eduzhai > Socail Sciences > Psychology >

The relationship between violence and anxiety and depression among junior doctors in Iraq

  • sky
  • (0) Download
  • 20211101
  • Save
https://www.eduzhai.net International Journal of Applied Psychology 2016, 6(6): 163-170 DOI: 10.5923/j.ijap.20160606.01 Association of Violence with Anxiety and Depression among Iraqi Junior Doctors Riyadh K. Lafta1, Saba Dhiaa2,*, Waleed A. Tawfeeq3, Ameel F. Al-Shawi3 1Affiliate Prof., University of Washington, Seattle, USA 2Coll. of Health & Medical Technologies, Baghdad, Iraq 3College of Medicine, Mustansiriya University, Iraq Abstract Background: Doctors are not protected to the occurrence and consequences of mental disorders such as anxiety, depression, and occupational burnout, likely owing to their exposure to high levels of occupational stress. Methods: Written questionnaires were completed by 323 junior resident doctors from 20 teaching Hospitals in Baghdad city. The questionnaire inquired about exposure to any sort of violence, and the presence of any psychological symptoms that may refer to anxiety or depression. The questions were borrowed from the Center for Epidemiologic Studies Depression Scale (CES-D). Findings: More than one half of the doctors (164, 50.8%) reported the presence of anxiety symptoms, and 147 (45.5%) reported depressive symptoms. There was a significant association between exposure to any sort of violence at work (OR= 1.976, p <.005) or outside the work (OR= 1.912, p < .005), and reporting anxiety symptoms. The odds ratio of exposure to arrest, kidnapping or intentional injury was 2.242 (p .006). A significant association was also found between reporting depressive symptoms and exposure to violence at the work (OR=2.547, p =.002) or outside the work (OR=1.841, p =.008), and with history of killing, kidnapping or injury of family members (OR= 1.769, p .012) or colleagues (OR= 1.796, p .031). Exposure to pressure during work was also significantly associated with depressive symptoms (OR=2.455, p .002). Interpretation: The unsafe situation in Iraq has led to a high prevalence of anxiety and depression among junior doctors, Special efforts are needed to insure psychological support, and rehabilitation programs for this “vulnerable” group. Keywords Anxiety, Depression, Iraq, Junior, Doctors 1. Introduction As Human beings, doctors are not protected to the occurrence and consequences of psychological illnesses. [1] Doctors (especially junior residents) face particular challenges such as high patients’ attendance, long duty hours, repetitive exposure to traumatic events, potentially violent situations, and critical decision-making that place them at more risk of anxiety, depression and other stress related psychosocial problems. [2] Physicians are vulnerable to some mental disorders such as anxiety, depression, and occupational burnout, likely owing to their exposure to high levels of occupational stress. [3] Many researches demonstrated that one-fourth to one-third of residents will be clinically depressed at some point in their training. [4-6] A study in USA revealed that the prevalence of depression in resident physicians is higher than that of the general population, and is associated with physical health, an unhappy childhood, and stress at work. [7] * Corresponding author: saba_dhiaa@yahoo.com (Saba Dhiaa) Published online at https://www.eduzhai.net Copyright © 2016 Scientific & Academic Publishing. All Rights Reserved Although the actual incidence of anxiety and depression in medical doctors is unknown, many studies on medical students in developing countries like Saudi Arabia and Pakistan reported 47% to 73% prevalence of anxiety and depression. [8-10] The literature revealed that exposure to violence may lead to abnormal neurological changes that can cause malfunction of the limbic system of the brain especially in cases of long periods of exposure to trauma, particularly when the exposure occurred at childhood. [11] Such trauma usually causes adverse psychological effects that may last for a very long time, may interfere with their capability, and inversely reflected on their performance regarding the health care services they are affording. Several studies have evaluated the mental health of doctors in developed countries and indicated that the prevalence of depressive symptoms among physicians ranged from 10% to 15% in the US, Britain, Norway, and Japan. [12-15] A recent Dutch investigation concluded that anxiety and depressive symptoms were