Articles of the month
Stress And Coping Among Homoeo Doctors
Dr.R.KRISHNAKANTH
Introduction:
Stress : In recent years the common man has become familiar with the term ‘stress’. Everyone seems to be talking about stress, yet, remarkably few people define the concept in the same way. The student thinks stress as a problem of examinations, the business persons thinks of stress in profit and loss, the biochemist and endochrinologist as purly chemical event, an athlet as a muscular tension and the doctor as a health problem.

The concept of ‘stress’ was first introduced in life sciences by Hans Seley in 1936. Lazarus and Folkman (1984) define stress as a particular relationship between person and environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being.

For some individuals ‘stress’ refers only to a crisis or calmity, while others percieve the day to day life problems and mild irritants as ‘stress’. Thus the situation causing stress and the experience of stress itself are highly subjective. But increased amount of stress for prolonged period will have deleterious effects on physical and mental health, and especially in doctors( Caplan 1994, Hirak & Suresh 2009), it effects on practicing performance. Prolonged stress in a person leads to lower levels of internal control, more depression, more emotional tension, lower life satisfaction, less vitality and energy, lower self esteem, less fun and playfulness and lower levels of happiness.

COPING : the term ‘coping’ refers broadly the efforts to manage environmental and internal demands and conflicts among demands. ( Lazarus 1966, 1981 ).

Coping may be defined as the use strategies for dealing with actual or anticipated problems and their attendant negative emotions. (Aldwin, 1994 ).

While coping with the stress, the person has to manage the emotions elicited by the stress and on the other hand the person must solve the problem concretely and realistically.


When an individual choose one of the coping types and puts it into operation, it is referred to as ‘coping strategy’. A person who has under his/her disposal more number of coping strategies suitable to different contexts is said to have a flexible style, while the one who choose from limited strategies in his/her repertoire is said to have a rigid style.
Taking a qualitative perspective, coping style is devided into proactive coping and avoidant coping. In proactive coping persons will act carefully, leaving nothing to chance, solve the problem planfully. But in avoidence coping, persons try to avoid the threatening event. Intially it may appears relaxfully, but in long run, it has the disadvantage of achieving their goal very difficult or impossible. (Meena and Radhanath)

Review of literature has shown that the doctors are in high stress (Mosley et al 1994, Anitha menon et al 2007, Siying wu 2007 ). Stress impact not only on doctor’s health, but also their abilities to cope with the job demands. This will seriously impair the provision of quality care and the efficacy of the health service delivery.(Hirak and Suresh, 2009). Many factors make doctors stressful, like work related, as, work overload, nature of working in today’s medical environment (Douglas & Weddington 1997), accident and emergency services (S.Mc Pherson et al 2002), physician’s feeling of responsibility for the welfare of patients (Promecene & Monga 2003), presenting cases, dealing with death and suffering (Firth 1986), night calls for patients (Al Rawaise 1993), patient dissatisfaction with the care received, dealing with incurable patients (Roshan,Rashmi,Raj), and professional identity(Robert, sarah et el 2009). Also daily events and other factors like time and economic pressure, lack of time spent at home( Heins et al1984) also cause stress. Due to stress, doctors are effected physically and psychologically, showing lack of interest in one self, sadness, crying, fear, fatigue(Molgard 1985), low moods, inability to concentrate, loss of temper (Babar 2004). Many coping strategies are practiced like, drinking alcohol, acceptance and carry on (Anitha menon et al 2007), support from spouse, relatives or friends (Paula et al), stress monitoring, action oriented approach, positive perspective ( Douglas & Weddington 1997), and other engagement strategies (Mosley et al 1994).

Objective :
  1. To assess the influece of gender, age, and work place on stress of homoeo doctors.
  2. To examine the impact of gender, age and work place on coping strategies of homoeo doctors.
Hypotheses :
The fallowing six hypotheses were formulated.
  1. Gender would significantly influence the experience of stress among homoeo doctors.
  2. Age of the doctors would significantly influence the experience of stress.
  3. Work place of the homoeo doctors would significantly influence the experience of stress.
  4. Gender would significantly influence the strategies/styles of coping of homoeo doctors.
  5. Age of the doctors would significantly influence the styles of coping.
  6. Work place of the doctors would significantly influence the styles of coping.

