title: When general practitioners don't feel appreciated by their patients: prospective effects on well-being and work-family conflict in a Swiss longitudinal study.
abstract: BACKGROUND
  Impaired well-being and high work-family conflict are critical issues among GPs. This research examined an understudied psychosocial risk factor for these outcomes, namely GPs' perception that they invest more in the relationship with their patients than what they receive in return (i.e. lack of reward in their relationship with patients).
  
  
  OBJECTIVE
  To test the effect of lack of reward as a risk factor for poor well-being and work-family conflict among GPs.
  
  
  METHODS
  Longitudinal study (12 months time lag). 272 GPs in Switzerland [mean age 54.5 (SD = 8.3), 73% male] volunteered to participate in the study. 270 participants completed the baseline survey and 252 completed the follow-up survey. Of these, six retired between the baseline and the follow-up survey, resulting in a sample size of 246 participants at t2. Outcome measures were burnout, sleep problems, self-perceived health and work-family conflict.
  
  
  RESULTS
  Strength and direction of prospective effects were tested using cross-lagged models. Lack of reward was related to an increase in emotional exhaustion (β = 0.15), sleep problems (β = 0.16) and work-family conflict (β = 0.19) and a decrease in self-perceived health (β = -0.17). Effects on depersonalization and personal accomplishment were not significant. Regarding reversed effects of impaired well-being on lack of reward, emotional exhaustion (β = 0.14) and self-perceived health (β = -0.13) predicted future level of lack of reward.
  
  
  CONCLUSIONS
  Lack of reward by patients is a risk factor in GPs' mental health.
authors.affiliation: Department of Psychology, University of Fribourg, Fribourg, laurenz.meier@unifr.ch.
authors.forename: Laurenz L
authors.initials: LL
authors.lastname: Meier
authors.affiliation: Institute of Primary Health Care, University of Basel, Basel and.
authors.forename: Peter
authors.initials: P
authors.lastname: Tschudi
authors.affiliation: Institute of Primary Health Care, University of Basel, Basel and.
authors.forename: Cornelia A
authors.initials: CA
authors.lastname: Meier
authors.affiliation: Federal Office of Public Health Switzerland, Bern, Switzerland.
authors.forename: Charles
authors.initials: C
authors.lastname: Dvorak
authors.affiliation: Institute of Primary Health Care, University of Basel, Basel and.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
mesh_terms: D002055:Burnout, Professional / Q000209:etiology*; D003861:Depersonalization / Q000209:etiology; D004644:Emotions; D005195:Family Relations / Q000523:psychology*; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D010817:Physician-Patient Relations; D012201:Reward; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires; D013557:Switzerland; D014937:Work / Q000523:psychology*
keywords: Depression/mood disorder; doctor–patient relationship; longitudinal; primary care; stress; work-related stress.