2012, Number 4
La integridad mental del personal clínico de un hospital psiquiátrico, asociada a una alta exigencia emocional y a la organización nociva del trabajo
PDF size: 117.03 Kb.
ABSTRACTThe Joint Committee on Health at Work make up by: ILO/WHO (International Labour Organization and the World Health Organization) in 1992, recognized that inappropriate management, affects people’s health through physiological and psychological mechanisms known as stress.
The aim of this study was to evaluate the risks associated to toxic management, and to certain psychological demands; as contributors to mental distress, lack of stress and job dissatisfaction of psychiatrists, vitality psychologists and medical residents of a Child Psychiatric Hospital (CHPH).
Material and methods: The study design was a cross-sectional survey, descriptive and observational. Instrument: The Copenhagen Psychosocial Questionnaire (The Copenhagen Psychosocial Questionnaire COPSOQ). Originally developed in Denmark, was adapted and validated in Spain. The internal consistency of the scales was Cronbach’s (0.66 to 0.92) and Kappa indices (0.69 to 0.77).
Statistical analysis. Descriptive analysis was expressed by means, percentages and standard deviations. Bivariate analysis was calculated between psychosocial factors and dimensions of health. The comparisons between categorical variables were analized through chi square tests, and Fisher’s exact test was used when the number of observations in the cells of the contingency table was less than 5. The results were expressed by prevalence ratios and their respective confidence intervals were calculated. Statistical analysis was performed using JMP statistical package version 7 and SPSS version 17.
Results: A total of 111 clinicians were surveyed: 30 psychiatrists, 46 psychologists and 35 medical residents. The response rate was 97%. The age range of the clinical staff was, from 26 to 65 years, with M=40, SD=6.5 years.
Association between psychosocial demands and dimensions of health. Major problems presented by clinical staff, were explained from 3 axes. First axis, about psychological demands. We evaluated five types of psychological demands, but those that emerged as predictors of mental distress, loss of energy and cognitive behavioral stress symptoms, were the emotional demands. Emotional demands had statistically significant associations with mental distress (OR 3.67, 95% CI 1.28-10.01), behavioral symptoms (OR 3.59, 95% CI 1.28-10.06) and cognitive stress (RP 2.15, 95% CI 1.00-5.12) as well as lack of vitality (OR 1.78, 95% CI 1.01-3.13) (table4). Second axis: about quality of leadership, this concept showed statistically significant association with: mental distress (OR 2.83, 95% CI 1.19-6.76), with cognitive symptoms (OR 2.33, 95% CI 1.00-5.60) and behavioral stress (RP 2.24, 95% CI 1.06-4.75) and lack of vitality (OR 1.65, 95% CI 1.06-4.75). Other high-risk concept was: Managers’ low social support, that showed statistically significant association with job dissatisfaction (OR 3.08, 95% CI 1.41-6.73), lack of vitality (OR 1.41, 95% CI 1.12-1.78) and mental distress (OR 1.39, 95% CI 1.07-1.81). Within the same second axis of analysis, lack of predictability was significantly associated with: mental distress (OR 2.33, 95% CI 1.40-3.88), behavioral symptoms (OR 2.11, 95% CI 1.31-3.41) cognitive stress symptoms (OR 2.07, 95% CI 1.19-3.61), and lack of vitality (OR 1.63, 95% CI 1.17-2.29). Third axis: the effort-reward imbalance; had a statistically significant association between job insecurity and all dimensions of health such as behavioral symptoms of stress (RP 1.97, 95% CI 1.14-3.41), lack of vitality (RP 1.94, 95% CI 1.23 -3.07), mental distress (RP 1.73, 95% CI 1.04-2.88), and cognitive symptoms of stress (RP 1.39, 95% CI 1.12-1.72). But stronger association was found between insecurity and job dissatisfaction (OR 7.65, 95% CI 1.09-53.75). Hence, the lack of esteem was significantly related to mental distress (OR 2.11, 95% CI 1.12-3.95), with behavioral symptoms of stress (OR 1.82, 95% CI 1.03-3.23), and lack of vitality (OR 1.42, 95% CI 1.00-2.11).
Discussion: According to Karasek-Theorell’s theoretical model, high demands, low control and low social support (the combination of these factors brought together the work of psychiatrists, psychologists and residents) this condition represents the greatest risk to health. Clinical professionals are treated disrespectfully, have no appreciation; causing an effort/reward imbalance in their work.
