The dependence analysis of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors

Размещено на http://www.allbest.ru

The dependence analysis of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors

Botiakova Viktoriia Viktorivna Postgraduate student of the Department of General Practice (Family Medicine), Bogomolets National Medical University, Kyiv

Abstract

The article is dedicated to the dependence analysis of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors, which is important not only for foreign and domestic psychology, but also for family medicine.

The purpose of the article is to analyze the dependence of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors.

According to the conducted research, the dependence of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors was analyzed and the following conclusions were revealed:

Increased risk of burnout syndrome was associated with the presence of moderate and high levels (4DSQ scale) of: distress (OR=2.00, 95% CI: 1.13-3.53; p=0.016), depression (OR=2.45, 95% Cl: 1.04-5.74; p =0.035), anxiety (OR=2.12, 95% CI: 1.18-3.79; p=0.011), somatization (OR=2.33, 95% CI: 1.27-4.30; p =0.006) and moderate & severe depression (OR=4.14, 95% CI: 1.32-13.01; p=0.010) according to Beck's Depression Inventory, BMI is more than 25 kg/m2 (OR=1.96, 95% CI: 1.11-3.47; p=0.020).

A positive correlation of medium strength between emotional exhaustion and the result on the distress scale of the 4DSQ questionnaire (r = 0.521; p = 0.000), the result on the depression scale of the 4DSQ questionnaire (r = 0.455; p = 0.000), the result on the depression scale according to Beck's Depression Inventory (r = 0.415; p = 0.000), the result on the anxiety scale on the 4DSQ questionnaire (r = 0.363; p = 0.000), the result on the somatization scale on to the 4DSQ questionnaire (r = 0.399; p = 0.000), as well as a direct correlation of moderate strength between depersonalization and the result on the distress scale (4DSQ) (r =

427; p = 0.000), the result on the depression scale of the 4DSQ (r = 0.361; p = 0.000), the result on the anxiety scale (4dSQ) (r = 0.301; p = 0.000) were found.

Nowadays it is necessary to carry out more scientific research in Ukraine and worldwide to develop a comprehensive preventive program that reduces the risk of burnout syndrome development, as well as decreases the risk of cardiovascular diseases development, in particular, it also should improve the health level of family doctors and medical professionals as well.

Keywords: burnout syndrome, depression, anxiety, somatization, distress, risk factors for cardiovascular diseases, obesity/adiposity, overweight, body mass index

Ботякова Вікторія Вікторівна аспірант кафедри загальної практики (сімейної медицини), Національний медичний університет імені О.О.Богомольця, Київ,

АНАЛІЗ ЗАЛЕЖНОСТІ СИНДРОМУ ПРОФЕСІЙНОГО ВИГОРАННЯ ВІД НАЯВНОСТІ ОЖИРІННЯ ЯК ФАКТОРА СЕРЦЕВО-СУДИННОГО РИЗИКУ, ДЕПРЕСІЇ, ТРИВОГИ,

СОМАТИЗАЦІЇ, ДИСТРЕСУ У ЛІКАРІВ ЗАГАЛЬНОЇ ПРАКТИКИ -

СІМЕЙНИХ ЛІКАРІВ

Анотація

Стаття присвячена аналізу залежності синдрому професійного вигорання від наявності ожиріння як фактора серцево-судинного ризику, депресії, тривоги, соматизації, дистресу у лікарів загальної практики - сімейних лікарів, що має важливе значення не тільки для зарубіжної й вітчизняної психології, але й також для сімейної медицини зокрема.

Мета статті полягає в аналізі залежності синдрому професійного вигорання від наявності ожиріння як фактора серцево-судинного ризику, депресії, тривоги, соматизації, дистресу у лікарів загальної практики - сімейних лікарів.

В ході поведеного дослідження було проаналізована та виявлена залежність синдрому професійного вигорання від наявності ожиріння як фактора серцево-судинного ризику, депресії, тривоги, соматизації, дистресу у лікарів загальної практики - сімейних лікарів, а саме:

Було виявлено, що наявність за шкалою 4DSQ помірного та високого рівня дистресу (OR=2,00, 95% CI: 1,13-3,53; p=0,016), депресії (OR=2,45, 95% CI: 1,04-5,74; p=0,035), тривоги (OR=2,12, 95% CI: 1,18-3,79; p=0,011), соматизації (OR=2,33, 95% CI: 1,27-4,30; p=0,006), вираженої та важкої депресії (OR=4,14, 95% CI: 1,32-13,01; p=0,010) за шкалою депресії А.Бека, ІМТ більше 25 кг/м2 (OR=1,96, 95% CI: 1,11-3,47; p=0,020) асоціювались із підвищенням ризику СПВ.

