Comparison with existing literature
Although the level of positive mental health among the GP sample was lower than reported in previously published UK general population surveys,9,10 it was comparable to the level observed in a recent Northern Irish population survey,11 and higher than levels reported for other occupational groups in the UK, such as university employees,25 vets,26 and teachers.13 This new insight into GP mental health suggests that there may be merit in extending the focus of GP wellbeing beyond negative constructs such as burnout and stress. Similar to general population survey findings, older GPs had the highest level of positive mental health,10,20 perhaps reflecting a ‘stage of life’ sense of comfortable competency and achievement, and perceived positive impact of anticipated retirement. It is interesting to contrast the relatively high level of positive mental health in older GPs, with reports that the proportion of GPs aged 55–64 years who left practice doubled in the period between 2005 and 2014.27 This finding of higher wellbeing in female GPs contrasts with the results of general population surveys,9,11,28,29 and diverges from recognised sex differences in the prevalence of depression.30 Higher positive mental wellbeing scores in female GPs may be explained in terms of variables that were not assessed in this study, such as different work-time patterns between females and male GPs. For example, role conflict and work–family balance influence wellbeing,31 and part-time compared to fulltime work is associated with higher life satisfaction among career women.32 While the relationship between burnout and hours worked is dependent on the extent to which work arrangements meet the needs of doctors, their partners, and children.33
Interestingly, females and older GPs were more optimistic in their outlook than other GPs. U-shaped age variation in optimism has been described in three UK population samples.34 Perhaps unsurprisingly, context and circumstances appear to play a role. For example, one international study found that young, highly educated, affluent Irish females were the most optimistic.35 This GP sample was more optimistic than general population samples in the UK,34 Portugal,36 and Germany,37 although a higher level of optimism was reported by other occupational groups, such as nurses38 and military personnel.39 Optimism appears to be a significant predictor of physical health outcomes,40–42 including decreased mortality,43 as well as being related to better subjective wellbeing in times of adversity, and higher levels of engagement, coping, and being proactive in personal health protection.44 The authors’ finding of a moderately positive association between resilience and optimism concurs with studies of resilience in healthcare.45,46 Positive attitudes including optimism, tolerance, and humour, and celebrating small gains have been identified as pertinent to resilience in GPs.47–49 ‘Learned optimism’ forms the basis of the Penn Resilience programme,50 highlighting the potential to exploit synergism between these psychological resources. Furthermore, physician resilience has been defined as the
‘... ability to invest personal resources in a way that initiates positive resource spirals despite stressful work conditions’.49
The finding of a moderately strong correlation between resilience and positive mental health resonates with the concept of a resource spiral and is consistent with evidence that positive emotions promote positive adaptation to adversity.51 Upward spirals generated by positive emotions increase mental flexibility, a commonly identified attribute of resilient individuals.45,52–55 Normative Brief Resilience Scale scores were higher for health care professionals than this sample, and may reflect depleted resources in the face of increasing pressures in general practice. GPs’ perceptions about their level of general self-efficacy was comparable to other occupational groups, including health care professionals,38,56–58 and higher than general population samples.59–61
Perceived general self-efficacy appears to moderate the effect of daily hassles on positive wellbeing and negative mental health, and is a predictor of positive mental health.61,62 GPs’ relatively higher levels of self-efficacy may point to ways in which to support the GP workforce, as self-efficacy and job satisfaction are positively related.63
Hope, too, correlates positively with job satisfaction and work happiness, and is negatively associated with job stress.63,64 Unsurprisingly, hope had the strongest relationship with positive mental health in this study. The authors’ finding of a high correlation between hope and optimism has been identified in clinical and occupational groups.64,65 Collectively, the results add to evidence about the relationships between psychological resources such as hope and resilience and health and wellbeing in a work context.66–68 Also, it is likely that this resources-positive mental health-context set of relationships is influenced by other variables, such as organisational factors and social networks. A composite construct comprised of hope, optimism, resilience, and self-efficacy is associated with higher job satisfaction, less burnout, and lower work-related stress in doctors.69–71 Brief and web-based interventions have been shown to develop resources within this composite construct.72,73
