kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.1.9 kjhp-17-9 Original Article Relationship of Sleep Quality, Physical Stress, Psychological Stress, and Job Stress among Residents YooSo-Young ChoiYoung-Ah ParkYoung-Kyu ChoSung-Min LeeKyung-Shik JooGa-Young LeeHyun Keun Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea Corresponding author : Young-Ah Choi, MD Department of Family Medicine, Bundang Jesaeng Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea Tel: +82-31-779-0357, Fax: +82-31-779-0827 E-mail: grchoi1@dmc.or.kr 012017 19012017 1719 19 08112016 17012017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

The purpose of this study is to identify the relationship of sleep quality, physical stress, psychological stress, and job stress among residents and to examine correlations of sleep quality, physical stress, psychological stress, and job stress according to average of working hours per day, frequency of night duty, sleep onset time on night duty and sleeping hour on night duty.

 Methods:

A descriptive correlation study included 164 residents working at 13 secondary and tertiary hospitals in Gyeong-gi Province who completed a self-administered structured questionnaires. The data were collected from June 1 to August 31, 2016. and analyzed through frequency, percentage, t-test, ANOVA, Scheffe's test, multiple regression analysis by SPSS program version 22.0 (IBM Corp., Chicago, IL, USA).

 Results:

The average level of residents’ sleep quality, physical stress, psychological stress, and job stress were 40.30, 16.74, 15.96, and 26.79, respectively. Sleep quality, physical, psychological and job stress have shown statistically significant correlations according to average of working hours per day, frequency of night duty, sleep onset time on night duty and sleeping hour on night duty. Poor sleep quality is related to higher physical, psychological and job stress.

 Conclusions:

Residents’ average of working hours per day is long and sleeping hour on night duty is scarce. Due to this, the level of residents’ sleep quality is poor and physical, psychological and job stress are severe. Obviously, sleep quality showed a positive correlation with physical, psychological and job stress. It is necessary to develop effective program to improve the residents’ sleep quality and reduce physical, psychological and job stress.

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Correlation of degree of Sleep quality, physical and psychological stress, job stress related to average of working hours, average of ND per week, sleep onset time on ND, sleeping hour on ND.

Baseline characteristics

Characteristics Categories M±SD No. Freq. (%)
Gender Male   85 51.8
Female   79 48.2
Age 27-29 31.8±4.6 164 41 100.0 25.0
30-32   54 32.9
33-35   55 33.5
36-38   14 8.5
BMIa Underweight   6 3.7
Normal   76 46.3
Overweight   82 50.0
Marital status Single   83 50.6
Married   81 49.4
Religion Christianity   41 25.0
Catholic   32 19.5
Buddhism   11 6.7
None   80 48.8
Education Medical college   116 70.7
Medical graduate school   48 29.3
Department IM   30 18.3
FM   41 25.0
PD   18 11.0
PY   2 1.2
Rad   12 7.3
DM   11 6.7
EM   8 4.9
PS   10 6.1
OS   10 6.1
ENT   11 6.7
EYE   11 6.7
Resident grade 1   74 45.1
2   33 20.1
3   40 24.4
4   17 10.4
Smoking Non-smoker   134 81.7
Smoker   30 18.3
Socioeconomic satisfaction High   88 53.7
Moderate   73 44.5
Low   3 1.8
Frequency of exercise (per week) 0   45 27.4
1   41 25.0
2   56 34.1
3   18 11.0
Over 4   4 2.4
Frequency of drink (per week) 0   17 10.4
1   41 25.0
2   45 27.4
3   47 28.7
Over 4   14 8.5
Frequency of caffeine intake (per day) 1   15 9.1
2   51 31.1
3   47 28.7
  Over 4   51 31.1
Average of working hours (per day)   11.52±2.27 164 100.0
<10   38 23.2
10-12   68 41.5
>12   58 35.4
Frequency of NDb (day per week) 0-1   56 34.1
2-3   57 34.8
4-5   29 17.7
6-   22 13.4
Sleep onset timec on NDb <22   3 1.8
22-23   55 33.5
24-25   43 26.2
26-27   61 37.2
28-   2 1.2
Sleeping hour on NDb (per day) 1-2   53 32.3
3-4   23 14.0
5-6   39 23.8
7-8   49 29.9