Також було виявлено позитивний кореляційний зв'язок середньої сили між емоційним виснаженням та результатом за шкалою дистресу за анкетою 4DSQ (r = 0,521; p = 0,000), результатом за шкалою депресії за анкетою 4DSQ (г = 0,455; p = 0,000), результатом за шкалою депресії А.Бека (г = 0,415; p = 0,000), результатом за шкалою тривоги за анкетою 4DSQ (г = 0,363; p = 0,000), результатом за шкалою соматизації за анкетою 4DSQ (г = 0,399; p = 0,000), прямий кореляційний зв'язок середньої сили між деперсоналізацією та результатом за шкалою дистресу (4DSQ) (г = 0,427; p = 0,000), результатом за шкалою депресії за анкетою 4DSQ (г = 0,361; p = 0,000), результатом за шкалою тривоги (4DSQ) (г = 0,301; p = 0,000).

Існує необхідність щодо здійснення більшої кількості наукових досліджень в Україні та світі задля розробки комплексної програми профілактики, що надасть змогу знизити ризик розвитку СПВ та ризик розвитку серцево-судинних захворювань, зокрема покращити рівень здоров'я як лікарів загальної практики - сімейних лікарів, так і медичних працівників інших спеціальностей.

Ключові слова: синдром професійного вигорання, депресія, тривога, соматизація, дистрес, фактори ризику серцево-судинних захворювань, ожиріння, надмірна маса тіла, індекс маси тіла

Formulation of the problem. Issues regarding the dependence analysis of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors are highly important not only for foreign and domestic psychology, but also for family medicine.

Analysis of recent research & publications. Burnout syndrome is included in the International Classification of Diseases of the Eleventh Revision as an occupational phenomenon (QD85 - Burnout) and is defined as «...a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed» [1]. In Ukraine, prevalence of burnout syndrome among medical professionals varies from 1.27% to 94% [2, p. 92]. Work-related stress usually can be caused by unsatisfactory working conditions, poor work organization, poor work design, poor management, lack of support from supervisors or/and colleagues [3]. It should be mentioned that according to recent study of the International Labour Organization (hereinafter - ILO) and World Health Organization (hereinafter - WHO), 745 000 deaths occurred due to stroke and also ischemic heart disease caused by long working hours (more than 55 hours per week) [4]. It also should be mentioned that annually 17.9 million people die due to cardiovascular diseases, furthermore, each year 2.8 million people die from such cardiovascular risk factors as obesity/adiposity or overweight [5; 6]. De Souza E. Silva et al. identified association between burnout syndrome and obesity [7]. Moreover, K.Batra et al. found out that depression, anxiety, stress, insomnia, and PTSD were increasingly reported among approximately 80 000 heath care workers as cofactors of burnout syndrome [8; 9]. Whereas according to WHO nearly 280 million of people have depression worldwide and > 700 000 people die each year due to suicide [10]. As well as 301 million people worldwide have anxiety disorders (data on 2019) and which make them the most common among all mental disorders [11]. We agree with W. Shaufeli, H. De Witte, R. Kok [12, p. 41-45] regarding the expediency of researching the burnout syndrome in combination with the detection of indicators such as distress, depression, anxiety, and somatization using the 4DSQ (n=5791) and we consider it necessary to investigate these indicators. Also, taking into account the fact that there is a bidirectional cause-and- effect relationship between burnout syndrome and depression, in particular, burnout syndrome can be a predictor of depression, while depression can increase the likelihood of burnout syndrome development [13; 14], it is also necessary to identify depression by using Beck's Depression Inventory [15, p. 37-40].

Overall, the problem of the dependence analysis of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors hasn't been sufficiently investigated.

The purpose of the article is to analyze the dependence of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors.

Presenting main material

Research materials & methods.

The physicians were familiarized with the aim and tasks of the research, and signed the informed consent as a voluntary consent to take part in the research. The study protocol was approved by the Commission of Bioethical Expertise & Research Ethics of O.O. Bogomolets National University (Protocol № 116 dated November 29, 2018). The examinations were performed according to the current legislation of Ukraine, as well as in accordance with the Declaration of Helsinki of the World Medical Association «Ethical Principals for Medical Research Involving Human Subjects» [16].

