Journal of Clinical Anesthesia (2007) 19, 334338

Original contribution

Work stress and gender-dependent coping strategies in

anesthesiologists at a university hospital
Johann F. Kinzl MD (Professor)a , Christian Traweger (Assistant Professor)b ,
Ernestine Trefalt MD (Staff Psychiatrist)a ,
Ulla Riccabona MD (Senior Anesthesiologist)c , Wolfgang Lederer MD (Professor)c,*
a

Division of Psychosomatic Medicine, Department of Psychiatry, Innsbruck Medical University, A-6020 Innsbruck, Austria
Department of Statistics, University of Innsbruck, A-6020 Innsbruck, Austria
c
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria
b

Received 16 February 2006; revised 9 August 2006; accepted 11 August 2006

Keywords:
Anesthesia;
Sex;
Job satisfaction;
Stress, psychological;
Original contribution;
Workplace

Abstract
Study Objective: To evaluate stressors and coping strategies for stress in a sample of anesthesiologists
working at a university hospital.
Design: Cross-sectional study via survey instrument.
Setting: University department of anesthesiology and critical care at a 1305-bed hospital.
Participants: 135 anesthesia specialists and specialist trainees of anesthesia.
Measurements and Main Results: A total of 135 self-reporting questionnaires used to assess
sociodemographic data, workload, task demands, stress-coping strategies, physical health, emotional
well-being, and working conditions, were distributed. Of these, 89 questionnaires were completed and
returned, for a response rate of 65.9%: 33 (37.1%) female anesthesiologists and 56 (62.9%) male
anesthesiologists. The burden of task-related stressors and of communication possibilities was assessed
differently by male and female anesthesiologists. Female anesthesiologists more frequently reported
higher concentration demands (P = 0.013) and limited possibilities to control work (P = 0.009) than did
their male colleagues. Work at intensive care units (P = 0.001) was particularly demanding and
burdensome for female anesthesiologists. Combined evaluation of various stress-coping strategies did not
show significant differences between the genders. Generally, anesthesiologists had more confidence in
their own personal capabilities and resources and in their socialparticularly familysupport outside the
workplace, than in their social support from colleagues and superiors.
Conclusions: Task-related stressors and communication possibilities differed between male and
female anesthesiologists in our institution. Female anesthesiologists felt that they had less control
over their work.
2007 Elsevier Inc. All rights reserved.

Corresponding author. Johann F. Kinzl is to be contacted at Division of Psychosomatic Medicine, Department of Psychiatry, Innsbruck Medical University,
A-6020 Innsbruck, Austria. Wolfgang Lederer, Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University Anichstr. 35, A-6020
Innsbruck, Austria. Tel.: +43 512 504 22400; fax: +43 512 504 22450.
E-mail address: wolfgang.lederer@i-med.ac.at (W. Lederer).
0952-8180/$ see front matter 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.jclinane.2006.08.014

Stress in anesthesiologists

1. Introduction
Anesthesiologists are frequently confronted with critical
situations when working in the operating room or the intensive
care unit (ICU). In particular, stress arises from confronting
severe illness and death, operating high-tech equipment, and
experiencing a lack of appreciation with members of other
occupational groups [1]. Further sources of chronic stress
include competence factors, long working hours, night call
demands, workload, and economic uncertainty [2-5]. Dissatisfaction with career correlates strongly with distress and
depression [6] and suffering from a variety of stressors can
lead to career impediments, stress reactions, and psychiatric
problems [7]. In spite of their knowledge about stressors, health
hazards, and coping, health professionals are generally not
aware of their own health risks [8].
A major source of stress indicated by physicians is time
pressure on the job. Major sources of satisfaction were relationships with patients and colleagues. Poor teamwork seems to
contribute to sickness and absenteeism among hospital physicians [9]. Compared with male colleagues, female physicians
experience the work environment as more stressful, report workrelated health problems more often, and run a higher risk of
suicide [10]. Young female physicians seem to be at risk for
experiencing stress and psychosocial problems [11].
This study aimed to investigate work stress and stress
coping strategies in anesthesiologists, and whether stress
coping strategies differ in female and male anesthesiologists.

