دورية أكاديمية
The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study.
العنوان: | The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study. |
---|---|
المؤلفون: | Castellini G; Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy., Tarchi L; Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy., Cassioli E; Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy., Ricca V; Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy., Abbate Daga G; Department of Neurosciences, University of Turin, Turin, Italy., Aguglia A; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy., Albert U; Department of Medicine, Surgery and Health Sciences, University of Trieste and Department of Mental Health, Trieste, Italy., Atti A; Section of Psychiatry, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy., Barlati S; Department of Clinical and Experimental Sciences, University of Brescia and Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy., Blasi G; Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy., Carmassi C; Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy., Carrà G; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy., De Fazio P; Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy., De Panfilis C; Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy., Di Lorenzo G; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy., Ferrari S; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy., Goracci A; Department of Molecular and Developmental medicine, University of Siena, Siena, Italy., Gramaglia C; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy., Luciano M; Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy., Martinotti G; Department of Neurosciences, Imaging and Clinical Sciences, 'G. D'Annunzio' University, Chieti, Italy., Menchetti M; Section of Psychiatry, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy., Menculini G; Department of Psychiatry, University of Perugia, Perugia, Italy., Nanni MG; Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy., Nivoli A; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy., Pinna F; Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy., Pompili M; Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy., Rosso G; Department of Neurosciences, University of Turin, Turin, Italy., Sambataro F; Department of Neuroscience (DNS), University of Padova, Padua, Italy., Sampogna G; Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy., Sani G; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy., Serafini G; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy., Signorelli MS; Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy., Tosato S; Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy., Ventriglio A; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy., Viganò C; Department of Biomedical and Clinical Sciences, Luigi Sacco and Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milano, Italy., Volpe U; Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy., Fiorillo A; Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy. |
المصدر: | Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2024 Mar; Vol. 149 (3), pp. 177-194. Date of Electronic Publication: 2024 Jan 03. |
نوع المنشور: | Multicenter Study; Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 0370364 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0447 (Electronic) Linking ISSN: 0001690X NLM ISO Abbreviation: Acta Psychiatr Scand Subsets: MEDLINE |
أسماء مطبوعة: | Publication: Malden, MA : Wiley-Blackwell Original Publication: Copenhagen : Munksgaard International Publishers |
مواضيع طبية MeSH: | Internship and Residency* , Mentalization* , Burnout, Professional*/epidemiology , Burnout, Professional*/psychology , Psychiatry*, Humans ; Surveys and Questionnaires ; Neuroticism |
مستخلص: | Background: A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency. Methods: An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors. Results: A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress. Conclusions: The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education. (© 2024 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.) |
