Self-perceived Stress and Job Satisfaction among Lebanese Dentist

Samar Abou Jaoude¹, Maha H. Daou^2* and Sara Khazaka^1
*Correspondence: Maha H. Daou, Department of Pediatric Dentistry, Mcgill University, Canada, Email:

Keywords

Job satisfaction; Stress; Dentist; Workplace

Introduction

Stress is a subjective sensation with a varied degree of perception [1]. It describes external demands (physical or mental) on an individual’s physical and psychological well-being [2,3].

Stress is a state of human psychological conflict arising from external threats that are constantly above or beyond the ability to manage, and an indispensable survival factor for individuals with limited resources in modern life [4].

Research on stress in health professions has mainly focused on doctors and nursing staff with minor studies about dentists, while it is recognized that dentistry is a stressful profession [2,5,6]. Although stress or pressure in a job can have a positive influence by increasing motivation, if it exceeds an individual’s ability to manage it can have a negative impact on mental health and well-being and potentially could lead to professional burnout [7,8].

The dental work is a unique social interaction influenced by specific demands of the clinical practice, exposure to an intimate and very sensitive area of the human body, personal characteristics and emotions of a health care provider and its recipient [9].

Dentists face numerous daily workplace challenges, such as working in uncomfortable positions, high noise levels, defective equipment, variability of treatment outcomes, financial matters, legal hazards, treating difficult patients, coordination of staff members, time and scheduling pressures, administrative responsibilities, periods of prolonged concentration and social isolation [6,10]. Such work stressors may disrupt the physical and mental well-being of dentists, progressively leading to outcomes such as burnout, the development of anxiety, depression, even suicidal thoughts and substance abuse involving alcohol and/or other drugs [5,6,10,11]. In addition, the high occupational stress can reduce work productivity, and lead to poor care for patients, which eventually affect negatively the quality of the public health [12].

Many of the psychological signs of stress manifest themselves as physiological responses. The physical disorder reported most frequently by dentists is lower back pain. Other physical manifestations include headaches, fatigue, dizziness, tachycardia and gastrointestinal problems [13,14]. Among the psychological disorders associated with stress are anxiety and depression [14].

Job satisfaction has been described as the “positive emotional state resulting from the appraisal of one’s job or job experience” [15,16]. The perception of high job satisfaction is not only an individual matter for the dentists, but it also provides a positive external outcome for patients and staff, as low job satisfaction is associated with low performance, suboptimal health care delivery, and clinical outcomes of primary care providers [17]. Subsequently, this can lead to loss of continuity of care [15,18].

Several studies have been conducted to evaluate stress and job satisfaction among dentists around the world. In Lebanon such scientific data is insufficient. There has been a lack of research on dentist’s occupational stress and mental health state. Therefore, the aim of this study was to evaluate occupational and psychosocial stress, job satisfaction among dentists in Lebanon. A further objective was to evaluate which factors were related to overall stress in Lebanese dentist’s life, stress manifestation and stress management.

Materials and Methods

A questionnaire focusing on psychosocial stress and job satisfaction of dentists was prepared. This research, which was an observational crosssectional study, and its consent procedure were approved by the ethics committee of the Saint-Joseph University (USJ) Beirut, Lebanon, in accordance with the World Medical Association Declaration of Helsinki.

The questionnaire was pretested and auto-administrated on a sample of 30 lecturer dentists arbitrarily chosen from the dental school of Saint Joseph University. Changes of this questionnaire which included 50 questions were done agreeing to this pilot study. Thereafter, the enhanced questionnaire was distributed in three languages (Arabic, French and English) to the general dental practitioners (GDPs), the specialists and the lecturers who attended the 3-day francophone symposium organized by USJ in 2014. This questionnaire was auto-administrated by each participant. The inclusion criteria were the Lebanese dentists registered in the Lebanese dental association who accepted to fulfill the questionnaire. The non-Lebanese dentists were not included in the study.

The number of Lebanese and non-Lebanese dentists attending the symposium (including the lecturers) was 1,100. A sample of 350 Lebanese dentists was randomly selected using the random number table generated by hand. The response rate was 90%, as 314 dentists accepted to participate in the study.

The outcome variable of the study was the presence of psychosocial stress (Yes/No), relationship problems with patients (Yes/No), concerns related to work accident (Yes/No), problems with assistant (Yes/No), conflict issues with dental technician (Yes/No), job satisfaction (Yes/No).

The predictor variables of the study were: gender, kind of practice, years of dental practice, mean number of working hours per day, number of tourist trips per year, number of vacation days per year, mean number of sleeping hours per night, addiction (Yes/No), sleep disorders (Yes/No), sick leave (Yes/No), interest for art (Yes/No), rest break between appointments (Yes/ No), outdoor activities, cultural activities, leisure activities, sport, listening to music while working.

