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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 20
| Issue : 1 | Page : 22-26 |
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A study to compare the correlation of perceived stress and insomnia between health professionals and other employees in a government medical college of Eastern India
Anjan Mukherjee, Arunima Chaudhuri, Shibaditya Chakraborty, Debasis Adhya
Department of Physiology, Burdwan Medical College, Burdwan, West Bengal, India
| Date of Submission | 20-Oct-2021 |
| Date of Decision | 01-Dec-2021 |
| Date of Acceptance | 16-Dec-2021 |
| Date of Web Publication | 04-Feb-2022 |
Correspondence Address:
Dr. Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_88_21
Background: Perception of higher stress may lead to insomnia which can adversely affect the mental and physical well-being of health professionals and patient care. The aim of the study was to compare the correlation of perceived stress and insomnia among health professionals and other employees in a Government Medical College of Eastern India. Materials and Methods: This online survey was conducted using two Google forms in a span of 18 months. In the first section of the document, the relevance was explained, and informed consent was taken. In the second part of the form, participants were asked to fill up demographic details and relevant history. In the third part of the form, participants had to fill up the following four scales: Perceived Stress Scale (PSS) of Sheldon Cohen, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Job Satisfaction Scale (JSS). Results: Participants were divided into two groups: Group A: Health Professionals and Group B: Other Employees. JSS scores were significantly higher among Group A (38.29 ± 6.34) as compared to Group B (35.47 ± 6.98) with a P = 0.0008**. Participants having higher JSS scores also had higher PSS scores (Group A with an r = 0.12; Group B with an r = 0.007). ISI scores were significantly higher in Group A (10.53 ± 3.43) as compared to Group B (6.21 ± 2.77) with a P < 0.001**. Participants having higher PSS scores also had higher scores for ISI (Group A with an r = 0.167 and Group B with an r = 0.333). PSQI scores were significantly higher among Group A (11.52 ± 2.05) as compared to Group B (6.37 ± 2.69) with a P < 0.0001**. PSS scores also positively correlated to PSQI scores (Group A, r = 0.963 and Group B r = 0.959). Participants having higher PSS scores also had higher scores for PSQI (Group A with an r = 0.963 and Group B with an r = 0.959). Conclusions: Perceived stress scores positively correlated to both severities of insomnia and poor quality of sleep among study participants. This suggests that higher perceived stress levels may be a significant contributor to insomnia and poor sleep quality among health professions as they are constantly exposed to higher professional stress in the present health-care system.
Keywords: Health professionals, insomnia, job satisfaction, perceived stress
How to cite this article:
Mukherjee A, Chaudhuri A, Chakraborty S, Adhya D. A study to compare the correlation of perceived stress and insomnia between health professionals and other employees in a government medical college of Eastern India. Curr Med Issues 2022;20:22-6 |
How to cite this URL:
Mukherjee A, Chaudhuri A, Chakraborty S, Adhya D. A study to compare the correlation of perceived stress and insomnia between health professionals and other employees in a government medical college of Eastern India. Curr Med Issues [serial online] 2022 [cited 2023 Jun 7];20:22-6. Available from: https://www.cmijournal.org/text.asp?2022/20/1/22/337312 |
| Introduction | |  |
Health professionals have been found to perceive higher stress as compared to other professionals in different studies.[1] Perception of higher stress may lead to insomnia which can adversely affect the mental and physical well-being of health professionals and patient care in the long run.[2],[3]
The mental health necessities of health-care professionals have been gaining attention as a major public health concern in recent times as these may impose a threat to the quality of the health-care delivery system. Health professionals are constantly exposed to multiple stressors in workplaces. These stressful events may have a negative impact and influence their well-being.[4],[5],[6] The World Health Organization in 2016 had estimated that there would likely be a shortfall of 18 million health professionals by the year 2030, in low and lower-middle-income countries.[7]
Several previous studies have looked into the link between stress and job satisfaction and these two topics are of major concern in human resource management research. Stress may directly impact employees' health and consequently result in a negative influence on work performance.[8],[9] Bytyqi et al. in a study observed that that job satisfaction and commitment to work may not lower the level of work-related stress.[10] Eustress is the positive psychological response to a stressor, and studies have suggested that eustress may help a person stay motivated and achieve goals without any psychological burnout.[11],[12] Correlation of job satisfaction and perceived stress varies among different workplaces as has been found in previous studies and thus needs further research.[8],[9],[10],[11],[12]