References: | Stanghellini G, Broome M, Fernandez AV, et al., eds. The Oxford Handbook of Phenomenological Psychopathology. Oxford University Press; 2019. Weil MH, Shoemaker WC. Pioneering contributions of Peter Safar to intensive care and the founding of the Society of Critical Care Medicine. Crit Care Med. 2004;32(2):S8-S10. doi:10.1097/01.CCM.0000110742.81376.FA. Weisz G. The emergence of medical specialization in the nineteenth century. Bull Hist Med. 2003;77(3):536-574. doi:10.1353/bhm.2003.0150. McGorry P, Keshavan M, Goldstone S, et al. Biomarkers and clinical staging in psychiatry. World Psychiatry. 2014;13(3):211-223. doi:10.1002/wps.20144. Fiorillo A, Pinto da Costa M, Nakamae T, et al. Associations of early career psychiatrists worldwide: history, role, and future perspectives. Middle East Curr Psychiatry. 2016;23:3-9. doi:10.1097/01.XME.0000475421.97320.26. Pinto da Costa M. Early career psychiatrists - history, 2020 and beyond. World Psychiatry. 2020;19(1):127-128. doi:10.1002/wps.20712. Pinto da Costa M, Palavra IR, Fung P, et al. The future of psychiatry commission. Lancet Psychiatry. 2018;5(1):15-16. doi:10.1016/S2215-0366(17)30466-2. Ackerly DC, Sangvai DG, Udayakumar K, et al. Training the next generation of physician-executives: an innovative residency pathway in management and leadership. Acad Med. 2011;86(5):575-579. doi:10.1097/ACM.0b013e318212e51b. Burke G, Melvin L, Ginsburg S. “Patients are the people who teach me the Most”: exploring the development of communication skills during internal medicine residency. J Grad Med Educ. 2023;15(1):59-66. doi:10.4300/JGME-D-22-00433.1. Dayal A, O'Connor DM, Qadri U, Arora VM. Comparison of male vs female resident milestone evaluations by faculty during emergency medicine residency training. JAMA Intern Med. 2017;177(5):651-657. doi:10.1001/jamainternmed.2016.9616. Green ML, Aagaard EM, Caverzagie KJ, et al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ. 2009;1(1):5-20. doi:10.4300/01.01.0003. Okhunov Z, Safiullah S, Patel R, et al. Evaluation of urology residency training and perceived resident abilities in the United States. J Surg Educ. 2019;76(4):936-948. doi:10.1016/j.jsurg.2019.02.002. van der Leeuw RM, Lombarts KM, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC Med. 2012;10(1):65. doi:10.1186/1741-7015-10-65. van Woezik TET, Stap TB, van der Wilt GJ, Reuzel RPB, Koksma JJ. Seeing the other: how residents expand their perspective by learning with the arts. J Grad Med Educ. 2023;15(1):50-58. doi:10.4300/JGME-D-22-00140.1. Fiorillo A, Malik A, Luciano M, et al. Challenges for trainees in psychiatry and early career psychiatrists. Int Rev Psychiatry. 2013;25(4):431-437. doi:10.3109/09540261.2013.812960. Stanghellini G, Bolton D, Fulford WKM. Person-centered psychopathology of schizophrenia: building on Karl Jaspers' understanding of patient's attitude toward his illness. Schizophr Bull. 2013;39(2):287-294. doi:10.1093/schbul/sbs154. Jaspers PK. General Psychopathology. Johns Hopkins University Press; 1997. Fonagy P, Gergely G, Jurist EL, Target M. Affect Regulation, Mentalization, and the Development of the Self. Other Press; 2002. Bateman AW, Fonagy P, Campbell C. Mentalization-based treatment. In: Livesley WJ, Larstone R, eds. Handbook of Personality Disorders: Theory, Research, and Treatment. 2nd ed. The Guilford Press; 2018:541-554. Fonagy P, Allison E. The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy. 2014;51:372-380. doi:10.1037/a0036505. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 2009;21(4):1355-1381. doi:10.1017/S0954579409990198. Luyten P, Fonagy P, Lowyck B, Vermote R. Assessment of mentalization. In: Bateman AW, Fonagy P, eds. Handbook of Mentalizing in Mental Health Practice. American Psychiatric Publishing; 2012:43-65. Schwarzer NH, Nolte T, Fonagy P, Gingelmaier S. Mentalizing and emotion regulation: evidence from a nonclinical sample. Int Forum Psychoanal. 2021;30(1):34-45. doi:10.1080/0803706X.2021.1873418. Schwarzer NH, Nolte T, Fonagy P, Gingelmaier S. Self-rated mentalizing mediates the relationship between stress and coping in a non-clinical sample. Psychol Rep. 2022;125(2):742-762. doi:10.1177/0033294121994846. Feeney JA. Adult attachment, coping style and health locus of control as predictors of health behaviour. Aust J Psychol. 1995;47(3):171-177. doi:10.1080/00049539508257520. Katznelson H. Reflective functioning: a review. Clin Psychol Rev. 2014;34(2):107-117. doi:10.1016/j.cpr.2013.12.003. Mikulincer M, Florian V. The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. In: Simpson JA, Rholes WS, eds. Attachment Theory and Close Relationships. The Guilford Press; 1998, 143-165. Ognibene TC, Collins NL. Adult attachment styles, perceived social support and coping strategies. J Soc Pers Relat. 1998;15(3):323-345. doi:10.1177/0265407598153002. Chan MK, Chew QH, Sim K. Burnout and associated factors in psychiatry residents: a systematic review. Int J Med Educ. 2019;10:149-160. doi:10.5116/ijme.5d21.b621. Bressi C, Porcellana M, Gambini O, et al. Burnout among psychiatrists in Milan: a multicenter survey. PS. 2009;60(7):985-988. doi:10.1176/ps.2009.60.7.985. Volpe U, Luciano M, Palumbo C, Sampogna G, Del Vecchio V, Fiorillo A. Risk of burnout among early career mental health professionals. J Psychiatr Ment Health Nurs. 2014;21(9):774-781. doi:10.1111/jpm.12137. Waugh CE, Shing EZ, Furr RM. Not all disengagement coping strategies are created equal: positive distraction, but not avoidance, can be an adaptive coping strategy for chronic life stressors. Anxiety Stress Coping. 