The examination of respondents included: anamnestic data collection, anthropometric measurements, the Ukrainian-language version of the Maslach Burnout Inventory Human Service Survey (MBI-HSS) to detect burnout syndrome, Beck's Depression Inventory [15, p. 37-40], Four-Dimensional Symptom Questionnaire (4DSQ) [17; 15, p. 32-34; 18].

Statistical processing of the obtained data was carried out by the methods of parametric & non-parametric statistics using the package of statistical programs for Windows IBM SPSS Statistics Base version 22, as well as "MS Excel". Quantitative data were presented as mean (M) & standard deviation (SD). Qualitative data was represented by %. Correlation analysis was carried out using Spearman's test. Differences in sample distributions were assessed using the chi-square test. The degree of influence of factor characteristics was determined by the odds ratio (OR). We determined the threshold value of the level of significance in all statistical calculations at р<0.05.

By anthropometric measurements we identified the height, body weight, and calculated the body mass index. Height was determined by using a height meter (accuracy of up to 0.5 cm) and body weight was measured with the help of medical scales RP-150MG. The body mass index (BMI) identifies general obesity and it is calculated as ratio of body weight (that indicates in kg) to height (that indicates in m2); BMI measurement classification was conducted in accordance with the WHO provisions [19].

Burnout syndrome was determined by using the MBI-HSS questionnaire, that contains 22 questions, which rated from 0 (never) to 6 (daily), as well as, the scores on the 3 scales (EE, DP, PA) and also the division into profiles (burnout, disengaged, overextended, ineffective, engaged) were calculated by using the MBI Manual 4th edition [20]. We bought a license to use the Ukrainian-language version of the MBI- HSS questionnaire (www.mindgarden.com).

Depression in family doctors was detected with the help of Beck's Depression Inventory [15, p. 37-40], which contains 21 questions and 4 answer options, in particular, answer "a" is 0 points, answer "b" is 1 point, answer "c" is 2 points and answer "d" is 3 points. This scale has two subscales: 1) cognitive-affective manifestations of depression (1-13 questions), as well as somatic manifestations of depression (14-21 questions) [15, p. 37-40]. The total number of points is summed, according to which: absence of depressive symptoms is 0-9 points, mild depression - 10-15 points, moderate depression - 16-19 points, moderately severe depression - 20-29 points, and severe depression - 30-63 points [15, p. 37-40].

A Four-Dimensional Questionnaire for the assessment of distress, depression, anxiety and somatization (4DSQ) was used, it contains 50 points and 4 scales - distress, depression, anxiety and somatization and it was created by B. Terluin [17; 15, p. 32-34; 18]. Answers are scored from 0 to 2 points, namely: the answer "no" is 0 points, "sometimes" is scored 1 point, "regularly", "often", as well as "very often/constantly" are scored 2 points [17; 15, p. 32-34; 18]. The number of points is summed in each scale to process the results: 1) the distress scale has 16 items (17, 19, 20, 22, 25, 26, 29, 31, 32, 36, 37, 38, 39, 41, 47, 48) and the total number of points is from 0 to 32; 2) the depression scale has 6 points (28, 30, 33, 34, 35, 46), the total score is from 0 to 12; 3) the anxiety scale has 12 points (18, 21, 23, 24, 27, 40, 42, 43, 44, 45, 49, 50) and the total score is from 0 to 24; 4) the somatization scale has 16 items (1-16) and the total score is from 0 to 32 [17; 15, p. 32-34; 18]. The interpretation of the results of the Four-Dimensional Questionnaire for the assessment of distress, depression, anxiety and somatization (4DSQ) is presented in Table 1.

Table 1

Interpretation of the results of the 4-Dimensional Distress, Depression,

Anxiety and Somatization Questionnaire (4DSQ) [17; 15, p. 32-34; 18]

Research results & their discussion.

Two hundred sixty-three family doctors (n=263) of Kyiv participated in the study, 237 (90.11%) were women and 26 (9.89%) were men, aged 24-69 years (average age of respondents was 46.51±12.58 years). The main group consisted of 199 (75.67%) family doctors with burnout syndrome signs (burnout syndrome profiles: 61 (23.19%) - burnout, 63 (23.95%) - overextended, 68 (25.87%) - ineffective, 7 (2.66%) - disengaged), average age of respondents was 46.34±12.98 years, the comparison group consisted of 64 family doctors without burnout syndrome signs (64 (24.33%) respondents had the engaged profile), average age of individuals was 47.02±11.31 years.

