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ORIGINAL ARTICLE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1377--1383

Gender Differences in Perceived Stress among Neurosurgeons: A Cross-Sectional Study

Anita Jagetia1, Krishna Vaitheeswaran2, Mahesh Mahajan3, Binita Dholakia3, B Indira Devi4,  
1 Department of Neurosurgery, Moolchand Medcity Hospital, New Delhi, India
2 Consultant Ophthalmologist, Moolchand Medcity Hospital, New Delhi, India
3 Department of Neurosurgery, GIPMER, New Delhi, India
4 Senior- Professor Neurosurgery and Dean Neurosciences, NIMHANS, New Delhi, India

Correspondence Address:
Anita Jagetia
Department of Neurosurgery, GIPMER, New Delhi
India

Abstract

Purpose: Surgeons are subjected to enhanced levels of work-related stress and women are likely to face unique challenges due to sub-optimal representation. The present study was conceived with a primary objective to study the gender differences faced by surgeons and neurosurgeons in particular. The secondary objective was to assess the correlation between the various stress inducers and busters of normal working and daily life and the mental state of neurosurgeons. Methods: The study was a cross-sectional, multi-centric study in which a structured questionnaire was sent to neurosurgeons through various neurosurgical forums of the country. A total of 93 complete responses were included in the study. The questions were broadly divided into four themes, demographic working data, stress inducers, stress busters, and questions to reflect the mental state of the respondent. Results: There were 74 males and 19 females in the study, with an average age of 39.34 ± 8.57 years. Statistically significant gender differences were noted in rating the out-patient department (OPD) hours, lectures and seminars, performing and assisting surgeries, attending conferences and working in the intensive care unit (ICU), with women scoring lower than men for these activities. There were no significant gender differences in the mental state of the respondents. A strong correlation was found between scoring for performance and assisting of surgery and the mental state questions, and a strong negative correlation was noted between music, playing games, going to the gym, practicing yoga and the mental state questions, indicative of a protective effect. Conclusions: There was no significant gender differences in the perceived stress levels among neurosurgeons. Women appeared more comfortable with certain normal activities of working. A strong negative correlation was reported for activities such as music, playing games, yoga, and going to the gym, indicating a protective effect.



How to cite this article:
Jagetia A, Vaitheeswaran K, Mahajan M, Dholakia B, Devi B I. Gender Differences in Perceived Stress among Neurosurgeons: A Cross-Sectional Study.Neurol India 2022;70:1377-1383


How to cite this URL:
Jagetia A, Vaitheeswaran K, Mahajan M, Dholakia B, Devi B I. Gender Differences in Perceived Stress among Neurosurgeons: A Cross-Sectional Study. Neurol India [serial online] 2022 [cited 2022 Dec 8 ];70:1377-1383
Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1377/355171


Full Text



Women have been involved in surgical care of patients since time immemorial. Despite this and the fact that there are an increasing number of women in medical universities, their representation in surgical specialties, particularly in neurosurgery, is sub-optimal. Gender prejudices and concerns about the stresses faced by surgeons in general and neurosurgeons in particular may account in part for the choices.

Surgeons and care givers are particularly prone to the deleterious effects of stress and professional burnout as their actions can have profound impact on the lives of their patients.[1],[2],[3] It has been estimated that 15% of physicians will be hampered by mental illness, alcoholism, and drug dependency at some point in their careers.[4] Women surgeons are more likely to report conflicts between family and career.[5] Additionally, they have until recently not been adequately represented in the specialty, leading to unique contributors to pressure of work and adverse mental states.

The present study was conceived with a primary objective to study the gender differences between perceived stress levels along with the aggravating and relieving factors of normal working and daily life. The correlation between these factors and the mental state was also planned to be studied in a cross sectional, multi-centric, questionnaire-based study.

 Methods



The study was a cross-sectional, multi-centric study in which a structured questionnaire was sent to neurosurgeons through various neurosurgical forums of the country. The primary objective was to study the gender differences among surgeons, and the secondary objective was to evaluate the correlation between various stress-inducing activities among normal working as well as stress relieving activities of daily life, with the surgeons' mental state as reflected in the questionnaire.

The questions were broadly divided into four themes, demographic working data, stress inducers, stress busters, and questions to reflect the mental state of the respondent. A scale of 0–3 was used in all questions to assess the severity or degree of agreement to the query with 0 being no agreement and 3 being maximum agreement.

The respondents included 74 male surgeons and 19 female surgeons.

Continuous variables were expressed in mean and standard deviation whereas categorical variables were expressed as proportion and percentages.

Inferential statistics for the continuous variables was performed using non-parametric tests such as the Wilcoxon rank-sum test and the Mann–Whitney U test with continuity correction. Categorical variables were analyzed using the Chi-squared test or Fisher's exact test when appropriate. Variables with P value of <0.05 were considered statistically significant.

All data visualizations and analyses were performed using R version 3.5.0 (2018-04-23).

