Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3334 (2012)

Identification of possible risk factors for alcohol use disorders among general practitioners in Rhineland-Palatinate, Germany

  • Michael Unrath
  • Hajo Zeeb
  • Stephan Letzel
  • Matthias Claus
  • Luis Carlos Escobar Pinzón
DOI
https://doi.org/10.4414/smw.2012.13664
Cite this as:
Swiss Med Wkly. 2012;142:w13664
Published
12.08.2012

Summary

QUESTIONS UNDER STUDY: Research on alcohol use disorders among physicians has been scarce in Germany. The aim of our study was to identify possible risk factors for alcohol use disorders among general practitioners (GPs) working in the outpatient sector in the federal German state of Rhineland-Palatinate (RP).

METHODS: An anonymous survey was carried out between June and July 2009. 2,092 practice-based GPs in the federal German state of RP were asked to take part in the cross-sectional study via postal mail. The CAGE screening tool was used in its German version (CAGE-G) to screen for alcohol use disorders (AUD). Moreover, possible risk factors such as work stress (effort-reward imbalance), stress experienced in the leisure time and personality characteristics (Type D personality, resilience) were included in the questionnaire.

RESULTS: 808 GPs participated (response rate 38.6%), n = 790 were eligible for the analysis. The frequency of AUD according to the CAGE-G was 18.9% (n = 149). Moreover, nearly one in four general practitioners reported consuming alcohol on a daily basis (23.0%, n = 182). In the logistic regression analyses, stress experienced in the leisure time was positively related to the occurrence of AUD, whereas resilience was negatively associated.

CONCLUSIONS: AUD as screened for by the CAGE-G was frequent in our sample of German GPs. Approaches to reduce their occurrence could comprise actions helping physicians to relieve stress in their leisure time. Furthermore, measures to increase physicians’ resilience by improving coping strategies might prove useful.

