AN ASSESSMENT OF DEPRESSION AMONG PRACTISING RADIOGRAPHERS IN SOUTH EAST NIGERIA

Generally, Radiographers’ psychological health is left unnoticed not just by the people in society but by the Radiographers too. In developed countries like the USA, a lot of work has been done to assess Radiographers’ psychological or mental status, however developing nations like Nigeria significantly fall behind. The aim of the study was to determine the prevalence of stress, anxiety and depression among Radiographers in Southeast Nigeria.  A quantitative cross-sectional design was employed. Population census data was used to select all the 125 Radiographers in Southeast Nigeria for the study. However, 111 were available and participated in the study. A structured questionnaire and a modified DASS-21 was used to measure the prevalence of stress, anxiety and depression, while data were analysed with STATA version 15. The study showed that Radiographers experience stress, anxiety and depression. Further enquiries revealed that workload was a major determinant of stress. Although the study sought to determine the association between stress, anxiety and depression and the different professional ranks and gender, the findings were statistically insignificant; other independent variables such as marital status, department and work experience were rather found to be significantly associated with stress, anxiety and depression. “Radiographers are not immune” to stress, anxiety and depression. This should prompt measures that would help improve their psychological health, which would in turn improve patient care.

Key Words: stress, anxiety, depression, prevalence, Radiographers

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background

Work-related stress at present is normally recognised as a worldwide problem that has an effect on every career and every employee in low and middle-income countries as well as in industrialised countries (ILO, 2016). It is worth mentioning that, the workforce is the most important asset of any organisation (DeNisi and Griffin, 2015). Therefore, the health and wellbeing of the workforce are essential for optimum performance and productivity of organisations (Alhassan and Poku, 2018). In the absence of ‘health at work’, an individual cannot make contributions to his or her society and to his or her own welfare. Whenever

‘health at work’ is jeopardised, productive work and socio-economic growth become difficult to attain. Mental ill-health is extremely important. It has an effect on people’s wellbeing by cutting down wages, and as a result affecting the finances of families and the productivity of enterprises, and also producing great costs, both direct and indirect to the economy (ILO, 2016). According to the Health and Safety Executive (2018), stress, depression or anxiety is more predominant in the public sector work like teaching and healthcare. In other words, professions that are demanding have been related to poor psychological or mental health because of several factors including working for long hours and evening shifts (Yahaya et al., 2018).

Becoming a radiographer requires the acquisition of finely honed skills and carefully cultivated dispositions. These include the technical skills to manage the latest technology, the expert judgment to make wise choices in difficult situations and the resilience to cope with uncomfortable social interactions such as dealing with a “non-compliant patient, inpatient physician or supervisor, non-professional staff member or an intensely emotional situation that deals with sadness, grief, anger, guilt, frustration, fear, anxiety, embarrassment, tenderness and joy” (Fortsch et al, 2009). The additional responsibilities make it necessary for the radiographers to know the following:

• Normal anatomic and normal anatomic variations so that the patient can be properly positioned.
• The radiographic characteristic of numerous common abnormalities (Ballinger et al, 2003).

The stressful situation experienced in the first months of practice could be minimized through opportunities of learning how to repackage knowledge, observe role models and have

supervisions that provide confirmations of plans and bridge the theory-practice divide. It is important that these new graduates (interns) are equipped to practice in the current healthcare environment and are confident about their professional contributions. It is essential to acquire knowledge and think in ways that will prepare them for practice, including both subjective analysis and as required in evidence- analysis of everyday practice.

The essence of the Bachelor of Science Diagnostic radiographic curricular is to facilitate the development of competent practitioners in the field of Diagnostic Radiography who have attained the professional academic and personal attributes that are required for current professional practice. Interns should be able to perform well in a wide range of areas including interprofessional work, evidence-based practice, knowledge of the personal and professional scope of the practice, use of information and communication technology and thinking logically and symmetrically.

The standards of performance of health care professionals are well defined and used to determine health curricula. However, to be confident that these curricular are producing professionals who are „fit for practice‟ it is necessary to have some empirical evidence that this is being achieved. (Mackay et al, 2007).