2. Materials and methods

2.1. Participants and procedures
Investigations were performed at the University Department of Anesthesiology and Critical Care Medicine. Anesthesiology staff at the Innsbruck Medical University, Austria,
served as participants. Self-reporting questionnaires, along
with an accompanying cover letter requesting anonymous
participation in the project and a return envelope, were
distributed by intradepartmental mail. All anesthesiologists
were repeatedly informed about the investigation in lectures
and written information for several weeks prior to onset of the
study. Participants were asked to return the questionnaires to a
box at the department. Procedures followed were in
accordance with the local research ethics board. Participation
was based on the understanding that results would be
published in medical journals. All participants volunteered
for this investigation; anonymity was completely preserved.

2.2. Instruments
2.2.1. Demographics
Demographic information requested included gender, age,
marital status, professional status, years at the department, area
of work, and workload.

335
2.2.2. Assessment of stress
The Coping and Stress Profile (German version) was
applied to assess physical health (17 items), emotional wellbeing (7 items), stressors (personal stress, stress at work,
stress in relationship, family stress) (90 items), self-esteem
(7 items), social support (11 items), and life satisfaction
(7 items) [12].
2.2.3. Assessment of stress-related job analysis
Influence of working conditions on stress was evaluated
with the Instrument for Stress-Related Job Analysis
(Version 5.1, short form, Vdf Hochschulverlag AG, ETH
Zrich, Switzerland) [13]. The Instrument for StressRelated Job Analysis covers quality of task demands,
control over work, and task-related stressors. Task
demands are assessed by measuring task complexity and
task variability. Possibilities to control work assess the
employee's influence on task handling and time control.
Task handling comprises how to independently plan and
organize one's own work, whereas time control specifies
the influence on one's own work pace and work schedule.
Communication possibilities and cooperation latitude
characterize the possibility to contact and communicate
with others at work and the possibility to choose work
partners. Task-related stressors are measured in terms of
time pressure due to fast work pace; high concentration
demands over a long time; and work interruptions by
supervisors, colleagues, or clients. Workload was operationally defined using the global question How great is
your workload on average? Probands rated workload from
1 very great to 5 very small using a 5-point scale.
2.2.4. Assessment of coping strategies
Stress-coping strategies were examined with the StressOvercoming Questionnaire [14]. The SVF (114 items, 19
subscales) measures the individual tendency for various
coping strategies in strained situations. Two large groups of
coping strategies are differentiated: positive coping strategies
(eg, strategies directed to and suitable for reducing stress,
such as control of situation, control of reaction, search
for self-affirmation, etc) and negative coping strategies (eg,
strategies that seem to increase stress in general, such as
refuge, social isolation, resignation, etc) [15].

2.3. Statistical methods

Ordinal variables were analyzed with the Mann-Whitney
U test for comparison between two groups and the KruskalWallis test for comparison between more than two groups.
Metric data were tested for normal distribution and, if given,
a multiway analysis of variance was computed. To analyze
the influence of variables including gender, age, marital
status, and training as a model on the dependent variables
(stressors on the working place: 0 = low stress, 1 = high
stress), a logistic regression was used. Results were deemed
significant at P b 0.05.

336

J.F. Kinzl et al.

3. Results

Table 2 Comparison of stressors concerning various aspects of

anesthesiology work

The overall response rate was 65.9% (89/135 eligible

subjects), namely, 33 (37.1%) female and 56 (62.9%) male
anesthesiologists. Distribution of age, marital status, and
specialization is shown in Table 1.
Of the total, 45 (50.6%) participants assessed workload
as great; 32 (36.0%), as moderate; and 12 (13.5%), as
small. No statistically significant gender differences were
seen in workload or in working hours (average, 59 h/wk).
There was a statistically significant difference between the
two genders only in the variable working at the intensive
care unit (P = 0.001), meaning that female anesthesiologists experienced work at the ICU as significantly more
difficult than did their male colleagues (Table 2). Female
anesthesiologists also showed a statistically significantly
lower general job satisfaction (P = 0.041) and reported
higher task-related stressors, for example, concentration
demands (P = 0.013), than did their male colleagues.
Female anesthesiologists reported fewer possibilities to
control work regarding task handling (P = 0.009) and less
influence on work schedule (P = 0.009). The possibility
for contact and communication with others at work (P =
0.034) and the ability to choose work partners (P = 0.026)
were given lower marks, compared with male anesthesiologists (Table 3).
No statistically significant gender differences were
seen either for physical complaints or for emotional wellbeing. The most frequent physical complaints were
muscle tension (back of the neck; 26.4%), low back
pain (15.2%), insomnia (13.6%), headache (12.8%),
feeling of fatigue (12.4%), and stomachache (8.8%).
Frequency of consumption of alcohol, nicotine, analgesics, or psychotropic drugs to cope with stress did not
differ between male and female anesthesiologists.
Female and male anesthesiologists reported great confidence in their personal capabilities and resources and in
Table 1

Sociodemographic data

Characteristics

Age (y)
30
31-40
N40
Marital status
Single
Partnership (without
children)
Partnership (with
children)
Level
Specialists
In specialist training

Female
Male
anesthesiologists anesthesiologists
(n = 56) (n [%]) (n = 33) (n [%])
10 (17.9)
30 (53.6)
16 (28.6)

7 (21.2%)
19 (57.6%)
7 (21.2%)

9 (16.1)
17 (30.4)

11 (33.3%)
14 (42.4%)

30 (53.6)

8 (24.2%)

27 (48.2)
29 (51.8)

11 (33.3%)
22 (66.7%)

Significance
Female
Characteristics Male
anesthesiologists anesthesiologists (P)
(n [%])
(n [%])
Perioperative
care
Long working
hours, night
duties
Dealings with
nursing staff
Dealings with
surgeons
Preoperative
medical care
Working at the
intensive
care unit
Dealings with
colleagues
Postoperative
medical care
Patients with
pain
disorder
Talks with
relatives

48 (85.7%)

25 (75.8%)

0.538

33 (58.9%)

23 (69.7%)

0.325

33 (58.9%)

13 (39.4%)

0.152

30 (53.6%)

18 (54.5%)

0.984

29 (51.8%)

12 (36.4%)

0.285

20 (35.7%)

23 (69.7%)

0.001

21 (37.5%)

10 (30.3%)

0.720

20 (35.7%)

10 (30.3%)

0.848

8 (14.3%)

8 (24.2%)

0.317

12 (21.4%)

7 (21.2%)

0.999

Data were analyzed with a logistic regression, where the independent

variables were a model containing gender, age, marital status, and level
of training.
Indicates statistically significant difference.

Table 3

Evaluation of task-related stressors in anesthesiologists

Characteristics

Male
anesthesiologists
(n = 56)
(mean SD)

Female
Significance
anesthesiologists (P)
(n = 33)
(mean SD)

Complexity of
demands
Task variability
Task handling
Influence
on work
schedule
Communication
possibilities
Cooperation
latitude
Concentration
demands
Time pressure
Work
interruptions

11.6 2.2

11.2 2.1

7.9 2.1
9.2 2.3
5.7 2.7

7.5 2.2
7.5 2.6
4.9 2.0

0.474
0.009
0.009*

6.9 2.7

6.1 2.5

0.034*

6.2 3.2

4.9 2.2

0.026*

15.3 2.0

16.0 2.1

0.013*

11.3 2.1
10.6 2.7

11.4 2.3
9.6 2.7

0.752
0.332

0.903

Values are expressed as means and standard deviations. Mean values of

answer scores were compared with analysis of variance.
Indicates statistically significant difference.

Stress in anesthesiologists

337

social support from outside the workplace, particularly from

their family. Regarding partnership, male anesthesiologists
reported significantly greater satisfaction (P = 0.015), fewer
problems (P = 0.066), better cohesion (P = 0.006), and less
family stress (P = 0.004) than did their female colleagues.
Most effective in diminishing stress at work were seen to
be more free time (58.4%), more staff (42.7%), more flexible
working hours (41.6%), more participation in work planning
(41.6%), and more autonomy (27.0%). Strategies for coping
with stress, as measured by means of SVF, showed high
values in the positive coping strategies, search for selfaffirmation and control of situation, in female anesthesiologists. Male anesthesiologists preferred to rely on their
professional skills to cope with stress, whereas female
anesthesiologists highlighted intelligence and physical constitution. Evaluation of all factors combined did not show
significant differences between male and female anesthesiologists (Table 4).