References

  1. Hughes PH, Brandenburg N, Baldwin DC, Jr., Storr CL, Williams KM, Anthony JC, et al. Prevalence of substance use among US physicians. JAMA. 1992;267:2333–9.
  2. Juntunen J, Asp S, Olkinuora M, Aarimaa M, Strid L, Kauttu K. Doctors’ drinking habits and consumption of alcohol. BMJ. 1988;297:951–4.
  3. Sebo P, Bouvier Gallacchi M, Goehring C, Kunzi B, Bovier PA. Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey. BMC Public Health. 2007;7:5. doi:1471-2458-7-5 [pii] 10.1186/1471-2458-7-5
  4. Kenna GA, Wood MD. Alcohol use by healthcare professionals. Drug Alcohol Depend. 2004;75:107–16. doi:10.1016/j.drugalcdep.2004.01.008S0376871604000328 [pii]
  5. McAuliffe WE, Rohman M, Breer P, Wyshak G, Santangelo S, Magnuson E. Alcohol use and abuse in random samples of physicians and medical students. Am J Public Health. 1991;81:177–82.
  6. Seppala MD, Berge KH. The addicted physician. A rational response to an irrational disease. Minn Med. 2010;93:46–9.
  7. Marshall EJ. Doctors’ health and fitness to practise: treating addicted doctors. Occup Med (Lond). 2008;58:334–40. doi:kqn081 [pii] 10.1093/occmed/kqn081
  8. Hodgins DC, Williams R, Munro G. Workplace responsibility, stress, alcohol availability and norms as predictors of alcohol consumption-related problems among employed workers. Subst Use Misuse. 2009;44:2062–9. doi:10.3109/10826080902855173
  9. Kouvonen A, Kivimaki M, Cox SJ, Poikolainen K, Cox T, Vahtera J. Job strain, effort-reward imbalance, and heavy drinking: a study in 40,851 employees. J Occup Environ Med. 2005;47:503–13. doi:00043764-200505000-00009 [pii]
  10. Siegrist J, Rodel A. Work stress and health risk behaviour. Scand J Work Environ Health. 2006;32:473–81. doi:1052 [pii]
  11. Rodríguez Fernández E, Espí Martínez F, Canteras Jordana M, Gómez Moraga A. Consumo de alcohol entre profesionales médicos de atención primaria. Aten Primaria. 2001;28:259–62.
  12. Hull SK, DiLalla LF, Dorsey JK. Prevalence of health-related behaviours among physicians and medical trainees. Acad Psychiatry. 2008;32:31–8. doi:32/1/31 [pii] 10.1176/appi.ap.32.1.31
  13. McNerney JP, Andes S, Blackwell DL. Self-reported health behaviours of osteopathic physicians. J Am Osteopath Assoc. 2007;107:537–46. doi:107/12/537 [pii]
  14. Rosta J.Hazardous Alcohol use among hospital doctors in Germany. Alcohol & Alcoholism. 2008;43:198–203. doi: 10.1963/alcalc/agm180
  15. Mühlau-Mahlke C. Suchterkrankungen bei Ärztinnen und Ärzten. Überblick über den derzeitigen Kenntnisstand mit erweiternden Aspekten aus der Integrativen Therapie. In: Petzold H, Schay P, Ebert W, editors. Integrative Suchttherapie. Theorie, Methoden, Praxis, Forschung. Wiesbaden: VS Verlag für Sozialwissenschaften; 2009.
  16. Soukup J, Schmale M. Das Suchtrisiko bei Medizinern. Sind wir Anästhesisten besonders gefährdet? Anästh Intensivmed. 2009;50:286–95.
  17. Friborg O, Hjemdal O, Rosenvinge JH, Martinussen M, Aslaksen PM, Flaten MA. Resilience as a moderator of pain and stress. J Psychosom Res. 2006;61:213–9. doi:S0022-3999(06)00006-7 [pii] 10.1016/j.jpsychores.2005.12.007
  18. Leppert K, Gunzelmann T, Schumacher J, Strauss B, Brahler E. Resilience as a protective personality characteristic in the elderly. Psychother Psychosom Med Psychol. 2005;55:365–369. doi:10.1055/s-2005-866873
  19. Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and positive emotional granularity: examining the benefits of positive emotions on coping and health. J Pers. 2004;72:1161–90. doi:JOPY294 [pii] 10.1111/j.1467-6494.2004.00294.x
  20. Schiffer AA, Smith OR, Pedersen SS, Widdershoven JW, Denollet J. Type D personality and cardiac mortality in patients with chronic heart failure. Int J Cardiol. 2009;142:230–5.
  21. Michal M, Wiltink J, Grande G, Beutel ME, Brähler E. Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population. Journal of Affective Disorders 2011;134:396–403.
  22. Mommersteeg PMC, Kupper N, Denollet J. Type D personality is associated with increased metabolic syndrome prevalence and an unhealthy lifestyle in a cross-sectional Dutch community sample. BMC Public Health 2010;10:714.
  23. Voigt K, Twork S, Mittag D, Gobel A, Voigt R, Klewer J, Kugler J, Bornstein SR, Bergmann A. Consumption of alcohol, cigarettes and illegal substances among physicians and medical students in Brandenburg and Saxony (Germany). BMC Health Serv Res. 2009;9:219. doi:1472-6963-9-219 [pii] 10.1186/1472-6963-9-219
  24. Rumpf H-J, Hapke U, John U. Deutsche Version des CAGE Fragebogens (CAGE-G). In: Glöckner-Rist A, Rist F, Küfner H, editors. Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES) Version 300. Mannheim: Zentrum für Umfragen, Methoden und Analysen; 2003.
  25. Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30:33–41.
  26. Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000;160:1977–89. doi:ioi90552 [pii]
  27. Siegrist J, Wege N, Puhlhofer F, Wahrendorf M. A short generic measure of work stress in the era of globalization: effort-reward imbalance. Int Arch Occup Environ Health. 2009;82:1005–13. doi:10.1007/s00420-008-0384-3.
  28. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58:1483–99. doi:10.1016/S0277-9536(03)00351-4S0277953603003514 [pii].
  29. Weyer G, Hodapp V, Neuhäuser S.Weiterentwicklung von Fragebogenskalen zur Erfassung der subjektiven Belastung und Unzufriedenheit im beruflichen Bereich (SBUS-B). Psychologische Beiträge. 1980;22:335–55.
  30. Lazarus, RS. Psychological stress and the coping process. New York: McGraw-Hill; 1966.
