Shift Work Disorder - Prevalence & Burden of Illness in Healthcare Providers of India

Abstract

Background: The proportion of shift workers in the society has taken a big leap in the last 2 decades or so. Thus, the epidemiological significance of shift work disorder (SWD) can no longer be ignored. Emergency Physicians & nurses almost always work in shifts and are an important subset of the population whose health and wellbeing directly and indirectly impacts the morbidity and mortality of the rest of the population. It is thus important to understand the magnitude of the problem in this population. Several studies describe a high incidence of SWD and psychosomatic complaints in EP. The main objective of this study is to examine the prevalence of symptoms of SWD; contribution of demographics, working hours, shift work, morningness/eveningness & sleep hygiene practices to occurrence of SWD, related health & occupational hazards and job satisfaction in a random sample of Emergency Physicians & nurses of India. Methods: A cross sectional survey of nurses and doctors working in emergency departments of at least 12 major urban hospitals across India was conducted during October 2016 – March 2017. Peer validated questionnaire with standard scales, descriptive & objective questions was emailed only to individuals who were known to be working in Emergency departments as nurses and doctors. This convenience-sample of email addresses was obtained through personal and professional contacts of the researcher. Those who volunteered responses were included in the study. No identifying information was collected. Those who reported diagnosed sleeping disorders were excluded from the analysis. For analysis, responses were divided into 2 groups – those who reported symptoms of SWD and those who did not. With aid of a professional biostatistician, these 2 groups were then compared for unique characteristics and statistically significant variables using t test, chi square test, odds ratio and logistic regression Results: Prevalence of symptoms indicative of SWD in a random sample of emergency medicine physicians and nurses in India ranges from 13-27% and was significantly (p=0.048) higher in those who did shift work and night shift work depending on the method of assessment. Women have 3 times higher risk than men. More than half (51%) the number of Emergency medicine physicians and nurses in the study suffer sleep disturbances due to work timings. This group may develop SWD in the future, pending due intervention. SWD is strongly (p<0.02) associated with bad sleep hygiene and excessive daytime sleepiness. The presence of symptoms of SWD also leads to poor job satisfaction. (p<0.05). Majority (60%) report preference for shifts that start later in the day.