prevalent in 24% and 29% of physicians, respectively. [16] Researchers in China focused on anxiety and depressive symptoms among physicians and concluded that the prevalence of depression ranged between 31.7%, and 65.3%. [17-19] In United Kingdom; about half of the senior medical staff suffer from 164 Riyadh K. Lafta et al.: Association of Violence with Anxiety and Depression among Iraqi Junior Doctors high levels of stress and anxiety, and half of the junior doctors are suffering from emotional disturbance. [20] Poor psychological health amongst doctors negatively affects the quantitative and qualitative care of patient, leading to poor performance and affects patient's satisfaction, and adherence to treatment, [21] moreover, it may have serious consequences on the wellbeing of the whole community. [22] Up to 100, 000 patients in USA die each year because of preventable unpleasant measures The stress of medical resident training, including lack of sleep and leisure time, are among the most commonly cited reasons for such errors. [23] Residents who are depressed are about six times more likely to make medication errors than those who are not depressed. [24] Iraqi doctors represent a unique group, they have been exposed to successive shots of intolerable stress, making them the most vulnerable group among all doctors globally, knowing that Iraq has been labeled as the most dangerous country in the world. Doctors in Iraq are not only lacking sleep or leisure time, they are living in panic through being continuously at risk of assassination, kidnapping, threats, and forced displacement which became part of everyday life in Iraq. The rate of violent events among Iraqi specialist doctors during 2004-2007 was estimated to be 3.7%, and the rate of violent death at 1.6%. [25] This stress continuous stress has pushed many of them to flee during the past years seeking asylum in other countries [26] resulting in a severe shortage in workforce and quality of health services, and added more burden on the (already limping) health system. Rationale of the study: Anxiety and depression symptoms are important to assess especially among medical doctors as they have a sensitive job that deals with human life. Raised levels of anxiety and depression among resident doctors can lead to physical and emotional ailments, poor performance, absenteeism and negativity in terms of attitudes and behavior. [27] It is also associated with medical errors, decreased ability to handle work-related stress, discontinuation of medical training, disruption in personal lives, and suicide. [7] The objective of this study was to explore the prevalence of anxiety and depressive symptoms in a sample of Iraqi junior doctors living in Baghdad city in an attempt to understand the pressure that the junior doctors are exposed to. 2. Methods This cross sectional study was conducted in 20 major and teaching hospitals in Baghdad city during the period from July through August 2016. A convenient non probability sample of junior doctors was chosen, those were either newly graduated or candidates of postgraduate studies working as rotators or permanent residents in the surveyed hospitals. The first part of the questionnaire was developed by the researchers and enquired about the exposure of doctors to any sort of violence including exposure to insults, assaults, threats, arrest, kidnapping or being intentionally injured. Also exposure of their colleagues or family members to any sort of violence (killed, kidnapped or injured), and whether any of their seniors or colleagues have left the country to escape the risk of violence, whether they have frequently seen bodies or injured people on the road, and whether they are exposing to any notable pressure in their job. The second part of the questionnaire was about the presence of any psychological symptoms that may refer to anxiety or depression (ten items for each) in those doctors. The questions related to depression were borrowed from the Center for Epidemiologic Studies Depression Scale (CES-D), [28, 29] they included the respondent’s feelings during the last month, responses ranged from (not at all, sometimes or most of the time). The likelihood of having anxiety or depression was set when the score is above the median (more than 10). We did not attempt to diagnose these diseases, but we, rather, classified those doctors as having “probable” anxiety or depression on symptomatic basis. 