Avhandlingen ble forsvart 18. juni 2010. Tema for prøveforelesning var ”Et helsefremmende arbeidsliv for leger: fra teorier om utvikling av arbeidsrelatert stress og utbrenthet til forebyggende tiltak”.
Summary
Several studies have shown that there is a relatively high prevalence of burnout and
mental distress among working physicians. This is an issue of concern, not only for the
individual physician, but also in relation to patient treatment. Both self-perceived and
objectively observed associations between physician distress and sub-optimal functioning at
work have been reported. In addition, physicians have been found to be reluctant to seek
treatment in the traditional health services. Easily accessible and low-threshold interventions
to reduce burnout and to prevent serious consequences of distress have therefore been
advised.
Few long-term follow-up studies have, however, examined the course of burnout
and/or mental distress in physicians after interventions aiming to reduce burnout and
associated factors. Such studies are therefore needed, in addition to knowledge about factors
predicting or being associated with such course over time. On this background, the three
year course of emotional exhaustion (one dimension in the burnout syndrome) and mental
distress in physicians, after a short-term intervention at Villa Sana in Norway, has been
investigated in the present thesis. Factors associated with the post-intervention course of
emotional exhaustion were examined. This knowledge can contribute to guide the design
and implementation of further studies to evaluate the effects of specific intervention
programs.
The thesis includes three papers based on a cohort of physicians who sought help at
Villa Sana, with assessments before the intervention, immediately after the intervention and
at one- and three-year follow-up.
The first paper presents the baseline levels of distress in the Villa Sana cohort, that
were found to be high compared with Norwegian physicians in general, indicating that
many of the physicians in our sample were in need of treatment.
In the second paper, changes from baseline to one-year follow-up were reported,
showing significant reductions in the distress measures. There was a mean reduction in
number of work hours/week during the year after the intervention and an increase in
proportion of physicians seeking psychotherapy. A substantial reduction in proportion of
physicians on sick leave at one-year follow-up, compared with baseline, was found.
Reduction of work hours after the intervention was associated with reduction in emotional
exhaustion, and among men, satisfaction with the intervention predicted reduction in
emotional exhaustion.
The third paper presents the results from the follow-up three years after the
intervention. We found that the reduced levels of distress were sustained from one- to three
year follow-up. The results indicate that reduction in emotion-focused coping strategies and
reduction in job stress had an impact upon reduction in emotional exhaustion.
The reduction and long-term sustainment of distress levels after a counselling
intervention for distressed physicians is promising in relation to the relatively high
prevalence of burnout and mental distress found within this profession, and the negative
consequences this may have for patient care as well as for the individual physician. Further
studies are needed to determine possible causal relationships of factors associated with such
improvement and with sustainment of lower distress levels.
Olaf G. Aasland, former leader at The Institute for Studies of The Medical Profession, co-supervised this PhD.
The thesis is available in pdf via the link below.