Factors associated with psychological distress of medical doctor in Kagawa prefecture, Japan: a pilot study

doi:10.4236/health.2011.312124

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Vol.3, No.12, 748-751 (2011)

doi:10.4236/health.2011.312124

Health

Factors associated with psychological distress of

medical doctor in Kagawa prefecture, Japan: a pilot study

Takeshi Suzue1, Noriko Sakano2, Yo shikazu Miyamae3, Takeshi Yo da1, Akira Yoshioka1, Taich i

Nagatomi4, Wataru Shiraki5, Tomohiro Hirao1

1Department of Public Health, Faculty of Medicine, Kagawa University, Kagawa, Japan;

*Corresponding Author: suzue@med.kagawa-u.ac.jp

2Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan;

3Center for Educational Research and Teacher Development, Faculty of Education, Kagawa University, Kagawa, Japan;

4Institute of Research Partnership Center for Social Collaboration and Intellectual Property, Kagawa University, Kagawa, Japan;

5Department of Reliability-Based Information Systems Engineering, Faculty of Engineering, Kagawa University, Kagawa, Japan.

Received 6 September 2011; revised 15 November 2011; accepted 30 November 2011.

ABSTRACT

Objective: We evaluated the psychological dis-

tress of medical doctor using a 6-item instru-

ment (the K6) in Kagawa prefecture, Japan. Me-

thods: A total of 284 medical doctors (236 men

and 48 women) were analyzed in a cross-sec-

tional investigation study. The association be-

tween psychological distress and clinical fac-

tors were evaluated by the K6 instrument, with

psychological distress defined as 13 or more

point s out of a total of 24 points. Results: A total

of 17 doctors (6.0% ) as defined as p s ychological

distress. The significant relationships between

the K6 score and age, experience duration as

clinician were not noted. The K6 score in sub-

jects with consciousness of suicide was sig-

nificantly higher than that without. In addition,

the K6 score in subjects without cooperation

with specialists was higher than those without,

but not at a significant lev el. Conclusions: Some

factors i.e. consciousness of suicide and coop-

eration with specialists might be associated with

psychological distress, as assessed by the K6

instrument, in medical doctor in Kagawa pre-

fecture, Japan.

Keywords: Psychological Distress; T he K6;

Medical Doctor; Kaga wa; Japan

1. INTRODUCTION

Mental health has become public health challenge in

Japan. For example, over 30 thousand subjects suicide in

a year for over 10 years [1]. About 14% of the global

disease burden has been attributed to mental illness,

mostly due to the chronically disabling nature of depres-

sion and othe r common mental disorde rs [ 2].

Recently, the demand for medical doctors has been

increasing in various areas because of a medical reform

bill and government amendments to the medical service

payment structure in Japan. In some literatures, the psy-

chological distress of medical doctors in Japan has re-

ported [3,4]. However, the evaluation of psychological

distress of medical doctors in Japan still remains to be

investigated.

Therefore, we evaluated the psychological distress of

medical doctors by using the K6 instrument, the scale of

psychological distress, in Kagawa prefecture, Japan and

its relation to clinical factors in this cross-sectional in-

vestigation study.

2. SUBJECTS AND METHODS

2.1. Subjects

We used data of 334 respondents (37.8%) among 884

medical doctors (physician, surgeon and psychiatrist) in

Kagawa prefecture, Japan, who met the following crite-

ria; 1) they had completely answered the questionnaires

(clinical characteristics and the K6); and 2) they pro-

vided informed consent. Therefore, we analyzed 284

(32.1%) medical doctors (236 men and 48 women), aged

55.8 ± 11.9 years in this cross sectional investigation

study.

Ethical approval for the study was obtained from the

Ethical Committee of Faculty of Medicine, Kagawa

University, Japan.

2.2. Psychological Distress

The K6 was used as an indicator of psychological dis-

T. Suzue et al. / Health 3 (2011) 748-751

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tress [8,9]. The 6 questions were as follows: “Over the

last month, how often did you feel: 1) nervous, 2) hope-

less, 3) restless or fidgety, 4) so sad that nothing could

cheer you up, 5) that every thing was an effort, 6)

worthless?”. Participants were asked to respond by

choosing “all of the time” (4 points), “most of the time”

(3 points), “some of the time” (2 points), “a little of the

time” (1 point), and “none of the time” (0 points). There-

fore, total point score ranged from 0 to 24. The K6 has

been developed using modern psychometric theory and

has been shown to be superior to some existing scales in

brevity and psychometric properties [5-7]. The Japanese

version of the K6 has been recently developed, using the

standard back-translation method, and has been vali-

dated [8]. As suggested by Kessler et al. [7], we classi-

fied participants with scores of 13 points or more as

having psychological distress.

2.3. Measurement of Clinical Variables

The questionnaires for medical doctors consisted of

the following details in sequence: age, sex, experience

duration as clinician. In addition, we evaluated the con-

sciousness of suicide in clinical practice, anxiety of pre-

venting suicide and cooperation with specialist in their

daily work.

2.4. Statistical Analysis

Data are expressed as mean ± standard deviation (SD)

values. A statistical analysis was performed using NOVA

and Scheffe’s F test. Simple correlation analysis was

performed as well to test for the significance of the linear

relationship among continuous variables, where p < 0.05

was considered to be statistically significant.