Generally, expects health care professionals to have up to- date knowledge and skills appropriate to the specialist field in which they practice. Healthcare professionals therefore need to be equipped to meet these challenges (Astedt- Kurki and Haggman- Laitila, 1992; Department of health, 1999). In Nigeria, Radiographers are increasingly involved in X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound investigations and various degrees of clinical role extensions. It is therefore imperative that they possess more than just their basic clinical knowledge and expertise if they are to meet the demands of a changing health care system and the expectations of an increasingly aware and informed patient population (Ugwu et al, 2009).

Stress in Radiography has become a relevant subject, partially because medical care includes dealing with the lives of people and errors can be very expensive and at times irrevocable. Accordingly, it is anticipated that Radiographers, nurses and other health care workers have to be in a “perfect state of mind devoid of morbid worries and anxiety”, so that they can take care of the enormous healthcare responsibility that is required of them. There is substantial proof that health care-associated stress affects healthcare workers negatively (Yeboah et al., 2014). These negative effects may include prescription errors, lack of teamwork, absenteeism, alcohol and drug abuse, depression and anxiety and even suicide (Shapiro et al., 2000).

Depression is a common ailment that is characterised by persistent sadness and a loss of interest in the activities that one usually love to do (WHO, 2017a). It normally occurs due to a combination of factors such as stress, personal life, and demands of work and workload of a physician. Globally, it is estimated that over 300 million people suffer from depression; this is equal to 4.4% of the world’s population. Almost the same number is also believed to suffer from anxiety since many people experience both conditions at the same time. Depression and anxiety affect the feelings of affected people and can be diagnosed (WHO, 2017b).

Every individual experiences anxiety at some point in his or her life. According to Shiel Jr. (2018) anxiety is a feeling of fear characterised by symptoms such as trembling, worrying and feelings of stress. Anxiety makes people nervous, afraid, uneasy, and distressful. These conditions have an effect on one’s feelings and demeanour and usually lead to physical and emotional symptoms. Mild anxiety is indistinct and unnerving, whereas severe anxiety can badly have an effect on daily life. Research shows that Radiographers undergo personal distress during their medical training and later in their practical life (Roberts, 1991), and it may even get to the level of physician burnout (Willcock et al., 2004).

1.2 Problem Statement

Aside, Radiographers being impacted by similar factors that impose stress on the populace, they are additionally susceptible to stress due to the distinctiveness of their work and the expectation of the society in general (Yeboah et al., 2014). Radiographers by virtue of their work which is inundated with stress are at peculiar danger of carrying psychological health problems which might lead to anxiety and depression or worsen it (Atif et al., 2016). Studies show that the prevalence rates of stress, anxiety and depression are high among Radiographers (AlFahhad, 2018; Dave et al., 2018; Caplan, 1994). In industrialised countries like the USA and Canada, a lot of work has been done to assess the psychological or mental position of Radiographers, yet low and middle-income countries significantly fall behind (Erdur et al., 2006). Little research exists on the rates of depression and anxiety in Africa and especially in Nigeria. Although a number of research has been done on the stress of nurses in Nigeria (Adzakpah, 2017; Dorcoo, 2016; Egungwu, 2015;  Dapaah, 2014 ) and among health care workers in general (Yeboah et al, 2014; Abdulai, 2011) there is still a dearth of research on the prevalence of stress, anxiety and depression among Radiographers in Nigeria. Besides, in Nigeria, the public health sector is among the sectors in which much has not been done concerning formulating policies on the management of stress amongst its workers whether medical or paramedical. Although Teaching and Regional hospitals, more or less have introduced policies to help workers cope with stress, continuous research is still necessary to examine the main factors of stress among the diverse groups of the workforce (Yeboah et al., 2014).

A typical first-year house officer is usually faced with a huge workload every day. The number of Radiographers is not enough for the huge number of patients. Also, there are usually no counselling sessions for house officers or Radiographers amid the sleepless nights and dealing with relatives of patients who had passed on. Most house officers are stressed out and anxious with some having the intention to quit their jobs after their horsemanship. Based on the foregoing, it is highly conceivable that most Radiographers in healthcare facilities in Nigeria may be facing these problems.

