This study related to the prevalence of depressive symptoms was an ancillary study of the survey dedicated to the burnout among French ICU physicians
[2].
Data collection
All directors of French adult ICUs from public hospitals were first contacted by letter and asked to participate in the study. In the agreement form, ICU directors had to indicate if they agreed to participate to the study and were asked to give the number of physicians (attending physicians, fellows, interns and residents) working in their ICU.
Survey instrument
Each participating ICU received two types of documents validated by the members of the study board (NE, EA, KB, NKB, FP, AL, and LP). The first had to be completed by the director of the unit and was designed to describe the intensive care setting: information about the ICU; activity the year before (no. of admissions, duration of stay, Simplified Acute Physiology Score (SAPS) II score on admission, mortality); patients per nurse ratio; number of nurses and physicians who were on sick leave for more than 1 week the year before; presence of a discussion group and/or a psychologist in their unit.
The second document was a self-administered questionnaire for each physician working in the ICU. A covering letter outlining the purpose of the study along with a three-page questionnaire was sent to each participant. The letter also explained that the responses would be anonymous. The questionnaire was divided into four parts. Part 1 included basic demographic data, data concerning their professional activity, some questions about experiences during the past week (number of night shifts, number of their patients who died, number of decisions to withhold/withdraw treatment, conflict with other intensivists, ICU nurses, or patients’ families), and five questions about their situation the day of the survey: number of patients under his or her responsibility, night shift before the survey, on leave the day before the survey, probable death of a patient, decision of withholding/withdrawing treatment. Two more questions were asked about the number of conflicts with nurses and other intensivists the year before. Intensivists also were asked to rate their relationships with nurses, chief nurses, non-ICU physicians, and hospital management on a scale of 0 to 10. Intensivists were asked about their workload (mean number of work hours per week during the previous 6 months, mean number of night shifts per month the previous 6 months, time elapsed since their last week of holidays/last weekend off/last day off).
Part 2 consisted of the Maslach Burnout Inventory (MBI) scale. The MBI is a 22-item questionnaire that has been shown to be reproducible and valid
[3, 8]. The inventory asks respondents to indicate on a 7-point Likert scale (which does not include the word “burnout”) the frequency with which they experience certain feelings related to their work during the last week preceding the day of the survey. Burnout was defined as a high level of MBI. For the French population, a high level of burnout is defined by a MBI score higher than −8
[9].
Part 3 consisted of the Center for Epidemiologic Studies Depression Scale
[10]. The Center for Epidemiologic Studies Depression Scale (CES-D) self-report includes 20 items comprising six subscales reflecting major dimensions of depression (depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite, and sleep disturbances). Items refer to the frequency of symptoms during the last week and are scored on a 4-point scale ranging from 0 (rarely or none of the time) to 3 (most or all over the time). Question scores are summed to provide an overall score ranging from 0 to 60. Intensivists with scores of 19 or more for men and 23 or more for women were considered in the present study as presenting depressive symptoms. The CES-D was validated in French
[11]. Due to the cross-sectional nature of this study, it is important to state that the single administration of the CES-D score does not represent a true diagnosis of depression, which is much more complex to establish. No services were provided for the respondents who presented depressive signs.
Part 4 of the survey consisted of seven questions regarding intensivists’ private lives using a 4-point categorical scale, as for the CES-D, from never to frequently. All respondents were asked to put their anonymous questionnaire in an envelope. In each center, all these envelopes were put in a single return envelope addressed to the researchers.
Statistical analysis
Data are expressed as mean ± SD or median with interquartile range (IQR) according to the distribution of the data. One-way analysis of variance or Wilcoxon signed-rank test (according to the distribution of the data) was performed to compare continuous variables. To identify variables associated with depression, logistic regressions (forward-stepwise selection) were performed. All variables with a p value < 0.2 in the univariate analysis were entered in the model. The final models expressed the odds ratios (OR) and 95% confidence intervals (CI). Because some of the predictor variables used in the analyses was collected at the level of the ICU rather than the level of the physician, an analytic approach that incorporates a clustered design [generalized estimating equations (GEE) methodology)] was also used. A p value < 0.05 indicated significance. The statistical analyses were performed by using the SPSS software package version 15.0 (SPSS Inc., Chicago, IL).