Work-life balance among mental health professionals in a tertiary care neuropsychiatry centre in India

ABSTRACT

Background:

Stress and distress are common among Mental Health Professionals (MHP). MHPs avoid seeking professional help to address their stress, leading to increased vulnerability to stress and mental health conditions. Inadequately addressed stress directly impacts their service delivery and well-being. However, a serious dearth of literature from India has examined the extent of work-life balance (WLB) stress and psychological distress (PD) among MHP.

Aim:

This cross-sectional study aims to assess WLB and examine the relationship between perceived stress (PS), PD, burnout, and WLB among MHP in a tertiary care neuropsychiatry center.

Methods:

Using stratified random sampling, 101 MHP were evaluated using Pareek’s work-life balance scale, Stamm’s professional quality of life (ProQoL) scale, WHO’s self-reporting questionnaire, and Cohen’s perceived stress scale. Data were analyzed using appropriate parametric or non-parametric tests.

Results:

The overall mean score on WLB was 80.45 (SD = 10.21), the PS scale was 24.86 (SD = 6.87), the burnout score was 22.68 (SD = 6), the ST score was 21.18 (SD = 6.35), and PD score was 5.07 (SD = 5.23). The level of WLB score was average to below average among 64% of participants. There is a positive correlation between WLB and compassion satisfaction (CS) and a negative correlation between ST and PS. The study found that the nature of the job, CS, and PD shall predict WLB.

Conclusion:

Stress, burnout, ProQoL, and WLB of MHPs vary significantly by job, income, and staying with family, indicating that MHPs are equally vulnerable to stress and burnout and imbalanced WLB, which require appropriate interventions.

Work-life balance (WLB) reflects an individual’s capacity to fulfil their duties inside and outside the work premises[1] and experience lesser conflict between the work and other roles. Work-life imbalance, stress, and psychological distress (PD) may be secondary to factors like demanding job roles, competitive workspace, lack of resources in terms of infrastructure and workforce, poor job satisfaction, unsupportive organizational structure, role multiplication, the shift in employment, emotional intelligence, and individual’s personality constructs.[2-4]

Mental Health Professionals (MHP) work at various levels to provide care and support to the mentally ill through promotive, preventive, and curative mental health services. At least 10% of the Indian population suffer from some form of mental health issue, and the number of MHP is 0–2 per one lakh population.[5] The available beds for mentally ill patients are 21,000 in the government sector and 5,100 in the private sector.[6] The treatment gap for mental health conditions varies between 70 and 90%.[7] Mental health care is usually handled by a multidisciplinary team (MDT) consisting of psychiatrists, psychiatric social workers (PSW), clinical psychologists (CP), and psychiatric nurses (PN) who perform different roles and responsibilities. It is an understatement that MHP is overstretched in discharging their duties in India. In this scenario, MHP is prone to work-life imbalance, leading to stress and distress.[5]

Stress refers to a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.[8] One cannot assume that MHPs would handle stress due to work-life imbalance only because they are trained and working for the well-being of the mentally ill. It has been reported worldwide that MHP is more susceptible to stress and burnout.[9,10] They often neglect self-care, making them vulnerable to stress and burnout, impacting their mental health.[11,12] WLB is usually disturbed due to factors like multitasking, role pressure, role conflict and role overloading due to situational practices and occupational dynamics, personal resources and available social and emotional support, career orientation and stage, stipulated timelines, coping resources, and strategies among MHP.[13,14] Additionally, MHPs stress themselves for their patients’ poor clinical response and recovery. A sense of powerlessness to deal with mental illness and its associated loss, grief, fear of turning mentally ill, or a desire to separate from and avoid patients to escape these feelings is commonly noted.[15]

In India, MHPs face a host of additional difficulties and challenges, notably less number of mental health personnel and a high patient ratio, which is one of the highest in the world.[5,16,17] The developed countries focus on the distress and well-being of MHPs for better quality of care and improved service delivery.[18] In India, while there have been case reports on stress and distress among residents, nurses, clinical psychologists (CP), and psychiatric social workers (PSW),[10,14,18-20] studies on work-life balance (WLB), professional quality of life (ProQoL), are not studied systematically. This study assesses WLB, perceived stress (PS), psychological distress (PD), and ProQoL in a group of MHP working in India’s largest tertiary care neuropsychiatry center.

