Abstract | Uvod: Posao liječnika obiteljske medicine (LOM) predstavlja izuzetno stresno zanimanje, a posebice tijekom vremena pandemije koronavirusne bolesti 2019 (COVID-19). S obzirom na važnost uloge LOM-a u društvenoj zajednici, cilj istraživanja bio je ispitati njihovo znanje i stavove vezane uz različite aspekte pandemije, te procijeniti razine simptoma anksioznosti, depresije, percipiranog stresa i stresa povezanog uz traumu. Nadalje, u posljednje se vrijeme poseban naglasak postavlja na važnost odgovarajućeg suočavanja s doživljenim stresom, budući da može voditi u razvoj različitih poremećaja mentalnog zdravlja (PMZ). Stoga je daljnji cilj bio istražiti iskustva i stavove o PMZ u populaciji LOM-ova, te obrasce nošenja sa stresom. Konačno, budući da se otpornost i pridržavanje zdravom načinu života spominju u kontekstu zaštite mentalnog zdravlja, cilj je bio ispitati njihovu povezanost s razinama simptoma izgaranja, kao i povijesti poremećaja mentalnog zdravlja. Ispitanici i metode: Ispitivana populacija se sastojala od LOM-ova na području Republike Hrvatske, uključivanih u studiju putem anonimnog online upitnika. U prvom dijelu istraživanja, koje je provedeno od studenog 2020. do siječnja 2021. godine, uključeno je ukupno 613 LOM-ova. Ispitivale su se razine simptoma anksioznosti, depresije, percipiranog stresa i stresa povezanog uz traumu putem validiranih upitnika, te znanje, stavovi i prakse o različitim aspektima pandemje COVID-19 putem ljestvica sastavljenih na Katedri za obiteljsku medicinu Medicinskog fakulteta u Splitu. Drugi dio istraživanja se organizirao na isti način u razdoblju od travnja do lipnja 2021. godine, a uključio je 483 LOM-a. Ispitali su se stavovi o PMZ i nošenju sa stresom putem sastavljenih ljestvica, te razine otpornosti, simptoma sagorijevanja, zadovoljstva životom i poslom, te pridržavanja zdravom načinu života putem validiranih upitnika. Rezultati: Rezultati prvog dijela istraživanja su pokazali da su dob (β= -0,02; P=0,013) i osobni rizik od COVID-19 komplikacija (β=1,05; P<0,001) značajni korelati rezultata znanja. Ukupno 87,7% LOM-ova izrazilo je umjereni/visoki percipirani stres, 45,2% umjerene/teške simptome povezane s traumom, 60,4% granične/abnormalne razine anksioznosti i 52,4% granične/abnormalne razine depresije. Rezultat znanja bio je neovisni prediktor razine percipiranog stresa (β= -0,33; P=0,023) i anksioznosti (β= -0,31; P=0,006). Ispitanici su se uglavnom složili oko ograničene dostupnosti zdravstvenih usluga pacijentima koji zahtijevaju kroničnu njegu zbog nezaraznih bolesti, kao i smanjenog broja novootkrivenih slučajeva. Rezultati drugog dijela istraživanja su pokazali da 32,5% LOM-ova ima pozitivnu anamnezu PMZ, dok je 68,7% koristilo neki oblik stručne pomoći. Razine otpornosti i pridržavanja zdravom načinu života bile su značajno više u liječnika bez povijesti PMZ (P<0,001), dok su razine izgaranja bile niže (P<0,001). Nadalje, pridržavanje zdravom načinu života (β=0,03; P<0,001) bilo je u značajnoj povezanosti s otpornosti, dok su otpornost (β= -1,82; P<0,001) i pridržavanje zdravom načinu (β= -0,35; P<0,001) bili povezani s razinama simptoma izgaranja. Konačno, otpornost (OR=0,387; P<0,001) i pridržavanje zdravom načinu života (OR=0,970; P=0,021) su se pokazali kao neovisni prediktori pozitivnog statusa povijesti PMZ-a. Zaključak: Pandemija postavlja značajan teret na mentalno zdravlje LOM-ova, ali i na organizaciju javnog zdravstva zbog smanjene ukupne kvalitete zdravstvene skrbi pacijenata s kroničnim bolestima. Edukacijski programi potencijalno mogu pozitivno utjecati na znanje i smanjenje anksioznosti, te na takav način poboljšati skrb za pacijente. Dodatno, podizanje svijesti i edukaciju populacije LOM-ova o otpornosti i pridržavanju zdravom načinu života je potrebno koristiti u praksi kako bi se mogla smanjiti mogućnost poremećaja mentalnog zdravlja i odgovarajućih posljedica. |
