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Código ISSN 2588-0551
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Bravo-Paredes L., Paredes-
Lascano P., Santana C., et al.
Mental health in resident and
postgraduate doctors during
the COVID-19 Pandemic at
the Ambato General Hospital
General Ambato. INSPILIP.
2023; Vol. 7, Num. 22.
Scientic magazine INSPILIP.
Volume 7, Number 22, May -
August 2023.
The author declares to be free of any
personal or commercial association
that may involve a conict of interest
in connection with the article, as
well as having respected the ethical
principles of research, such as having
requested authorizations from the
institution where the study was
conducted, permission to use the data,
informed consents and in the case of
observational studies and clinical
trials, authorization from a CEISH,
ARCSA, Environment, among
others, according to the category. In
addition, the license to publish images
of the person or persons appearing in
the manuscript. Therefore, INSPILIP
is not responsible for any aectation
to third parties, neither INSPI as
publishing entity, nor the Editor, the
responsibility of the publication is of
absolute responsibility of the authors.
Patricio Vega Luzuriaga
EDITOR-IN-CHIEF
iD
Paredes Lascano Patricia
a
, * patypediatra68@gmail.com
iD
Bravo Paredes Alejandro
c
, el_alejobravo@hotmail.com
iD
Santana Barreno Carmen
b
, carmitasb23@gmail.com
iD
Chicaiza López Mónica
b
, mony872004@hotmail.com
iD
Aguayo Escobar Andrea
d
, andrea.aguayoe@gmail.com
a. Specialist in Pediatrics and Neonatology, Hospital General Ambato, Ambato, Ecuador.
b. Postgraduate Physician in Family and Community Medicine, Technical University of Ambato,
Ambato, Ecuador.
c. General Practitioner, Comprehensive Pediatric Center, Ambato, Ecuador.
d. General Practitioner in Hospital Functions, Hospital General Ambato, Ambato, Ecuador.
*Correspondence: Patricia Lorena Paredes Lascano Email: patypediatra68@gmail.com
Identication of authors' responsibility and contribution: Authors declare to have
contributed original idea (PP), methodological part (systematic review) (PP, CS, MC), draft
writing (CS, MC, AB, AA) and article writing (PP, AB, AA)
Date of Entry: 06/05/2022
Date of Aproval: 05/05/2023
Date of Publication: 05/05/2023
Mental health in resident and postgraduate doctors during the COVID-19 Pandemic at the
Ambato General Hospital
Salud mental en los médicos residentes asistenciales y de posgrado durante la pandemia COVID–19 en el Hospital General
Ambato
Original Article
Open Access
Abstract
Citation
Introduction: In the formative stage of physicians in Ecuador, the work
as a resident physician is essential within the acquisition of skills and
competencies, through medical care and teaching in hospitals; however, daily
work in emergency conditions or other situations can lead to professional
exhaustion associated with physical and mental fatigue. Objective: To assess
the mental health status of 113 resident and postgraduate doctors working
during the COVID-19 pandemic at the Ambato General Hospital, during the
period of May – July 2020. Material and methods: Descriptive research,
cross-sectional, quantitative research using a survey and the Maslach
Burnout Inventory (MBI) questionnaire, applied to professionals who met the
inclusion and exclusion criteria. Results: The studied population ranged from
25 to 44 years old and had a mean age of 30 years, a 56% belonging to the
female sex. The most aected in the mental health spheres were behavioral
and physical. Burnout syndrome was detected in 25% of resident physicians,
with a predominance in 14% of the male sex, with the highest aectation of
the high emotional exhaustion subscale (71%). Conclusions: It is concluded
that the ndings could be associated with the current health condition due
to the SARS-COV2 health emergency, in addition to corresponding to
situations that are not attended to in a timely manner, so it is recommended
that personalized interventions be carried out through coordination between
Occupational Medicine, Psychology Service and Psychiatry of the hospital.
Keywords: Burnout, Lifestyle, Pandemic, Residents, Mental health.