2.1. Ethical Issue The self- administered questionnaire form was anonymous. A verbal consent was taken from all the respondents after explaining to them the purpose of the study, giving them the full choice to participate, and assuring them that all the information will be kept strictly confidential and will not be used for any purpose other than research work. The questionnaire was validated and approved by the Ethics Committee at the College of Medicine/ Mustansiriya University. 2.2. ADAS Calculation The calculation of anxiety and depression scores was done as follows: the 10 items of anxiety questions were coded as not at all, sometimes, and most of the time, each item was scored (0 to 2), with higher scores indicating most of the time. For each person, a total score of more than 10 (median) indicates significant anxiety symptoms. [30] The same was applied for depression questions. 2.3. Statistical Analysis Analysis of data was carried out using the available statistical package of SPSS-22 (Statistical Packages for Social Sciences- version 22). Data was presented in simple measures of frequency, percentage, mean, standard deviation, and range. The significance of association of different percentages (qualitative data) was tested using Pearson Chi-square test (χ2-test) with application of Yate's correction or Fisher Exact test when indicated. Statistical significance was considered whenever the P value is equal or less than 0.05. The odds ratio (OR) as a measure of association between an exposure and an outcome was calculated. Odds ratio is most commonly used in case-control studies, however it can also be used (with some modifications and/or assumptions) International Journal of Applied Psychology 2016, 6(6): 163-170 165 in cross-sectional and cohort study designs. Table 1. Demographic characteristics of the study sample: age range (24 – 39) with mean of 29.5±3.8 Gender Male Female No. % 178 55.1 145 44.9 Specialty: Rotator Permanent resident Board candidate 88 27.2 71 22.0 164 50.8 Monthly income: Total <$1000 >$1000 291 90.1 32 9.9 323 100 3. Results Of the 400 forms that were distributed; 323 were collected giving a response rate of 81%. The junior doctors’ age ranged from 24-39 (mean 29.5+ 3.8), with 55.1% males and 44.9% females, half of the sample (50.8%) was postgraduate (Board) candidates, 27.2% rotators and 22% were permanent residents, more than 90% of the doctors reported a monthly income of less than $1000. See table 1. Table 2 shows the percent of doctors that were exposed to different forms of violence including exposure to insults, assaults or threats (77.7%), being arrested, kidnapped or intentionally injured (18.6%), also exposure to any sort of violence at work (65%) or outside the work (37.2%), and exposure of their colleagues (76.8%) or family members to any sort of violence (killed, kidnapped or injured) (48.1%). All doctors (100%) reported that they know colleagues who left the country to escape the risk of violence, (73.1%) said that they have frequently seen injured people or dead bodies on the road or during duty (100%), and (79.6%) answered “yes” for exposure to a notable pressure at their work place. Tables (3A and 3B) demonstrate the response of the participants to each of the ten questions of anxiety and depression scales. Table 2. Frequency of exposure to different forms of violence Being insulted, assaulted, or threatened while being in duty Exposure to any sort of violence at work Exposure to any sort of violence outside the work Being arrested, kidnapped, or injured (violently) during the last 10 years Family members being killed, kidnapped, or injured (violently) in the last 10 years Senior/colleagues being killed, kidnapped, or injured (last 10 years) <10 Colleagues left Iraq to escape violence 10---19 =>20 Have frequently seen injured people or dead bodies on the road Many Have seen cases of violent injury or death during duty. Some Few Exposure to any kind of pressure while doing their job? No. % 251 77.7 210 65.0 120 37.2 60 18.6 136 42.1 248 76.8 179 55.4 92 28.5 52 16.1 236 73.1 228 70.6 72 22.3 23 7.1 257 79.6 Table 3A. Anxiety symptoms among the study sample (n=323) Have experienced the following symptoms during the last month Feeling more nervous and anxious than usual Feeling afraid for no reason at all Having nightmares Getting upset easily Feeling panicky Can feel your heart beating fast Feel calm and can sit still easily Bothered by stomach aches or indigestion Your arms and legs shake and tremble Bothered by headaches neck and back pain Not at all No. % 39 12.1 99 30.7 128 39.6 53 16.4 