SPSS for Windows (version 25) was used to achieve the statistical analyses. The level of significance was set at p ≤ 0.05. Mean and standard deviation were Univariate analyses followed by multivariate analyses were executed to assess the factors associated with psychosocial stress, relationship problem, fears related to work accidents and satisfaction. Chi-square tests and Fisher Exact tests were performed for the comparison of percentage. Student t tests and Mann-Whitney tests were used for the comparison of continuous variables. Logistic regression analyses were performed and the explanatory variables with a p<0.200 were included in the model. Collinearity assumptions were verified and explanatory variables highly correlated were excluded from the model.

Results

A total of 314 dentists (184 male and 130 female), aged 39.2 ± 11.66 years, completed the questionnaire; 45.9% were general practitioners. The results revealed that 90.8% (n=285) were satisfied with their work and 54.8% (n=172) had got rest breaks between appointments. Our study showed that 37.3% (n=117) always listen to music while working and 69.1% (n=217) didn’t have any addiction. However, 23.2% (n=73) had sleep disorders although the sleeping hours per night was 6.79 ± 1.30 h (n=298). Concerning activities, 52.5% (n=165) had cultural activities and 60.2% (n=189) leisure activities. In the other hand, rarely are the dentists who had practiced outdoors activities 65.9% (n=207).

Concerning sports activities, 49.7% (n=156) practiced it occasionally and 36.3% (n=114) did so frequently. In addition, 51.9% (n=163) have had interest for art and 20.4% (n=64) had taken sick leave. Our statistics revealed that the number of touristic trip was 1.57 ± 1.06 per year (n=266) and the number of vacation days/year was 7.04 ± 6.095 (n=55). The mean number of years of dental practice was 15.50 ± 11.18 years (Range: 0–45 years). The mean number of working hours per day was 6.99 ± 2.13 hours (range 2-15). Common stressors identified as occurring very often or always are presented in (Table 1).

Results relating to psychosocial stress

The sport was significantly associated with the presence of psychosocial stress; the presence of restrictions was less prevalent among dentists who frequently practiced sport (13.3%) and higher among dentists who did not practice sport (40.7%). In addition, psychosocial restrictions were prevalent among dentists who did not have leisure activities (p=0.026) and those with sleep disorders (p<0.001). However, the average number of vacation days was significantly lower among dentists with psychosocial restrictions (p=0.013) (Table 2).

Results concerning the relationship problems with patients

The presence of relationship problems with patients was significantly prevalent among dentists without outdoor activities (p=0.020) (Table 3).

Results about concerns related to work accident

The average number of hours of sleep was significantly lower among dentists with fears related to work accidents (p=0.034) (Table 4).

Results related to the problems with the assistant

Conflicting problems with the assistant were significantly associated with the lack of leisure activities (p=0.035) and with the number of sick days per year (p=0.045) (Table 5).

Results about the relationship problems with dental technician

The presence of conflicting problems with the prosthetist was less prevalent among dentists who frequently practiced sport (16.4%) and higher among dentists who did not practice sport (38.7%) (p=0.026). In addition, problems with the dental technician were significantly associated with lack of cultural activities (p=0.010), sleep disorders (p=0.045), the presence of dependence (p=0.010). The problems were more frequent among dentists who take sick leave (317%) compared to those who do not take sick leave (19.2%) (p=0.036). Also, the average number of years of experience was significantly smaller among dentists with problems (p=0.013) (Table 6).

Results about job satisfaction

Job satisfaction was significantly associated with the presence of cultural activities (p=0.008) and the number of years of experience (p=0.038). Young dentists were significantly more satisfied with the profession than older dentists (Table 7 and 8).

Discussion

The sample of 314 Lebanese dentists, which was randomly selected, completed the questionnaire.

Job satisfaction

Our results revealed that 90.8% of Lebanese dentists were satisfied with their job. While studies have shown different levels of satisfaction of dentists about their profession in other countries. For example, 90% of the Polish dentists, 82.6% of the Australian dentists and 80.7% of the Lithuanian dentists were highly satisfied [9,16,19]. While in UAE 3.7 ± 1.2 out of 5, and 3.08 out of 5 of the Indian dentists were normally satisfied [15,20]. Though, 51% of the Korean dentists and 51.4% of the Egyptian dentists had almost a neutral feeling about their job satisfaction [21,22].

Our results revealed that job satisfaction in Lebanese dentists was significantly associated with the number of years of experience (p=0.038). The younger dentists who had 15 years (± 11) of experience where found to have higher job satisfaction than those with 21 years (± 11), this is with accordance with the study done in India, where dentists who had clinical experience less than 5 years have higher satisfaction levels (3.12 ± 0.31), similarly a study in Australia revealed that dentists aged between 35-54 years old are less satisfied and job satisfaction is decrease with years in Brazil [16,20,23].

The negative association between age and job satisfaction could be attributed to more responsibilities, demands, family commitments and increased stress associated to sustain a modern practice.

Our results showed that job satisfaction in Lebanese dentists was significantly associated with the presence of cultural activities (p=0.008), this is in accordance with a Norwegian study on doctors that revealed a significant correlation between the doctors’ level of cultural activity and their job satisfaction [24]. Cultural activities could be considered as a matter of relaxation from a hardworking day.

