Prevalence of stress and its determinants among residents in Saudi Arabia

Objectives:

To examine perceived stress among residents in Saudi Arabia and its associated risk factors.

Methods:

A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS).

Results:

Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession.

Conclusion:

Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.The healthcare profession needs adequate medical residency training programs to increase its members’ professional qualifications and to maintain patient safety. However, residency training is a difficult and stressful stage of development in a professional career.1 Residents are often subject to prolonged working hours, prolonged sleep deprivation, uncontrolled schedules, high job demands, and inadequate personal time.2 High job demands are combined with poor job resources, such as poor opportunities for professional development and low supervisor support. These factors may cause burnout, which is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment.3,4 Additionally, residency may impact the residents’ quality of life5 and cause them to experience sleep disorders,6 family problems,7 and even psychiatric disorders.8 These stress symptoms may in turn negatively impact patient care and result in frequent medical errors9 and suboptimal care practices.10 Some countries have implemented mandatory work hour limitations to improve residents’ quality of life with promising results, but this approach may diminish patient care and educational outcomes.11,12 We categorized the stressors that residents face into the following categories: institutional stressors, such as heavy workload, sleep deprivation, and poor learning environments; personal stressors, such as social problems, family problems, and financial difficulties; and professional stressors, such as career planning issues and information overload.13 Several studies from various parts of the world have already evaluated the presence of stress symptoms or their risk factors among medical residents in different programs.14-18 However, we struggled to compare the findings from these studies, because they employed different tools to assess the presence of stress. The study populations also varied considerably. In recent years, universities, and other major healthcare providers have been implementing additional recognized residency programs and have been enrolling more residents in Saudi Arabia to fix the huge deficiency in the number of Saudi-National practicing physicians.19 Yet no data pertaining to the stress among residents in Saudi Arabia exists. This information is a critical step toward occupational stress management, so the objective of the present study is to examine perceived stress among residents in Saudi Arabia and its associated risk factors, including personal and work-related stressors.