Stress is a major contributor to sleep disturbances, one of the most important concerns in public health in recent times. This disorder has a negative impact on the quality of life across the globe.[13],[14],[15] Lack of sleep has significant negative effects on one's personal life and results in the reduction of work performance. Sleep disturbances are associated with a variety of physical and mental health complications.[13],[14],[15],[16] Doctors and nurses have shift duties and must constantly remain alert to provide quality health-care services. Hence, circadian rhythm often gets altered among them and results in sleep disturbances. Studies have reported that lack of sleep can lead to reduced work performance. Errors in judgment due to fatigue may lead to a patient's death. These conditions lead to a vicious cycle and increase job burnout which adversely affects the efficiency of health-care professionals in critical situations.[13],[14],[15],[16]
Government Medical Colleges across Eastern India cater to a huge patient load with many a time inadequate infrastructure and manpower and health professionals must take the extra burden to provide quality services to patients. Under these prevailing circumstances, health professionals must take an extra load of shift work and irregular working hours. With many doctors and nurses doing shift duties, it is important to study the consequences of shift work. Several previous studies have demonstrated the negative effects of shift work on both the physical and mental health of health professionals.[1],[2],[3],[13],[14],[15],[16] This study was conducted to compare the correlation of perceived stress and insomnia among health professionals and other employees in a Government Medical College of Eastern India. This online survey may help to identify the prevalence of stress-related sleep problems among the study population so that remedial measures can be implemented for the well-being of health professionals and thus improve the quality of patient care in future.
| Materials and Methods | | |
Study design, setting, and study participants
The present cross-sectional observational study was conducted in a Government Medical College of Eastern India over 18 months. Institutional ethical clearance (Memo No: BMC/Ethics/033 Dated: 28/1/2020) and informed consent were taken before the conduction of the study.
Inclusion criteria
Doctors, Nursing Staff, and other hospital employees (office staff) have an educational level of minimum graduation.
Exclusion criteria
Subjects with a history of drug abuse for last or history of consumption of any psychiatric medication or alcohol for the past 6 months were not included. Subjects under regular yoga or relaxation exercise were excluded as their stress levels may be influenced by these stress management programs may alter stress levels. Subjects with recent bereavement in the family (3 months) were not included to avoid the effect of posttraumatic stress as a confounding variable.
Sample size calculation
Four hundred and six physicians and nursing personals were working in the Medical Institution during the study period. An online sample size calculator was available at calculator. Net (Confidence level 95%, Confidence interval [CI] 5%) was used for calculating the sample size. The estimated sample size was 198 (Group A). One hundred and thirty other employees were working in the Medical College. The calculated sample size was 98 (Group B).
Data collection
This online survey was conducted using two Google forms (one for Group A and the other for Group B). The forms were shared with participants using their e-mail addresses and WhatsApp numbers, collected from the official records. In the first section of the document, the relevance of the present study was explained. Informed consent was obtained from the participants. There were no direct identifiers in the form, and participants were assured that information provided by them will be kept strictly confidential.
In the second part of the form, participants were asked to fill up demographic details and relevant history. All particulars to be filled up were meticulously addressed. In the third part of the form, participants had to fill up the following four scales: Perceived Stress Scale (PSS) of Sheldon Cohen, “Pittsburgh Sleep Quality Index (PSQI),” “Insomnia Severity Index (ISI),” and “Job Satisfaction Scale (JSS).”
Older individuals are more susceptible to insomnia as compared to younger counterparts, and females are more affected by stressors as compared to males. Hence, the subject of the two groups was age and gender matched. Two scales to measure insomnia were used to increase the validity and reliability of this online survey.