DOI: 10.31790/inspilip.v7i22.535
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Resumen
Introducción: En la etapa formativa de los
médicos en Ecuador, el trabajo como médico
residente es primordial dentro de la adquisición
de habilidades ycompetencias, mediante el
trabajo asistencial y docente en los hospitales; sin
embargo, el trabajo cotidiano en condiciones de
emergencia u otras situaciones,puede dar lugar
a un desgaste profesional asocia do al cansancio
físico y mental. Objetivo. El objetivo de esta
investigación es cualicar el estado de salud
mental de 113 médicos residentes asistenciales
y de posgrado que laboran durante la pandemia
COVID -19 en el Hospital General Ambato,
durante el período mayo – julio 2020; para lo
que se empleó una investigación descriptiva,
transversal, cuantitativa, en el cual se utilizó
una encuesta y el cuestionario Maslach Burnout
Inventory (MBI), aplicados a los profesionales que
cumplieron los criterios de inclusión y exclusión.
Los resultados evidencian: edad con un rango de
25 a 44 años y una media de 30 años de edad,
de los cuales corresponden al sexo femenino en
el 56 %. La mayor afectación dentro las esferas
de salud mental fueron la conductual como son:
el aislamiento, dicultad para el autocuidado y el
descanso, y en cuanto a la física: predominaron
cefaleas. molestias gastrointestinales y las
contracturas musculares. El síndrome de Burnout
fue detectado en el 25 % de médicos residentes, de
predominio en el sexo masculino en el 14 %, con
mayor afectación en la subescala de cansancio
emocional (71 %). Este estudio concluyó en que los
hallazgos podrían estar asociados a la condición
desalud actual por la emergencia sanitaria
del SARS-CoV-2, además que corresponden a
situaciones que no son atendidas oportunamente,
por lo que se recomienda se realicen intervenciones
personalizadas con acciones coordinadas entre
Medicina Ocupacional, Servicio de Psicología y
Psiquiatría del hospital.
Palabras clave: Burnout, Estilo de vida, Pandemia,
Residentes, Salud mental.
Introduction
Burnout is a disorder that undoubtedly aects the
mental health of resident physicians (RP), and has
a direct impact on the quality of patient care and
the doctor's quality of life (1). Mental health is
dened as a broad term that implies social aspects,
which inuence the well-being of the population,
and for its maintenance it includes actions aimed
at prevention, promotion, care and treatment,
complementing by indicating that mental health
encompasses four spheres: emotional, cognitive,
behavioral and physical, which can be altered
by the increase in the workload. the constant
pressures of time, the endless bureaucratic tasks
that culminate in a progressive loss of enthusiasm
at work (2).
Medical residency is an immensely stressful
period with long working hours and demanding
work schedules, with interference in professionals'
work and home. Several stressors predispose
residents to burnout, including lack of sleep,
conicts with co-workers, diculty adjusting to
a new environment, patient demands, and lack
of control over time management. In addition,
people who are inherently neurotic or introverted
are at higher risk, which would contribute to the
onset of burnout. (1)
"Burnout" was rst described in 1974 by
psychologist Herbert Freudenberger. It is dened
as a condition of physical and mental exhaustion
related to caregiving activities and arises as
a result of chronic exposure to interpersonal
stressors at work. (2)The World Health
Organization (WHO) in the tenth revision of its
International Classication of Diseases, described
it as "a state of vital exhaustion" (3) which has
three main dimensions: emotional exhaustion,
depersonalization, and feelings of ineectiveness
and inadequate personal achievement (4).
The Maslach Burnout Inventory (MBI) is
considered the gold standard for measuring
healthcare provider burnout (5), is the tool used
to assess burnout and comprises 22 items divided
into three subscales: the emotional exhaustion
subscale (9 questions): assesses burnout at work
and feeling on edge; The Depersonalization
subscale (5 questions) assesses lack of empathy
and impersonal responses, and the Personal
Achievement subscale (8 questions) assesses
the sense of accomplishment of success and
competence at work.
Each item is rated on a Likert scale from 0 to 6 (0
= never, 1 = few times a year, 2 = once a month,
3 = few times a month, 4 = once a week, 5 = few
times a week, 6 = daily) and consist of questions
such as "I feel like I'm working too hard at my
job," "I feel emotionally drained by my job" and
"Working with people all day is really a strain
for me." The total cut-o scores for emotional
exhaustion are greater than or equal to 27, for
depersonalization greater than 9, and less than or
equal to 33 for poor personal performance. (3)
Burnout among healthcare professionals has
received signicant attention in recent years.
