Seda TÜRKİLİ, Yücel UYSAL, Şenel TOT, Ertan MERT

AİLE HEKİMLERİNDE KORONA VİRÜS SALGINI NEDENİYLE YAŞANILAN ZORLUKLAR, KAYGI VE TÜKENMİŞLİK DURUMLARININ İNCELENMESİ

Amaç: Yeni tip koronavirüs (SARS-Cov2, COVID-19) pandemisi tüm dünyada sağlık çalışanlarını gerek fiziksel gerekse ruhsal açıdan etkileyecek birçok zorluğu beraberinde getirmiştir. Bu çalışmada amaç, COVID-19pandemisi sürecinde görev alan aile hekimlerinin karşılaştıkları zorlukların, kaygı yaratan durumlar ile anksiyete, depresyon ve tükenmişlik sendromu ve ilişkili faktörlerin değerlendirilmesi ve risk faktörleri için bir çerçeve sunulmasıdır. Metot: Çalışmamız internet üzerinden uygulanan bir anket çalışması olup, Mersin ilinde görevli aile hekimleri ile yapılmıştır. Ankette sosyodemografik veriler ve COVID-19 pandemisi deneyimleri soru formu, Hasta Sağlık Anketi-4 ve Maslach Tükenmişlik Ölçeği kullanılmıştır. Bulgular: Yüz kırk altı aile hekimi anketi tamamladı. Ankete katılanların %78,08’inin (n=114) anksiyete, %71,23’ünün (n=104) depresyon yaşadığını saptadık. Tükenmişlik alt ölçeklerinde ortalama puanlar “duygusal tükenme” için 21,49 (±6,39), “duyarsızlaşma” için 10,86 (±3,72) ve “kişisel başarı” için 16,71 (±5,60) idi. COVID-19 hastaları ile temas sıklığı, aynı evde 65 yaş üstü veya kronik hastalığı olan bireylerle yaşamak, SARS-Cov2 için pozitif test sonucu, kişisel koruyucu ekipmanlara erişim sorunu, idareciler tarafından algılanan destek eksikliği, sosyal destek eksikliği, damgalanma ve COVID-19 konusunda bilgi edinmek amaçlı aşırı sosyal medya kullanımının depresyon, anksiyete ve tükenmişlik için risk faktörü olduğu saptanmıştır. Sonuç: Pandemi sürecinde sağlık hizmetlerinin etkin ve kaliteli bir şekilde sürdürülmesi, sağlık çalışanlarının gerek fiziksel gerekse ruhsal açıdan iyi oluş hali ile doğrudan ilişkilidir. Bu süreçte büyük özveri ile yüksek risk altında çalışan birinci basamak hekimlerinde, sürecin zorluklarına bağlı ortaya çıkması olası ruhsal bozuklukların erken dönemde tespiti ve ilerlemesinin önlenmesi; risk faktörlerinin tespit edilip gerekli müdahalelerin erken dönemde hayata geçirilebilmesi, pandemi ile mücadelenin etkin bir şekilde sürdürülmesi için son derece önemlidir.

Anahtar Kelimeler:

pandemi, aile hekimi, birinci basamak, anksiyete, depresyon, tükenmişlik

EXAMINATION OF CHALLENGES, ANXIETY AND BURNOUT AMONG FAMILY PHYSICIANS DUE TO CORONA VIRUS OUTBREAK

Objective: The new type of corona virus (SARS-Cov2, COVID-19) pandemic has brought many difficulties that will affect healthcare professionals both physically and mentally all over the world. The aim of this study is to evaluate the difficulties faced by family physicians involved in the COVID-19 pandemic process, anxiety-causing conditions, anxiety, depression and burn out syndrome and related factors and to present a framework for risk factors. Method: Our study is an online survey study and was conducted with family physicians working in Mersin city. Sociodemographic data and COVID-19 pandemic experiences questionnaire, Patient Health Questionnaire-4 and Maslach Burnout Inventory Scale were used in the survey. Results: 146 family physicians completed the survey. We found that 78.08% (n=114) of the respondents experienced anxiety and 71.23% (n=104) experienced depression. Average scores on burnout subscales were 21.49 (±6.39) for “emotional exhaustion,” 10.86 (±3.72) for “desensitization,” and 16.71 (±5.60) for “personal achievement”. The frequency of contactwithCOVID-19 patients, living in the same house with individuals over 65 or with chronic diseases, positive test result for COVID-19, problem access to personal protective equipment, lack of support perceived by administrators, lack of social support, stigma and excessive social media use to learn about SARS-Cov2 were found to be risk factors for depression, anxiety and burnout. Conclusion: The effective and high quality maintenance of health services during the pandemic process is directly related to the well-being of health workers both physically and spiritually. Early detection and prevention of progression of mental disorders that may arise due to the difficulties of the process in primary care physicians working under high risk with great devotion during this process; it is extremely important to identify risk factors and to implement the necessary interventions at an early stage, in order to continue the effective fight against the pandemic.

