Being a medical professional is a highly esteemed privilege, demanding respect and humility, as doctors are entrusted with the noble duty of caring for patients. Regardless of the extensive education and training received in medical school or during residency,doctors must always be ready to take on sudden increases in responsibility and make critical decisions within moments. The constant pressure of dealing with life-and-death situations imposes significant stress on doctors, adversely impacting their mental health and increasing their risk of various health issues. the alarming trend of increasing suicide rates among doctors, previouslyrare, has become a serious concern. Doctors, including residents, often work 60-70 hours per week or more, leaving them with little to no time to address personal issues. Frommedical school through residency to becoming specialists, doctors typically enjoy jobsecurity and eventually earn wellmajor NCD like depression leading to suicide, cardiac problem,hyperlipidemia, diabetes, cancer etc Various factors have been identified that contributeto the reduced life expectancy among doctors. Research by the Indian Medical Association points to a sedentary lifestyle, lack of physical activity, stress, and obesity askey factors leading to heart disease within the medical community. The primary factors contributing to these early deaths were stress and the lack of regular health checkups¹ physicians have often overlooked their own health due to their numerous professional and personal responsibilities. Consequently, several organisations have initiated programs to cater to the healthcare needs of physicians.Moreover, there is a growing awareness that the health of physicians significantly affects the well-being of the broader population, as many studies have shown a connection between physicians health behaviours and their patient interaction^2.

AIM

To study mental and physical health and prevalence of comorbidities in doctors

In a cross-sectional observational study conducted over 18 months from September 2022 to March 2024, the research aimed to investigate a specified phenomenon within the population of Mahatma Gandhi Medical College & Hospital. The study included all consultants and post-graduate residents across both clinical and paraclinical branches of the institution. The inclusion criteria encompassed consultants and post-graduate residents from these branches, while pregnant women and individuals unwilling to provide consent were excluded. The study utilised a total enumeration sampling technique, collecting data on all relevant individuals from the academic section of the institution. Approval from the Institute Ethics Committee was secured prior to initiating the study, and informed consent was obtained from all participants prior to their inclusion.

STUDY PROCEDURE

In this cross-sectional observational study, all participants were contacted and, following their consent, completed a comprehensive questionnaire covering socio-demographic characteristics, comorbidities, and personal habits. Each participant underwent a physical examination, including blood pressure measurement, and baseline investigations such as HbA1C, lipid profile, CBC, ECG, and liver function tests were conducted. The level of anxiety was assessed using the Hamilton Anxiety Rating Scale (HAM-A), which includes 14 items measuring both psychic and somatic anxiety, with scores ranging from 0 to 56 to categorise severity. Depression levels were evaluated using the Hamilton Depression Rating Scale (HDRS), which consists of 17 items assessing symptoms over the past week, with scores indicating normal range to moderate severity.

Table 1 - Distribution of study subject according to gender and marital status.

The above table shows that in the study there are 104 (69.3%) males and 46 (30.7%) females and the male to female ratio is 2.26. In this study among study subject there are 36 (24%)  unmarried doctors and 114 (76) married doctors. .

Table 2 - Distribution of study subject according to HAM- D  and HAM A scale

As depicted in the table above and figure below, 91(60.7%), 40 (26.7%),  16 (10.7%) and  3 (2%) doctors are having from no depression (0-7), mild depression (8-13), moderate depression (14-18) and severe depression (19-22)  respectively. The mean HAM-D scale is 7.70( SD 4.51). Similarly 80 (53.3%),  49 (32.7%),  18 (12.0%),  3 (2.0%) are having no anxiety (0), mild anxiety (<17) , mild to moderate anxiety (18-24) and moderate to severe anxiety (25-30) respectively. The mean HAM-A score is 5.89 (SD 7.85)

Table 3: Distribution Of Co-morbidity according to Designation and Subject of doctors

As shown in the table 15 (20.0%), 29 (38.7%), 11 (14.7%), 18 (24.0%), 15 (6.7%) and 5 (6.7%) consultants and 5(6.7%), 36 (48.0%), 2 (2.7%), 15 (20.0%), 0(0.0%) and 0 (0.0%) residents are suffering from diabetes, dyslipidemia, joint pain, hypertension, COPD and CAD respectively. Again 3 (4.0%), 15 (20.0%), 2 (2.7%), 3 (4.0%), 1 (1.3%) and 0 (0.0%) doctors of pre clinical subjects ; 1 (1.3%), 19 (25.3%), 4 (5.3%), 8 (10.7%), 1 (1.3%), 1 (1.3%) and 22 (29.3%) doctors of para clinical subjects; and 16 (21.3%), 31 (41.3%), 7 (9.3%), 22 (29.3%), 3 (4.0%) and 4 (5.3%) doctors of clinical subjects are suffering from diabetes, dyslipidemia, joint pain, hypertension, COPD and CAD respectively

Table 4 :Relationship between designation and work related factors

 All consultants have duty hours of less than 48 hours per week, whereas residents are more varied, with 48% working less than 48 hours, 41% between 48 to 72 hours, and 11% more than 72 hours, showing a significant difference (p=0.000). Additionally, residents have more night duties, with 32% having more than 4 per month, compared to 20% of consultants with similar duties, which is also statistically significant (p=0.000). Regarding work pressure, 58% of residents report feeling pressure compared to 36% of consultants (p=0.011), and 64% of consultants have time to relax compared to 45% of residents, highlighting a significant difference in relaxation time (p=0.028).

