Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity

• Authors: Jennifer Mascaro, Emory University; Amanda Wallace, Emory University; Brooke Hyman, Emory University; Carla Haack, Emory University; Cherie Hill, Emory University; Miranda Moore, Emory University; Maha B. Lund, Emory University; Eric Nehl, Emory University; Sharon Bergquist, Emory University; Steve W. Cole, University of California Los Angeles
• Journal Title: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• Volume: Volume 19, Number 4
• Publisher: MDPI | 2022-02-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/ijerph19042255
• Subjects: Health Sciences, Public Health; Environmental Sciences; Biology, Ecology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Environmental Sciences; Public, Environmental & Occupational Health; Environmental Sciences & Ecology; well-being; flourishing; loneliness; inflammation; resident physicians; physician assistants; POSITIVE MENTAL-HEALTH; WORK-LIFE BALANCE; QUALITY-OF-LIFE; INFLAMMATORY GENE-EXPRESSION; RANDOMIZED CONTROLLED-TRIAL; MEDICAL-STUDENTS; PHYSICIAN BURNOUT; LEUKOCYTE TRANSCRIPTOME; DEPRESSIVE SYMPTOMS; OLDER-ADULTS

Abstract

While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the “conserved transcriptional response to adversity” (CTRA) charac-terized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.