Intended for healthcare professionals


Stress in NHS consultants

BMJ 1995; 310 doi: (Published 25 February 1995) Cite this as: BMJ 1995;310:534
  1. Harriet Blenkin,
  2. Ian Deary,
  3. Andrew Sadler,
  4. Raymond Agius
  1. Postgraduate student Department of Psychology, Institute of Psychiatry, London SE5 8AF
  2. Reader Research associate Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ
  3. Senior lecturer Department of Public Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG

    EDITOR,—Richard P Caplan highlights the fact that few studies have examined stress and psychological symptoms in senior doctors.1 We conducted a cross sectional survey of 500 randomly selected NHS consultants in Scotland, of whom 375 (75%) responded; this response rate compares well with the 77% response to the postal questionnaire that Caplan sent to consultants. We applied a wider range of questionnaires2 but report here our results with the general health questionnaire-28, in a manner comparable to Caplan's.

    Of the 374 respondents whose responses to the general health questionnaire could be scored for caseness (for possible clinically important psychiatric distress), 80 (21%) scored higher than 5; the mean (SD) score was 3.0 (4.6). Eighteen consultants (5%) had suicidal thoughts as derived from the severe depression section of the questionnaire. Our results show a prevalence of caseness roughly half that shown by Caplan. This difference could be partly explained by selection bias in Caplan's study since 17% of his respondents had effectively self selected themselves by accepting an invitation to attend a presentation by him on stress in the workplace. Our study was limited to consultants but permitted further analysis by specialty groups. The table shows differences in caseness and in the scores on the general health questionnaire (expressed as medians because of the skewed distribution) as well as the prevalence of suicidal thoughts. As in Caplan's categorisation for the same variables, the difference among the groups was not significant, although the highest rates seemed to be among anaesthetists.

    As well as measuring outcomes we used qualitative and quantitative methods to derive a specialist doctors stress inventory to measure self reported stressors specific to health service consultants (R M Agius et al, unpublished findings). The score on this inventory showed highly significant correlations (P<0.0005) with scores on the general health questionnaire (rs=0.26), and with suicidal thoughts (rs=0.18). Only part of the variance in psychological distress, however, was accounted for by work stressors, and underlying personality probably plays an important part.2 Further study is needed to elucidate the complex transaction between stress in the workplace, underlying personality, and adverse outcome in consultant doctors.

    Score on general health questionnaire-28 and prevalence of suicidal thoughts by specialty

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