To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study

Abstract

Background Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease. Objectives We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load. Methods In a mixed-method design, Fava’s clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner’s symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO. Results Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3–4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5–7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility. Conclusion Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.

Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study

“…Although studies showed the mental health of students, trainees and faculty have suffered from the impact of COVID-19 [ 2 , 4 , 35 , 36 ], our results show that working in a training practice lowered the risk of adverse mental health events. This effect persists even after controlling for having a multidisciplinary team, the respondent’s years of experience in primary health care, number of GPs in the practice, urban or rural location and function of the respondent in the practice (GP or GP trainee).…”

Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions

“…Time pressure is a common stressor in general practice and negatively affects the GP seeking relevant information and reading scientific literature [31,32]. During a pandemic, increased time pressure due to a higher workload, uncertainties regarding an unknown disease, work reorganization, and potential lack of confidence in caring for COVID-19 patients might underpin additional psychological distress among GPs [33][34][35][36][37][38][39]. Time pressure has been recognized as one of the workplace challenges with a negative impact on GPs' professional resilience [22].…”

Allostatic load and physiological responses to work stress: an integrative review

“…Carga alostática y estrés laboral: una revisión integrativa BIOMARCADORES PRIMARIOS DEL ÍNDICE DE CARGA ALOSTÁTICA Dos estudios 27,30 no utilizaron biomarcadores para calcular el índice de carga alostática, en vez de ello, utilizaron el índice clínimétrico de Fava et al 32 , adaptado del índice psicosocial. La medición de al menos un biomarcador primario de carga alostática (DHEA, cortisol, norepinefrina y epinefrina) estuvo presente en el 60% de las investigaciones, excluyendo los estudios clínimétrico puros.…”

“…El índice psicosocial (psychosocial index, PSI) 34 fue usado en dos estudios 27,30 para reemplazar biomarcadores clínicos, teniendo en cuenta los siguientes pasos: el criterio A consiste en la identificación del factor estresante o de la amenaza contextual detonante del estrés, factores no controlados e imprevistos que persisten en el tiempo, por ejemplo, pérdida de una persona importante, pérdida de la salud, conflictos laborales y familiares entre otros, sin desconocer que algunas situaciones de la vida cotidiana pueden superar los mecanismos de afrontamiento del individuo y convertirse en factores estresantes. El segundo punto de los criterios, o el criterio B, implica las manifestaciones clínicas, que pueden incluir síntomas psicológicos, deterioro en el funcionamiento social y ocupacional.…”