Given the intense emotional demands of the
work environment, clinicians are particularly
susceptible to developing burnout beyond the
usual work stress. RP training, in particular,
DOI: 10.31790/inspilip.v7i22.535
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can cause a signicant degree of burnout,
which interferes with the ability to build good
relationships with colleagues and patients, resolve
diagnostic dilemmas, and make complex treatment
decisions.(3)
Overall, burnout is associated with a variety of
negative consequences including depression, risk
of medical errors, and negative eects on patient
safety (3), this increases in emergency situations
such as the current pandemic of COVID-19,
where Healthcare workers are at signicant risk
of adverse mental health outcomes. Reasons for
this include long working hours, perceived risk
of infection, shortage of protective equipment,
loneliness, physical fatigue, and separation from
families (6).
This research aims to evaluate the mental health
of RPs in a general hospital during the Covid-19
pandemic, as well as to analyze changes in
lifestyles at a personal, family and work level,
since being a current issue, it will allow us to
have our own information that supports actions of
prevention and promotion of mental health. As a
means to guarantee the right to health and timely
and comprehensive care of medical personnel at
the institutional level.
Methodology
A cross-sectional descriptive study was carried out
between May – July 2020. The study population is
made up of 113 RPs from Ambato General Hospital,
of which ninety-four are healthcare RPs and 19 are
RPs from the postgraduate specialization in Family
and Community Medicine. Included in the study
were RPs regardless of working time and type of
contract and who voluntarily agreed to participate,
signing the informed consent submitted by the
researchers, with the prior approval of the Hospital
authorities.
Two instruments were applied: a) a structured
survey that collected informative data from the
participants, their comorbidities, work area,
history of contagion, and the impact on quality
of life associated with the physical, mental,
behavioral, and cognitive spheres associated
with the COVID-19 pandemic. B), the MBI
questionnaire that independently assesses the
emotional exhaustion subscale (low: 0-18,
medium 19-27, high 28-54); The depersonalization
subscale (low: 0-5, medium 6 -9, High 10 - 30) and
the Personal Achievement Subscale (low 0 - 33,
Mid 34 - 39 High 40 - 56), burnout syndrome was
dened as participants who met 3 criteria: high
depersonalization, high emotional exhaustion, and
low personal achievement (3).
The application of the instruments was conducted
in a reserved space in each of the hospital's services,
each professional answered the survey and the
MBI questionnaire independently, if there were
any doubts they were claried by the researchers.
From the ethical point of view, the condentiality
and privacy of the participants was guaranteed
through the assignment of an alphanumeric code
to the instruments applied in the research, access to
the information was not allowed to people outside
the research, each participant in the exercise of his
or her autonomy freely and voluntarily decided to
sign the informed consent form and respond to the
research instruments.
Once the information was collected, it was
processed using the Excel program, the results are
presented through graphs and tables, as well as
descriptive and inferential statistics.
Results
Demographic and clinical characteristics
The study population consisted of 113 physicians,
whose age range was 25 to 44 years with a mean
age of 30 years; Of those, 56% were women, 60%
were single; Regarding the place of residence,
64% (72) live in the city of Ambato, although 36%
of the doctors live in nearby provinces.
On the other hand, 67% (65) live with family
members who belong to priority groups (children
under 5 years of age, chronically ill, older adults,
and people with disabilities). 21% reported a
history of various diseases, establishing that
migraine and thyroid conditions are the most
prevalent (Table 1); It should be noted that there
are two people with depressive anxiety disorder
prior to the pandemic, who are at greater risk of
suering from work burnout (1).
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Table 1: Morbidity in RP. Ambato
General Hospital. May - July 2020
Source and elaboration: Authors
Exposure to SARS-COV2:
So far in the pandemic, 17 doctors (15%) have
been diagnosed with COVID-19; Of these, ten
had mild symptoms and seven had moderate
symptoms. None required inpatient treatment.
30% (34 people) reported having a family member
with a positive diagnosis, and 11% (12 people)
have lost a family member to COVID-19.
Working time
The working hours of the RPs under investigation
are diverse: they work in shifts that last between 12
and 36 hours (Figure 1). Intervals between shifts
range from two to six days; with a predominance
every fth day in 69%, while the longest intervals
were observed in the RPs of the Intensive Care
Unit, although these professionals work long days
of 36 hours. Additionally, 81% of resident doctors
state that the workload has increased during this
health emergency.
Lifestyle
The main change in their lifestyle was isolation
from the family for fear of contagion, which
occurred in 69% of the participants; isolation from
friends exists 56%; loss of contact occurs in 33%,
sports and recreation habits have disappeared in
16% of RPs. Two out of every three RPs stated that
their nancial situation has been greatly aected by
the pandemic, due to additional expenses such as
rent, food, mobilization, and purchase of personal
protective equipment to fulll their work, while
7% (8) have become their families' only income.