MATERIALS AND METHOD

This study was conducted at a tertiary neuropsychiatric care center in India. The sample size was estimated by assuming a standard deviation (SD) of 11 and margin of error of 2-unit score and a 95% confidence level; the minimum sample size required is 117. MHPs are the person working in a multidisciplinary team (MDT) in a mental health setting. MDT refers to the team consisting of a psychiatrist, psychiatric social workers, clinical psychologists, and psychiatric nurses. MHP designation was considered as one stratum, and the research sample selection was based on 1:5 ratio. Online random numbers are generated from www.random.org. Overall, 130 professionals were selected from among 570 professionals by employing stratified random sampling from four mental health allied departments: psychiatry, psychiatric social work, clinical psychology, and psychiatric nursing. One hundred and one/130 MHP completed the key variables of interest for this study.

The Institute Ethics Committee approval was obtained. The researcher obtained formal permission to conduct the study from the respective departments and written informed consent from the participants before providing self-rating questionnaires. Ethical approval and informed consent were attained in accordance with the Helsinki declaration (2000). External trainees and those unwilling to consent were excluded from the study.

The subjects were assessed using a semi-structured investigator-developed socio-demographic data sheet for background information about the respondents. WLB was measured using 36 items, a five-point Likert scale comprising six domains and 36 items. The higher the score higher the WLB is.[21] PS scale-14 was used to measure PS. It has a five-point Likert scale from never to very often. A higher score indicates a higher PS level.[22] Self-reporting questionnaire (SRQ) is a 20-item self-report screening tool; it employs a yes/no answer format with a precedence period of 30 days’ history of psychological symptoms.[23] The higher score indicates the need to assess mental health issues in India.[24] ProQoL version-5 scale consists of three domains (compassion satisfaction (CS), burnout, and secondary traumatic stress) and 30 items in Likert point questions from never to very often. ProQoL-5 specifically measures one’s experience in the last 30 days. Psychometric testing of the scale has shown high reliability.[25] This scale is widely used to measure QOL among professionals, including India.[19,26]

The data were analyzed using the Statistical Package for Social Sciences.[27] Descriptive statistics for age, gender, marital status, monthly income, profession, job nature, and experience were calculated for all variables. Shapiro–Wilk test was performed to test for normality. WLB, PS, CS, and burnout scores followed a normal distribution. ST and PD scores were not normally distributed. Bivariate analysis (independent t-test and Mann–Whitney U test), analysis of variant, and Kruskal–Wallis test were used to examine any significant group difference between the dependent variables (PS and PD). Further, the relationship between variables was examined using Spearman’s correlation coefficient. The level of significance for all tests was set at 0.05.

RESULTS

The socio-demographic profile and mean score of the key variables are summarized in Table 1.

Table 1.

Socio-demographic Profile (n=101)

	Variables	Category	Frequency	Percent
1.	Gender	Male	50	49.5
		Female	51	50.5
2.	Age in years	20-30 years	61	60.4
		31-40 years	33	32.7
		41-50 years	5	5
		> 51 years	2	2
3.	Profession	PSW	46	45.5
		CP	18	17.8
		Psychiatrist	19	18.8
		PN	18	17.8
4.	Professional experience in years	Nil	40	39
		1 to 3	33	33
		4 to 6	15	15
		7 to 9	11	11
		> 10	2	1.9
5.	Monthly Income in Rupees	< 10,000	3	3
		10,001-20,000	20	19.8
		20,001-30,000	30	29.7
		30,001-40,000	6	5.9
		40,001-50,000	5	5
		> 50,001	37	36.6
	Variable	Mean score+SD
6.	Work-life Balance score	80.45±10.21
7.	Perceived stress	24.86±06.87
8.	Psychological Distress	05.07±05.24
9.	Compassion Satisfaction	39.06±05.13
10.	Burnout	22.68±06.00
11.	Secondary Trauma	21.18±06.35