Table 5 :Relationship between designation and cigarette related factors

 Among consultants, 56.0% do not smoke, while 8.0% smoke 11 to 20 cigarettes per day. In contrast, 81.0% of residents do not smoke, with 5.0% smoking more than 20 cigarettes daily, showing a statistically significant difference (p=0.000). Smoking initiation also differed significantly, with 56.0% of consultants starting before or during their MBBS, compared to 81.0% of residents who similarly started smoking before or during their MBBS (p=0.001). Regarding smoking in response to stress, 24.0% of consultants smoke when stressed, compared to 14.0% of residents, with this difference being statistically significant (p=0.002).

Table 6 :Relationship between designation and Life Style Related Factors

The study revealed significant differences in dietary habits and exercise routines between consultants and residents. Among consultants, 26.0% never eat outside meals, while 20.0% eat outside three or more times a week. In contrast, 12.0% of residents never eat outside, and 8.0% eat outside every day, with this difference being statistically significant (p=0.004). Additionally,

72.0% of consultants have fixed meal times compared to only 25.0% of residents, with this difference also significant (p=0.000). Regarding exercise, 36.0% of consultants engage in 30 to 90 minutes of exercise, whereas 32.0% of residents do not exercise at all. The variation in exercise habits between the two groups was statistically significant (p=0.000).

In this on studying the depression and anxiety  prevalence on doctors it is found out that 91(60.7%), 40 (26.7%),  16 (10.7%) and  3 (2%) doctors are having from no depression (0-7), mild depression (8-13), moderate depression (14-18) and severe depression (19-22)  respectively. The mean HAM-D scale is 7.70( SD 4.51).  Similarly 80 (53.3%),  49 (32.7%),  18 (12.0%),  3 (2.0%) are having no anxiety (0), mild anxiety (<17) , mild to moderate anxiety (18-24) and moderate to severe anxiety (25-30) respectively. The mean HAM-A score is 5.89 (SD 7.85) .Parikh et all³ among resident doctors of general hospital in Ahmedabad it was found that About 27.7% resident doctors had depression, 36.6% had anxiety, and 24.2% had stress. Depression and stress were more often mild to moderate and anxiety severity was higher.

On comparing the HAM- D score among consultant and resident by  doing one way ANOVA we found the difference of prevalence of depression among consultants and residents is statistically significant (p=0.000) i.e depression more in resident. On comparing the HAM- D score among doctors of pre clinical, para clinical and clinical subjects  by  doing one way ANOVA we found the difference of prevalence of depression of all grade statistically significant (p=0.000), i.e depression more in clinical group. Dave et all5   depicted that anxiety levels were notably elevated among residents in clinical disciplines compared to those in nonclinical disciplines (P = 0.03), and among residents enrolled in diploma programs compared to those in degree programs (P = 0.02).

Marital status did not demonstrate a significant impact (p = 0.157).Parikh et al did not  any association of marital status, sex, and socio-economic status with either depression or stress levels among resident doctors. Nasheel Joules et all in a systematic review of studies on resident physicians found that several studies found that female residents were more likely to experience depression and with increased severity^4,5 (Goebert et al., 2009; Sen et al., 2010).

The difference of duty hours per week among doctors of pre clinical, para clinical and clinical subjects is statistically significant (p=0.000) which means duty hour is much more in doctors of clinical subjects compared to pre and para clinical subjects.Niewiadomska et all⁶ reported the occurrence of anxiety symptoms (as per HADS) by 181 (25.8%) doctors, depressive symptoms were reported by 135 (19.3%) respondents and both anxiety and depressive symptoms reported by 115 doctors (16.4%) . An editorial by Wei Chen⁷ studied the online nutrition survey to measure healthcare workers lifestyle, and health condition in China in June 2020 showed that the extended and busy work shifts (80.51% of them worked ≥40 hours/ week) had an unfavourable impact on the health condition.

