Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors
Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors
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DOI：
10.1016/j.midw.2019.08.008
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发表时间：
2019-12-01
期刊：
影响因子：
2.7
通讯作者：
Henley, Josie
中科院分区：
文献类型：
--
作者：
Hunter, Billie;Fenwick, Jennifer;Henley, Josie
目的：探讨英国助产士的情绪幸福感与其工作环境之间的关系。具体的研究问题是：评估英国助产士的倦怠、抑郁、焦虑和压力水平;比较英国助产士样本中的倦怠、抑郁、焦虑和压力水平，以及澳大利亚、新西兰和瑞典的报告水平;确定与倦怠、抑郁、焦虑和压力水平升高相关的人口统计学和工作相关因素。设计：使用在线调查的横断面研究设计。WHELM调查工具是在澳大利亚产妇背景下开发的，包括一些经过验证的测量：哥本哈根倦怠量表（CBI），抑郁，焦虑和压力量表（DASS-21），以及来自皇家助产士学院（RCM）“为什么助产士离开”研究的项目（Ball等人，环境：联合王国.参加者：2017年，通过RCM向所有正式助产士成员（n = 31，898）分发了一份在线调查。数据分析：使用描述性分析对样本的人口统计学和工作相关特征进行了分析。抑郁，焦虑，压力和倦怠的水平，测量的CBI和DASS分数，使用非参数统计检验进行分析。根据人口统计学和工作特征对各组进行了比较。Mann-Whitney U检验用于两组比较，Kruskal沃利斯检验用于2+组。鉴于大量的分析进行，统计学上显着的比较，确定了一个保守的α水平（p <0.01）。结果：1997年助产士回答了调查，占16%的RCM成员。主要结果表明，英国的助产士队伍正在经历显着的情绪困扰。83%（n = 1464）的被试个人倦怠得分在中度及以上，67%（n = 1167）的被试工作倦怠得分在中度及以上。与客户相关的倦怠率较低，为15.5%（n = 268）。超过三分之一的参与者在压力（36.7%），焦虑（38%）和抑郁（33%）方面处于中度/重度/极端范围。个人和工作相关的倦怠得分，压力，焦虑和抑郁得分远高于其他国家的结果，其中WHELM研究已经进行了日期。如果助产士年龄在40岁及以下;报告有残疾;经验少于10年;在临床助产环境中工作，特别是如果他们在医院和综合医院/社区环境中轮流工作，则更有可能记录高水平的倦怠，抑郁，焦虑和压力。许多英国助产士正在经历高水平的压力，倦怠，焦虑和抑郁，这应该引起行业及其领导者的严重关注。NHS雇用的临床助产士比其他接受调查的人面临更大的情绪困扰风险，这对提供高质量，安全的孕产妇护理具有严重影响。同样令人严重关切的是，较年轻、最近获得资格的助产士的倦怠、压力、焦虑和抑郁得分最高，自我报告有残疾的助产士也是如此。需要向年轻的、最近合格的助产士和残疾助产士提供积极的支持，以帮助维持他们的情绪健康。该行业需要游说系统层面的变化，如何在英国产妇护理的资源和提供。要做到这一点，就需要区域和国家两级一系列相关利益攸关方的支持和承诺。(C)2019爱思唯尔有限公司版权所有。
Objective: The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress.Design: Cross sectional research design using an online survey. The WHELM survey tool was developed within the Australian maternity context and includes a number of validated measures: The Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), as well as items from the Royal College of Midwives (RCM) 'Why Midwives Leave' study (Ball et al., 2002).Setting: United Kingdom.Participants: An on-line survey was distributed via the RCM to all full midwife members in 2017 (n = 31,898).Data analysis: The demographic and work-related characteristics of the sample were analysed using descriptive analyses. Levels of depression, anxiety, stress and burnout, measured by the CBI and DASS scores, were analysed using non-parametric statistical tests. Comparisons were made between groups based on demographic and work characteristics. Mann-Whitney U tests were used for two group comparisons, and Kruskal Wallis tests were used for groups with 2+ groups. Given the large number of analyses undertaken, statistically significant comparisons were identified with a conservative alpha level (p < .01).Findings: A total of 1997 midwives responded to the survey, representing 16% of the RCM membership. The key results indicate that the UK's midwifery workforce is experiencing significant levels of emotional distress. 83% (n = 1464) of participants scored moderate and above for personal burnout and 67% (n = 1167) recorded moderate and above for work-related burnout. Client-related burnout was low at 15.5% (n = 268). Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%), anxiety (38%) and depression (33%). Personal and work-related burnout scores, and stress, anxiety and depression scores were well above results from other countries in which the WHELM study has been conducted to date. Midwives were more likely to record high levels of burnout, depression, anxiety and stress if they were aged 40 and below; reported having a disability; had less than 10 years' experience; worked in a clinical midwifery setting, particularly if they worked in rotation in hospital and in integrated hospital/community settings.Key conclusions and implications for practice: Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability.There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels. (C) 2019 Elsevier Ltd. All rights reserved.