According to the conducted research, we analyzed the dependence of burnout syndrome on the presence of adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors (Table 2).

burnout syndrome distress

Table 2

Comparative frequency of detection of burnout syndrome signs depending on the presence of anxiety, depression, somatization, distress and BMI

Note. *- statistica

ly significant difference between indicators (р<0.05)

A significant increase in the frequency of identifying burnout syndrome signs was found among family doctors, who had moderate and high levels of distress (according to the distress scale on 4DSQ [17; 15, p. 32-34; 18]) - 81.0% compared to respondents, who had a low level of distress - 68.2%. Moreover, the proportion of respondents without burnout syndrome signs and low-level distress (4DSQ) was significantly higher 31.8% versus 19.0% with moderate and high levels of distress (4DSQ), p =0.016. The presence of distress (moderate and high levels on the distress scale of 4DSQ [17; 15, p. 32-34; 18]) reveals a 2.00-fold increase in the risk of burnout syndrome, OR=2.00 (1.13-3.53). In particular, a positive correlation of medium strength between emotional exhaustion and the result on the distress scale of the 4DSQ (r = 0.521; p = 0.000) and a direct correlation of medium strength between depersonalization and the result on the distress scale (4DSQ) ( r = 0.427; p = 0.000) were found. The correlation analysis indicates that respondents with a high level of emotional exhaustion and depersonalization had higher scores on the distress scale of the 4DSQ and vice versa.

In particular, the presence of moderate and high levels on the scale of depression of 4DSQ [17; 15, p. 32-34; 18] establish a 2.45-fold increase in the risk of burnout syndrome, OR=2.45 (1.04-5.74), as well as the presence of moderately severe and severe depression on Beck's Depression Inventory [15, p. 37-40] reveals a 4.14-fold increase in the risk of burnout syndrome, OR=4.14 (1.32-13.01). The frequency of burnout syndrome in respondents with moderate and high depression on the depression scale of 4DSQ [17; 15, p. 32-34; 18] (86.8%) and moderately severe and severe depression on Beck's Depression Inventory [15, p. 37-40] (90.0%) was higher compared to the respondents (72.9% and 68.5%), who had a low-level depression on the 4DSQ, mild depression on Beck's Depression Inventory, respectively. The proportion of respondents without burnout syndrome signs was statistically significantly higher 27.1% and 31.5% for those who had low level of depression on 4DSQ and mild depression on Beck's Depression Inventory, compared to 13.2% and 10.0% for those who had moderate and high levels of depression on 4DSQ and moderately severe and severe depression on Beck's Depression Inventory, p=0.035 and p=0.010, respectively. A positive correlation of medium strength between emotional exhaustion and the result on the depression scale of the 4DSQ (r = 0.455; p = 0.000), the result on the Beck's Depression Inventory (r = 0.415; p = 0.000), as well as a direct correlation of medium strength between depersonalization and the result on the depression scale of the 4DSQ (r = 0.361; p = 0.000) were identified. Overall, respondents with a high level of emotional exhaustion had higher scores on the depression scale of the 4DSQ and higher scores on the depression scale of Beck's Depression Inventory, moreover, family doctors with a high level of depersonalization had higher scores on the depression scale of the 4DSQ and vice versa.

A statistically significant increase in the frequency of identifying burnout syndrome signs was found among family doctors with moderate and high levels of anxiety on the anxiety scale of 4DSQ [17; 15, p. 32-34; 18] - 82.4% in comparison with the subgroup that had a low level of anxiety on the anxiety scale of 4DSQ - 68.9%. The proportion of respondents of the comparison group (without burnout syndrome signs) with a low level of anxiety (4DSQ) was significantly higher 31.1% versus 17.6% with moderate and high levels of anxiety (4DSQ), p=0.011. Anxiety (moderate and high levels on the anxiety scale of 4DSQ [17; 15, p. 32-34; 18]) is a factor that determines 2.12-fold increase in the risk of burnout syndrome, OR=2.12 (1.18-3.79). A positive correlation of medium strength between emotional exhaustion and the result of the anxiety scale of the 4DSQ (r = 0.363; p = 0.000), as well as a direct correlation of medium strength between depersonalization and the result of the anxiety scale (4DSQ) (r = 0.301; p = 0.000) were found. The correlation analysis indicated that respondents with a high level of emotional exhaustion and depersonalization had higher scores on the anxiety scale of the 4DSQ and vice versa.

A significant increase in the frequency of establishing burnout syndrome signs was found among family doctors with moderate and high levels of somatization on somatization scale of the 4DSQ [17; 15, p. 32-34; 18] - 84.1% compared to the respondents who had a low level on the somatization scale (4DSQ) - 69.3%. The proportion of respondents without burnout syndrome signs with a low level of somatization (4DSQ) was statistically significantly higher 30.7% compared to 15.9% with moderate and high levels of somatization (4DSQ), p=0.006. The presence of such factor as somatization (moderate and high levels on somatization scale of 4DSQ [17; 15, p. 32-34; 18]) reveals a 2.33-fold increase in the risk of burnout syndrome, OR=2.33 (1.27-4.30). A positive correlation of medium strength between emotional exhaustion and the result on the somatization scale of the 4DSQ (r = 0.399; p = 0.000) was identified. Family doctors with a high level of emotional exhaustion had higher scores on the somatization scale of the 4DSQ and vice versa.

A significant increase in the frequency of establishing burnout syndrome signs was found among respondents with a BMI above 25 kg/m2 (overweight and obesity/adiposity [19]) - 81.4% compared to the subgroup with a BMI below 25 kg/m2 - 69.1%. The proportion of respondents without burnout syndrome signs and with BMI below 25 kg/m2 was significantly higher - 30.9% and decreased with increasing body weight (BMI above 25 kg/m2) to 18.6%, p=0.020. The factor of overweight/obesity/adiposity (BMI above 25 kg/m2) determines a 1.96-fold increase in the risk of burnout syndrome - OR=1.96 (1.11-3.47).

Overall, the obtained results are confirmed by other scientific studies [21, p. 3063; 22, p. 18; 23, p. 669; 13; 14; 8; 9; 7; 12, p. 41-45].

It should be mentioned, that obtained results are probably caused by a low level of stress resistance, excessive mental overload, dissatisfaction with one's own professional efficiency, lack of social support from employees, a constant feeling of purposeless fear and anxiety, constant dissatisfaction with oneself, apathy, lack of desire to perform production tasks, an increase frequency and intensity of negative emotions, as well as a decrease in the level of positive emotions, overeating; a decrease in production motivation, loss of interest, enthusiasm, significance and meaning of one's own professional activity [24; 25, p. 37-44; 15, p. 37; 26, p. 20-27] etc.

Conclusions

According to the conducted research, the dependence of burnout syndrome on adiposity as cardiovascular risk factor, depression, anxiety, somatization and distress among family doctors was analyzed and the following conclusions were revealed:

Increased risk of burnout syndrome was associated with the presence of moderate and high levels (4DSQ scale) of: distress (OR=2.00, 95% CI: 1.13-3.53; p=0.016), depression (OR=2.45, 95% Cl: 1.04-5.74; p =0.035), anxiety (OR=2.12, 95% CI: 1.18-3.79; p=0.011), somatization (OR=2.33, 95% CI: 1.27-4.30; p =0.006) and moderate & severe depression (OR=4.14, 95% CI: 1.32-13.01; p=0.010) according to Beck's Depression Inventory, BMI is more than 25 kg/m2 (OR=1.96, 95% CI: 1.11-3.47; p=0.020).

A positive correlation of medium strength between emotional exhaustion and the result on the distress scale of the 4DSQ questionnaire (r = 0.521; p = 0.000), the result on the depression scale of the 4DSQ questionnaire (r = 0.455; p = 0.000), the result on the depression scale according to Beck's Depression Inventory (r = 0.415; p = 0.000), the result on the anxiety scale on the 4DSQ questionnaire (r = 0.363; p = 0.000), the result on the somatization scale on to the 4DSQ questionnaire (r = 0.399; p = 0.000), as well as a direct correlation of moderate strength between depersonalization and the result on the distress scale (4DSQ) (r = 0.427; p = 0.000), the result on the depression scale of the 4DSQ (r = 0.361; p = 0.000), the result on the anxiety scale (4DSQ) (r = 0.301; p = 0.000) were found.

Nowadays it is necessary to carry out more scientific research in Ukraine and worldwide to develop a comprehensive preventive program that reduces the risk of burnout syndrome development, as well as decreases the risk of cardiovascular diseases development, in particular, it also should improve the health level of family doctors and medical professionals as well.

