title: Stress, depression and burnout among hospital physicians in Rijeka, Croatia.
abstract: BACKGROUND
  Six years of recent ongoing economic and structural crisis in Croatia have brought to a significant decrease of socioeconomic standard in our country, and had an important impact on the health care system. In this background we examined the prevalence of depression and burnout and their association with work stressors.
  
  
  METHODS
  Cross sectional survey was conducted with self reported questionnaires in 459 hospital physicians in Rijeka, Croatia. Physicians were divided into three groups: surgical, nonsurgical and diagnostic group. Socio-demographic and work-related characteristics questionnaire, Occupational Stress Assessment Questionnaire (OSAQ), Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and Beck Depression Inventory II (BDI-II) were used. Sperman correlation and logistic regression were calculated to rank association between stressors at work with depression and burnout syndrome.
  
  
  RESULTS
  Response rate was 62.3%, (286/459). Every fifth doctor experienced all examined stressors in the workplace as stressful. The prevalence of moderate and severe depression was 12.2%. High levels of emotional exhaustion were 43.6%, depersonalization 33.5%, and lack of personal accomplishment 49.1%. There was no statistical difference in surgical, nonsurgical and diagnostic groups in depression and all domains of MBI-HSS. Almost all stressors were correlated with depression and burnout syndrome. Most of the perceived stressors were significant predictors of burnout syndrome and depression.
  
  
  CONCLUSIONS
  High levels of burnout domain compared to overall results from similar studies from other countries, placed the results in our sample on the higher end of the range, while results for depression after adjustment with lower cutoff point would be similar to those usually found in research literature. Our study showed that burnout is highly prevalent among Croatian physicians. Target interventions at the workplace should be considered as one of the strategies to reduce negative impact of work stress on physicians' mental health.
authors.affiliation: Department of Social medicine and Epidemiology, Faculty of Medicine, University of Rijeka, Braće Branchetta St. No. 20, 51 000 Rijeka, Croatia, morana.tomljenovic@medri.uniri.hr.
authors.forename: Morana
authors.initials: M
authors.lastname: Tomljenovic
authors.forename: Branko
authors.initials: B
authors.lastname: Kolaric
authors.forename: Dinko
authors.initials: D
authors.lastname: Stajduhar
authors.forename: Vanja
authors.initials: V
authors.lastname: Tesic