Results relating to psychosocial stress

Our results showed that there is relationship between sports and stress: 86.7% (n=91) of the dentists practice sports and don’t have psychological stress this is in accordance with the study in Iran that showed that 45.2% of dentists use sports as a strategy to destress while in New Zealand 64% of dentists use sports to manage their stress, in Romania 59% (n=250) adapt sport as a prevention attitude [3,25-29].

Over 56.5% (n=35) of Lebanese dentists have sleep disorders associated to psychosocial stress which is in accordance with a study made in UK where 60% (n=2441) of dentists reported difficulty in sleeping, in Romania 59% (n=250) sleeplessness was reported and 74% (n=2449) of Lithuanians dentists [5,9].

The most common techniques for managing stress were resting and engaging in sport activities, participation in a stress management course would help to learn to manage stress levels [27].

Stress management and coping behaviors should therefore be included in the dental curriculum in order to avoid physical and psychological problems that may occur later as a result of occupational stress. Moreover, workshops, seminars and education programs on occupational stress for clinical dental staff should be organized periodically, a continuing professional development package to reduce stress, build resilience and improve clinical decision-making, improve dentist well-being and decision making [27,30].

Results concerning the relationship problems with patients

The presence of relationship problems with patients was significantly prevalent among dentists without outdoor activities (p=0.020). In Lebanon 5.7% (n=18) are dealing with aggressive patient while 43% of the dentist in Iran are coping with difficult patients, in UK 61.2% had difficult patients [8,27]. In Lebanon 51.9% (n=163) had payment issue while in Iran 14% felt underrated by patient and 48.4% had collection payments [27]. In Lebanon 3.8% (n=12) patient dissatisfaction while in Iran 25.8% were stressed because of lack of patient appreciation while in UK 75.1% are stressed of having dissatisfied patient [8,27]. In Lebanon 24.8% (n=78) patient were anxious while in Iran 26.9% dentist treated nervous patients, in Denmark 14% of dentists reported having anxious patients [28]. In Lebanon 41.7% forget their appointment in Iran cancellations/no-shows were 35.5%. To treat the anxious dentists have to apply talking strategy with patients, followed by assuring painless treatment and use of pharmacological remedy

Results about concerns related to work accident

Our results showed that 42.7% (n=134) had concerns related to work accident, these results meet the study in Hong Kong where 51.5% (n=299) were stressed of making mistakes during their practice, while 74.9% of UK dentists are stressed of making a mistake however 19.4% of Iranian dentists have this concern [8,26,27]. Our results showed that the average number of hours of sleep was significantly lower among dentists with fears related to work accidents (p=0.034).

Problems with the assistant

Our results showed that 14% (n=44) Lebanese dentists have misunderstanding with the assistant while in U.A.E the dentists were most satisfied with their assistant and 71.6% of Australian dentist were satisfied in their relationships with staff [16]. In Yemen management of auxiliary staff constituted 52.9% of the stressor factors of the dentists [14].

It showed that problem with the assistant is significantly associated with the lack of leisure activities and with the number of sick days per year (p=0.045) (Table 5).

Results about the relationship problems with dental technician

Our results showed that 21.3% (n=67) of Lebanese dentists have relationship problems with dental technician. Quality of communication between dentists and private laboratory technicians in Khartoum was largely inadequate [25].

The presence of conflicting problems with the dental technician was associated with sport, with lack of cultural activities, with sleep disorders, the presence of dependence and with taking sick leave. Also, the average number of years of experience was significantly smaller among dentists with problems (p=0.013) this could be explained by the lack of experience, practice and manual dexterity in the youngest.

Results of multivariate analysis between the different variables

Results of this statistical analysis showed no statistically significance between the different variables except for the sleeping disorder and psychological stress (p<0.02) (Table 8).

Conclusion

In conclusion, our findings indicate a potential stress of Lebanese dentists. Although the majority are satisfied with their job and enjoy their professional lives, some dentists are experiencing issues with dental laboratory, assistant and stressed patients.

Elimination of stress from dental practice is unavoidable. However, recognition and understanding causes of stress is the first step to be taken for prevention, therefore, preventive programs should be initiated to help professionals to cope with their professional duties without hazardous effects on their mental health. Continual education programs on stress management should be proposed to all dentists and must be incorporated for dental students at dental schools.

It is also important to teach dentists to engage early in sport activities, relaxing activities, to rest and take breaks. Moreover, obligatory topics of studies should include: financial business management, psychology and oratory that could be an important step to help reduce the prevalence of mental health problems among dentists in our country.

Acknowledgement

We would like to thank all the dentists who participated in this research.

Conflicts of Interest

It is declared that there is no conflict of interest.

Author Contribution

Dr. Samar Abou Jaoude was in charge of data collection and writing the manuscript. Maha Daou has supervised and corrected the manuscript. Sara Khazaka has corrected and submitted the manuscript.

Ethical Approval and Consent to Participate

All methods in this study were carried out in accordance with relevant guidelines and regulations. The experimental methods applied in this study were confirmed by the Ethical Committee at the Saint Joseph University. Informed consent of the participants was obtained prior to the questionnaire they have filled.

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