114 35.3 106 32.8 87 26.9 96 29.7 170 52.6 60 18.6 Sometimes No. % 163 50.5 154 47.7 162 50.2 167 51.7 171 52.9 165 51.1 192 59.4 174 53.9 119 36.8 175 54.2 Most of time No. % 121 37.5 70 21.7 33 10.2 103 31.9 38 11.8 52 16.1 44 13.6 53 16.4 34 10.5 88 27.2 166 Riyadh K. Lafta et al.: Association of Violence with Anxiety and Depression among Iraqi Junior Doctors Table 3B. Depressive symptoms among the study sample (n=323) Have experienced the following symptoms during the last month Poor appetite or eating more than usual Trouble keeping the mind on what was doing Feeling depressed Feeling that would be better off dead Hurting yourself in a way or another Feeling alone Feeling sad Bothered by things that usually don’t bother you Feel hopeful about the future People are unfriendly Not at all No. % 80 24.8 45 13.9 40 12.4 175 54.2 251 77.7 126 39.0 68 21.1 63 19.5 125 38.7 74 22.9 Sometimes No. % 189 58.5 180 55.7 180 55.7 116 35.9 54 16.7 149 46.1 189 58.5 207 64.1 145 44.9 169 52.3 Most of time No. % 54 16.7 98 30.3 103 31.9 32 9.9 18 5.6 48 14.9 66 20.4 53 16.4 53 16.4 80 24.8 Anxiety, 164, 50.8% Depressio n, 147, 45.5% (A) (B) Figure 1. Prevalence of Anxiety (A) and for Depression (B) among the study sample Figure (1) illustrates the prevalence of anxiety and depression according to the score of positive symptoms, 164 doctors reported a score of more than 10 giving a prevalence of 50.8%, while 147 doctors reported a score that is indicative of depressive symptoms with a prevalence of 45.5%. Table (4) depicts that being a female is associated with a higher risk of experiencing anxiety symptoms (OR= 2,300, p <.0001). There was a significant association between exposure to any sort of violence at work (OR= 1.976, p <.005) or outside the work (OR= 1.912, p < .005) and reporting anxiety symptoms. The odds ratio of exposure to arrest, kidnapping or intentional injuries was 2.242 (p .006). A significant association was also found between anxiety and history of killing, kidnapping or injury of family members (OR= 1.579, p .044) and the frequency of seeing cases of violent injury/death during duty (OR= 3.204, p .047). Table (5) shows that doctors’ exposure to violence was significantly associated with depressive symptoms. A significant association was found between reporting depressive symptoms and exposure to insult, assault or threats ng many cases of violent injury/death during work (OR= 4.834, p .004), Exposure to pressure during work was also sign (OR=2.448, p < .001), exposure to any sort of violence at work (OR=2.547, p .002), or outside the work (OR=1.841, p .008). A significant association was also found between depression and history of killing, kidnapping or injury to family members (OR= 1.769, p .012) or colleagues (OR= 1.796, p .031) and seeing many cases of violent injury/death during work (OR= 4.834, p .004), Exposure to pressure during work was also significantly associated with depressive symptoms (OR=2.455, p .002). International Journal of Applied Psychology 2016, 6(6): 163-170 167 Table 4. Association between exposure to different forms of violence and reporting anxiety symptoms Anxiety (>Median) No. % Gender Female 90 62.1 Male 74 41.6 Being insulted, assaulted, or threatened while being in duty Yes 134 53.4 No 30 41.7 Exposure to any sort of violence at work Yes 119 56.7 No 45 39.8 Exposure to any sort of violence outside the work Yes 73 60.8 No 91 44.8 Being arrested, kidnapped, or injured (violently) during the last 10 years Yes 40 66.7 No 124 47.1 Family members being killed, kidnapped, or injured Yes in the last 10 years No 78 57.4 86 46.0 Colleagues being killed, kidnapped, or injured during Yes the last 10 years No 129 52.0 35 46.7 Have frequently seen injured people or dead bodies on the road Yes 120 50.8 No 44 50.6 Many 121 53.1 Have seen cases of violent injury or death during duty Some 37 51.4 Few 6 26.1 Yes Exposed to any kind of pressure while doing their job No 131 51.0 33 50.0 *Significant difference in proportions using Pearson Chi-square test at 0.05 level. No No. % 55 37.9 104 58.4 117 46.6 42 58.3 91 43.3 68 60.2 47 39.2 112 55.2 20 33.3 139 52.9 58 42.6 101 54.0 119 48.0 40 53.3 116 49.2 43 49.4 107 46.9 35 48.6 17 73.9 126 49.0 33 50.0 OR 2.300 - 1.603 - 1.976 - 1.912 - 2.242 - 1.579 - 1.239 - 1.011 - 3.204 2.995 1.040 - 95%CI 1.468-3.602 0.944-2.724 1.241-3.146 1.208-3.026 1.244-4.040 1.012-2.465 0.738-2.079 0.618-1.653 1.219-8.421 1.060-8.467 0.605-1.786 Table 5. Association between exposure to different forms of violence