3. RESULTS

The total K6 score was 4.3 ± 3.9, and details were as

follows: 1) nervous: 1.1 ± 1.0; 2) hopeless: 0.4 ± 0.7; 3)

restless or fidgety: 0.8 ± 0.9; 4) so sad that nothing could

cheer you up: 0.7 ± 0.8; 5) that every thing was an effort:

0.8 ± 0.9; 6) worthless: 0.5 ± 0.8. A total of 17 medical

doctors (6.0%) as defined as psychological distress. We

evaluated the relationship between the K6 score and age

(Figure 1), exp erience duration as clinician. The signifi-

cant relationships between the K6 score and age (r =

–0.018, p = 0.7663), and between the K6 score and

experience duration as clinician (r = –0.011, p = 0.8519)

were not noted in this study.

In addition we evaluated the factors i.e. conscious-

ness of suicide, anxiety of preventing suicide and co-

operation with specialist (Table 1). The K6 score in

subjects with consciousness of suicide (most of the

time) was signifi- cantly higher than that without (a

little of the time). In addition, the K6 score in subjects

with cooperation with specialist (most of the time) was

lower than that in sub- jects without that, but not at a

significant level.

4. DISCUSSION

We firstly evaluated the psychological distress of me-

dical doctors using the K6 instrument in Kagawa pre-

fecture, Japan.

According to the link between psychological distress

and medical doctors, Hayasaka et al. has reported that

work environment factors, particularly night duty, play

important roles in modulating psychological distress

among female doctors by using the thirty-item version of

the General Health Questionnaire (GHQ-30) [3,9]. Wada

et al. also showed that depressive symptoms were indi-

Figure 1. Relationship between the K6 score and age in medical doctor in

Kagawa prefecture, Japan.

T. Suzue et al. / Health 3 (2011) 748-751

750

Table 1. Relation between the K6 soore and clinical factors in medical doctor.

Most of the time Some of the time A little of the time None of the time

Consciousness of suiside

Number of subjects 7 124 132 21

The K6 socre 8.6 ± 7.8 4.7 ± 3.8 3.7 ± 3.3 a 5.0 ± 5.4

Anxiety of preventing suicide

Number of subject s 111 153 16 4

The K6 socre 4.4 ± 4.0 4.3 ± 3.9 4.6 ± 4.6 5.3 ± 5.6

Cooperation with specialist

Number of subjects 21 115 101 47

The K6 socre 3.7 ± 3.8 4.6 ± 3.9 4.2 ± 3.9 4.3 ± 4.2

a: p < 0.05 vs Most of th e time.

cated in 8.3% of men and 10.5% of women, and 5.7% of

men and 5.8% women were determined to exhibit suici-

dal ideation using the Japanese version of the Quick In-

ventory of Depressive Symptomatology (QIDS) [4]. The

number of unreasonable demands and complaints in the

previous 6 months was significantly associated with de-

pressive symptoms and suicidal ideation [4]. In this

study, we evaluated the psychological distress of medical

doctors evaluated by the K6 instrument in Kagawa pre-

fecture, Japan. Consciousness of suicide and cooperation

with specialist in their daily work might be associated

with psychological distress in medical doctors in Ka-

gawa prefecture, Japan. Therefore, it seems reasonable

to suggest that simply supporting in medical doctors in

mental health and suicide is also required in Kagawa

prefecture, Japan.

In some literatures, psychological distress by using the

K6 has been reported. Kuriyama et al. reported that they

evaluated psychological distress of 43,716 community-

dwelling people aged 40 years or older living in Japan

[10]. Subjective social status seems to be a stronger pre-

dictor of psychological distress among both men and

women in the Japanese community than traditional so-

cioeconomic status [11]. Inoue et al. showed that part

time workers in men and temporary/contract workers in

women were associated with poor mental health in a

total of 9461 men and 7777 women employees. No clear

relation in mental health was noted in company size or

occupation [12]. However, there is no report of psycho-

logical distress of medical doctors evaluated by the K6

instrument in Japan. In this study, by using the K6, we

evaluated the psychological distress of medical doctors

in Kagawa prefecture, Japan. A total of 17 medical doc-

tors (6.0%) was defined as psychological distress. The

rate of psychological distress was similar to that previ-

ous report [10]. However, some factors in their daily

work i.e. consciousness of suicide and cooperation with

specialists might be associated with their psychological

distress. This reference and pilot data obtained from this

study might be useful for preventing psychological dis-

tress in medical doctors in Japan.

Potential limitations still remain in this study. First,

our study was a cross sectional and not a longitudinal

study. Second, 284 medical doctors among 884 doctors

in our study voluntarily underwent measurement in Ka-

gawa prefecture, Japan: they were therefore more likely

to be health-conscious compared with the average medi-

cal doctors. The third, most of them were physicians and

there was no psychiatrist. To show this, further prospec-

tive studies and in other prefectures are needed in the

Japanese.

5. ACKNOWLEDGEMENTS

This research was supported in pa rt by Kagawa prefecture, Japan.

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