Abbreviations: M, mean; SD, standard deviation; No., number; Freq., frequency; BMI, body mass index; IM, internal medicine; FM, family medicine; PD, pediatrics; PY, psychiatrics; Rad, radiology; DM, dermatology; EM, emergency medicine; PS, plastic surgery; OS, orthopedic surgery; ENT, otorhinolaryngology; EYE, ophthalmology; ND, night duty. Values are presented as mean±standard deviation, number or frequency (%).

BMI: underweight (<18), normal (18-23), overweight (>23).

ND: emergency room duty included.

25 indicate ante meridiem (AM) 1, 26 indicate AM 2, 27 indicate AM 3, 28 indicate AM 4.

Degree of Sleep quality, physical and psychological stress, job stress

  Question no. Total score Question score
  M±SD Min.-Max. M±SD Min.-Max
Sleep quality 28 40.30±11.83 13.00-60.00 1.44±1.13 0-3
Physical stress 15 16.74±8.26 0.00-34.00 1.12±1.20 0-3
Psychological stress 15 15.96±10.79 0.00-37.00 1.06±1.08 0-3
Job stress 9 26.79±5.79 10.00-36.00 2.98±1.11 0-4

Abbreviations: M, mean; SD, standard deviation; No., number; Min., minimum value; Max., maximum value. Values are presented as mean±standard deviation.

Degree of sleep quality related to baseline characteristics

Characteristics Categories M±SD t or F P Scheffe
Gender Male 40.15±5.79 -0.169 0.866d  
  Female 40.47±4.92      
Age 27-29 49.22±6.36 1.532 0.308e  
  30-32 39.63±3.60      
  33-35 36.58±4.25      
  36-38 31.43±5.85      
BMIa Underweight 43.67±5.36 0.280 0.756e  
  Normal 40.42±4.14      
  Overweight 39.95±3.12      
Marital status Single 40.34±4.68 0.035 0.972d  
  Married 40.27±5.06      
Religion Christianity 32.98±4.07 0.208 0.984e  
  Catholic 41.75±4.85      
  Buddhism 53.18±3.74      
  None 41.71±5.24      
Education Medical college 40.28±4.27 -0.051 0.959d  
  Medical graduate school 40.38±3.84      
Department IM 42.10±5.85 2.126 0.026e -
  FM PD 39.20±3.54 35.33±3.58      
  PY 41.50±3.19      
  Rad 33.75±4.87      
  DM 35.64±5.05      
  EM 37.25±4.29      
  PS 47.60±5.90      
  OS 45.90±4.61      
  ENT 44.10±2.48      
  EYE a 46.00±2.39     e
Resident grade 1a 47.08±4.59 35.063 < <0.001 e a, b>c, d
  2b 41.88±5.89      
  3c 31.83±3.32      
  4d 27.71±5.10      
Smoking Non-smoker 39.23±4.93 -2.494 0.014d  
  Smoker 45.10±3.24   e  
Socioeconomic satisfaction High Moderate 36.90±2.09 44.79±4.20 0.039 0.401e  
  Low 31.00±4.00      
Frequency of exercise (per week) 0a 48.44±4.80 12.021 < <0.001 e a>d
  1b 39.63±5.10      
  2c 37.86±2.37      
  3d 30.06±3.48      
  Over 4e 36.00±3.79      
Frequency of drink (per week) 0a 38.29±4.85 6.638 < <0.001 e c>d, e
  1b 39.93±4.40      
  2c 47.11±5.27      
  3d 36.47±5.29      
  Over 4e 34.86±4.29      
Frequency of caffeine intake (per day) 1a 34.93±4.69 4.264 0.006e d>a
  2b 37.84±4.67      
  3c 40.02±3.09      
  Over 4d 44.61±3.93      
Average of working hours (per day) Average of NDb (day per week) <10a 29.87±3.06 62.699 < <0.001 e c>b>a
  10-12b 37.87±4.60      
  >12c 50.00±4.14      
  0-1a 30.04±3.89 50.462 < <0.001 e d>b, c>a
  2-3b 43.33±4.80      
  4-5c 43.48±4.32      
    Over 6d 54.41±5.79    
Sleep onset timec on NDb <22a 22-23b 26.33±3.09 34.18±3.17 18.999 < <0.001 e d>a
  24-25c 37.21±4.93      
  26-27d 48.72±4.81      
  Over 28e 39.50±4.19      
Sleeping hour on NDb (per day) 1-2a 3-4b 5-6c 48.15±5.63 47.91±4.00 34.72±4.39 32.541 < <0.001 e a, b>c, d
  7-8d 32.69±3.99      