COVID 19 pandemic and work environment
65% have received training on the use of personal
protective equipment, while 61% have been
trained in caring for COVID patients in each of
their areas. It was observed that more than seven
out of ten RPs indicated that they have little
condence in the management of the authorities,
arguing that they carry out a management that
does not respond to the needs of hospital sta
in terms of the provision of personal protective
equipment and clothing, they consider that there
is an inadequate distribution of resources and
hospital sta.
Only one in four RPs have received psychological
support during the pandemic. In addition, three
out of ten RPs perceive attitudes of social and
psychological discrimination on the part of
patients, relatives, neighbors, among others, both
inside and outside the institution.
Mental health
Emotional and Behavioral Sphere
The survey established that, in the emotional
sphere, the most frequent manifestations were
anxiety (27%), fear (23%) and sadness (13%),
with non-signicant dierences between men
and women (Table 2). Changes in the cognitive
sphere, where the most frequent are diculty
concentrating (33%), presence of nightmares
(23%), memory diculty and confusion (12%).
No signicant dierences were found according
to sex of RPs.
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Behavioral and Physical Sphere
The most frequent behavioral changes among hospital RPs are isolation present in 58% of RPs; diculty in self-
care and rest was present in 21%, avoiding conict situations (14%), while in the physical sphere, headaches
(38%), gastrointestinal discomfort (24%) and muscle contractures (20%) predominated (Table 3).
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Once the levels according to the risk in each
subscale have been established, burnout is
determined in 25% of RP, which is prevalent in
men in 14%, with a 51% risk of developing it in
women (Table 5).
Discussion
The demographic and clinical data show that the
research was carried out with a group of young
doctors who are doing their residency at the
hospital, without signicant dierences in gender,
some of the RPs presented comorbidities being
respiratory conditions and thyroid diseases the
most frequent, in the family environment 65% of
them live with vulnerable people, who may be at
risk for severe illness from COVID-19 (7)What the
prevalence of underlying diseases, They increase
the risk of complications.
Contagion during the emergency represents 15%
of RPs have been diagnosed with COVID-19
positive. Frontline healthcare workers face a
substantially increased risk of infection and death
due to excessive exposure to COVID-19 and
potentially spreading to others, contributing to the
pressures and concerns of healthcare
professionals(8) (9).
In this research, it can also be observed that
there is discrimination against health personnel
in the personal, family and social spheres of
psychological predominance, Bedoya (2020) in
his research describes an increase in discrimination
and physical, verbal and psychological aggressions
against health personnel with the COVID-19
pandemic, this reaction on the part of some people
points to beliefs and irrationality to face them,
since medical personnel symbolically represent
the disease itself and the cure (10).
There is a broad consensus that the COVID-19
pandemic aects not only physical health, but
also mental health, this has upset doctors' sense
of order and control. Such disruption can lead
to substantial short-term stress and an increased
risk of long-term burnout (11), all this due to the
increase in patient demand in hospitals that is
challenging the agenda of health professionals
with an increase in their workload (12), This
coincides with the results of this study where 81%
of RP report that their workload is greater, because
in the process of containing the pandemic, this
institution became a sentinel hospital, which led
to a readjustment of work for all sta, without RPs
being the exception.
In this research, mental health is analyzed from
four spheres, nding aectation in order of
frequency: in the behavioral scale, isolation
in 58%; on the physical scale, the presence of
headache in 38%; On the cognitive scale, there
Results of the Maslach Burnout Inventory (MBI) Questionnaire
It is established that 71% of the RPs present Emotional Fatigue at a high level, work depersonalization at a high
level in 55%, with respect to personal fulllment a medium level is determined with 45%, more frequently in
men. (Table 4).
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is diculty concentrating in 33% and on the
emotional scale the presence of anxiety in 27%,
so it is imperative to analyze the eects on the
mental spheres faced by health personnel (13),
these mental health problems not only aect the
quality of care, but also their capacity for clinical
understanding or their decision-making skills,
therefore, it is very important to protect the mental
health of health personnel for the proper control of
the pandemic (14).
