANTS: On-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%. MAIN MEASUREMENTS: Prevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use. Outcomes: 72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7) depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training. In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress. CONCLUSIONS: The prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures

Traducción y adaptación transcultural l español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria / Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care

OBJETIVO: Describir el proceso de traducción y adaptación transcultural de la escala Hopkins Symptom Checklist-25 (HSCL-25) al español, catalán y gallego. DISEÑO: Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. EMPLAZAMIENTO: Unidades de Investigación de Atención Primaria de Barcelona y Vigo. PARTICIPANTES: Médicos de familia y pacientes de Atención Primaria. MEDICIONES PRINCIPALES: Siguiendo las guías de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR), se realizaron: 1) traducción directa; 2) estudio piloto basado en metodología Delphi con médicos de familia; 3) retrotraducción; 4) análisis de equivalencias; 5) análisis de comprensibilidad de las versiones obtenidas en español, catalán y gallego mediante entrevista cognitiva en una muestra de pacientes, y 6) armonización transcultural. RESULTADOS: En el estudio Delphi participaron 73 médicos de familia. El consenso se estableció en la primera ronda para la traducción española y catalana, y en la segunda ronda para la gallega. Las retrotraducciones fueron similares en los 3 idiomas. Todas las versiones fueron equivalentes entre ellas y respecto a la versión original inglesa. En la entrevista cognitiva participaron 10 pacientes por cada idioma, sin que se modificara la redacción de los ítems. CONCLUSIONES: Las traducciones de la escala HSCL-25 en español, catalán y gallego son equivalentes semántica y conceptualmente a la versión original. Las traducciones son comprensibles y bien aceptadas por los pacientes

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3 languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients

[Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care]. / Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria.

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients.

[Burnout and psychological distress among trainee General Practitioners]. / Burnout y malestar psicológico en los residentes de Medicina Familiar y Comunitaria.

OBJECTIVE: To estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions. DESIGN: Cross-sectional study. LOCATION: Primary Care. PARTICIPANTS: On-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%. MAIN MEASUREMENTS: Prevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use. OUTCOMES: 72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7)depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training. In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress. CONCLUSIONS: The prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures.