Effects of compassion satisfaction, burnout, and secondary traumatic stress on current drug use among healthcare workers: Differences by occupational level

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Effects of compassion satisfaction, burnout, and secondary traumatic stress on current drug use among healthcare workers: Differences by occupational level

https://doi.org/10.21203/rs.3.rs-4437449/v1

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Work-related stress has been well-examined among physicians, but little is known about how it might affect drug use or healthcare workers in lower-wage occupations characterized by high job demands and low occupational autonomy (e.g., medical assistants, nursing assistants). In March 2022, we collected data from a diverse sample of healthcare workers (N = 200). We separately examined the cross-sectional relationships between several work-related experiences (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and measures of current drug use (i.e., non-medical use of prescription drugs [NMUPD], cannabis use, and illicit drug use). We then examined for differences occupational level (i.e., prescriber/administrator vs. other healthcare worker). In main effects models, greater burnout and secondary traumatic stress were both associated with higher odds of NMUPD, cannabis use, and illicit drug use (ps < 0.01). Greater compassion satisfaction was associated with lower odds of illicit drug use (p < 0.05), but not with NMUPD or cannabis use (ps > 0.05). There was a significant interaction between secondary traumatic stress and occupational level on NMUPD (p < 0.05) such that there was no relationship between secondary traumatic stress and NMUPD among prescribers/administrators, but the likelihood of NMUPD among other healthcare workers increased with greater secondary traumatic stress. Similar trend-level interactions were observed between secondary traumatic stress and occupational level on cannabis use (p < 0.10) and between burnout and occupational level on NMUPD. Burnout and secondary traumatic stress are systemic issues, and results suggest they may contribute to drug use. Healthcare workers in positions characterized by high demands and low autonomy may be especially vulnerable.

compassion satisfaction

burnout

secondary traumatic stress

drug use

healthcare workers

The Healthcare and Social Assistance sector in the United States (US) employs over 20 million workers and is expected to have about 1.8 million job opportunities annually on average (U.S. Bureau of Labor Statistics, 2021). This sector encompasses a diverse array of occupations, each with its unique set of educational prerequisites, training criteria, and job demands which can predispose healthcare workers to work-related stress, and the COVID-19 pandemic has exacerbated these stressors (e.g., Buselli et al., 2021; Pappa et al., 2020; Que et al., 2020). The recent White House COVID Coordinator stated that the healthcare sector would continue to experience periods of dysfunction and overwhelming “for years” (Washington Post, 2023).

The psychological well-being of healthcare workers is a significant public health issue due to their pivotal role in healthcare delivery, which can have rippled effects on their well-being, the health of their families, and the quality of care provided to patients. Healthcare workers may encounter several occupational challenges such as demanding workloads, potential contact with hazardous medical waste and transmission of infectious diseases, and insufficient personal protective equipment and safety measures (Buselli et al., 2021; Pappa et al., 2020). These working conditions may act as stressors that can manifest in psychological distress, such as burnout and secondary traumatic stress (Pappa et al., 2020).

Burnout has been understood as the “result of chronic stress in the workplace that has not been successfully managed (World Health Organization). Burnout develops gradually, whereas secondary traumatic stress swiftly materializes with a more accelerated onset (Jakimowicz et al., 2018). Burnout and secondary traumatic stress have been posited to come from failed survival strategies, namely assertiveness-goal achievement response (characterized by a drive to achieve vital goals and activation of the sympathetic nervous system) and rescue-caretaking response (characterized by intense empathy, pity, compassion, care, devotion, and responsibility), respectively (Valent, 2013). Burnout is common among physicians and has contributed to turnover-related costs of approximately $4.6 billion and fewer clinical hours each year in the US (Han et al., 2019). Experiencing greater occupational burnout has been associated with increased mental health symptomatology, reduced help-seeking behavior, and increased medical errors (Dyrbye et al., 2021; Hyman et al., 2017; Menon et al., 2020; Panagioti et al., 2018).

Secondary traumatic stress, also known as compassion fatigue, is defined as the “cost of caring” for others in emotional or physical pain (Figley & McCubbin, 1983). Secondary traumatic stress is that arising from contact with a traumatized patient rather than direct exposure to the trauma itself and is prevalent among workers who also experience burnout (Cieslak et al., 2014). Working conditions that are both physically and emotionally demanding increase susceptibility to secondary traumatic stress (Galek et al., 2011). Pandemic-era research suggests that secondary traumatic stress may contribute to anxiety, depression, and suicidality among healthcare workers (Ariapooran et al., 2022; İlhan & Küpeli, 2022). Importantly, secondary traumatic stress (i.e., compassion fatigue) can be viewed in contrast to compassion satisfaction, which is the sense of fulfillment that is derived from providing care to patients (Joinson, 1992). This phenomenon describes the perception that one’s work is yielding social value reflected in the mitigation of another person’s discomfort (Ruiz-Fernández et al., 2020) and has been shown to ameliorate challenges associated with patient care (Harr, 2013).

To cope with work-related stressors, some people may use substances. For example, a recent study of Brazilian healthcare workers suggests that substance use increased among this population during the pandemic and that the use of some substances varied by occupation (Gir et al., 2022). Although work-related stress and its effects have been well-examined among physicians, little is known about how it might affect healthcare workers in lower-wage occupations characterized by high job demands and low occupational autonomy (e.g., medical assistants, and nursing assistants). Gir and colleagues (2022) purported that occupation and educational status of healthcare providers can amplify vulnerability to substance use. Moreover, prior work suggests that disparities in help-seeking and healthcare access among lower-wage healthcare workers may contribute to a greater risk of NMUPD (Hoopsick et al., 2023). Therefore, this study seeks to investigate the effect of work-related experiences (i.e., compassion satisfaction, burnout, and secondary traumatic stress) on a range of drug use outcomes among healthcare workers in the United States, and whether these effects differ by occupational level.

Participants and Procedure

We recruited a diverse sample of people working in various healthcare settings across the US in March of 2022 (N = 200) using a social media ad targeted at healthcare workers. To participate, participants needed to be at least 18 years of age and currently working for wages in one or more of the following healthcare settings: hospital, ambulatory or outpatient clinic, nursing or residential facility, social assistance program, and/or home healthcare. Additionally, participants also needed to be able to read and understand the English language and be willing and able to participate. Eligible participants were asked to complete one online survey at a place of their choosing, which took approximately 60 minutes to complete. All participants were compensated with a $50 gift card. The study protocol was approved by the Institutional Review Board of the University of Illinois Urbana-Champaign. Of those who were eligible for inclusion in the current study (N = 284), 70.4% agreed to participate and completed the survey. We conducted sensitivity analyses and found that there were no statistically significant differences in the screening variables (i.e., age, gender, work setting) between those who were eligible and participated and those who were eligible but did not participate (ps > 0.05).

Our study sample included healthcare workers from 28 different US states plus Washington, DC. The sample was comprised of a wide range of different healthcare occupations, including low-wage healthcare support roles (e.g., nursing assistants, dietary aides, administrative support staff), licensed practical nurses, registered nurses, psychologists, case managers, social workers, physical therapists, mid-level providers (e.g., nurse practitioners, physician assistants), physicians, pharmacists, dentists, and healthcare administrators. These healthcare workers reported working across a variety of healthcare settings, including ambulatory/outpatient clinics, home healthcare, hospitals, social assistance programs, and nursing/residential facilities. Our final sample was racially and ethnically diverse, ranged in age from 19 to 58 years, and included men (32.5%), women (66.5%), and non-binary people (1.0%). Although the sample was mostly women healthcare workers, this is consistent with healthcare workers nationally (U.S. Census Bureau, 2021). Additional characteristics of the study sample are presented in Table 1.

Measures

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress

We assessed the positive and negative aspects of healthcare workers’ experiences using the Professional Quality of Life Scale (ProQOL; Stamm, 2010). This 30-item measure assesses workers’ experiences over the last 30 days and items comprise subscales on compassion satisfaction, burnout, and secondary traumatic stress over the last 30 days. Respondents are asked to rate how frequently they experience a number of affective states, feelings, and thoughts related to their work. Each item is measured on a 5-point Likert scale ranging from 1 (Never) to 5 (Very Often). Higher scores on each subscale indicate greater compassion satisfaction, burnout, and secondary traumatic stress, respectively. Example items from the compassion satisfaction subscale (α = .92) include “My work makes me feel satisfied” and “I get satisfaction from being able to help people.” The burnout subscale (α = .72) includes items such as “I feel trapped by my job as a healthcare worker,” “I feel overwhelmed because my workload seems endless,” and “I feel "bogged down" by the system.” Example items from the secondary traumatic stress subscale (α = .86) include “I feel as though I am experiencing the trauma of someone I have helped,” “As a result of my healthcare work, I have intrusive, frightening thoughts.” and “I avoid certain activities or situations because they remind me of frightening experiences of the people I help.”

Current Drug Use

To assess current drug use, we used the NIDA Modified Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) version 2.0 (WHO ASSIST Working Group, 2002), a measure of lifetime and current use of alcohol, tobacco, recreational and medical cannabis, non-medical use of prescription drugs (NMUPD), and illicit drug use. The current study focused on NMUPD, cannabis use, and illicit drug use. The NIDA Modified ASSIST defines NMUPD as using prescription stimulants, sedatives, opioids, or other prescriptions “on your own, that is either without a doctor’s prescription, in greater amounts, more often, or longer than prescribed, or for a reason other than a doctor said you should use them.” The NIDA Modified ASSIST assesses NMUPD with the following question: “In the past three months, how often have you used [substance]?” We considered any use in the past three months as a positive screen for current NMUPD and dichotomized current use (no/yes). Given that cannabis has been decriminalized in many US states for medical and recreational purposes, cannabis use was examined separately from illicit drug use, including cocaine or crack, stimulants, inhalants, sedatives, hallucinogens, and street opioids. Current cannabis use and illicit drug use were assessed with the NIDA Modified ASSIST using the following question: “In the past three months, how often have you used [substance]?” We considered any use of the substance in the past three months as a positive screen for current use. We dichotomized current cannabis use and illicit drug use (no/yes).

Occupational Level

Participants were asked to report their type of occupation in the healthcare sector. To examine for differences in the relations between compassion satisfaction, burnout, and secondary traumatic stress on current drug use by occupational level, we created a dichotomous variable (healthcare administrator/prescriber vs. other healthcare worker). To capture the potential differences between the high-earning high-autonomy positions from other roles, we first grouped healthcare administrators and prescribers (e.g., physicians, nurse practitioners, physician assistants) and then grouped other healthcare professionals (e.g., registered nurses, nursing assistants, dietary aides, administrative support staff).

Covariates

Age. Participants self-reported their age. Given that some research suggests that work-related stress is more common among younger healthcare workers (Galanis et al., 2021) and that there are notable age differences in the rates of substance use in the general population (SAMHSA, 2020), we included age in years as a covariate in all adjusted models.

Gender Identity. National data suggests that there are significant differences in substance use patterns among US adults by gender (SAMHSA, 2020). Further, a recent meta-analysis examining more than 33,000 healthcare workers across 12 different studies conducted during the COVID-19 pandemic suggests that women in the healthcare workforce may be more likely to experience pandemic-related psychological sequelae (Pappa et al., 2020). Taken together, this suggests that gender might confound the association between healthcare workers’ experiences and substance use. We controlled for participants’ self-reported gender in all adjusted models.

Race/ethnicity. All participants self-reported their race and ethnicity. There are differences in the types of substances used among different racial and ethnic groups in the general population (SAMHSA, 2020). Additionally, non-Hispanic white healthcare workers are more likely to report work-related burnout than other racial/ethnic groups (Mercado et al., 2022). Thus, to control for potential confounding effects, we included race/ethnicity as a covariate in our adjusted models.

Annual Family Income. In addition to the aforementioned sociodemographic factors, research suggests that people with lower household incomes may also be more likely to experience problematic substance use (Baptiste-Roberts & Hossain, 2018). A pre-pandemic national survey of nurses suggests that nurses with lower income levels were more likely to leave their jobs due to burnout (Shah et al., 2021). Taken together, this suggests that annual family income might confound the relations between healthcare workers’ work-related experiences (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and substance use. We controlled for participants’ self-reported family income in our adjusted models.

Type of Healthcare Setting. Work-related stress and burnout are prevalent across all healthcare settings (Green et al., 2020), but there is growing evidence suggesting that those working in hospital settings may be particularly vulnerable (Buran & Altın, 2021; Lasater et al., 2021; Sanghera et al., 2020; Shah et al., 2021) We included the type of healthcare setting (i.e., hospital setting vs. non-hospital setting) in all adjusted regression models.

Data Analysis

We first used descriptive statistics to characterize the study sample. Next, we examined the separate effects of compassion satisfaction, burnout, and secondary traumatic stress on current drug use using logistic regression models. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. We then added age, gender identity, race/ethnicity, and annual family income as covariates to all regression models and reported adjusted odds ratios (aORs) and 95% CIs. Finally, we added an interaction term to each fully adjusted model representing the cross-product of each ProQOL subscale and occupational level (healthcare administrator or prescriber vs. other healthcare worker) to examine for differences in the relations between compassion satisfaction, burnout, and secondary traumatic stress on current drug use by occupational level. To better understand statistically significant interactions, we examined predictive margins and plotted the predicted probability of current drug use by ProQOL subscale and occupational level.

Descriptive Results

Current drug use was prevalent among our study sample. The prevalence of NMUPD was 21.0%, which primarily (78.6%) consisted of prescription sedatives and sleeping medications (e.g., Valium, Serepax, Ativan, Xanax), followed by prescription stimulants (26.2%; e.g., Ritalin, Concerta, Dexedrine, Adderall), and other psychotropic medications (7.1%; e.g., Zoloft, Trazodone, Lamictal, Seroquel). The prevalence of current cannabis use was 29.0% and the prevalence of illicit drug use (excluding cannabis) was 7.0%. There were no statistically significant differences in the prevalence of NMUPD (χ²(1, N = 200) = 3.00, p = .08), cannabis (χ²(1, N = 200) = .01, p = .94), or illicit drugs (χ²(1, N = 200) = .84, p = .36) by occupational level. Mean (M) subscale scores for compassion satisfaction (M = 34.58, standard deviation (SD) = 7.52), burnout (M = 26.23, SD = 5.73), and secondary traumatic stress (M = 23.36, SD = 7.40) were in line with the mean ProQOL subscale scores derived from a meta-analysis of studies examining compassion satisfaction (M = 33.12, 95% CI [32.22, 34.03]), burnout (M = 26.64, 95% CI [26.01, 27.27]), and secondary traumatic stress (M = 25.24, [24.69, 25.79]) among nurses (Xie et al., 2021).

Main Effects of ProQOL Subscales on Current Drug Use

In unadjusted models, greater compassion satisfaction was not associated with NMUPD (OR = 0.98, 95% CI [0.93, 1.02]; Table 2) or cannabis use (OR = 0.98, 95% CI [0.94, 1.02]), but was associated with lower odds of illicit drug use (OR = 0.93, 95% CI [0.87, 0.99]). After controlling for age, gender identity, race/ethnicity, annual family income, and hospital setting (yes/no), compassion satisfaction was still not associated with NMUPD (aOR = 0.97, 95% CI [0.92, 1.02]) or cannabis use (aOR = 0.98, 95% CI [0.94, 1.02]), but was associated with increased odds of illicit drug use (aOR = 0.92, 95% CI [0.86, 0.99]). Greater burnout was associated with greater odds of NMUPD (OR = 1.11, 95% CI [1.04, 1.19]), cannabis use (OR = 1.09, 95% CI [1.03, 1.15]), and illicit drug use (OR = 1.17, 95% CI [1.05, 1.31]) in unadjusted models. Greater burnout also remained associated with increased odds of NMUPD (aOR = 1.13, 95% CI [1.05, 1.22]), cannabis use (aOR = 1.11, 95% CI: 1.04, 1.18), and illicit drug use (aOR = 1.27, 95% CI [1.09, 1.47]) in adjusted models. Greater secondary traumatic stress was associated with greater odds of current NMUPD (OR = 1.13, 95% CI [1.07, 1.20]), cannabis use (OR = 1.06, 95% CI [1.02, 1.11]), and illicit drug use (OR = 1.12, 95% CI [1.04, 1.20]) in unadjusted models. After controlling for relevant covariates, greater secondary traumatic stress remained associated with increased odds of NMUPD (aOR = 1.14, 95% CI: 1.07, 1.21), cannabis use (aOR = 1.07, 95% CI: 1.02, 1.12), and illicit drug use (aOR = 1.11, 95% CI: 1.02, 1.21).

Interaction Effects of ProQOL Subscales and Occupational Level on Current Drug Use

There was a significant interaction between secondary traumatic stress and occupational level on the odds of NMUPD (aOR = 0.86, 95% CI: 0.75, 0.97; Table 3), such that there was no relation between the ProQOL Secondary Traumatic Stress subscale score and the odds of NMUPD among prescribers and healthcare administrators, but greater secondary traumatic stress was associated with an increased likelihood of NMUPD among other healthcare workers (Fig. 1). There were also trend-level interactions between burnout and occupational level on the odds of NMUPD (aOR = 0.86, 95% CI: 0.72, 1.02; Fig. 2) and between secondary traumatic stress and occupational level on cannabis use (aOR = 0.91, 95% CI: 0.83, 1.01; Fig. 3) that were similar in magnitude and direction, suggesting no relations between these work experience and drug use among prescribers/administrators and a positive relation among other healthcare workers.

Results from the current study suggest that greater burnout and secondary traumatic stress are associated with higher odds of NMUPD, cannabis use, and illicit drug use among healthcare workers. Greater compassion satisfaction was associated with lower odds of other illicit drug use, but not with NMUPD or cannabis use. Importantly, we found a significant interaction between secondary traumatic stress and occupational level on NMUPD such that there was no relationship between secondary traumatic stress and NMUPD among prescribers/administrators, but the likelihood of NMUPD among other healthcare workers increased with greater levels of secondary traumatic stress. Few studies have focused on drug use among lower-wage occupations and work-related stress in the healthcare sector, underscoring the importance of the novel findings from this study.

Sorensen and colleagues (2021) developed a conceptual framework highlighting work as a critical determinant of health and the multiple levels of influence on worker health, safety, and welfare. It recognizes that work-related concerns comprise larger social, economic, and political forces in addition to occupational safety and health considerations. According to this paradigm, experiences at work can influence people's behaviors and health outcomes by serving as stressors or protective factors. Furthermore, this conceptual framework emphasizes how crucial it is to consider multiple levels of impact when examining the relationships between work-related experiences and health behaviors, including organizational policies, job design, the psychosocial work environment, and broader socioeconomic considerations. For instance, elements like workplace stress, a lack of social support system, and unstable economic conditions can all lead to adverse health behaviors and outcomes (Sorensen et al., 2021). Within the context of this framework, findings from our study suggest that the work-related experiences of healthcare workers may affect their likelihood of coping with these stressors using a range of substances and that those in lower-wage occupations may be at disproportionately greater risk.

Work by Prins and colleagues (2019) examined more than 12,000 full-time workers and demonstrated that occupations characterized by higher authority, autonomy, and expertise were associated with lower odds of binge drinking, heavy drinking, and mental illness. Although poverty and substance use are inextricably and bidirectionally related, differences may not be explained by social stratification based on individual attributes alone (e.g., socioeconomic status). Rather, mechanisms that produce social stratification may increase the risk for problems with substance use and mental health. For example, a study examining data from the 1983 to 2017 waves of the Panel Study of Income Dynamics (Prins et al., 2021) showed that greater labor exploitation (i.e., working unpaid hours) was associated with greater psychological distress. Thus, despite the compelling evidence that work-related stressors have a deleterious effect on physicians, those working in lower-wage positions characterized by high demands and low autonomy may be at even greater risk. Findings from the current study suggest that not only are the workplace experiences of healthcare workers associated with the use of substances but that lower-wage healthcare workers may be made especially vulnerable to substance use via their workplace experiences. This is important to consider, especially as many employers of low-wage workers do not leverage effective substance use intervention strategies (e.g., substance use education and employee assistance programs) (Hoopsick & Samad, 2023).

It is important to situate our findings within the larger context of other research regarding pandemic-related effects on healthcare workers. Our results are generally consistent with other studies examining the psychological effects of the COVID-19 pandemic on healthcare workers. Research carried out in the first stages of the pandemic indicated that healthcare professionals had high levels of stress and problematic mental health symptomatology (e.g., Buselli et al., 2021; Pappa et al., 2020; Que et al., 2020). Findings from our study suggest that burnout and secondary traumatic stress have remained prevalent among this population and are associated with maladaptive coping strategies (e.g., substance use). Importantly, findings from the current study extend prior research by demonstrating the differential effects of work-related experiences on the substance use of healthcare workers by occupational level.

Limitations

Evidence from this study should be interpreted within the context of some limitations. First, it is challenging to establish causal conclusions with cross-sectional data. Other work-related factors not examined in the current study might partially explain the relationships we observed. Second, participants provided self-reports which are subjected to social desirability bias. However, we made use of computer-assisted interviewing which has shown to provide accurate estimates of substance use, mental health symptomatology, and other sensitive topics (Gerbert et al., 1999; Kumar et al., 2016; McNeely et al., 2016; Spear et al., 2016; Waruru et al., 2005) and is often preferred by research participants compared to face-to-face interview methods (Perlis et al., 2004; Waruru et al., 2005). Third, we used non-probability sampling methods so our sample might not be representative of all healthcare workers in the US, but they were diverse with regards to demographic attributes. Finally, burnout and secondary traumatic stress have been conceptualized and measured in various ways, which may limit comparisons to other research.

Strengths

Despite these limitations, this study also has notable strengths. First, our sample was made up of occupationally, demographically, and socioeconomically diverse healthcare workers across the United States. Second, considering the impact of COVID-19 on healthcare workers, our study is timely and relevant in identifying vulnerable populations within the healthcare sector. Finally, the administration of validated measures of the work-related experiences and substance use of these healthcare workers bolsters our research findings.

Results from the study showed that healthcare workers who experience greater burnout and secondary traumatic stress may be more likely to use substances, while healthcare workers who experience greater compassion satisfaction may be less likely to use substances. Importantly, our findings also highlight a possible disparity among healthcare workers in non-administrative or prescriber roles. Future studies should investigate these relationships using longitudinal data to better understand how work-related experiences can impact drug use over time. Additionally, studies conducted with larger nationally representative samples could illuminate potential occupation- and setting-specific effects.

In conclusion, our research begins to clarify some of the intricate connections between work-related experiences and drug use behaviors among healthcare workers. Lower-wage healthcare professionals may be made especially vulnerable to the negative effects of work-related stressors. Our findings underscore the need for systems-level changes that improve the working environments and mechanisms of support for healthcare workers, especially those who face high job demands and low autonomy in the workplace.

FUNDING STATEMENT:

Research reported in this manuscript was provided by the Mary Jane Neer Fund of the University of Illinois Urbana-Champaign

CONCLICT OF INTEREST DISCLOSURE

The authors have no conflicts of interest to report.

ETHICAL STANDARDS STATEMENT

This research was reviewed and approved by the University of Illinois Urbana-Champaign Institutional Review Board. All research participants provided informed consent before participation.

PATIENT CONSENT STATEMENT

Not applicable.

PERMISSION TO REPRODUCE MATERIAL FROM OTHER SOURCES

Not applicable.

Author Contribution

R.H. conceived of and designed the study. R.H. completed the formal data analysis. S.O. wrote the first draft of the manuscript with sections contributed by T.K., N.D., C.R., and R.H. All authors reviewed the manuscript.

Data Availability

Data will be provided upon reasonable request to the corresponding author.

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Table 1. Sample Characteristics (N = 200 healthcare workers)

% (n) or mean (± SD)

Age, years

30.8 (± 7.3)

Gender Identity

Man

Woman

Non-binary/genderqueer

32.5% (65)

66.5% (133)

1.0% (2)

Race/Ethnicity

Non-Hispanic white

Non-Hispanic Black

Non-Hispanic Asian

Non-Hispanic American Indian or Alaska Native

Hispanic or Latinx

Other

54.5% (109)

17.5% (35)

14.0% (28)

1.0% (2)

10.0% (20)

3.0% (6)

Education

High school diploma or equivalent (GED)

Some college (no degree)

Associate's/Other Technical 2-year degree

Bachelor's/Other 4-year degree

Graduate or Professional degree

3.0% (6)

5.0% (10)

14.0% (28)

35.5% (71)

42.5% (85)

Family Income

Less than $10,000

$10,000 - $19,999

$20,000 - $29,999

$30,000 - $39,999

$40,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 or more

0.5% (1)

3.5% (7)

2.5% (5)

4.5% (9)

10.0% (20)

19.5% (39)

20.0% (40)

24.0% (48)

15.5% (31)

Years in Job

Less than 1 year

1 – 5 years

6 – 10 years

11 – 20 years

More than 20 years

14.5% (29)

61.0% (122)

17.5% (35)

6.0% (12)

1.0% (2)

Hospital Setting

Yes

46.0% (92)

54.0% (108)

Prescriber/Healthcare Administrator

Yes

75.5 % (151)

24.5% (49)

SD = standard deviation

Table 2

*Main Effects of ProQOL Subscale Scores on Current Drug Use*
	NMUPD		Cannabis Use		Illicit Drug Use
	OR (95% CI)	aOR^a (95% CI)	OR (95% CI)	aOR^a (95% CI)	OR (95% CI)	aOR^a (95% CI)
Compassion Satisfaction	0.98 (0.93, 1.02)	0.97 (0.92, 1.02)	0.98 (0.94, 1.02)	0.98 (0.94, 1.02)	0.93* (0.87, 0.99)	0.92* (0.86, 0.99)
Burnout	1.11 (1.04, 1.19)**	1.13 (1.05, 1.22)**	1.09 (1.03, 1.15)**	1.11 (1.04, 1.18)**	1.17 (1.05, 1.31)**	1.27 (1.09, 1.47)**
Secondary Traumatic Stress	1.13* (1.07, 1.20)**	1.14* (1.07, 1.21)**	1.06 (1.02, 1.11)**	1.07 (1.02, 1.12)**	1.12 (1.04, 1.20)**	1.11* (1.02, 1.21)
^aAdjusted models control for age, gender identity, race/ethnicity, annual family income, and hospital setting (yes/no)
p < 0.05; p < 0.01; *p < 0.001; NMUPD = non-medical use of prescription drugs; OR = odds ratio; aOR* = adjusted odds ratio

Table 3

*Interaction Effects of ProQOL Subscale Scores and Occupational Level on Current Drug Use*
	NMUPD	Cannabis Use	Illicit Drug Use
	aOR^a (95% CI)	aOR^a (95% CI)	aOR^a (95% CI)
Compassion Satisfaction X Occupational Level	1.02 (0.89, 1.17)	0.95 (0.85, 1.07)	1.06 (0.85, 1.32)
Burnout X Occupational Level	0.86^b (0.72, 1.02)	1.00 (0.86, 1.17)	1.22 (0.71, 2.11)
Secondary Traumatic Stress X Occupational Level	0.86* (0.75, 0.97)	0.91^b (0.83, 1.01)	1.03 (0.83, 1.27)
^aAdjusted models control for age, gender identity, race/ethnicity, annual family income, hospital setting (yes/no), and main effect of occupational level (prescriber/healthcare administrator vs. other healthcare worker)
p < 0.05; ^bp < 0.10; NMUPD = non-medical use of prescription drugs; aOR* = adjusted odds ratio

No competing interests reported.

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Effects of compassion satisfaction, burnout, and secondary traumatic stress on current drug use among healthcare workers: Differences by occupational level

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INTRODUCTION

METHOD

Participants and Procedure

Measures

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress

Current Drug Use

Occupational Level

Covariates

Data Analysis

RESULTS

Descriptive Results

Main Effects of ProQOL Subscales on Current Drug Use

Interaction Effects of ProQOL Subscales and Occupational Level on Current Drug Use

DISCUSSION

Limitations

Strengths

Conclusion and Future Directions

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