Abbreviations: M, mean; SD, standard deviation; No., number; Freq., frequency; BMI, body mass index; IM, internal medicine; FM, family medicine; PD, pediatrics; PY, psychiatrics; Rad, radiology; DM, dermatology; EM, emergency medicine; PS, plastic surgery; OS, orthopedic surgery; ENT, otorhinolaryngology; EYE, ophthalmology; ND, night duty. Values are presented as mean±standard deviation and P value.

BMI: underweight (<18), normal (18-23), overweight (>23).

ND: emergency room duty included.

25 indicate ante meridiem (AM) 1, 26 indicate AM 2, 27 indicate AM 3, 28 indicate AM 4.

Calculated by t-test.

Calculated by ANOVA.

Degree of physical stress, psychological stress and job stress related to baseline characteristics

Characteristics Categories Physical stress Psychological stress Job stress
M±SD t or F P Scheffef M±SD t or F P Scheffef M±SD t or F P Scheffef
Gender Male 15.38±2.29 -2.225 0.027d   16.54±1.93 0.710 0.479d   26.88±2.89 0.219 0.827d  
Female 18.22±2.02       15.34±1.67       26.68±2.73      
Age 27-29 21.93±2.51 0.712 0.141e   23.66±2.57 0.997 0.493e   29.59±3.70 0.717 0.965e  
30-32 17.39±2.55       14.63±1.27       25.48±2.88      
33-35 13.85±2.12       13.87±1.92       26.24±2.15      
36-38 10.43±3.04       6.79±1.35       25.79±3.48      
BMIa Underweight 24.83±3.93 0.327 0.056e   21.50±2.53 1.096 0.337e   31.33±2.88 1.949 0.146e  
Normal 17.20±1.87       15.10±1.85       26.57±2.75      
Overweight 15.73±2.23       16.37±1.24       26.66±3.35      
Marital status Single 17.18±2.46 0.683 0.496d   16.61±1.78 0.780 0.437d   26.20±3.59 -1.305 0.194d  
Married 16.30±2.04       15.30±1.75       27.38±3.96      
Religion Christianity 11.56±1.04 0.349 0.060e   10.05±0.80 0.910 0.079e   26.10±2.81 1.268 0.287e  
Catholic 18.31±2.47       16.16±1.27       26.38±2.67      
Buddhism 23.73±3.76       26.27±2.88       29.81±1.27      
None 17.81±2.12       17.50±1.92       26.89±2.29      
Education Medical college 16.97±2.25 0.554 0.581d   15.18±1.69 -1.449 0.149d   26.62±3.17 -0.569 0.570d  
Medical graduate school 16.19±1.34       17.85±1.91       27.19±3.87      
Department IMa 19.70±2.26 1.219 0.283e   17.30±2.85 3.961 <0.001e e - 30.97±4.03 13.460 <0.001e e a>b
FM 15.24±1.04       14.71±1.48       26.80±3.80      
PD 14.56±1.34       12.67±2.27       24.72±2.17      
PY 19.00±2.24       22.50±2.54       25.50±2.95      
Radb 14.58±2.19       3.25±0.84       15.33±2.35      
DM 16.64±2.66       11.91±1.72       23.45±2.94      
EM 12.13±1.73       18.50±2.45       25.38±3.00      
PS 19.00±2.17       22.20±3.38       29.60±4.14      
OS 17.90±1.38       22.10±3.24       28.50±4.88      
ENT 17.64±1.81       21.55±2.76       29.27±3.82      
EYE 19.27±2.12       20.45±2.21       29.18±3.14      