2020;33(5):511-529. doi:10.1080/10615806.2020.1755820. Shermeyer L, Morrow MT, Mediate N. College students' daily coping, mood, and quality of life: benefits of problem-focused engagement. Stress Health. 2019;35(2):211-216. doi:10.1002/smi.2847. Britt TW, Crane M, Hodson SE, Adler AB. Effective and ineffective coping strategies in a low-autonomy work environment. J Occup Health Psychol. 2016;21(2):154-168. doi:10.1037/a0039898. Santana IR, Chalkley M. Getting the right balance? A mixed logit analysis of the relationship between UK training doctors' characteristics and their specialties using the 2013 National Training Survey. BMJ Open. 2017;7(8):e015219. doi:10.1136/bmjopen-2016-015219. Buckley CE, Nugent E, Neary PC, Traynor O, Carroll SM. Do plastic surgical trainees naturally self-select based on fundamental ability? J Plast Reconstr Aesthet Surg. 2014;67(9):1303-1304. doi:10.1016/j.bjps.2014.04.037. Fino E, Agostini A, Mazzetti M, Colonnello V, Caponera E, Russo PM. There is a limit to your openness: mental illness stigma mediates effects of individual traits on preference for psychiatry specialty. Front Psych. 2019;10:775. doi:10.3389/fpsyt.2019.00775. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010. Guido G, Peluso AM, Capestro M, Miglietta M. An Italian version of the 10-item big five inventory: an application to hedonic and utilitarian shopping values. Personal Individ Differ. 2015;76:135-140. doi:10.1016/j.paid.2014.11.053. Corr PJ, Matthews G. The Cambridge Handbook of Personality Psychology. Cambridge University Press; 2009 Accessed October 30, 2021. https://www.cambridge.org/core/books/cambridge-handbook-of-personality-psychology/8E0820BD8B627FB17B009A34E81A5DEB. Busonera A, Martini PS, Zavattini GC, Santona A. Psychometric properties of an Italian version of the Experiences in Close Relationships-Revised (ECR-R) Scale. Psychol Rep. 2014;114(3):785-801. doi:10.2466/03.21.PR0.114k23w9. Sacchi C, Vieno A, Simonelli A. Italian validation of the childhood trauma questionnaire-short form on a college group. Psychol Trauma. 2018;10(5):563-571. doi:10.1037/tra0000333. Sica C, Magni C, Ghisi M. et al. Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoterapia Cognitiva e Comportamentale. 2008;14:27-53. Eckenrode J. The Social Context of Coping. Plenum Press; 1991. Giromini L, Velotti P, de Campora G, Bonalume L, Zavattini GC. Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian version. J Clin Psychol. 2012;68(9):989-1007. doi:10.1002/jclp.21876. Giromini L, de Campora G, Brusadelli E, Zennaro A, Zavattini GC, Lang M. Validity and reliability of the interpersonal competence questionnaire: empirical evidence from an Italian study. J Psychopathol Behav Assess. 2016;38(1):113-123. Sirigatti S, Stefanile C. MBI - Maslach burnout inventory. Adattamento e Taratura per l'Italia. Maslach Burnout Inventory; 1993. Lue BH, Chen HJ, Wang CW, Cheng Y, Chen MC. Stress, personal characteristics and burnout among first postgraduate year residents: a nationwide study in Taiwan. Med Teach. 2010;32(5):400-407. doi:10.3109/01421590903437188. Zuckerman M. Diathesis-stress models. In: Zuckerman M ed. Vulnerability to Psychopathology: A Biosocial Model. American Psychological Association; 1999:3-23. doi:10.1037/10316-001. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2023. Accessed April 21, 2023. https://www.R-project.org. RStudio Team. RStudio: Integrated Development for R. 2023 http://www.rstudio.com/. JASP Team. JASP (Version 0.17.3.0). 2023 https://jasp-stats.org/. Wickham H, Averick M, Bryan J, et al. Welcome to the Tidyverse. J Open Source Softw. 2019;4(43):1686. doi:10.21105/joss.01686. Rosseel Y. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48:1-36. doi:10.18637/jss.v048.i02. Prins JT, Hoekstra-Weebers JEHM, van de Wiel HBM, et al. Burnout among Dutch medical residents. Int J Behav Med. 2007;14(3):119-125. doi:10.1007/BF03000182. Andlauer O, Guicherd W, Haffen E, et al. Factors influencing French medical students towards a career in psychiatry. Psychiatr Danub. 2012;24(Suppl 1):S185-90. Eagle PF, Marcos LR. Factors in medical students' choice of psychiatry. Am J Psychiatry. 1980;137:423-427. doi:10.1176/ajp.137.4.423. Farooq K, Lydall GJ, Malik A, Ndetei DM, Bhugra D, ISOSCCIP Group. Why medical students choose psychiatry - a 20 country cross-sectional survey. BMC Med Educ. 2014;14(1):12. doi:10.1186/1472-6920-14-12. Jennings KS, Goguen KN, Britt TW, et al. The role of personality traits and barriers to mental health treatment seeking among college students. Psychol Serv. 2017;14:513-523. doi:10.1037/ser0000157. Williams AL, Craske MG, Mineka S, Zinbarg RE. Neuroticism and the longitudinal trajectories of anxiety and depressive symptoms in older adolescents. J Abnorm Psychol. 