WLB scale score differs significantly with age (P = 0.038), nature of the job (P = 0.05) and participants belonging to department (f = 3.87, P = 0.001), monthly income (0.014), number of children (P = 0.005), and current living setting (0.002). ST differs significantly with participants belonging to department (P = 0.001), nature of the job (P = 0.002), monthly income (P ≤ 0.001), marital status (P = 0.01), current living arrangement (P = 0.003), and participants belonging department (P = 0.02*). Burnout scale scores differ significantly concerning age (P = 0.01), gender (P = 0.02), nature of the job (P = 0.02), monthly income (P = 0.03), marital status (p = 0.05), and current living arrangement (P = 0.005). CS scores differ significantly regarding gender (P = 0.04) and marital status (P = 0.05). PD significant differences with age (P = 0.002), participants belonging to department (P = 0.04), gender (P = 0.003), nature of the job (P ≤ 0.001), monthly income (P ≤ 0.001), current living arrangement (P ≤ 0.001), and participants belonging department (P = 0.04). PS scale scores differ significantly with respect to age (P = 0.01), gender (P = 0.02), nature of the job (P = 0.001), monthly income (P = 0.02), marital status (P = 0.003), and current living arrangement (P = 0.002) [Table 2]. WLB and MHP time spent with family’s [r = 0.2*, (P < 0.05)], CS [r = 0.25* (P = 0.01)] is positively correlated. Correlation test results are summarized in Table 3.

Table 2.

Comparison of Socio-demographic Variables and PS, Burnout, & Work-Life Balance

Variables	Category	n	WLB		ST		Burnout		CS		PD		PS
			Mean+SD	P	Median (IQR)	P	Mean+SD	p	Median (IQR)	P	Median (IQR)	P	Mean+SD	P
Age	< 30	61	52±12.7	0.038*	23.3 (9.5)	0.065	23.55±5.87	0.127	38 (7.5)	0.194	5 (9)	0.002*	26.26±6.74	0.011*
	> 30	40	57.7±14.5		36 (7)		21.65±6.39		39.5 (7)		3.32 (5.5)		22.72±6.59
Department	PSW	46	79.83±10.43	0.001**	23 (7.25)	0.002**	23.91±6.6	0.22	38.5 (9)	0.71	5 (8.5)	0.04	24.63±7.3	0.31
	CP	18	79.29±6.38		19.5 (7.5)		21.39±3.38		41.5 (5.5)		3.67 (3.75)		27.5±6.53
	Psychiatry	19	76.6±10.19		16 (2)		20.89±6		39 (8)		1 (4)		24,26±6.47
	Nursing	18	87.11±10.42		20 (9.25)		22.72±6.14		38.5 (7.5)		3 (8.75)		23.44±6.28
Domicile	Urban	80	55.01±13.83	0.269	20 (9.75)	0.831	22.75±5.97	0.868	39 (6)	0.557	3 (7)	0.282	24.43±6.81	0.22
	Rural	21	51.3±12.71		22 (10)		23±6.84		41 (9)		4 (9.5)		26.47±7.01
Nature of job	Student	62	50.54±12.16	<.001*	23 (7.25)	0.001*	24.01±6	0.011*	38 (8.5)	0.105	5 (8.25)	<0.001*	26.56±6.63	0.001*
	Others	39	60.11±13.93		17 (8)		20.87±5.88		40 (7)		1 (4)		22.15±6.42
Monthly income	< 30000	53	51.1±12.23	0.014*	23 (6.5)	0.001*	24.15±6.25	0.019*	38 (9)	0.216	5 (9)	<0.001*	26.32±6.65	0.02*
	> 30000	48	57.7±14.37		16.5 (8)		21.31±5.7		39 (7.5)		1 (5)		23.25±6.8
Number of children	> 1	77	52.13±13.5	0.005*	22 (9.5)	0.05*	23.45±6.27	0.05*	39 (9)	0.867	4 (9)	0.002*	25.94±6.71	0.003*
	> 2	24	60.99±11.97		16.5 (7.75)		20.7±5.19		39 (5)		1 (3)		21.37±6.28
Current living setting	With family	38	59.46±14.01	0.002*	17 (5.75)	0.002*	20.52±5.14	0.003*	40.5 (6.25)	0.067	1 (3.5)	<0.001*	22.23±6.37	0.002*
	Not with family	63	51.07±12.48		23 (9)		24.17±6.3		38 (10)		5 (8)		26.44±6.71