and reporting depressive symptoms Depression (>Median) No. % Gender Male 80 44.9 Female 67 46.2 Being insulted, assaulted, or threatened while being in duty Yes 126 50.2 No 21 29.2 Exposure to any sort of violence at work Yes 112 53.3 No 35 31.0 Exposure to any sort of violence outside the work Yes 66 55.0 No 81 39.9 Being arrested, kidnapped, or injured (violently) during the last 10 years Yes 34 56.7 No 113 43.0 Family members being killed, kidnapped, or injured Yes in the last 10 years No 73 53.7 74 39.6 Colleagues being killed, kidnapped, or injured during Yes the last 10 years No 121 48.8 26 34.7 Have frequently seen injured people or dead bodies on the road Yes 113 47.9 No 34 39.1 Many 115 50.4 Have seen cases of violent injury or death during duty Some 28 38.9 Few 4 17.4 Yes Exposed to any kind of pressure while doing their job No 128 49.8 19 28.8 *Significant difference in proportions using Pearson Chi-square test at 0.05 level. No No. % 98 55.1 78 53.8 125 49.8 51 70.8 98 46.7 78 69.0 54 45.0 122 60.1 26 43.3 150 57.0 63 46.3 113 60.4 127 51.2 49 65.3 123 52.1 53 60.9 113 49.6 44 61.1 19 82.6 129 50.2 47 71.2 OR 1.052 - 2.448 - 2.547 - 1.841 - 1.736 - 1.769 - 1.796 - 1.432 - 4.834 3.023 2.455 - 95%CI 0.678-1.634 1.391-4.308 1.573-4.125 1.166-2.905 0.986-3.057 1.132-2.766 1.050-3.071 0.868-2.363 1.595-14.654 0.931-9.815 1.366-4.411 P value 0.0001* 0.080 0.004* 0.005* 0.006* 0.044* 0.417 0.965 0.047* 0.888 P value 0.821 0.002* 0.001* 0.008* 0.054 0.012* 0.031* 0.159 0.004* 0.002* 168 Riyadh K. Lafta et al.: Association of Violence with Anxiety and Depression among Iraqi Junior Doctors 4. Discussion The 323 junior doctors from 20 major and teaching hospitals in our study aged between 24-39 years, which means that they grew up under high stress during the period of unrest that the Iraqis were experiencing in the eighties and nineties (including the Iraq-Iran-war, the first Gulf war and the economic sanction), [31, 32] during which the cohort of Iraqi children and youth (some of whom are now included in our study) have been subjected to dire conditions, they were facing very real dangers of disease, starvation, psychological trauma and death, [33] such conditions make people less resilient to adverse experiences later in their life. The prevalence of “probable” anxiety was shown to be 50.8%, which means that more than half of the resident doctors were experiencing symptoms of anxiety; likewise, the prevalence of “probable” depression was shown to be 45.5%. This prevalence is remarkably higher than that in the general population. WHO reported (in the Iraqi Mental Health survey) that the prevalence of anxiety in the general population was 13.8% and of depression was 7.2%, [34] while in a previous study conducted in Baghdad; the prevalence of probable depression among health care providers was found to be 66.5%. [35] This indicates that the high prevalence among junior doctors is not just part of the general unstable condition in the country, but that there is an additional pressure on this stratum that makes the problem an issue. The comparison of our findings with other countries revealed that it is way higher than the results of a study in USA which showed a prevalence of depression among health practitioners of only 9.6%, [36] while another study in Orlando/Florida revealed a prevalence of depression of 7% for mild and 5% for moderate to severe scoring. [37] Our results were also higher than those in the regional countries; in Pakistan, the prevalence of anxiety and depression in resident doctors was 27.3%, [38] in Nigeria the prevalence of depression was 17.3% in resident doctors and 1.3% in non-resident doctors with no gender significant variations, [39] and in Turkey, the prevalence of probable depression among 156 resident doctors was found to be 16%, more in females. [40] While our results were close to the findings in some Arab countries like UAE where the reported prevalence of anxiety and depression was 57.4% and 63.3% respectively although these countries are considered stable in comparison to Iraq. [41] Female doctors showed a more tendency to have anxiety symptoms than males; this finding is consistent with other articles which suggested that females are more vulnerable to develop mental disorders when exposed to traumatic events. [42] As Iraq now tops the most dangerous countries in the world, we dealt with anxiety and depression from the angle of its relation to violence. Since the USA invasion in 2003, the Iraqi academics (and doctors in