Viabilidade e eficácia preliminar de uma intervenção baseada em mindfulness nos sintomas de Burnout em profissionais da atenção primária à saúde: estudo controlado
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2017-09-22
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Sopezki, Daniela da Silva [UNIFESP]
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Demarzo, Marcelo Marcos Piva [UNIFESP]
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Tese de doutorado
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Abstract
Um dos principais riscos à saúde do trabalhador da Atenção Primária à Saúde (APS) é a Síndrome de Burnout (SB). Mindfulness é um estado psicológico que está positivamente associado com uma variedade de indicadores de saúde mental. As intervenções baseadas em mindfulness (IBM) são uma alternativa para o manejo do estresse e SB na APS. O objetivo principal deste estudo foi comparar o efeito de uma IBM de oito encontros (G1), na sintomatologia da SB em profissionais da APS, com uma intervenção breve, de quatro encontros, baseada em relaxamento (G2), além de um grupo do tipo lista de espera (G3). A hipótese inicial foi de que a IBM é superior ao relaxamento nas variáveis de interesse. Método: Ensaio Clínico Controlado não-randomizado, com investigação mista. Para a avaliação dos dados quantitativos utilizou-se: questionário de dados sociodemográficos, MBI-GS, para identificar as dimensões da SB, PANAS, para avaliar afeto, FFMQ, para mensurar as facetas de mindfulness, Escala de experiências, para medir descentramento e ruminação e a Escala de Autocompaixão. Resultados: participaram do estudo 142 profissionais de distintos perfis da APS. A prevalência de sintomas de Burnout no total da amostra foi considerada moderada. A exaustão e despersonalização foram correlacionadas com todas as dimensões negativas das demais escalas do estudo. Os resultados do estudo de intervenção confirmaram parcialmente a hipótese de superioridade da IBM. Houve superioridade significativa comparada aos demais grupos nas medidas de: bondade, total de autocompaixão, subescala não-julgar e não-reagir e resultados semelhantes em G1 e G2 nas medidas de exaustão, autocrítica e isolamento. G1 é superior ao G3 nas subescalas: cinismo, afeto positivo e negativo, descentramento, fixação e mindfulness, descrever e observar, enquanto que o G2 não é superior a G3. Em relação aos dados qualitativos, foram comparados dois grupos, G1 e G2, e após análise temática, no pré-teste, para entender as características do sofrimento do trabalhador, chegou-se a nove distintos temas: sobrecarga, sentimento de injustiça, manifestações do estresse (físicas e psicológicas), interferência do estresse na qualidade do trabalho, conflitos na equipe, falta de cuidado com a saúde do trabalhador, estratégias de enfrentamento (absenteísmo e medicalização), expectativas com a intervenção e implantação do cuidado à saúde (barreiras e possíveis facilitadores), todos debatidos em confronto com a literatura. E no pós-teste: percepção sobre o impacto da intervenção, percepção sobre a intervenção (forças e fraquezas), engajamento nas práticas (formais e informais) e novamente implantação e sentimento de injustiça. Conclusão: Foram evidenciados mais e distintos benefícios a favor da IBM, possivelmente por abordar um repertório mais amplo de habilidades cognitivas, porém a intervenção de relaxamento demostrou mudanças significativas no alívio da sintomatologia aguda do estresse e da SB. É necessário projetar medidas preventivas para o cuidado da saúde do trabalhador da APS, que promovam habilidades de atenção e manejo do estresse para lidar com as adversidades constantes deste cenário de atuação, tal como se propõe as intervenções baseadas em relaxamento, compaixão e mindfulness, conforme proposto nesta pesquisa.
