Dr Olga Chelidoni

Background The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals. Methods Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity. Results Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed. Conclusions Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.

Executive functions are cognitive abilities that allow people to focus their attention on a specific task, redirect and shift their attention between tasks, block the intrusion of irrelevant thoughts, and update information in memory. Executive functions are also central for planning and directing behaviour towards the achievement of a goal. Although difficulties in executive functions are commonly presented in ruminative thinking, research investigating the role of executive functions in work-related rumination is scarce. One of the aims of this thesis was to examine the prevalence of executive function difficulties, as reflected in daily life, in the different facets of work-related rumination. Another objective of this thesis was to investigate the association between Heart Rate Variability (HRV) and work-related rumination. HRV is an index of cardiovascular health and reflects the individual?s ability to recover from stressful situations, but very minimal research has investigated their association so far. Four studies were conducted in total. In Study 1, results from a cross-sectional study (N=334) showed that daily life executive functioning difficulties in time-management and concentration were significantly associated with affective rumination and detachment. It was also revealed that emotion regulation partially mediates this association. In Study 2, results from six-month longitudinal study design (N=106) showed that executive function difficulty in time-management at baseline predicted psychological detachment from work six months later. Findings also showed that executive function difficulties and work-related rumination consistently covaried during the six months. Study 3 reports the results of a feasibility study (N=17) to support the methods used in Study 4. Study 4 reported the results from a randomised controlled study (N=75) and showed that five minutes of instructed biofeedback breathing-delivered through a smartphone app.-enhances recovery in HRV following stress exposure. Overall, findings reported in this thesis suggest that cognitive and emotional difficulties are critical features of work-related rumination, and the development of mobile-based interventions incorporating biofeedback can be beneficial for employee physiological recovery from stress.