Table 3.

Correlation of Personal and Work Profile, PS, & PD.

Variable	Years of training in mental health	Years of professional experience	PS	PD	CS	Burnout	ST
WLB	0.01	-0.05	-0.04	0.17	0.25*	-0.08	0.07
ST	-0.37**	-0.26**	0.36**	0.60**	-0.16	0.65**	1
Burnout	-0.34**	-0.005	0.44**	0.56**	-0.55**	1	-
CS	0.33**	0.05	-0.29**	-0.34**	1	-	-
PD	-0.32**	-0.39**	0.56**	1	-	-	-
PS	-0.003	-0.007	1	-	-	-	-

*Correlation is significant at the 0.05 level (2-tailed). **Correlation is significant at the > 0.005 level (2-tailed).

Regression analysis was performed to understand the predictors of WLB. WLB was used as the dependent variable, and other statistically significant variables with scores less than 0.10 were used as independent variables. After performing stepwise regression, the significant predictors of WLB were the nature of the job, CS, and PD.

DISCUSSION

The WLB, compassion satisfaction, and secondary trauma level were unknown among MHP in India. This study result provides the opportunity to measure and compare with other countries. WLB scale reveals a high mean score observed in the study, that is, 80.45 ± 10.21, which is close to a study conducted among IT professionals.[28] Among MHPs, psychiatrists have the lowest WLB. This may be due to their nature of work, that is, working as residents with the huge number of caseloads. MHP and information technology professionals have different work requirements, tasks, and responsibilities, but both are highly demanding. This implies that the participants did not have a healthy WLB. It is observed that age and WLB are negatively correlated, and it can be assumed that IT professionals initially may have lower job responsibilities and workload.[28] But in the current study, age and WLB are positively correlated as it can be attributed that MHP would eventually learn to balance work and life as they advance in their career. It is also observed that WLB is found to be associated with family, institutional support, availability of leave on required time, nature of the job, and annual income, which corresponds with the studies done in Africa and India among nursing professionals.[29,30] WLB and type of work, that is, student or employed personnel scores significantly varied similar results were reported from the US.[31]

The mean score of ST was found to be 21.18 ± 6.35. Considering ST among MHPs, PSWs have higher ST. The reasons would be workload, working with the community, and a lower sense of mastery.[32] This score corresponds with the African and Indian studies conducted among medical professionals, which also find ST due to the nature of the job pressuring subjects and their ability to deal positively. ST scores were significant with the amount of time spent with family, social aspects, years of training and experiences, PS, PD, and burnout. Similar results were reported in variation in workload, available resources, and cultural differences in the previous studies observed among mental health and social work students.[26,33-37]

The assessment of burnout reveals a mean score of 22.68 ± 6, which is consistent with the findings of the previous studies conducted in Haryana among female nurses and lady doctors and MHP in Africa.[36,37] These studies observed that burnout is significantly higher among the healthcare professionals like diabetologists, as patients demand more time and more empowerment in shared decision-making to achieve the therapeutic goals, which is similar to the MHP. Burnout can also be high because of younger age and lack of experience in mental healthcare service delivery.[26,36]