One of the predominant health risks of Primary Health Care (PHC) to the professionals is the Burnout Syndrome (BS). Mindfulness is a psychological state which is positively associated with a variety of mental health indicators. Mindfulness-based interventions (MBI) are alternatives to manage stress and the BS in PHC professioanals. The main objective of this study is to compare the effect of an eight-week MBI (group 1 or G1), on the BS symptoms in PHC professionals, with a brief, four-weeks, Relaxation-based intervention (group 2 or G2), as well as a waiting list type group (group 3 or G3). The initial hypothesis is that IBM is superior to relaxation within the variables of interest of the study. Method: Non-randomized controlled clinical trial, with mixed investigation. Different scales were used for the evaluation of the quantitative data: a MBI-GS to identify the dimensions of SB, sociodemographic data questionnaire, PANAS to evaluate affection; FFMQ to measure the aspects of mindfulness; Experience Scale to measure decentring and rumination and the Self-Compassion Scale. Results: 142 professionals from different PHC profiles took part in the study. The prevalence of Burnout symptoms in the total sample was considered moderate. Exhaustion and depersonalization were correlated with all the negative dimensions of the scales used in this study. Results of the intervention study partially confirmed the hypothesis of superiority of IBM. There was significant superiority compared to the other groups in the measurements of goodness, total self-compassion, non-judgmental and non-reactive subscales and similar results in G1 and G2 in the measurements of exhaustion, self-criticism and isolation. G1 is superior to G3 in the following subscales: cynicism, positive and negative affection, decentring, fixation, mindfulness, describe and observe. G2 is not superior to G3. Regarding qualitative data, two groups, G1 and G2, were compared by the thematic analysis in the pre-test, to understand the characteristics of the professional's suffering. Then, nine different topics were reached: overload, injustice, physical and psichological stress manifestations, stress interfering on the quality of work, conflicts within teams, lack of care for the professional's health, coping strategies (absenteeism and medicalization), expectations with intervention and implementation of health care (barriers and possible facilitators). And in the post-test: perception of the intervention's impact, perception of intervention itself (strengths and weaknesses), engagement in practices (formal and informal) and again, implantation and injustice. All themes were debated with basis on the literature. Conclusion: More and distinct benefits of IBM have become clear, possibly by addressing a wider repertoire of cognitive abilities, but the relaxation intervention demonstrated significant changes in the relief of acute stress and BS symptomatology. It is necessary to design protective measures for the health care professionals of PHC to promote skills like attention and stress management to deal with the adversities, like relaxation, compassion and mindfulness interventions, as proposed in this research.
One of the predominant health risks of Primary Health Care (PHC) to the professionals is the Burnout Syndrome (BS). Mindfulness is a psychological state which is positively associated with a variety of mental health indicators. Mindfulness-based interventions (MBI) are alternatives to manage stress and the BS in PHC professioanals. The main objective of this study is to compare the effect of an eight-week MBI (group 1 or G1), on the BS symptoms in PHC professionals, with a brief, four-weeks, Relaxation-based intervention (group 2 or G2), as well as a waiting list type group (group 3 or G3). The initial hypothesis is that IBM is superior to relaxation within the variables of interest of the study. Method: Non-randomized controlled clinical trial, with mixed investigation. Different scales were used for the evaluation of the quantitative data: a MBI-GS to identify the dimensions of SB, sociodemographic data questionnaire, PANAS to evaluate affection; FFMQ to measure the aspects of mindfulness; Experience Scale to measure decentring and rumination and the Self-Compassion Scale. Results: 142 professionals from different PHC profiles took part in the study. The prevalence of Burnout symptoms in the total sample was considered moderate. Exhaustion and depersonalization were correlated with all the negative dimensions of the scales used in this study. Results of the intervention study partially confirmed the hypothesis of superiority of IBM. There was significant superiority compared to the other groups in the measurements of goodness, total self-compassion, non-judgmental and non-reactive subscales and similar results in G1 and G2 in the measurements of exhaustion, self-criticism and isolation. G1 is superior to G3 in the following subscales: cynicism, positive and negative affection, decentring, fixation, mindfulness, describe and observe. G2 is not superior to G3. Regarding qualitative data, two groups, G1 and G2, were compared by the thematic analysis in the pre-test, to understand the characteristics of the professional's suffering. Then, nine different topics were reached: overload, injustice, physical and psichological stress manifestations, stress interfering on the quality of work, conflicts within teams, lack of care for the professional's health, coping strategies (absenteeism and medicalization), expectations with intervention and implementation of health care (barriers and possible facilitators). And in the post-test: perception of the intervention's impact, perception of intervention itself (strengths and weaknesses), engagement in practices (formal and informal) and again, implantation and injustice. All themes were debated with basis on the literature. Conclusion: More and distinct benefits of IBM have become clear, possibly by addressing a wider repertoire of cognitive abilities, but the relaxation intervention demonstrated significant changes in the relief of acute stress and BS symptomatology. It is necessary to design protective measures for the health care professionals of PHC to promote skills like attention and stress management to deal with the adversities, like relaxation, compassion and mindfulness interventions, as proposed in this research.
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SOPEZKI, Daniela da Silva. Viabilidade e eficácia preliminar de uma intervenção baseada em mindfulness nos sintomas de Burnout em profissionais da atenção primária à saúde : estudo controlado. 2017. São Paulo, [244] p. Tese (Doutorado em Saúde coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.