References

World Health Organization. (2019). Burn-out as “an occupational phenomenon”: International Classification of Diseases. Retrieved from https://www.who.int/news/item/28-05-2019-burn-out- an-occupational-phenomenon-international-classification-of-diseases.

Botiakova, V. (2023). Prevalence of Burnout Syndrome among Medical Professionals in Ukraine from 2018 to 2022. Art of Medicine, 25(1), 92-100. https://doi.org/10.21802/ artm.2023.1.25.92.

World Health Organization. (2020). Occupational health: Stress at the workplace. Retrieved from https://www.who.int/news-room/questions-and-answers/item/ccupational-health- stress-at-the-workplace.

Pega, F., Nafradi, B., Momen, N. C., Ujita, Y., Streicher, K. N., Pruss-Ustun, et al. (2021). Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment international, 154, 106595. Retrieved from https://doi.org/10.1016/j.envint.2021.106595.

World Health Organization. (2021). Obesity. Retrieved from https://www.who.int/news- room/facts-in-pictures/detail/6-facts-on-obesity.

Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 (GBD 2019) Results (2020, Institute for Health Metrics and Evaluation - IHME). Retrieved from https://vizhub.healthdata.org/gbd-results/.

De Souza E Silva, D., das Merces, M. C., Lua, I., Coelho, J. M. F., Santana, A. I. C., Reis, et al. (2023). Association between burnout syndrome and obesity: A cross-sectional population-based study. Work (Reading, Mass.), 74(3), 991-1000. Retrieved from https://doi.org/10.3233/WOR-210245.

Tanios, M., Haberman, D., Bouchard, J., Motherwell, M., & Patel, J. (2022). Analyses of burn-out among medical professionals and suggested solutions--a narrative review. Journal of Hospital Management and Health Policy, 6:7. Retrieved from https://doi.org/10.21037/jhmhp-20-153.

Batra, K., Singh, T. P., Sharma, M., Batra, R., & Schvaneveldt, N. (2020). Investigating the Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis. International journal of environmental research and public health, 17(23), 9096. Retrieved from https://doi.org/ 10.3390/ijerph17239096.

World Health Organization. (2023). Depressive disorder (depression). Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression.

World Health Organization. (2023). Anxiety disorders. Retrieved from https://www.who.int/ news-room/fact-sheets/detail/anxiety-disorders.

Schaufeli, W., De Witte, H., & Kok, R. (2022). Het verschil maken met BAT en 4DKL. TBV - Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 30(3), 41-45. Retrieved from https://doi.org/10.1007/s12498-022-1476-9.

Yellowlees, P., Rea, M. (2022). Burnout. Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primer/burnout.

Kane L. (2021). Death by 1000 Cuts: Medscape National Physician Burnout & Suicide Report 2021. Medscape. Retrieved from https://www.medscape.com/slideshow/2021-lifestyle- burnout-6013456

Chaban, O.S., Khaustova, O.O. (Eds.). (2021). Praktychnapsykhosomatyka: diahnostychni shkaly. Navchalnyi posibnyk [Practical psychosomatics: diagnostic scales. Tutorial]. 3-ie vyd., vypr. i dop. Kyiv: Vydavnychyi dim Medknyha [in Ukrainian].

Helsinska deklaratsiia Vsesvitnoi medychnoi asotsiatsii "Etychni pryntsypy medychnykh doslidzhen za uchastiu liudyny u yakosti obiekta doslidzhennia" vid 01.06.1964 r. [World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects from 01.06.1964]. (2008). Khelsinki: Vsesvitnia medychna asotsiatsiia. Retrieved from https://zakon.rada.gov.ua/laws/show/990_005#Text [in Ukrainian].

Terluin B., Rhenen, W. V., Schaufeli, W. B., & De Haan, M. (2004). The fourdimensional symptom questionnaire (4DSQ): measuring distress and other mental health problems in a working population. Work & Stress, 18(3), 187-207. Retrieved from https://doi.org/10.1080/ 0267837042000297535.

Terluin, B., Oosterbaan, D. B., Brouwers, E. P., van Straten, A., van de Ven, P. M., Langerak, W., & van Marwijk, H. W. (2014). To what extent does the anxiety scale of the FourDimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study. BMC psychiatry, 14, 121. https://doi.org/10.1186/1471-244X-14-121

World Health Organization. (2011). Waist circumference and waist-hip ratio : report of a WHO expert consultation. Geneva, 8-11 December 2008. World Health Organization. Retrieved from https://apps.who.int/iris/handle/10665/44583.