MATERIALS AND METHODS :
Subjects : 200 randomly selected Homoeo doctors, of both sexes, of different age (25 yrs to 60 yrs), practicing homoeopathy in different clinics and hospitals, in Andhra Pradesh.

Tools : 1)Daily Stress Inventory developed by Brantley and Jones (1989), which consits of 58 items devided into five components – Interpersonal problems, Cognitive stressors, Environmental hassels, Varied stressors, Personal competency problems.

2)Coping Inventory developed by Sreenivas and Kumar (1999) consisting 40 statements, devided into three components, Appraisal focused coping, Emotional focused coping, and problem focused coping.
Variables :
Independent variables :
  1. Gender (Male and Female)
  2. Age (Below 30 years and above 30 years)
  3. Work place (Clinic and Hospital)
Dependent variables :
  1. Stress
  2. Coping Strategies/Styles


Analyses of Data :
As there are three independent variables in the investigation and each variable is futhur classified into two, a 2x2x2 factorial design was employed. The obtained data treated statistically using ANOVA and ‘t’ Test.
RESULTS AND DISCUSSION :
STRESS :
Table – I : MEANS AND SDS FOR SCORES ON STRESS
Particulars Males Females
Below 30yr Above 30yr Below 30yr Above 30yr
Clinic Mean 96.12 116.20 40.16 52.00
S.D 4.72 10.53 31.46 27.03
Hospital Mean 112.32 89.20 56.96 78.24
S.D 34.14 22.07 8.5 6.74

Means of the Groups, variable wise :
Male = 103.60 Below 30 years = 76.39 Clinic = 76.12
Female = 56.84 Above 30 years = 83.91 Hospital = 84.18


An observation of table – I, indicates the mean values of stress experienced by the Homoeo doctors of ages below and above 30 years working in clinics and hospitals. Stress due to interpersonal problems, cognitive stressors, Environmental hossles, varied stressors, personal competency problems. Male doctors above 30 years doing their homoeo medical practice in clinics have obtained a highest mean of 116.20 indicating more stress compared to other groups. Female doctors, below 30 years doing their Homoeo practice in clinics have obtained a low mean of 40.16 indicating their lowest stress.

When we observe the mean stress scores variable wise, first, when we consider gender, male and female doctors have obtained means of 103.6 and 56.84 respectively. There are gender differences on total stress scores; it is the males who experience more stress than female doctors irrespective of age and work place.

When we look at the mean stress scores of homoeo doctors, of ages above and below 30 years. Below 30years homoeo doctors have less stress (M=76.39) than above 30 years of age (M=83.91) irrespective of their gender and work place.

The influence of work place on stress is as follows. Doctors practicing in hospital have experience more stress (M=84.18) than doctors in clinics (M=76.12) irrespective of gender and age.

There are difference in the mean scores of the groups on stress. In order to test whether there are any significant influence of gender, age, work place on stress, the data were further subjected to factorial analysis of variance and the results are presented in Table – II.

Table –II: Summary of Anova for scores on stress.
Source Sum of squares (SS) Df Sum of mean square (MSS) F
Gender 109923.87 1 109923.87 238.43**
Age 29911.53 1 29911.53 6.31*
Work Place 2805.00 1 2805.00 6.08*
Gender x age 4837.21 1 4837.21 10.49**
Gender x work place 9505.21 1 9505.21 20.61**
Age x work place 3582.95 1 3582.95 7.77**
Gender x age x work place 9924.82 1 9924.82 21.52**
Error 88514.98 192 461.016
Corrected total 230749.50 199

Note: @ Not significant level
* Significant at 0.05 level
** Significant at 0.01 level.
The 1st hypothesis stated that gender would significantly influence the experience of stress among homoeo doctors. The obtained ‘F’ value of 238.43 is significant at 0.01 levels. As the ‘F’ value is significant the hypothesis 1 which stated significant influence of gender on stress, is accepted as warranted by the results.

When we take means into consideration the mean score of Male doctors is 103.60 and Female doctors 56.84. This shows that it is the male doctors who experienced more stress than female doctors. In the Indian setting ,it is the male plays more roles in the work, family and society than female and males may have high aspiration levels to earn money with low frustration tolerance. When the involvement is more in various activities, he has to meet many people and consequently face more conflicts and problems and it is natural that he finds it difficult to pay attention on the practice.