Keywords:

pandemics, familiy physicians, primary care, anxiety, depression, burnout,

PDF

___

1. Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics 2009; 50(6): 613-621
2. Demirci, İ, Ekşi H. Don't bother your pretty little head otherwise you can’t enjoy life. ERPA International Congresses on Education 2018, 28 June -1 July 2018, Istanbul / Turkey. pg. 287-292
3. Maslach C, Jackson SE. The measurement of experienced burnout. Journal of Occupational Behavior, 1981; 2: 99-113
4. Ergin C. Doktor ve hemşirelerde tükenmişlik ve Maslach tükenmişlik ölçeğinin uyarlanması. VII. Ulusal Psikoloji Kongresi Bilimsel Çalışmaları. Hacettepe Üniversitesi, Ankara, s.143- 153
5. Çapri B. Tükenmişlik ölçeğinin Türkçe uyarlaması. Mersin Üniversitesi Eğitim Fakültesi Dergisi 2006; 12: 62-77
6. Kumar R, Naseem S, Jayatissa J, Adhikari CL, Aziz T, Qureshi R et al. A Statement of Solidarity on COVID‑19 Pandemic 2020 bythe South Asian Family Physicians. Journal of Family Medicine and Primary Care; 2020;9 (4): 1795-97
7. ShanzhuZhu, Donald Li. Sharing experience from Chinese General Practitioners to International colleagues on how to tackle COVID-19. Journal of Asia Pacific Family Medicine, 2019; 18;1. https://doi.org/10.22146/apfm.v18i1.217 8. Rohilla J, Tak P, Jhanwar S, Hasan S. Primary care physician's approach for mental health impact of COVID-19. J FamilyMed Prim Care. 2020 Jul; 9(7): 3189–3194.
9. Monterrosa-Castro A, Redondo-Mendoza V, Mercado-Lara M. Psychosocial factors associated with symptoms of generalized anxiety disorder in general practitioners during the COVID-19 pandemic. J InvestigMed2020;68:1228–1234
10. Amerio A, Bianchi D, Santi F, Costantini L, Odone A, Signorelli C et al. Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners. Acta Biomed 2020; 91(2): 83-88 DOI: 10.23750/abm.v91i2.9619
11. Lee AM, Wong JG, Mc Alonan GM, Cheung V, Cheung C, Sham PC et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry2007; 52: 233-40
12. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, andaltruistic acceptance of risk. Can J Psychiatry 2009; 54:302-11 13. Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S et al. Long-term Psychologıcal and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak. Emerging Infectious Diseases; 2006; 12(12); 1924-1932
14. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N et al. Factorsassociatedwithmentalhealthoutcomesamonghealthcareworkersexposedtocoronavirusdisease 2019. JAMA Network Open. 2020; 3(3); e203976. Doi: 10.1001/jamanetworkopen.2020.3976
15. Morgantini LA, Naha U, Wang H, Francavilla S, Acar O, Flores JM et al. Factors Contributingto Healthcare Professional Burnout During the COVID-19 Pandemic: A Rapid Turnaround Global Survey. medRxivpreprintdoi: https://doi.org/10.1101/2020.05.17.20101915. Erişim tarihi: 19.09.2020.
16. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. PsychiatryResearch 290 (2020) 113130. https://doi.org/10.1016/j.psychres.2020.113130
17. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ 2020; 369:m1642
18. Feng Z, Li Q, Zhang Y, Wu Z, Dong X, Ma H et al. The epidemiological characteristics of an outbreak of 2019 novel corona virus diseases (COVID-19)-China. Chinese Center for Disease Control and Prevention, 2020; 2: 1-10.
19. Damery S, Draper H, Wilson S, Greenfield S, Ives J, Parry J et al. Healthcare workers’ perceptions of the duty to work during an influenza pandemic. J Med Ethics 2010; 36: 12–8
20. Imai H, Matsuishi K, Ito A, Mouri K, Kitamura N, Akimoto K et al. Factorsassociatedwithmotivationandhesitationtoworkamonghealthprofessionalsduring a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009. BMC Public Health 2010; 10: 672.
21. Huremović D. Socialdistancing, quarantine, andisolation. In Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak (ed D Huremović): Springer, 2019 85–94.
22. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Chinese Journal of Industrial Hygiene and Occupational Diseases, 2020; 38(3):192-195.
23. Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosci. 2020; 74(4): 281–282.
24. SongJ, Song TM, Seo DC, Jin DL, Kim JS. Social big data analysis of information spread and perceived infection risk during the 2015 Middle East Respiratory Syndrome outbreak in South Korea. Cyberpsychology, Behavior, andSocial Networking. 2017;20(1):22–29
25. Depoux A, Martin S, Karafillakis E, Preet R, Wilder-Smith A, Larson H. The pandemic of social media panic travels faster than the COVID-19 outbreak. Journal of Travel Medicine, 2020; 27(3):1-2, https://doi.org/10.1093/jtm/taaa031