Maslach, С., Leiter, M.P., Jackson, S.E., et al (2018). Manual - Maslach Burnout Inventory. Mind Garden. 4th ed. Retrieved from https://www.mindgarden.com/maslach-burnout- inventory-mbi/685-mbi-manual.html#horizontalTab.

Ong, J., Ong, A. M. L., Ong, S., Xin, X., Lee, Y. Y., Pausawasdi, N., et al. (2021). The impact of the coronavirus disease 2019 pandemic on gastroenterologists in Southeast Asia: A mixed-methods study. Journal of gastroenterology and hepatology, 36(11), 3056-3068. Retrieved from https://doi.org/10.1111/jgh.15594.

World Health Organization. (1994). Lexicon of psychiatric and mental health terms. 2nd ed. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/handle/ 10665/39342

Andrijic, M., Tepavcevic, D. K., Nikitovic, M., Miletic, N., & Pekmezovic, T. (2021). Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center. International archives of occupational and environmental health, 94(4), 669-677. Retrieved from https://doi.org/10.1007/s00420-020-01621-7.

Schaarschmidt U., Fischer A.W. (2008). AVEM- Arbeitsbezogenes Verhaltens- und Erlebensmuster. Handanweisung (3. uberarbeitete und erweiterte Aufl.). London: Pearson. Retrieved from https://www.testzentrale.de/shop/arbeitsbezogenes-verhaltens-und-erlebensmuster.html.

Fischer A.W. (2006). Beanspruchungsmuster im Pflegeberuf: eine Studie an osterreichischem Pflegepersonal im Schnittpunkt von personlichkeits-, gesundheits-und arbeitspsychologischem Herangehen. Candidates thesis. Universitat Potsdam: Potsdam. Retrieved from https://publishup.uni- potsdam.de/opus4-ubp/frontdoor/deliver/index/docId/716/file/fischer diss.pdf.

Schaufeli W., Enzmann D. (1998). The Burnout Companion to Study and Practice: A Critical Analysis. London: CRC Press. Retrieved from https://doi.org/10.1201/9781003062745.

Література

World Health Organization. Burn-out an “an occupational phenomenon”: International Classification of Diseases. 2019. URL: https://www.who.int/news/item/28-05-2019-burn-out-an- occupational-phenomenon-international-classification-of-diseases (дата звернення: 11.11.2023).

Botiakova V. Prevalence of Burnout Syndrome among Medical Professionals in Ukraine from 2018 to 2022. Art of Medicine. 2023. Vol. 25. Issue 1. P. 92-100. URL: https://doi.org/ 10.21802/artm.2023.1.25.92 (дата звернення: 11.11.2023).

World Health Organization. Occupational health: Stress at the workplace. 2020. URL: https://www.who.int/news-room/questions-and-answers/item/ccupational-health-stress-at-the- workplace (дата звернення: 11.11.2023).

Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury / F.Pega et al. Environment international. 2021. Vol. 154. P. 106595. URL: https://doi.org/10.1016/j.envint. 2021.106595(дата звернення: 11.11.2023).

World Health Organization. Obesity. 2021. URL: https://www.who.int/news-room/ facts-in-pictures/detail/6-facts-on-obesity (дата звернення: 11.11.2023).

Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 (GBD 2019) Results (2020, Institute for Health Metrics and Evaluation - IHME). URL: https://vizhub.healthdata.org/gbd-results/ (дата звернення 11.11.2023).

Association between burnout syndrome and obesity: A cross-sectional population-based study / D. De Souza E Silva et al. Work (Reading, Mass.). 2023.Vol. 74. Issue 3. P. 991-1000. URL: https://doi.org/10.3233/WOR-210245 (дата звернення 11.11.2023).

Analyses of burn-out among medical professionals and suggested solutions--a narrative review / M. Tanios et al. Journal of Hospital Management and Health Polic. 2021. 6:7. URL: https://doi.org/10.21037/jhmhp-20-153 (дата звернення 11.11.2023).

Investigating the Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis / K.Batra et al. International Journal of Environmental Research and Public Health. 2020.Vol. 17. Issue 23. P. 9096. URL: https://doi.org/10.3390/ijerph17239096 (дата звернення: 11.11.2023).

World Health Organization. Depressive disorder (depression). 2023. URL: https://www.who.int/ news-room/fact-sheets/detail/depression (дата звернення: 11.11.2023).