The 2nd hypothesis stated that age of homoeo doctors would significantly influence in their experience of stress. In order to test whether there are any significant differences with regard to the experience of stress by below 30 years and above 30 years of homoeo doctors, the data were further subjected to analysis of variance and presented in Table – II.
The obtained ‘F’ value of 6.31 is significant beyond 0.05 levels. As the ‘F’ value is significant the second hypothesis which stated age of doctors would significantly influence in their experience of stress is accepted. Between age below and above 30years of doctors, it is the age above 30 years doctors experienced more stress (M=83.91) than below age 30years doctors (M =76.39). This is may be due to factors like heavy work load, financial constraints, sleep deprivation, exposure to patients suffering and deaths, and a hidden curriculum of cynicism may be observed.

The 3rd hypothesis states that work place would significantly influence the experience of stress. To test whether there is any influence of work place on stress the data were subjected to analysis of variance and presented in Table – II.

It is evident from Table –II that, the obtained ‘F’ value of 6.08 is significant at 0.05 level. As the ‘F’ value is significant the hypothesis which states that work place would significantly influence the experience of stress among homoeo doctors is accepted. Between the doctors of clinic and hospitals it is the hospital doctors who experience more stress (M =84.18) than the doctors of clinics (M =76.12) and it statistically significant.

This is because, hospital infrastructure is different from clinic, more unhygienic, with inpatients, group discussions with colleagues, hectic time schedule. Chronic diseases of the patients, long working hours and high responsibilities may be the reasons for showing more stress in hospital working doctors.

Since some of the ‘F’ values are found significant, in order to test whether there are any significant differences among the groups with regard to stress, the data were further analyzed by using ‘t’ test and the results are presented in Table –III.

Table –III “T’ VALUES AMONG EIGHT GROUPS ON STRESS
G1 G2 G3 G4 G5 G6 G7 G8
G1 - 2.35* 8.69** 1.53@ 8.79** 20.10** 8.03** 10.86**
G2 - 0.54@ 2.84** 7.77** 7.86** 6.92** 4.89**
G3 - 5.51** 11.45** 21.86** 11.06** 15.17**
G4 - 6.37** 6.81** 5.32** 2.37**
G5 - 2.57** 1.42@ 5.91**
G6 - 0.87@ 9.79**
G7 - 4.70**
G8 -

Note: @ Not significant level
* Significant at 0.05 level
** Significant at 0.01 level
G1 – Male, below 30 years, clinic. G5 - Female, below 30years, clinic.
G2 – Male, below 30 years, Hospital. G6 - Female, below 30years, Hospital.
G3 – Male, above 30 years, clinic. G7 - Female, above 30years, clinic.
G4 – Male, above 30 years, Hospital G7 - Female, above 30years, clinic.


On observation of Table – IV it is clear that among the groups significant difference were found between G1 – G2, G1 – G3, G1 – G5, G1 – G6, G1 – G7, G1-G8, G2-G4, G2-G5, G2-G6, G2-G7, G2-G8, G3-G4, G3-G5, G3-G6, G3-G7, G3-G8, G4-G5, G4-G6, G4-G7, G4-G8, G5-G6, G5-G8, G6-G8, G7-G8 on stress. Among the eight groups of subjects, the Stress of G6 is the highest and G4 is the lowest.
COPING:
Table - IV: Means and SDS FOR SCORES ON COPING STYLES
Particulars Males Females
Below 30yr Above 30yr Below 30yr Above 30yr
Clinic Mean 52.44 55.80 78.16 77.48
S.D 9.73 8.71 26.35 18.81
Hospital Mean 52.16 61.6 64.48 51.40
S.D 11.52 10.22 21.03 16.09
Means of the Groups variable wise :
Male = 55.5 Below 30 years = 61.81 Clinic = 65.97
Female = 67.88 Above 30 years = 61.57 Hospital = 57.41

An observation of Table IV indicates the mean values of coping. Coping includes, using all three coping strategies i.e. appraisal, problem focused and emotional coping.
When we look into the means of total coping styles , females below 30 years working in clinics have obtained a high mean of 78.16 indicating that they have used more of coping styles than the other groups. Female doctors above 30 years working in hospitals obtained low mean of 51.4 indicating that they have used less of the coping styles than the other groups.