Perceived stress scale by Sheldon Cohen
PSS is the most used scale to measure perceived stress scores. The range of the total score varies between 0 and 40.[17]
Insomnia severity index
The ISI consists of seven questions concerning sleep. The total score ranges between 0 and 28. Higher ISI scores indicate higher chances of insomnia and more severe insomnia.[18],[19]
Pittsburgh sleep quality index
The PSQI consists of 19 items required to evaluate sleep quality. Subjects having scored more than 5 are considered as having poor sleep quality.[18],[19]
Job satisfaction scale
Th JSS correlates different factors related to the workplace environment. There are ten components. JSS scores: 42–50: very high job satisfaction; 39–41: high job satisfaction; 32–38: average job satisfaction; 27–31: low job satisfaction; and 10–26: very low job satisfaction.[20],[21]
Statistical analysis
The computer software “Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, Illinois, USA SPSS Inc.)” was used for the analysis of the data. P < 0.05: significant*; Unpaired t-test was used, and the correlation coefficient was calculated.
| Results | | |
One hundred and ninety doctors, ten nursing personnel, and hundred other employees of a medical college in Eastern India participated in the present study. Participants were divided into the following groups: Group A: Health professionals and Group B: Other employees. There were 190 doctors (92.5% male doctor and 2.5% female doctor), 10 nurses (5%), and 100 other employees (85 males and 15 females) in the present study. In Group A, 158 participants were between 30 and 40 years, 33 participants between 41 and 50 years, and only 9 between 51 and 60 years, whereas in Group B, 78 participants were between 30 and 40 years, 12 participants between 41 and 50 years, and 10 participants between 51 and 60-year age group.
Comparison of PSS between Group A and Group B demonstrated no significant difference (Group A: 19.65 ± 3.78 vs. Group B: 18.76 ± 4.86; P = 0.112). JSS scores were significantly higher among Group A (38.29 ± 6.34) as compared to Group B (35.47 ± 6.98) with a P = 0.0008** [Table 1]. Participants having higher JSS scores also had higher PSS scores (Group A with an r = 0.12 and Group B with an r = 0.007). Hence, the positive correlation was higher between JSS and PSS in Group A. ISI scores were significantly higher in Group A (10.53 ± 3.43) as compared to Group B (6.21 ± 2.77) with a P < 0.001** [Table 1]. Participants having higher PSS scores also had higher scores for ISI (Group A with an r = 0.167 and Group B with an r = 0.333). Hence, the positive correlation was higher between PSS and ISI in Group A [Figure 1] and [Figure 2]. PSQI scores were significantly higher among Group A (11.52 ± 2.05) as compared to Group B (6.37 ± 2.69) with a P < 0.0001** [Table 1] and [Figure 2]. Participants having higher PSS scores also had higher scores for PSQI (Group A: r = 0.963 and Group B r = –0.959, respectively) [Figure 3] and [Figure 4]. | Table 1: Comparison of Perceived Stress Scale, Job Satisfaction Scale, insomnia severity index, and Pittsburgh sleep quality index scores of Group A and Group B
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 | Figure 1: Correlation between Perceived Stress Scale scores and Insomnia Severity Index scores among Group A Participants.
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 | Figure 2: Correlation between Perceived Stress Scale scores and Insomnia Severity Index scores among Group B Participants.
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 | Figure 3: Correlation between Perceived Stress Scale scores and Pittsburgh Sleep Quality Index scores among Group A Participants.
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 | Figure 4: Correlation between Perceived Stress Scale scores and Pittsburgh Sleep Quality Index scores among Group B Participants.
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| Discussion | | |
The goal of the present study was to observe the correlation between perceived stress and insomnia among health-care professionals. JSS, PSQI, and ISI scores were higher among Group A as compared to Group B. A positive correlation was observed between PSS and ISI as well as PSQI scores. Health professionals had higher job satisfaction as compared to other employees, but insomnia severity was higher among health professionals and quality of sleep was also poor as compared to the other groups. Increased job satisfaction was also associated with higher job responsibilities in the workplace, and this also significantly increased perceived stress levels.
Only ten nursing personnel participated in the present study as many had a problem using this online form, and they were not technology friendly. However, due to the ongoing pandemic, we could not conduct the survey offline.