On the other hand, the doctors received some
form of psychological support and even group
intervention (15), psychological rst aid is also a
crucial early intervention that targets the mental
health of frontline sta by providing psychosocial
support during outbreaks such as COVID-19 and
is a tool designed to mitigate acute distress and
assess the need for ongoing mental health care
through a compassionate and caring presence (16).
In the present research, psychological support is
limited as only 1 in 4 doctors have received such
care, which may be due to the fact that doctors not
only have diculty sharing their concerns about
mental health with their colleagues, but are also
often reluctant to seek psychological help (17),
this clearly demonstrates that there is no culture
of mental health care whose reasons need to
be thoroughly investigated in the future, as the
problem needs to be addressed in greater depth.
Much more so when it comes to the mental health
of the resident medical sta, who in turn have
a trust of only 26% in the hospital authorities,
because they are dedicated only to oce work, do
not provide the necessary equipment, there is poor
management of resources and personnel, protective
implements and the treatment of patients in each of
the services.
From this perspective, one of the most severe
conditions is the identication of burnout
syndrome, which was established in 25% and
the risk of suering from it is found in 51%
of the hospital's RPs, with aectation of the
subscale of high emotional fatigue 71%, high
work depersonalization 55% and low personal
fulllment 34%. compared to a study conducted
by (18) In the same hospital, the risk of burnout
syndrome was identied, with aectation of the
subscale of high emotional exhaustion 14%, high
depersonalization 4% and low personal fulllment
in 2%, which diers abysmally the results in times
of pandemic, it was also compared with other
studies such as that of (19) where showed high
scores of Emotional Exhaustion high levels of
depersonalization, while only about 15% reported
low levels of personal fulllment.
The high gures detected in this study may be
related to the extension of working days that
reach up to 36 hours and the fact of attending
daily to people suspected or conrmed of COVID
19 infection, the fear of bringing the infection
to their homes, in addition to having to change
their professional and family activities due to the
presence of the pandemic.
In this way, the alterations found in the research
may be the result not only of a workload, but also
of the lack of adequate plans for psychosocial
interventions, this psychological support based on
multidisciplinary teams, where general measures
are taken with shorter working hours, regular rest
periods and rotating shifts for those who work in
high-risk areas (20).
It should be noted that at the time of the
investigation 19.6 million people infected with
coronavirus around the world, according to data
from the Johns Hopkins University, while the
death toll has surpassed the 727,000 deaths (21),
at the level of Ecuador since March 5, when the
rst case of Coronavirus was detected in Machala,
94,701 infections and 9471 deaths have been
registered, data updated until August 10, 2020
(22).
Conclusions
The mental health of RPs was aected in all four
spheres, with isolation predominating on the
behavioral scale, headaches on the physical scale,
diculty concentrating on the cognitive scale,
and anxiety on the emotional scale, so an aected
professional cannot provide a quality service
and is more likely to make errors in diagnosis or
treatment.
Burnout syndrome in the studied population occurs
in almost 4 out of 10 RP, with greater aectation
in the emotional fatigue subscale, predominant
in men, in addition to the risk of suering from
this syndrome in more than half of the cases, with
prevalence in women, which may be related to
workload or overwork. lack of sleep, excessive
rotations or shifts and the health emergency that
the world and the country are going through,
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which act directly to trigger professional burnout.
Likewise, we intend that from this diagnosis
of the situation, intervention strategies can be
generated that allow treating, eradicating and
preventing this syndrome, with these results being
the starting point to propose new research such as
the response to treatment and the follow-up of the
cases detected.
In addition, taking into consideration that the
RPs have worked on the front line during the
pandemic, and the provisions of the Organic Law
on Humanitarian Support to combat the Health
Crisis derived from Covid-19, which indicates
that the denitive appointment will be granted to
health workers and professionals who have worked
during the health emergency, since the hospital's
RPs, not having job stability, generates concern,
which can have an impact on the performance of
their duties.
Source of funding
Work was done with the authors' own resources
Conict of interest
The authors declare that they have no conict of
interest
Thanks
The present research would not have been possible
without the support of the Ambato General
Hospital, which has allowed us to carry out this
work, as well as highlighting the collaboration
of each of the resident doctors, who gave us their
time and predisposition to provide us with the
data that allow us to develop this research with the
sole purpose of contributing positively from the
academy with real data on a current and protable
topic for the public. the medical community.
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Código ISSN 2588-0551
Scientic magazine INSPILIP - Volume 7 - Number 22 - May - August 2023
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