The assessment of CS depicts a mean score of 39.1 ± 5.88. The results indicate that the participants have lower CS scores which concur with the earlier studies in terms of the number of years of training and experience in the mental health field.[33-35]

A higher PD score of 5.07 ± 5.23 denotes sub-clinical PD. However, earlier studies did not use SRQ among the MHP. Further, the observed score warrants in case of any precipitating event that increases the chances of psychological symptoms leading to psychiatric morbidity. PSWs had higher PD when compared to MHPs from other departments. This could be due to being single, having more negative life events, and having a lower sense of mastery. This confirms the earlier studies done among community-level workers and the general population.[24,38] Hence, nearly 33% of the participants have significant mental health issues, and the scores are not different from the studies conducted among the general population.[39] This proves the hypothesis that higher work-life imbalance lowers mental health.

The findings of the self-report questionnaire score on age and nature of the job concurred with an Indian study conducted among community-level workers.[38] It is observed from the literature that common psychiatric symptoms found are burnout, sadness, being anxious, substance use of anxiolytic drugs, and alcoholism. Most of them did not seek treatment similar to the general population. This may be due to the stigma associated with mental health issues and self-denial.[40]

The assessment on the PS scale of the subjects reveals a higher PS. These findings may be attributed to work pressure, inability to handle the issues, lack of skills and understanding, and inability to manage in a stipulated time period that might lead them to stress. The mean score of 24.86 ± 6.87 denotes moderate levels of PS,[19] which is similar to the findings observed among MHP from other parts of India, Singapore, and the US.[9,18,19,41-43] It is interesting to observe that no attempt has been made to assess the PS levels of Mental Health Professionals in India.

Current research is found to be consistent with the findings from the earlier studies on PS, age, nature of the job, monthly income, and current living settings. This may be attributed to a lack of experience, individual capacity, personality, emotional involvement with the patients, pressure to complete treatment, increased workload, dealing with multiple needs, role conflicts, younger age, and lack of personal time and support. These observations are in congruence with the studies conducted among health professionals.[9,33,34,44] The participant’s gender, marital status, and having children significantly differ from the stress levels in an earlier study conducted on Psychotherapists.[33] In the current study, there is no significant difference in the aspect of marital status as the majority of the respondents are single, belonging to social work students, clinical psychologists, and MHP.[9,10,45]

The correlation of the participant’s work aspects and measurement of various factors reveal that the extent of the PS, mental health morbidly, CS, burnout ST, and WLB is congruent with the earlier studies.[30,42,46-48] However, the application of instruments differs across studies denoting no uniform outcome.

Contrary to the prevailing opinion that MHPs maintain better mental health practices, the present study revealed that they are equally vulnerable to mental health issues and work-life imbalance, as seen among the general population.[30,39] Results of this study can be generalized in a similar setting.

Most of the participants are students, 50% have undergone 2–4 years of mental health training, and the rest belonged to PhD scholars and permanent workers with more work years of experience. Around 33% of participants had 1–3 years of experience, similar to an earlier study conducted in a mental health setting and PICU nurses.[9,49]

This study was initiated with stratified random sampling; the selected sample for the study is 130. Around 29 participants did not return the questionnaires due to lack of time. Most samples are from the PSW discipline because of decreased response rate from other department researchers who approached known colleagues to reach an adequate sample size. Hence, the study sample size is not equally distributed. The self-administered questionnaires were used to assess the quantitative aspects. However, qualitative aspects of the study would have been assessed. An equal number of participants from different professional backgrounds would have yielded a better perspective.

CONCLUSION

Stress, burnout, ProQoL, and WLB of MHPs vary significantly by job, income, and staying with family, indicating that MHPs are equally vulnerable to stress and burnout and imbalanced WLB, which require appropriate interventions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.