World Health Organization. Anxiety disorders. 2023. URL: https://www.who.int/news- room/fact-sheets/detail/anxiety-disorders (дата звернення: 11.11.2023).

Schaufeli W., De Witte H., & Kok R. Het verschil maken met BAT en 4DKL. TBV - Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde. 2022. Vol. 30. Issue 3. P. 41-45. URL: https://doi.org/10.1007/s12498-022-1476-9 (дата звернення: 11.11.2023).

Yellowlees P., Rea M. Burnout. Patient Safety Network. 2022. URL: https://psnet.ahrq.gov/ primer/burnout (дата звернення 11.11.2023).

Kane L. Death by 1000 Cuts: Medscape National Physician Burnout & Suicide Report

2021. Medscape. 2021. URL: https://www.medscape.com/slideshow/2021-lifestyle-burnout-

6013456 (дата звернення 11.11.2023).

Практична психосоматика: діагностичні шкали. Навчальний посібник / За заг. ред. О.С. Чабана, О.О. Хаустової. 3-є вид., випр. і доп. Київ: Видавничий дім Медкнига, 2021. 200 с.

Гельсінська декларація Всесвітньої медичної асоціації "Етичні принципи медичних досліджень за участю людини у якості об'єкта дослідження" : Декларація Всесвіт. мед. асоц. від 01.06.1964 р. : станом на 1 жовт. 2008 р. URL: https://zakon.rada.gov.ua/laws/ show/990_005#Text (дата звернення: 11.11.2023).

The four-dimensional symptom questionnaire (4DSQ): measuring distress and other mental health problems in a working population / B.Terluin et al. Work & Stress. 2004. Vol. 18. Issue 3. P. 187-207. URL: https://doi.org/10.1080/0267837042000297535 (дата звернення 11.11.2023).

To what extent does the anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study / B. Terluin. BMC Psychiatry. 2014. Vol. 14. URL: https://doi.org/10.1186/1471-244x-14-121 (дата звернення 11.11.2023).

World Health Organization. Waist circumference and waist-hip ratio : report of a WHO expert consultation. 8-11 December 2008. Geneva: World Health Organization. 2011. 39 p. URL: https://apps.who.int/iris/handle/10665/44583 (дата звернення: 11.11.2023)

Maslach Burnout Inventory Manual / С. Maslach et al. 4th ed. Mind Garden, 2018. URL: https://www.mindgarden.com/maslach-burnout-inventory-mbi/685-mbi-manual.html#horizontalTab (дата звернення: 11.11.2023).

The impact of the coronavirus disease 2019 pandemic on gastroenterologists in Southeast Asia: A mixed-methods study / J. Ong et al. Gastroenterology and Hepatology. 2021. Vol. 36. Issue 11. P. 3056-3068. URL: https://doi.org/10.1111/jgh.15594 (дата звернення: 11.11.2023).

World Health Organization. Lexicon of psychiatric and mental health terms. 2nd ed. Geneva: World Health Organization, 1994. 108 p. URL: https://apps.who.int/iris/handle/10665/39342 (дата звернення: 11.11.2023).

Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center / M. Andrijic et al. International Archives of Occupational and Environmental Health. 2021. Vol. 94. Issue 4. P. 669-677. URL: https://doi.org/10.1007/s00420-020-01621-7 (дата звернення: 11.11.2023).

Schaarschmidt U., Fischer A.W. AVEM - Arbeitsbezogenes Verhaltens- und Erlebensmuster. Handanweisung (3. uberarbeitete und erweiterte Aufl.). London: Pearson, 2008. URL: https://www.testzentrale.de/shop/arbeitsbezogenes-verhaltens-und-erlebensmuster.html (дата звернення: 11.11.2023).

Fischer A.W. Beanspruchungsmuster im Pflegeberuf: eine Studie an osterreichischem Pflegepersonal im Schnittpunkt von personlichkeits-, gesundheits-und arbeitspsychologischem Herangehen. Candidate's thesis. Universitat Potsdam. Potsdam, 2006. 135 p. URL: https://publishup.uni- potsdam.de/opus4-ubp/frontdoor/deliver/index/docId/716/file/fischer diss.pdf (дата звернення 11.11.2023).

Schaufeli W., Enzmann D. The Burnout Companion to Study and Practice: A Critical Analysis. London: CRC Press, 1998. 232 p. URL : https://doi.org/10.1201/9781003062745 (дата звернення 11.11.2023).

Размещено на Allbest.ru