  31. Grande G, Jordan J, Kummel M, Struwe C, Schubmann R, Schulze F, et al. Evaluation of the German type D scale (DS14) and prevalence of the type D personality pattern in cardiological and psychosomatic patients and healthy subjects. Psychother Psychosom Med Psychol. 2004;54:413–22.
  32. Leppert K, Koch B, Brähler E, Strauss B. Die Resilienzskala (RS) – Überprüfung der Langform RS-25 und einer Kurzform RS-13. Klinische Diagnostik und Evaluation. 2008;1:226–43.
  33. Bono C, Ried D, Kimberlin C, Vogel B. Missing data on the Centre for Epidemiologic Studies Depression Scale: a comparison of 4 imputation techniques. Social and Administrative Pharmacy. 2007;3:1–27. doi:10.1016/j.sapharm.2006.04.001
  34. Buhler A, Kraus L, Augustin R, Kramer S. Screening for alcohol-related problems in the general population using CAGE and DSM-IV: characteristics of congruently and incongruently identified participants. Addict Behav. 2004;29:867–78. doi:10.1016/j.addbeh.2004.02.057S0306460304000693 [pii]
  35. Kraus L, Bloomfield K, Augustin R, Reese A. Prevalence of alcohol use and the association between onset of use and alcohol-related patterns in a general population sample in Germany. Addiction. 2000;95:1389–401.
  36. Aalto M, Hyvönen S, Seppä K. Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey. Drug and Alcohol Dependence. 2006;83:169–173.
  37. Bloomfield K, Grittner U, Kramer S. Developments in alcohol consumption in reunited Germany. Addiction. 2005;100:1770–8. Doi: 10.1111/j.1360-0443.2005.01250.x
  38. Kaneita Y, Uchida T, Ohida T. Epidemiological study of smoking among Japanese physicians. Prev Med. 2010;51:164–7. Epub 2010 May 8.
  39. Marcus GM, Smith LM, Whiteman D, Tseng ZH, Badhwar N, Lee BK, et al. Alcohol intake is significantly associated with atrial flutter in patients under 60 years of age and a shorter right atrial effective refractory period. Pacing Clin Electrophysiol. 2008;31:266–72.
  40. Kaneko K, Murakami Y, Katagiri A, Konishi K, Kubota Y, Muramoto T, et al. Does daily alcohol and/or cigarette consumption cause low-grade dysplasia, a precursor of oesophageal squamous cell carcinoma? J Clin Gastroenterol. 2010;44:173–9.
  41. Jurkat HB, Reimer C. Arbeitsbelastung und Lebenszufriedenheit bei berufstätigen Medizinern in Abhängigkeit von der Fachrichtung. Schweizerische Ärztezeitung. 2001;82:1745–50.
  42. Jensen PM, Trollope-Kumar K, Waters H, Everson J. Building physician resilience. Can Fam Physician. 2008;54:722–9.
  43. Post, D. Value, stress, and coping among practicing family physicians. Arch Fam Med. 1997;6:252–5.
  44. Firth-Cozens J. Interventions to improve physicians’ well-being and patient care. Soc Sci Med. 2001;52:215–22.
  45. Lee FJ, Stewart M, Brown JB. Stress, burnout, and strategies for reducing them. What’s the situation among Canadian family physicians? Can Fam Physician. 2008;54:234-5.e5
  46. Zwack J, Abel C, Schweitzer J. Resilienz im Arztberuf – salutogenetische Praktiken und Einstellungsmuster erfahrener Ärzte. Psychother Psych Med. 2011;61:495–502.
  47. Lloyd S, Streiner D, Shannon S. Burnout, depression, life and job satisfaction among Canadian emergency physicians. J Emerg Med. 1994;12:559–65.
  48. Rodrigues Torres A, Ruiz T, Swain Müller S, Pereira Lima MC. Quality of life, physical and mental health of physicians: a self-evaluation by graduates from the Botucatu Medical School – UNESP. Rev Bras Epidemiol. 2011;14:264–75.
  49. Gardiner M, Lovell G, Williamson P. Physician you can heal yourself! Cognitive behavioural training reduces stress in GPs. Fam Pract. 2004;21:545–51.
  50. Sood A, Prasad K, Schroeder D, Varkey P. Stress management and resilience among department of medicine faculty: a pilot randomized clinical trial. J Gen Intern Med. 2011;26:858–61.
  51. Thomas SE, Haney MK, Pelic CM, Shaw D, Wong JG. Developing a program to promote stress resilience and self-care in first-year medical students. Can Med Educ J; 2011;2:e32-6.
  52. Kjeldman D, Holmström I. Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med. 2008;6:138–45.
  53. Unrath M, Zeeb H, Letzel S, Claus M, Escobar Pinzón LC. Arbeitssituation und Gesundheit von Hausärzten in Rheinland-Pfalz: Erste Ergebnisse einer landesweiten Befragung. Gesundheitswesen. 2012;74:389–96. Epub 2011 Jul 13.
  54. Aertgeerts B, Buntinx F, Ansoms S, Fevery J. Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population. Br J Gen Pract. 2001;51:206–17.
  55. Skogen JC, Overland S, Knudsen AK, Mykletun A. Concurrent validity of the CAGE questionnaire. The Nord-Trøndelag Health Study. Addict Behav. 2011;36:302–7. Epub 2010 Nov 27.
  56. Batty GD, Hunt K, Emslie C, Lewars H, Gale CR. Alcohol problems and all-cause mortality in men and women: predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based survey. J Psychosom Res. 2009;66:317–21. Epub 2009 Jan 8.
  57. Berger K, Ajani U, Kase CS, Gaziano M, Buring J, Glynn R, et al. Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. N Engl J Med. 1999;341:1557–64.
  58. Djoussé L, Gaziano M. Alcohol consumption and heart failure in hypertensive US male physicians. Am J Cardiol. 2008;102(5):593–7. Epub 2008 Jun 12.
  59. Merz B, Oberlander W. Berufszufriedenheit: Ärztinnen und Ärzte beklagen die Einschränkung ihrer Autonomie. Dtsch Arztebl. 2008;105:A-322 / B-290 / C-28.
  60. Gebuhr K. Die vertragsärztliche Tätigkeit im Lichte des Burnout-Syndroms. Ergebnisse schriftlicher Befragungen von 1996, 2002, 2004 und 2007. Berlin: Brendan-Schmittmann-Stiftung; 2008.