It is against these backgrounds that this study attempted to assess the prevalence of stress, anxiety and depression among Radiographers in Southeast Nigeria with a view to proposing measures to combat them.

1.3 Research Questions

1. What is the proportion of Radiographers who are living with stress, anxiety and depression in Southeast Nigeria?
2. What are the factors that contribute to stress, anxiety and depression among Radiographers in Southeast Nigeria?
3. What is the association between the prevalence of stress, anxiety and depression and the different ranks and gender of Radiographers in Southeast Nigeria?

1.4 General Objective

To determine the prevalence of stress, anxiety and depression among Radiographers in Southeast Nigeria.

1.5 Specific Objectives

1. To assess the proportion of Radiographers who are living with stress, anxiety and depression in Southeast Nigeria.
2. To identify the factors that contribute to stress, anxiety and depression among Radiographers in Southeast Nigeria.
3. To determine the association between the prevalence of stress, anxiety and depression and the different professional ranks and gender of Radiographers in Southeast Nigeria.

 1.7 Conceptual Framework

The relationship between Stress, Anxiety and Depression (SAD) is such that depression may be both a cause and an effect of psychological stress and anxiety. In some reports, stress is seen as a start point which then leads to anxiety and depression (ILO, 2016, Kinicki and Williams, 2011). For instance, the ILO (2016) reports that when stress levels are high, it can lead to health-related problems such as psychological and behavioural conditions like anxiety, depression, exhaustion, burnout etc. From Figure 1.1 below, the causes of stress may include workload, inadequate material and financial resources, long working hours, little control over the job such as dealing with emergency situations, socio-demographic features like sex and age; family issues, financial strain and many other factors. The causes of SAD are influenced by individual differences like perceptions of SAD or coping strategies. Increased levels of SAD are expressed in 3 main symptoms – physiological, psychological and behavioural; but the study focused on the psychological symptoms. These symptoms may as a consequence affect the productivity and performance of Radiographers.

1.6 Justification for the Study

Radiographers’ physical and mental health care in recent times, has been a subject area for the concentration of researchers globally. A lot of Radiographers are under stress as a result of various factors such as overwork, job dissatisfaction, financial difficulties, etc. The aforementioned factors do not merely influence the health of Radiographers physically but also psychologically (Nisar et al., 2012). Symptoms of stress, anxiety and depression are important to assess especially among Radiographers as they have a delicate job that deals with the preservation of human lives. Increased levels of stress, anxiety and depression among Radiographers can lead to physical and emotional ailments, poor job performance and negativity in terms of attitudes and behaviour towards patients and other staff of the hospital (Harris et al., 2006). They also lead to medical errors, reduced capability to manage work-related stress, discontinuation of postgraduate medical training, problems in personal lives, and suicide are also prevalent (Joules et al., 2014). The study would provide evidence-based data which would enhance knowledge on stress, anxiety and depression among Radiographers. In addition, it would provide information on factors related to the psychological or mental health of Radiographers in Southeast Nigeria and generally in Nigeria. Since stress, anxiety and depression could lead to low productivity and poor work performance which drain health institutions and the country’s economy as a whole, data generated from this research would serve as a resource for the formulation of policies to deal with stress, anxiety and depression among Radiographers. This research would furthermore aid in developing appropriate health and safety regulations, add up to data on knowledge of stress, anxiety and depression among Radiographers in Nigeria and serve as a baseline for further studies on the subject.

1.8 Definition of Concepts

The key concepts used in this study are defined as follows:

• Stress: A state of the mind that occurs when job demands do not correspond with or surpass the abilities, resourcefulness, or wants of the employee (ILO, 2012a).
• Anxiety: It is a feeling of fear characterised by symptoms such as trembling, worrying and feelings of stress (Shiel Jr., 2018).
• Depression: It is a psychological ailment that is characterised by persistent sadness and a loss of interest in the activities that one usually love to do (WHO, 2017a).

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