4. Discussion
Our data indicate that anesthesiologists at our institution
would like shorter working hours, more flexible working
hours, and more free time. Female and male anesthesiologists
experienced similar complexity of demands and task variability, but female anesthesiologists reported more frequently
limited communication possibilities and limited possibilities
for control over their work than did their male colleagues.
Within the last 20 years, the anesthesiologist's job has
changed in many aspects. Anesthesiologists are no longer
merely the surgeons' assistant for anesthesia. Anesthesiologists independently run ICUs and are becoming more and
more integrated in organizing perioperative care. Gender

Table 4 Comparison of stress coping strategies in

anesthesiologists (multiple responses)
Resources

Male
Female
anesthesiologists anesthesiologists
(n = 56)
(n = 33)

Ability to take stress

Family emotional support
Professional skills
Physical constitution
Job atmosphere
Intelligence
Social support by
colleagues
Social support by
superiors

37 (66.1%)
25 (44.6%)
28 (50.0%)
15 (26.8%)
17 (30.3%)
13 (23.2%)
9 (16.1%)

21 (63.6%)
18 (54.5%)
10 (30.3%)
14 (42.4%)
8 (24.2%)
11 (33.3%)
5 (15.2%)

6 (10.7%)

5 (15.2%)

Using 2 test for evaluation of all factors combined, the coping strategies
did not significantly differ between male and female anesthesiologists.
(2 = 5150; df = 7, P = 0.642).

differences were reported in terms of specific variables for

predicted job stress and satisfaction [16]. In agreement with
the results of Deckard et al, [17] our findings confirm that
few possibilities to control work influence job satisfaction
negatively and cause a higher risk for developing burnout
syndrome. This finding underlines the importance of paying
more attention to working conditions, in general, and to those
of women physicians, in particular. Furthermore, a functioning stress management program should prevent uncontrolled
increases in stress or illness in employees [18].
Recent research has outlined the negative physiological
and psychological consequences of dysfunctional occupational stress. In a survey by Bergman et al [19], somatic
symptoms correlated significantly with satisfaction with
amount of time spent working, mental health, work
satisfaction, workload, healthy lifestyle, coping abilities,
and support in stress. The results of Rossi and Lubbers
correspond with our data showing that physiological
responses in the musculoskeletal system are the most
prevalent stress disorders in male and female anesthesiologists [20]. In contrast to Carter-Snell et al [21], who
reported increased prevalence rates for stress-related
disorders such as acute stress disorder, our study did not
detect an increased rate.
In our study, combined evaluation of various coping
strategies did not show significant differences between male
and female anesthesiologists. Overall, anesthesiologists
showed more confidence in their own personal capabilities
and physical and intellectual resources to cope with burdens
and demands than they did in their workplace resources or
their social support from colleagues or superiors. This
finding underlines the importance of personal and social
resources (eg, more leisure time, cultivation of friendships,
and family relations) on the one hand and the need to pay
more attention to workplace atmosphere by superiors on the
other. Most participants considered flexible working hours
and more free time to be an important step toward improving
life quality for themselves, their friends, and their families.
These factors are regarded as important resources for coping
with stress.
Our data demonstrate that regarding partnership, male
anesthesiologists reported significantly greater satisfaction
and less family stress than did their female colleagues. The
double burden of job and private life, as experienced more
frequently by female anesthesiologists, may be the reason
why women, first, seem to recognize restrictions on
possibilities to control work in a more sensitive way and,
second, are more likely to subordinate their personal interests
at work in order to conserve energy.
The strengths of the study are its comparatively high
response rate and in its concurrent completion of a battery of
tests for assessment of stressors and stress coping mechanisms. The results of our study, however, are limited by the fact
that no statement can be made about the anesthesiologists
who did not participate in the study. We cannot determine
whether those anesthesiologists who experience the greatest

338
stress are adequately represented in the study groups. The
sample is not randomized. The conditions studied might be
typical of a university hospital and do not necessarily reflect
gender-dependent coping strategies for work stress of
anesthesiologists in general. Working conditions and subjective perception of working conditions may change with
national culture, hospital culture, and departmental culture,
among others. Confounding factors such as position within
the department are limited to the status of specialist and in
specialist training. The prevalence of most of the stressor and
coping variables used in this study is most certainly
dependent not only on gender but also age, marital status
(as a proxy for out-of-the-job support or lack of support), and
professional experience. Some or all of these factors could
have had an impact on many of the study variables, for
example, a trainee anesthesiologist might perceive stress and
job handling-related issues differently from a specialist,
regardless of gender differences. An objective assessment of
working conditions as a reflection of subjective selfassessment was not applied. Furthermore, the multitude of
additional burdens from family life was not assessed in detail.

Acknowledgment
The study was supported by the Association for the
Advancement of Scientific Psychiatry, Psychosomatic
Research Group, Innsbruck Medical University (1/2003
Hypo Bank, Tirol, Germany).

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