When we look into the means of coping styles gender wise, females had a high mean of 67.88 than males whose mean is 55.55 irrespective of age and work place.

In terms of age, doctors, below 30 years had high mean of 61.81 than doctors of above 30 years whose mean is 61.57 irrespective of gender and work place.

In terms of work place, doctors, do clinics obtained a high mean of 65.97 than doctors do hospitals, mean is 57.47.

There are differences in the mean scores of the groups related to coping styles. In order to test whether gender, age and work place have any significant impact on total coping styles of Doctors, the data were further subjected to factorial analysis of variance and the results are presented in table –V.

Table – V: SUMMARY OF ANOVA FOR SCORES ON COPING STYLES
Source Sum of squares (SS) Df Sum of mean square (MSS) F
Gender 7673.51 1 7673.51 27.17**
Age 10.37 1 10.37 0.03@
Work Place 3519.53 1 3519.53 12.46*
Gender x age 2464.59 1 2464.59 8.727**
Gender x work place 6338.71 1 6338.71 22.44**
Age x work place 82.97 1 82.97 0.29@
Gender x age x work place 832.67 1 832.67 2.94@
Error 54222.13 192 282.40
Corrected total 75346.78 199


Note: @ Not significant level
* Significant at 0.05 level
** Significant at 0.01 level.
It is evident from the table V that the obtained ‘F’ value for gender is 27.17 is significant indicating that male doctors and female doctors differ in using coping styles. And the ‘F’ value is significant influence of gender on Total coping style is accepted. When we examine the ‘F’ values for age and work place the obtained ‘F’ values of 0.03 for age is not significant. Obtained F value do 12.46 for workplace is significant in total coping styles.

To test whether there is any significant influence of age on the use of coping styles, the data were subjected to factorial analysis of variance and the results are presented in Table V. The ‘F’ value for age is 0.03 and it is not significant, indicating that the homeo doctors of age below and above 30 years did not differ in the use of coping styles.

To test the influence of work place on coping styles, the data were subjected to analysis of variance and the results are presented in Table V. The ‘F’ value of 12.46 is significant, indicating that the doctors do clinic and hospitals differ in using the coping styles and there is influence of work place on coping styles.

Since there are no set of norms to show that a particular coping style should be used by male and female doctors, they may use any strategy depending on the habit and resources they have. The manner in which the doctors cope with stress generally depends on the knowledge of various ways of solving problems to overcome the stress. It depends upon the habits of coping which the individual has developed over a period of time. These habits would again depend on the opportunities available to them and their general intellectual caliber at the time of coping.

Since the ‘F’ values of gender workplace are found significant, there is need to test the significant differences among the groups with regard to usage of coping styles.

Table –VI: “t” VALUES AMONG EIGHT GROUPS ON COPING STYLES
G1 G2 G3 G4 G5 G6 G7 G8
G1 - 0.09@ 1.28@ 3.24** 4.54** 2.59* 5.91 ** 0.27@
G2 - 1.26@ 3.06** 4.49** 2.56** 5.73 ** 0.19@
G3 - 2.15 * 4.00** 1.90@ 5.22** 1.20@
G4 - 2.90* 0.61@ 3.70** 2.67*
G5 - 2.01@ 0.10@ 4.30**
G6 - 2.30 * 2.47 *
G7 - 5.26**
G8 -

Note: @ Not significant level
* Significant at 0.05 level
** Significant at 0.01 level.
G1 – Male, below 30 years, clinic. G5 - Female, below 30years,,clinic.
G2 – Male, below 30 years, Hospital. G6 - Female, below 30years, Hospital.
G3 – Male, above 30 years, clinic. G7 - Female, above 30years, clinic.
G4 – Male, above 30 years, Hospital. G8 - Female, above 30years, Hospital.