Previous studies showed higher levels of stress among health professionals as compared to other counterparts,[1],[2],[3] but the perceived stress levels of both groups were comparable in the present study. The PSS levels in both groups were well above average. We had to conduct this survey during the pandemic, which may be a significant contributor to the increase in the stress levels among Group B participants. Chatterjee et al. conducted a study during the present pandemic on 140 health-care workers to see the effects of perceived stress and insomnia.[19] Doctors had the highest levels of anxiety. PSS levels of doctors and nurses were 19.8 ± 4.5 and 18.6 ± 4.3, respectively. Female participants and younger employees perceived more stress as compared to the other counterpart in the study.[19] These PSS levels are similar to the scores of health professionals of the present study. Our study groups were age and sex matched, so we did not observe this difference.
Job satisfaction scores were more in health professionals, but these scores positively correlated with perceived stress levels. Some previous studies demonstrated a varied correlation between job satisfaction and perceived stress.[8],[9],[10],[11],[12] Participants who had higher job responsibilities had higher job satisfaction in the present study, but to meet the challenges of these commitments in their job during the present pandemic, they had to face multiple challenges which may have increased their perceived stress levels.
ISI as well as PSQI scores were significantly higher among health professionals as compared to the other groups and positively correlated with PSS scores. Thirteen studies were included in a review conducted by Pappa et al. on a combined pool of 33,062 health-care workers.[22] Insomnia prevalence was 38·9% (across 5 studies). The review suggested that a majority of health-care workers experienced mood and sleep disturbances during the present pandemic, increasing mental health risks.[22] We also observed increased levels of ISI and PSQI scores among health-care professionals in the present study.
Health professionals are more exposed to irregular shift duties, and this may lead to disturbances in circadian rhythm. Sleep and rest are two important factors essential for good health. Shift work and short leisure time between shifts may hurt health profile and cause several psychosocial and behavioral abnormalities.[23],[24],[25] Previous studies suggested that inadequate leisure time between the shifts may cause insufficient sleep among the health-care workers.[26],[27] Sleep deprivation among these workers results in reduced work performance. These factors increase the risk of errors while providing patient care and may result in accidents during patient management.[26],[27]
A cross-sectional study was done by Abdulah and Musa with 268 physician participants. The physicians were asked to assess the perceived stress made on them during the COVID-19 outbreak and rate from 0 (no stress) to 10 (highest intense perceived stress). The mean sleep score and stress of physicians were 8.43 and 4.20, respectively. More than two-thirds of the physicians were sleepless (68.3%), and the majority had stress (93.7%). The insomnia of physicians was escalated with increasing stress (r = 0.558; P < 0.001).[28]
A systematic review and meta-analysis were conducted by Salari et al. to study the prevalence of sleep disturbances among physicians and nurses facing the COVID-19 patients.[29] Six studies with of 3745 nurses were examined, and the prevalence of sleep disturbance was found to be 34.8% (95% CI: 24.8%–46.4%). The prevalence of sleep disturbances in physicians was also measured in five studies with a total sample size of 2123. The prevalence of sleep disturbances in physicians caring for COVID-19 patients was reported to be 41.6% (95% CI: 27.7%–57%).[29]
| Conclusions | | |
Health professionals had higher job satisfaction as compared to other employees, but insomnia severity was higher among health professionals and quality of sleep was also poor as compared to the other group. Increased job satisfaction was also associated with higher job responsibilities in the workplace, and this also significantly increased perceived stress levels. Perceived stress scores were positively correlated to both severities of insomnia and also to poor quality of sleep among all study participants.
Acknowledgments
We would like to thank all participants of the study.
Research quality and ethics statement
All authors of this manuscript declare that this scientific study complies with standard reporting guidelines set forth by the EQUATOR Network. The authors ratify that this study required Institutional Review Board/Ethics Committee review, and hence prior approval was obtained, IRB Min. No. BMC/Ethics/033 Dated: 28/1/2020). We also declare that we did not plagiarize the contents of this manuscript and have performed a Plagiarism Check.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1]
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