Our results are consistent with research conducted with the same instrument in Sweden, Denmark, Serbia, Germany and Spain. These articles found that psychiatrists and psychologists are exposed to high emotional demands. In contrast a high quality management shows clear relationship to mental well-being, with high vitality and acceptable levels of stress. Our findings show that low social support from managers, increase psychosocial risks and stress findings which are consistent with a Chilean study. Although most participants (except residents) have an acceptable job safety almost eight of every ten respondents claimed to be quite concerned about possible changes or delays in salary, or requiring a second job.
Security at work is a fundamental aspect of the model of effortreward-balance. Lack of this characteristic has a negative impact on human health. The human rights organization in Latin America (HR), found that 33% of latino workers expressed “anxiety” because of job insecurity, furthermore recognized the relationship between job insecurity and an increase in cancer and depression.
Latino workers seem to be the most affected by new global order, where employment is based on the informal economy. A poll by the Washington Post, Kaiser Family Foundation and Harvard University affirmed that 33% of latinos expressed “anxiety” by job insecurity, compared with 22% of Afro-American and 20% of white people.
Complications in health and life prognosis for these workers and their productivity, affects directly the quality care of the patients, beyond production costs. The Chilean analysis concluded that is necessary to give special attention to health sector working population due to the importance of their work.
In conclusion, our results suggest that high emotional demands coupled with a poor quality of leadership, characterized by a highly hierarchical power structure, with low esteem, lack of support and unfair treatment was associated with mental distress, and behavioral symptoms of stress and lack of vitality. The total of these deficiencies and their interaction could potentially cause an effort/reward imbalance in clinician work.
From the standpoint of prevention, it is about working there; where the exposures have been identified. The risk factors such as stress need to be controlled from its source: toxic management. It seems relevant to include our proposals, in order to improve organization culture and create healthier environments for the staff, so we recommend:
1) A strategic program to protect health of the hospital staff. 2) To assess and reward the efforts, accomplishments, contributions, results and not permanence. 3) Assign a fair wage according to their preparation and the functions performed. 4) It is necessary that managers and middle managers solve conflict well, plan their job correctly and be able to establish proper communication channels with their subordinates. 5) Promote labor stability. 6) Flexible hours, according to the needs of people and not just production. 7) Working conditions should provide development opportunities and the tasks must be varied and meaningful. 8) Promote teamwork, encourage social support and avoid competition. 9) Strengthen the esteem and recognition, including a promotion plan in terms of expectations of each employee. 10) Eliminate highly hierarchical power structures.
Comité OIT/OMS Identificación y control de los factores psicosociales nocivos en el trabajo. Informe del comité mixto OIT/OMS de medicina del trabajo. Novena reunión, Ginebra. [Seriada en línea] 1992; [7 páginas]. Disponible en: http//:www.who.int/occupational_health/globalestrategy/en/index4html. Consultado septiembre 23,2008.
Kaseburg M, Chahal N, Duan S, Smailes E. Changing the workplace: Improving mental health of hospital workers summary of work conditions results from the Baseline Survey 2008. Vancouver, BC: Occupational Health and Safety Agency for Healthcare in British Columbia. 2008. Disponible en: http//www.ohsah.bc.ca/media/Changing the workplace Phase II Brief Report.pdf. Consultado noviembre 25, 2008.
Laszlo KD. La inseguridad laboral como determinante de mala salud mental. Instituto Karolinska Suecia. Resultado de tres estudios. Social Science & Medicine. [Seriada en línea] 2009; 1: [4 páginas]. Disponible en: www.ins.gob.pe/insvirtual/images/revista/pdf/rpmesp2011.v28.n3.pdf. Consultado marzo 10, 2011.
Ponce A. Crisis mundial y desempleo: Violación masiva de derechos laborales, nuevas formas de organización y lucha sindical. [Seriada en línea] 2011; [6 páginas]. Disponible en: www.kaosenlared.net/noticia/crisis-mundial-esempleo-violacion-masiva-derechos-laborales-nuevas-formas-deorg. Consultado marzo 18, 2011.
Canepa C, Briones JL, Pérez C, Vera A et al. Programa Fogarty, Mount Sinai University, NY, USA. Desequilibrio Esfuerzo-Recompensa y estado de malestar mental en trabajadores de servicios de salud en Chile. 2° Foro de las Américas en Investigación sobre factores psicosociales. Estrés y Salud Mental en el Trabajo. Concepción y perspectiva local de un fenómeno global. 2008.