It is evident from the Table – VI that among eight groups of subjects, significant difference were found between the groups G1-G4, G1-G5, G1-G6, G1-G7, G2-G4, G2-G5, G2-G6, G2-G7, G3-G4, G3-G5, G3-G7, G4-G5, G4-G7, G4-G8, G5-G8, G6-G7, G6-G8, G7-G8 in using the emotional focused coping styles. Among the eight groups of subjects G7 has got the highest score and G2 has got the least score on coping styles.
CONCLUSION :
The study was carried to observe the impact of gender, age, and workplace on experience of stress and coping styles of homoeo doctors. The data was collected using Daily Stress Inventory and Coping Strategies Scale. The analysis of data using ANOVA and ‘t’ test concluded that the gender of homoeo doctors has significant influence on experience of stress among homoeo doctors. Male doctors experienced more stress than female doctors. Age of the doctors has significant influence on stress, as the doctors above 30 years of age, experienced more stress than below 30 years age. Work place has significant influence in stress of doctors. Doctors working in hospitals have more stress than doctors working in clinics. It is also concluded that, gender has significant impact in using coping styles of homoeo doctors. Female homoeo doctors used more coping styles than male homoeo doctors. But, age has no significant impact on coping styles of doctors. However, doctors of below 30 years of age used more coping styles than age above 30 years. And, work place has significant impact on coping styles. Homoeo doctors working in clinics used more coping styles than homoeo doctors working in hospitals.

REFERENCES :

Al – Rawaise (1993) Burn out, stress and coping strategies of doctors in King Khalid University Hospital, Saudi. Saudi Medical Journal. Vol.17, No.2 ,1996, pp 235- 244

Anitha et al, (2007) Stress in doctors : a pilot study of the university teaching hospital, Lusaka, Zambia – Journal of Psychology in Africa, 2007, 17(1) pp 137-140

Babar Shaikh, and Arsalan, Kahloon (2004). Students, Stress and Coping strategies: A case of pakisthani medical school. Education for health. Vol 17(3)346-353

Caplan. R.P. (1994). Stress, anxiety and depression in hospital consultants, general practitioners and senior health service managers. Journal of critical care. Vol.309, 1261-1263

Carson, Butcher and Mineka, Abnormal psychology and Modern life.

Catherine.M. (2004), Stress and coping of Orthopaedic residents. The Journal of bone and Joint Surgery. Vol.86-A,(7) July 2004.

Chandrashekar et al Psychological Morbidity, Sources of stress and coping strategies among undergraduate medical students of Nepal. – www.biomedcentral.com

Dave Clark and Racquel Singh, (2004) Psychological distress among Auckland health Board Hospital doctors. The NewZealand Medical journal. Vol.117, No.1204, Oct-2004

Douglas et al –The impact of culture on physician stress and coping – Journal of National Medical Association, Vol 89, No. 9, USA.

Elzubair M.A. et al Stress and coping strategies among Arab Medical Students : towards a research agenda – www.educationforhealth.net

Firth. J (1986). Levels and sources of stress in medical students. British Medical Journal. Vol.292, 1177-1180

Heins, Marilvin; Fahev, Shriller – N.; Lei den, - Lisa j. (1984). Perceived stress in medical, law and graduate students. Journal of Medical Education, 59(3), 169-179

Hirak et al (2009). Role stress among doctors working in a Govt. hospitals in Shimla (India) – European Journal of Social Sciences, Volume 9, No. 3 (2009) – pp : 356-370.

Lazarus, R.S. (1978, 1984). Psychology, New York, Mc Graw Hill book co. 410 – 421

Mc.Pherson, (2002), UK, Stress and Coping Among Accident and Emergency senior House Officers. Emerg Med Journal, vol.20 May 2003.

Meena and Radhanath, (2008), Coping with life stress – The Indian Experience.

Mosley, TH Jr. Perrin, S.G. et al (1994), Stress, coping and well being among third year medical students. Vol.69. Issue 9.

Paula E Nesbitt. Stress and coping among Dental Educators- Does Gender matter?. www.advance.rackham.umich.edu.

Pestonjee.D.M, (1999),Stress and Coping ; The Indian Experience

Promecene and Monga, USA, (2003), Stress in Obstetricians and Gynaecologist , South Medical Journal, 96(12), pg 1187-1189, Dec- 2003.

Purvi Parikh, Aathish and Tanmayi, (2004) Mumbai, Occupational stress and coping of Nurses : Journal of Health Management. Vol.6(2), pg 115- 127, Oct-2004.

Roshan et al Stress among Homoeo Doctors, www.esocialsciences.com

Siying Wu et al, (2007)Relationship between job burnout and occupational stress among doctors in China. 2007 – www.interscinece.wiley.com.



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