particular) continued to face intolerable levels of violence and systematic targeting. [43] they are exposed continuously to assassination, kidnapping, threats, and humiliation. [26] About two thirds of the sampled doctors reported exposure to different forms of violence, and about one fifth of them were exposed to either arrest, kidnapping or intentional injuries. The results of the current study revealed a statistically significant association between depression symptoms and exposure to violence during duty and with frequent seeing and dealing with cases of violent injury/death during duty. Several articles confirmed that doctors exposed to high stressful conditions especially those working in the emergency units and in times of wars are more susceptible to develop mental disorders. [43-45] 5. Limitations As anxiety and depression could be multifactorial; the effect of confounders (personality, family history of psychological problems, threshold of stress) couldn’t be evaluated, however, we did not attempt to diagnose these diseases but we, rather, classified the respondents as having “probable” anxiety or depression on symptomatic basis. 6. Conclusions The study revealed a high prevalence of anxiety and depression among junior doctors, that might be due to the high pressure they are exposing to in their job, their daily living with high risk, and their gloomy future. Special efforts are needed to insure psychological support for those doctors through special sessions of residency counseling, assurance, rehabilitation programs, and providing security protection for them at least at the work during doing their job. REFERENCES [1] Malani PN. When Doctors Become Patients. JAMA 2008; 299(17): 2093-94. [2] Anjali N. Shete, K. D. Garkal. A study of stress, anxiety, and depression among postgraduate medical students. CHRISMED journal of Health and Research 2015; 2(2): 119-23. [3] Wallace JE. Mental health and stigma in the medical profession. Health (London) 2012; 16: 3–18. [4] Sadeghi M, Navidi M, Sadeghi AE. Depression among Resident Doctors in Tehran, Iran. Iran J Psychiatry 2007; 2: 50. [5] Peterlini M, Tiberio IF, Saadeh A, Pereira JC, Martins MA. Anxiety and depression in the first year of medical residency training. Med Educ 2002; 36: 66-72. [6] Katz ED, Sharp L, Ferguson E. Depression among emergency medicine residents over an academic year. Acad Emerg Med 2006; 13: 284-7. International Journal of Applied Psychology 2016, 6(6): 163-170 169 [7] Nasheel Joules, Daniel M. Williams, Alexander W. Thompson. Depression in Resident Physicians: A Systematic Review. Open Journal of Depression, 2014; (3): 89-100. [8] Abdulghani HM. Stress and depression among medical students: A cross sectional study at college in Saudi Arabia. Pak J Med Sci January - March 2008; 24(1): 1217. [9] Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y. Prevalence of Depression, Anxiety and their associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc December 2006; 56:583-86. [10] Inam SNB, Saqib A, Alam E. Prevalance of anxiety and depression among medical students of private University. J Pak Med Ass Feb 2003; 53(2):44-7. [11] Ahmed SA. Post-traumatic disorders, resilience and vulnerability. Advance in Psychiatric Treatment 2007, vol.13, 369-75. [12] Coomber S, Todd C, Park G, Baxter P, Firth-Cozens J, et al. Stress in UK intensive care unit doctors. British Journal of Anesthesia 2002; 89: 873–81. [23] West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy. A Prospective Longitudinal Study. JAMA. 2006; 296: 1071-78. [24] US News & World Report. Depression in young doctors tied to medication errors. Tuesday, April 7, 2009. Available from URL: http://health.usnews.com/usnews/health/healthday/080 208/depression-inyoung-doctors-tied-to-medicationerrors.ht m. (accessed August 25, 2016). [25] Alwan NA. The killing of doctors in Iraq must stop. BMJ (online). July 2011 DOI:10.1136/bmj.d4467:P 1-2. [26] Gilbert Burnham, Riyadh K Lafta, Shannon Doocy. Doctors leaving 12 tertiary hospitals in Iraq 2004-2007. Social Sciences and Medicine, 69 (2009) 172-177. [27] Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001; 130: 696-705. [28] Zung WWK 1971. A rating instrument for anxiety. Psychosomatics; 12(6):371-9. [13] Ofili AN, Asuzu MC, Isah EC, Ogbeide O. Job satisfaction [29] Radloff LS. The CES-D Scale: a self-report depression scale and psychological health of doctors at the University of Benin for research in the general population. Applied Psychological Teaching Hospital. Occup Med (Lond) 2004; 54: 400–3. Measurement 1977; 1, 385-401. [14] Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. Journal of Clinical Psychiatry 2008; 69: 617–20. [15] Wada K, Yoshikawa T, Goto T, Hirai A, Matsushima E, et al. Association of depression and suicidal ideation with unreasonable patient demands and complaints among Japanese physicians: a national cross-sectional survey. Int J Behav Med 2011; 18: 384–90. [16] Ruitenburg MM, Frings-Dresen MH, Sluiter JK. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC Health Serv Res 2012; 12: 292–8. [17] Li J, Yang W, Cho SI. Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Social Science and Medicine 2006; 62: 1066–77. [18] Shen LL, Lao LM, Jiang SF, Yang H, Ren LM, et al. A survey of anxiety and depression symptoms among primary-care physicians in China. Int J Psychiatry Med 2012; 44: 257–70. [19] Wang, Sun W, Chi TS, Wu H, Wang L. Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health 2010; 83: 905–911. [20] Caplan RP. Stress, anxiety and depression in hospital consultants, general practitioners and senior health service managers. BMJ 1994; 309: 1261-63. [21] Haas JS, Cook EF, Puopolo AL, et al. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000; 15: 122-8. [22] Gadit AA. Economic burden of Depression in Pakistan. J Pak Med Ass Feburary 2004; 54(2):43-44. [30] Szklo M, Nieto FJ. Epidemiology: Beyond the basics. 2nd edition. Sudbury, MA: Jones and Bartlett Publishers; 2007. [31] Fearson JD. Iraq's civil war. Foreign Affairs; 2007, 86(2): 2-15. [32] Al Hilfi k, Lafta R, Burnham G. Health services in Iraq. The Lancet 2013; 381, 939-48. Download from http://www.ed.ac.uk/polopoly_fs/1.115933!/fileManager/La ncet%20paper%20Thamer. (accessed August 25, 2016). [33] Al-Jawadi A and Abdul-Rhman S. Prevalence of childhood and early adolescence mental disorder among children attending primary health care centers in Mosul, Iraq: a cross-sectional study. BMC 2007; 7 274-82. [34] Alhasnawi SM, Sadik S1, Moha MM. Iraq Mental health Survey Study. World Psychiatry 2009; 8:2: 97-109. [35] Alkhazrajy LA, Sabah S, Dr. Abed SM. Prevalence of depressive symptoms among primary health care providers in Baghdad. International Journal of Health and Psychology Research 2014; 2 (2): 1-20. [36] Jane Chin. Jane's Mental Health. Source Page 67(3):407-14. http://chinspirations.com/mhsourcepage/work-place-depressi on-common-in-healthcareworkers. (accessed Sept. 25, 2016). [37] Costa AJ, Schrop SL, McCord G, Ritter C. Depression in family medicine faculty. Fam Med 2005; 37(4):271-5. [38] Naheed Nabi, Aisha Yousif, Azam Iqbal. Prevalence of Anxiety and Depression among doctors working in a private hospital in Pakistan. ASEAN Journal of Psychiatry 2012; 13(1). [39] Aguocha Gu1, Onyeama GM, Bakare MO, Igwe MN. Prevalence of Depression among Resident Doctors in a Teaching Hospital, South East Nigeria. International Journal of Clinical Psychiatry 2015, 3(1): 1-5 DOI: 10.5923/j.ijcp.20150301.01. (accessed August 24, 2016). 170 Riyadh K. Lafta et al.: Association of Violence with Anxiety and Depression among Iraqi Junior Doctors [40] Figen Demir, Pınar AY, Melek Erbaş, Mine Özdil, Esra Yaşar. The Prevalence of Depression and its Associated Factors among Resident Doctors Working in a Training Hospital in Istanbul. Turkish journal of psychiatry 2007; 18(1): 1-6. [41] Monsef NA, Al Hajaj KE, Al Basti AK, et al. Perceived Depression, Anxiety and Stress Among Dubai Health Authority Residents, Dubai, UAE. American Journal of Psychology and Cognitive Science. 2015; 1(3):75-82. cross-sectional study of three Saudi medical colleges’ hospitals. Neuropsychiatric Disease and Treatment 2014:10 1879–86. [44] Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis. JAMA 2015; December 8; 314(22): 2373–2383. doi:10.1001/jama.2015.15845. (accessed August 23, 2016). [42] Jalili, I. Iraqi academics and doctors: Innocent victims of a wider geopolitical struggle. Humanities 2007; 22:23. [43] Abdulghani HM, irshad M, al Zunitan MA et al. Prevalence of stress in junior doctors during their internship training: a [45] Kerrien M, Pougnet R, Garlantézec R, et al. Prevalence of anxiety disorders and depression among junior doctors and their links with their work. Presse Med. 2015; Apr; 44(4 Pt 1):e84-91. doi: 10.1016/j.lpm.2014.06.042. Epub 2015 Jan 29. (accessed August 24, 2016).

... pages left unread,continue reading

Document pages: 8 pages

Please select stars to rate!

         

0 comments Sign in to leave a comment.

    Data loading, please wait...
×