Abstract (english) | Introduction: Family physicians (FP) have an extremely stressful occupation, especially during the time of the coronavirus disease 2019 (COVID-19) pandemic. Considering the importance of the role of FPs in the community, the aim of the research was to examine their knowledge and attitudes related to various aspects of the pandemic, and to assess the levels of symptoms of anxiety, depression, perceived stress and trauma-related stress. Furthermore, in recent times, special emphasis has been placed on the importance of coping positively with experienced stress, since it can lead to the development of various mental health disorders (MHD). Therefore, the further goal was to investigate experiences and attitudes regarding MHDs in the FP population, and patterns of dealing with stress. Finally, since resilience and healthy lifestyle are mentioned in the context of mental health care, the aim was to examine their association with levels of burnout symptoms, as well as positive history of MHDs. Subjects and Methods: The studied population consisted of FPs from the Republic of Croatia, included in the study through an anonymous online questionnaire. In the first part of the research, which was conducted from November 2020 to January 2021, a total of 613 FPs were included. Symptoms of anxiety, depression, perceived stress and trauma-related stress were assessed using validated questionnaires, as well as knowledge, attitudes and practices about different aspects of the COVID-19 pandemic using scales compiled at the Department of Family Medicine, University of Split School of Medicine. The second part of the research was organized in the same manner in the period from April to June 2021, and it included 483 FPs. Attitudes about MHDs and coping with stress were examined using compiled scales. Levels of resistance, burnout symptoms, satisfaction with life and work, and adherence to a healthy lifestyle were assessed with validated questionnaires. Results: The results of the first part of the research showed that age (β= -0.02, P=0.013) and risk of COVID-19 complications (β=1.05, P<0.001) were significant correlates of knowledge score. In addition, 87.7% FPs expressed moderate and high perceived stress, 45.2% moderate and severe trauma-related symptoms, 60.4% borderline and abnormal levels of anxiety, and 52.4% borderline and abnormal levels of depression. Knowledge score was an independent predictor of perceived stress (β= -0.33, P=0.023) and anxiety (β= -0.31, P=0.006) levels. Participants mostly agreed on limited availability of health services for patients requiring chronic care due to non-communicable diseases, as well as the reduced number of newly diagnosed cases. The results of the second part of the research showed that 32.5% of FPs have positive MHD history, while 68.7% used some form of professional help. Levels of resilience and adherence to a healthy lifestyle were significantly higher in MHD negative population (P<0.001), while levels of burnout were lower (P<0.001). Furthermore, adherence to a healthy lifestyle (β=0.03, P<0.001) was significantly associated with resilience, while healthy lifestyle adherence (β= -0.35, P<0.001), and resilience (β= -1.82, P<0.001) with burnout levels. Finally, resilience (OR=0.387, P<0.001) and adherence to a healthy lifestyle (OR=0.970, P=0.021) were shown to be independent predictors of positive MHD history status. Conclusion: Pandemic places a significant burden on FPs mental health, but as well as organization of public health due to the reduced overall quality of health care for patients with chronic diseases. Educational programs can potentially positively influence knowledge levels and reduce anxiety, thereby improving patient care. Additionally, raising awareness and educating the FPs regarding resilience and adherence to a healthy lifestyle needs to be used in practice in order to reduce the possibility of mental health disorders and the corresponding consequences. |