2021;130:126-140. doi:10.1037/abn0000638. Summers RF, Gorrindo T, Hwang S, Aggarwal R, Guille C. Well-being, burnout, and depression among north American psychiatrists: the state of our profession. AJP. 2020;177(10):955-964. doi:10.1176/appi.ajp.2020.19090901. Woodside JR, Miller MN, Floyd MR, McGowen KR, Pfortmiller DT. Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry. 2008;32(1):13-19. doi:10.1176/appi.ap.32.1.13. Doolittle BR, Windish DM, Seelig CB. Burnout, coping, and spirituality among internal medicine resident physicians. J Grad Med Educ. 2013;5(2):257-261. doi:10.4300/JGME-D-12-00136.1. Haymaker C, Bane C, Roise A, Greene J. Emotion regulation and burnout in family medicine residents. Fam Med. 2022;54(2):139-141. doi:10.22454/FamMed.2022.660204. Zhang S, Wang J, Xie F, et al. A cross-sectional study of job burnout, psychological attachment, and the career calling of Chinese doctors. BMC Health Serv Res. 2020;20(1):193. doi:10.1186/s12913-020-4996-y. Chew QH, Ang LP, Tan LL, et al. A cross-sectional study of burnout and its associations with learning environment and learner factors among psychiatry residents within a national psychiatry residency Programme. BMJ Open. 2019;9(8):e030619. doi:10.1136/bmjopen-2019-030619. Puscas L, Kogan JR, Holmboe ES. Assessing interpersonal and communication skills. J Grad Med Educ. 2021;13(2s):91-95. doi:10.4300/JGME-D-20-00883.1. Eby LT, Robertson MM. The psychology of workplace mentoring relationships. Annu Rev Organ Psych Organ Behav. 2020;7(1):75-100. doi:10.1146/annurev-orgpsych-012119-044924. Grist CL, Caudle LA. An examination of the relationships between adverse childhood experiences, personality traits, and job-related burnout in early childhood educators. Teach Teach Educ. 2021;105:103426. doi:10.1016/j.tate.2021.103426. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001;86(3):499-512. doi:10.1037/0021-9010.86.3.499. Brennan KA, Shaver PR. Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Personal Soc Psychol Bull. 1995;21(3):267-283. doi:10.1177/0146167295213008. Fraley RC, Heffernan ME, Vicary AM, Brumbaugh CC. The experiences in close relationships-relationship structures questionnaire: a method for assessing attachment orientations across relationships. Psychol Assess. 2011;23(3):615-625. doi:10.1037/a0022898. Aronsson G, Theorell T, Grape T, et al. A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health. 2017;17(1):264. doi:10.1186/s12889-017-4153-7. Sun JW, Lin PZ, Zhang HH, Li JH, Cao FL. A non-linear relationship between the cumulative exposure to occupational stressors and nurses' burnout and the potentially emotion regulation factors. J Ment Health. 2018;27(5):409-415. doi:10.1080/09638237.2017.1385740. Kovach JG, Dubin WR, Combs CJ. Psychotherapy training: residents' perceptions and experiences. Acad Psychiatry. 2015;39(5):567-574. doi:10.1007/s40596-014-0187-7. Dennis NM, Swartz MS. Emergency psychiatry experience, resident burnout, and future plans to treat publicly funded patients. Psychiatr Serv. 2015;66(8):892-895. doi:10.1176/appi.ps.201400234. Orlinsky DE, Botermans JF, Rønnestad MH. Towards an empirically grounded model of psychotherapy training: four thousand therapists rate influences on their development. Aust Psychol. 2001;36(2):139-148. doi:10.1080/00050060108259646. Edgar L, Roberts S, Holmboe E. Milestones 2.0: a step forward. J Grad Med Educ. 2018;10(3):367-369. doi:10.4300/JGME-D-18-00372.1. Gude T, Finset A, Anvik T, et al. Do medical students and young physicians assess reliably their self-efficacy regarding communication skills? A prospective study from end of medical school until end of internship. BMC Med Educ. 2017;17(1):107. doi:10.1186/s12909-017-0943-y. Puder D, Dominguez C, Borecky A, et al. Assessing interpersonal relationships in medical education: the connection index. Acad Psychiatry. 2022;46(6):683-691. doi:10.1007/s40596-021-01574-0. World Health Organization. Regional Office for Europe Health and care workforce in Europe: Time to act. World Health Organization. 2022. https://www.who.int/europe/publications/i/item/9789289058339. |
فهرسة مساهمة: | Keywords: adverse childhood experiences; burnout; coping; emotion regulation; medical education; occupational psychology |
تواريخ الأحداث: | Date Created: 20240103 Date Completed: 20240208 Latest Revision: 20240624 |
رمز التحديث: | 20240624 |
DOI: | 10.1111/acps.13649 |
PMID: | 38167781 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1600-0447 |
---|---|
DOI: | 10.1111/acps.13649 |