Em empregos estressantes, o risco de depressão aumenta com as horas trabalhadas, revela um estudo com novos médicos
Quanto mais horas alguém trabalha por semana em um trabalho estressante, mais aumenta o risco de depressão, segundo um estudo com novos médicos.
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)
Domínio público
Quanto mais horas alguém trabalha por semana em um trabalho estressante, mais aumenta o risco de depressão, segundo um estudo com novos médicos.
Trabalhar 90 ou mais horas por semana foi associado a mudanças nos escores de sintomas de depressão três vezes maiores do que a mudança nos sintomas de depressão entre aqueles que trabalhavam de 40 a 45 horas por semana.
Além disso, uma porcentagem maior daqueles que trabalhavam um grande número de horas tinham pontuações altas o suficiente para se qualificar para um diagnóstico de depressão moderada a grave – grave o suficiente para justificar tratamento – em comparação com aqueles que trabalhavam menos horas.
A equipe de pesquisa, sediada na Universidade de Michigan, usou métodos estatísticos avançados para emular um ensaio clínico randomizado, respondendo por muitos outros fatores na vida pessoal e profissional dos médicos.
Eles encontraram um efeito de "resposta à dose" entre as horas trabalhadas e os sintomas de depressão, com um aumento médio dos sintomas de 1,8 pontos em uma escala padrão para aqueles que trabalham de 40 a 45 horas, variando até 5,2 pontos para aqueles que trabalham mais de 90 horas. Eles concluem que entre todos os estressores que afetam os médicos, trabalhar um grande número de horas é um dos principais contribuintes para a depressão.
Escrevendo no New England Journal of Medicine , a equipe do Michigan Medicine, centro médico acadêmico da UM, relata suas descobertas ao estudar 11 anos de dados de mais de 17.000 residentes médicos do primeiro ano. Os médicos recém-formados estavam em treinamento em centenas de hospitais nos Estados Unidos.
Os dados são do Intern Health Study, do Michigan Neuroscience Institute e do Eisenberg Family Depression Center. A cada ano, o estudo recruta novos graduados da faculdade de medicina para participar de um ano de rastreamento de seus sintomas depressivos, horas de trabalho, sono e muito mais enquanto completam o primeiro ano de residência, também chamado de ano de estágio.
O impacto do alto número de horas de trabalho
Este estudo ocorre no momento em que grandes organizações nacionais, como a Academia Nacional de Medicina e a Associação de Faculdades Médicas Americanas, lutam para lidar com as altas taxas de depressão entre médicos, médicos em treinamento e outros profissionais de saúde. Embora os estagiários do estudo tenham relatado uma ampla gama de horas de trabalho da semana anterior, os níveis de horas de trabalho mais comuns foram entre 65 e 80 horas por semana.
O Accreditation Council for Graduate Medical Education, que define os padrões nacionais para os programas de residência, atualmente estabelece um limite de 80 horas para as semanas de trabalho dos residentes, mas isso pode ser calculado em quatro semanas e há possíveis exceções. A ACGME também limita a duração de um único turno e o número de dias seguidos em que os residentes podem trabalhar. Estudos mostraram resultados mistos sobre o impacto que esses limites tiveram no bem-estar dos residentes e nos riscos de segurança do paciente.
Os autores dizem que suas descobertas apontam para uma clara necessidade de reduzir ainda mais o número de horas que os residentes trabalham a cada semana, em média.
"Esta análise sugere fortemente que a redução do número médio de horas de trabalho faria a diferença no grau em que os sintomas depressivos dos internos aumentam ao longo do tempo e reduziria o número de pessoas que desenvolvem depressão diagnosticável", diz Amy Bohnert, Ph.D., a autor sênior do estudo e professor da UM Medical School. "O principal é fazer com que as pessoas trabalhem menos horas; você pode lidar de maneira mais eficaz com o estresse ou as frustrações do seu trabalho quando tiver mais tempo para se recuperar."
Yu Fang, MSE, principal autor do estudo e especialista em pesquisa do Michigan Neuroscience Institute, observa que o número de horas é importante, mas também são as oportunidades de treinamento que vêm do tempo gasto em hospitais e clínicas. "É importante usar o tempo gasto no trabalho para oportunidades de aprendizado supervisionado, e não para tarefas de serviço clínico de baixo valor", diz ela.
Uma população madura para o estudo
O novo estudo usa um desenho chamado ensaio clínico emulado, que simula um ensaio clínico randomizado em situações em que a realização de um estudo randomizado real não é viável. Como quase todos os estagiários em todo o país começam na mesma época do ano e estão sujeitos a horários de trabalho variados definidos por seus programas, estudar pessoas que passam por esse estágio de treinamento médico é ideal para emular um ensaio clínico.
Esta oportunidade é o que levou o fundador do Intern Health Study, Srijan Sen, MD, Ph.D. para lançar o projeto de pesquisa em primeiro lugar: Novos médicos que entram no ano mais estressante de suas carreiras formam um grupo perfeito para estudar o papel de muitos fatores no risco ou aparecimento de depressão.
Os autores sugerem que estudos paralelos a este trabalho com médicos sejam realizados em outros empregos de alto estresse e alta jornada de trabalho. “Esperamos que o efeito negativo das longas horas de trabalho na saúde mental do médico esteja presente em outras profissões”, diz o senador.
A idade média dos médicos no estudo foi de 27 anos, e pouco mais da metade eram mulheres. Um em cada cinco estava treinando em disciplinas cirúrgicas e 18% eram de grupos raciais ou étnicos tradicionalmente sub-representados na profissão médica.
Menos de 1 em 20 preencheram os critérios para depressão moderada a grave no início do ano de estágio. Ao todo, 46% tiveram um evento de vida estressante, como morte ou nascimento familiar, ou casamento, durante o ano de estágio, e 37% disseram ter se envolvido em pelo menos um erro médico durante o ano.
Ao analisar os resultados, os pesquisadores ajustaram para gênero, neuroticismo, história pré-estágio de depressão, ambiente familiar precoce, idade, ano de início do estágio, estado civil, se tiveram filhos e eventos de vida estressantes e erros médicos durante o ano de estágio. .
Faça a diferença para os moradores de hoje
“Iniciativas nacionais sobre o bem-estar clínico têm enfatizado cada vez mais o complexo conjunto de fatores que afetam o bem-estar clínico, incluindo o registro eletrônico de saúde, carga regulatória, resiliência, violência no local de trabalho e cultura”, diz Sen, diretor do EFDC e o Professor Eisenberg de Depressão e Neurociências. "Acho que essa ênfase inadvertidamente levou à sensação de que o problema é infinitamente complicado e não há esperança para o progresso real. Este artigo demonstra o impacto que o fator único das horas de trabalho tem na depressão e no bem-estar do clínico".
Sen faz parte do Grupo de Trabalho da Academia Nacional de Medicina sobre Navegar pelos Impactos do COVID-19 no Bem-Estar do Clínico, parte de um esforço maior que recentemente emitiu um Plano Nacional para o Bem-Estar da Força de Trabalho em Saúde.
Bohnert observa que os diretores de residência que executam programas de treinamento para novos médicos podem reduzir as horas de trabalho priorizando esforços que aumentam a eficiência e diminuem o trabalho desnecessário.
Fang também observa que os dados de residentes nos EUA podem se aplicar a médicos juniores, como são chamados, em outras nações. O Intern Health Study agora também inscreve estagiários na China e no Quênia.