Resident grade 1a 20.45±3.52 19.417 <0.001e e a, b>c, d 22.76±1.54 51.927 0.011e a, b>c, d 28.62±3.55 8.336 <0.001e e a>c, d
2b 18.33±3.36       17.91±2.43       27.39±3.17     b>d
3c 10.88±2.44       7.18±0.92       24.73±2.35      
4d 11.35±1.10       3.29±0.80       22.53±2.84      
Smoking Non-smoker 15.72±2.85 -3.479 <0.001d d 14.42±2.46 -4.057 <0.001d d 26.16±3.76 -2.980 0.003d  
Smoker 21.33±2.63       22.87±1.57       29.57±3.12      
Socioeconomic satisfaction High Moderate 14.72±1.79 19.51±1.11 0.825 0.101e   12.64±1.36 20.18±2.03 1.353 0.851e   20.16±2.62 24.21±2.73 32.569 0.006e c>a, b
Low 9.00±1.90       11.00±1.29       30.67±3.14      
Frequency of exercise (per week) 0a 1b 2c 21.31±2.13 17.24±2.84 14.00±2.12 7.021 <0.001e - e 23.29±2.44 16.27±1.84 12.95±1.55 13.018 <0.001e a>d e 28.98±3.62 27.15±2.57 26.63±3.85 7.458 <0.001e e a>d
3d 12.67±2.31       6.11±0.94       20.83±2.95      
Over 4e 17.00±1.89       17.00±1.85       27.50±3.26      
Frequency of drink (per week) 0a 1b 2c 16.12±1.89 17.29±2.12 21.64±2.18 0.168 0.638e   14.06±1.89 18.32±1.94 19.49±2.14 1.132 0.303e   29.29±3.15 27.07±3.98 28.16±3.06 1.274 0.113e  
3d 13.28±1.05       11.53±1.99       24.94±2.78      
Over 4e 11.79±1.83       14.93±1.78       24.71±2.39      
Frequency of caffeine intake (per day) 1a 2b 3c 10.67±1.85 14.73±2.77 16.11±2.42 0.058 0.051e   12.80±1.59 14.10±1.86 14.74±1.37 3.540 0.016e - 25.27±1.85 26.25±2.72 26.55±3.42 1.242 0.296e  
  Over 4d 21.14±3.90       19.88±2.10       27.98±3.12    
Average of working hours (per day) <10a 12.32±2.65 37.784 <0.001e e c>a, b 3.79±0.66 125.789 <0.001e e c>b>a 22.03±2.23 29.750 <0.001 e c>b>a
  10-12b 13.90±2.13       14.28±1.96       26.68±3.00      
  >12c 23.00±2.03       25.91±2.29       30.03±3.92      
Average of NDb (day per week) 0-1a 10.96±2.34 40.376 <0.001e e d>b, c>a 5.88±0.91 89.198 <0.001e e d>b, c>a 23.95±4.44 10.979 <0.001 e d>a, b
2-3b 18.46±3.18       17.18±2.47       27.26±3.92     c>a
4-5c 19.07±2.29       21.34±2.75       28.00±3.71      
Over 6d 27.91±3.78       31.41±3.79       31.18±4.89      
Sleep onset timec on NDb <22a b 11.67±1.03 7.166 <0.001e e - 8.00±1.27 31.252 <0.001e e d>a, b 19.00±2.19 14.283 <0.001 e e>a
22-23b 13.29±1.77       8.69±1.28       23.76±2.19      
24-25c 16.21±1.21       13.28±1.19       26.21±2.51      
26-27d 20.62±2.52       21.93±2.74       27.28±3.36      
Over 28e 22.50±3.12       22.00±2.67       30.50±3.54      
Sleeping hour on NDb (per day) 1-2a 24.02±2.15 20.577 <0.001e e a, b>c, d 24.85±1.96 63.177 <0.001e e a, b>c>d 30.74±4.03 31.420 <0.001 e a, b>c, d
3-4b 24.00±2.56       21.70±2.95       29.87±3.72      
5-6c 12.97±2.39       13.28±2.01       24.72±2.15      
7-8d 12.80±1.51       5.80±0.63       22.71±1.48      