 In this study 43 (28.7% ) doctors don't do any exercise and 35 (23.3%), 30(20.0%), 27 (18.0%) and 15 (10.0%) doctors do workout <30 minutes, >30-<90 minutes, >90-<150 minutes and >150 minutes per week respectively. Most of the consultants i.e 18(36.0%) exercise >30 to <90 min per week  and most of the residents i.e 32(32.0%) do not exercise and this difference is statistically significant. (p<0.05)Most of the doctors of pre clinical subject i.e 11(36.7%) do exercise <30 min per week, most of the doctors of para clinical subject i.e 19(63.3%) do not do exercise and  most of the doctors of clinical subject i.e 43(28.7%) do not do exercise and this difference is statistically significant (p=0.000).

In the study among the doctors in a General Hospital in Dhaka  by Tonima Sultana et all⁸ it was found that 3.0% were involved in vigorous-intensity activities . More than 30% were involved in moderate-intensity activities . In general, low physical activity was prevalent in 39.9% of the participants; men had higher prevalence (44.4%) compared to women (34.3%), and the difference was statistically significant (p = 0.02) .

In this study 20 doctors (14.2%) have diabetes, 65 (46.1%) suffer from dyslipidemia, 13 (9.2%) experience joint pain, 33 (23.4%) have hypertension, and 5 (3.5%) each are affected by COPD and CAD. Among consultants, 15 (20.0%) have diabetes and 29 (38.7%) have dyslipidemia, whereas among residents, 36 (48.0%) suffer from dyslipidemia, with no reported cases of COPD or CAD. In terms of subject-specific differences, pre-clinical doctors mostly suffer from joint pain and hypertension, para-clinical doctors have a high incidence of dyslipidemia and hypertension, while clinical doctors show high rates of diabetes and dyslipidemia.  Eva Niewiadomska et all⁶ studied the mental⁹ wellbeing of doctors found out that The chronic diseases affected 480 (68.5%) of the surveyed doctors out of which obesity (68.3%) was the most prevalent followed by hypertension¹⁰ (33.8%), dyslipidemia (27.1%), allergy (26.7%), CAD¹¹ (24.4%), diabetes¹² (14.1%)  respectively

The study highlights significant concerns regarding the physical and mental health of doctors, with a focus on consultants and residents. Key findings include a high prevalence of dyslipidemia and pre-obesity, along with statistically significant levels of depression and anxiety among residents and clinical doctors. These mental health issues are notably higher in females and unmarried doctors, likely exacerbated by long duty hours and frequent night shifts. Residents and clinical doctors face greater work pressure, leading to less relaxation time compared to their counterparts. Lifestyle factors such as high consumption of tea, occasional alcohol use, and minimal exercise are prevalent, with smoking being more common among residents, particularly as a response to stress. The study underscores the detrimental impact of demanding work environments on doctors' well-being and calls for improvements such as reduced duty hours, better mental health support, and healthier workplace amenities to enhance overall health and job satisfaction.

1. Pandey, S. K., and V. Sharma. “Doctor, Heal Thyself: Addressing the Shorter Life Expectancy of Doctors in India.” Indian Journal of Ophthalmology, vol. 67, no. 7, 2019, pp. 1248. DOI: 10.4103/ijo.IJO_1084_18.
2. Frank, E., C. Segura, H. Shen, and E. Oberg. “Predictors of Canadian Physicians’ Prevention Counseling Practices.” Canadian Journal of Public Health, vol. 101, no. 5, 2010, pp. 390–395. DOI: 10.1007/BF03405062.
3. Provincial Physician Health Programs. Canadian Medical Association, https://www.cma.ca/physician-wellness-hub/resources/stress/provincial-physician-health-programs. Accessed 21 Aug. 2023.
4. Hypertension. World Health Organization, https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 10 Oct. 2023.
5. Mental Health. World Health Organization, https://www.who.int/health-topics/mental-health. Accessed 10 Oct. 2023.
6. Budreviciute, A., S. Damiati, D. K. Sabir, K. Onder, P. Schuller-Goetzburg, G. Plakys, et al. “Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors.” Frontiers in Public Health, vol. 8, 2020, DOI: 10.3389/fpubh.2020.574111.
7. Non-communicable Diseases. World Health Organization, https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed 5 Feb. 2024.
8. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation, Geneva, 28 January - 1 February 2002. World Health Organization, https://www.who.int/publications-detail-redirect/924120916X. Accessed 5 Feb. 2024.
9. Mental Health. World Health Organization, https://www.who.int/india/health-topics/mental-health. Accessed 11 Oct. 2023.
10. Hypertension. World Health Organization, https://www.who.int/india/health-topics/hypertension. Accessed 11 Oct. 2023.
11. Cardiovascular Diseases. World Health Organization, https://www.who.int/india/health-topics/cardiovascular-diseases. Accessed 11 Oct. 2023.
12. Diabetes - India. World Health Organization, https://www.who.int/india/health-topics/mobile-technology-for-preventing-ncds. Accessed 11 Oct. 2023.