 Results



A total of 93 complete responses were included in the study for the analysis. These included 74 responses from males and 19 from females, with an average age of 39.34 ± 8.57 years. The sample characteristics are summarized in [Table 1].{Table 1}

The gender differences in the sample group did not reach statistically significant levels when comparing age [Figure 1] and relationship status [Figure 2]. There was a statistically significant difference between males and females in the number of years in the specialty [Figure 3].{Figure 1}{Figure 2}{Figure 3}

The responses to the questions were analyzed for gender differences and showed statistically significant differences in rating the out-patient department (OPD) hours, lectures and seminars, performing and assisting surgeries, attending conferences and working in the intensive care unit (ICU) [Figure 4].{Figure 4}

Among the stress busters, significant gender differences in the response to the questions was seen in dancing and cooking as stress busters. There were no significant differences in the other questions with respect to stress busters.

There were no significant gender differences in the questions relating to the mental state [Figure 5] except feeling little pleasure in doing things where significant differences in the response distribution was noted.{Figure 5}

The scoring for the individual questions is presented in [Table 2].{Table 2}

A strong correlation was found between scoring for performance and assisting of surgery and the mental state questions [Figure 6].{Figure 6}

A strong negative correlation was noted between music, playing games, going to the gym, practicing yoga, and the mental state questions [Figure 7].{Figure 7}

 Discussion



The study was a cross-sectional, multi-centric study with a primary objective to study the gender differences in the mental state of surgeons and a secondary objective to assess the correlation between the mental state of the surgeons and the various stress-inducing and relieving activities. This was done using a structured questionnaire with a scale of 0–3.

The first historical record of a woman surgeon is of Queen Shubad of Ur,[6] who worked 5000 years ago showing great commitment to her patients and work. However, till the 1970's women only accounted for 6% of medical students in the US.[6] Though this trend has reversed today, with more medical students being female in the UK and the US, concern about gender discrimination continues to linger.[7]

In the demographic assessment, more than 81% of neurosurgeons are married and a majority had 5–15 years of experience in this field. This indicates that neurosurgery is not a hindrance in the social life of neurosurgeons, as is thought by many young residents. Fifty-two point six percent of women in the present study had 10 or more years of work in the specialty whereas only 37.8% of men had been in the specialty for more than 10 years. This reflects the level of comfort and acceptance in the specialty, negatively colored by gendered perceptions often enough to prevent women residents from taking it up.

In this study, however, there was no significant gender differences noted in the responses to questions elucidating the respondent's mental state except the question asking if there was no interest or pleasure in doing things where a statistically significant difference was noted. Males scored higher than females in their responses, indicating that a higher proportion of males agreed about the presence of this mental state.

There were no significant gender differences in the responses to questions designed to elicit depressive mental states. Mental state issues were not seen to be related to gender except in the score for interest and pleasure where male dominance was noted, possibly indicating earlier burnout risks.

There were significant differences in the scoring pattern among men and women surgeons for various stress inducers including OPD, administrative work, taking classes, performing and assisting surgery, and working in the ICU, as well as attending conferences and zoom calls. The average scoring pattern was higher for men, indicating that women were more comfortable than men in these events of normal work. The only exception was the attending of conferences where men scored lower than women.

These results indicate a high level of comfort in normal work and a greater adaptation to the needs of daily functioning among women than men. Neurosurgical training and working have been considered difficult and therefore a deterrent to women entrants to the specialty.[8] The present study illustrates the greater comfort and adaptation to normal activities of work among women, paving the way to reconsider conventional thought.

The questions on stress relievers had comparable responses among women and men except for dancing and cooking where higher scores were reported by women. The adaptation pattern for the surgeons were similar and had little gender differences.

The correlation assessment between the mental state and stress inducers revealed a strong positive correlation between questions probing the performance and assisting of surgery and the mental state. For surgeons, this reflects the need for continued training and improving of surgical skills for generalized well-being. Professional bodies should support surgical wet labs and retrain enhanced skills not merely to improve clinical acumen but also to direct toward the mental health of the care giver.

The study showed a strong negative correlation with activities such as exercise, yoga, music, and playing games. People who scored higher on these activities scored lower in questions seeking out negative mental states. Such lifestyle activities indicate the need for the care giver to rethink their busy schedules and incorporate protective mechanisms through lifestyle changes.

The study was limited by it being a questionnaire distributed in a social media group. Respondents may have been reluctant to reveal the true stress levels in such a design. The reflective nature of the questions may have introduced recall bias. Women and men report and experience stress differently and a more rigorous evaluation with standardized questions for stress assessment may be required as a follow-up study. A larger sample size would have allowed subset analysis.

The study brings forth the realization that surgical disciplines and neurosurgery in particular is a good career choice for women. The young medical students at their beginning of the career should not be swayed by gendered prejudices and should consider working in the field of their choice, in an environment free from discrimination. All surgeons should consider lifestyle modifications in their rushed and busy schedules to protect and maintain their well-being so as to continue to provide quality care to society.

 Conclusion



Women are naturally gifted to take stress in a positive way, and neurosurgery should not be perceived as a stressful branch. All surgeons and, for that matter, all human beings should modify their lifestyle to deal with stress and incorporate various activities. This can be achieved by following yoga, exercises, sleep, food, recreation and meditation in moderation to eliminates stress.

Ethical clearance

The study was conducted according to the tenets of the Declaration of Helsinki. No institutional ethical clearance was required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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