Abbreviations: M, mean; SD, standard deviation; BMI, body mass index; IM, internal medicine; FM, family medicine; PD, pediatrics; PY, psychiatrics; Rad, radiology; DM, dermatology; EM, emergency medicine; PS, plastic surgery; OS, orthopedic surgery; ENT, otorhinolaryngology; EYE, ophthalmology; ND, night duty. Values are presented as mean±standard deviation and P value.

BMI: underweight (<18), normal (18-23), overweight (>23).

ND: emergency room duty included.

25 indicate ante meridiem (AM) 1, 26 indicate AM 2, 27 indicate AM 3, 28 indicate AM 4.

Calculated by t-test.

Calculated by ANOVA.

P value<0.05, Scheffe's test: significant difference among group marked a, b, c, d, and e.

Correlation of degree of sleep quality, physical and psychological stress, job stress

  Sleep quality Physical stress Psychological stress Job stress
  β SE P β SE P β SE P β SE P
Sleep quality - - - 0.304 0.063 0.001 0.498 0.056 <0.001 0.177 0.053 0.004
Physical stress 0.220 0.093 0.001 - - - 0.286 0.075 <0.001 0.031 0.065 0.036
Psychological stress 0.591 0.079 <0.001 0.467 0.072 <0.001 - - - 0.449 0.061 <0.001
Job stress 0.093 0.116 0.004 0.023 0.096 0.036 0.198 0.093 <0.001 - - -
  F=114.416, P<0.001, F=68.216, P<0.001, F=145.573, P<0.001, F=34.317, P<0.001,
  R2=0.682, adjusted R2=0.561, adjusted R2= 0.732, adjusted R2=0.392, adjusted
  R2=0.676 R2=0.553 R2=0.727 R2=0.380

Abbreviations: β, standardized regression coefficient; SE, standard error. Values are presented as standardized regression coefficient, standard error and P value. Calculated by multiple linear regression analyses adjusted by gender, age, marital status, education, department, and smoking.

Correlation of degree of Sleep quality, physical and psychological stress, job stress related to average of working hours, average of ND per week, sleep onset time on ND, sleeping hour on ND

  Sleep quality Physical stress Psychological stress Job stress
  β SE P β SE P β SE P β SE P
Average of working hours 0.188 1.425 0.041 0.145 1.181 0.002 0.179 0.856 0.003 0.063 0.825 0.042
Average of ND per week 0.414 0.793 <0.001 0.422 0.657 <0.001 0.497 0.476 <0.001 0.152 0.459 0.023
Sleep onset time on ND 0.141 1.109 <0.001 0.019 0.919 0.040 0.054 0.666 0.041 0.065 0.641 0.013
Sleeping hour on ND -0.159 0.939 0.005 -0.127 0.778 0.003 -0.344 0.564 <0.001 -0.434 0.544 <0.001
  F=50.581, P<0.001, R2=0.560, adjusted R2=0.549     F=24.369, P<0.001, R2=0.380, adjusted R2=0.364     F=168.548, P<0.001, R2= 0.809, adjusted R2=0.804     F=24.803, P<0.001, R2=0.384, adjusted R2=0.369    

Abbreviations: ND, night duty (emergency room duty included); β, standardized regression coefficient; SE, standard error. Values are presented as standardized regression coefficient, standard error and P value. Calculated by multiple linear regression analyses adjusted by gender, age, marital status, education, department and smoking.