{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T15:49:43Z","timestamp":1780328983408,"version":"3.54.1"},"reference-count":73,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the joint project of Chongqing Science and Technology Commission, Health and Construction Commission","award":["2020ZLXM003"],"award-info":[{"award-number":["2020ZLXM003"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,10,31]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a cross-sectional online self-report survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The survey was conducted in Chongqing, China from July to August 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data were collected from 2145 GPs, with an effective response rate of 91.0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The main evaluation indicators were stress (Cohen\u2019s Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work\u2013life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p&lt;0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-068333","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T09:15:15Z","timestamp":1701335715000},"page":"e068333","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6637-0459","authenticated-orcid":false,"given":"Yang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-893X","authenticated-orcid":false,"given":"JingZhi","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhao","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huisheng","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"2025121403274793000_13.11.e068333.1","unstructured":"World Health Organization . Novel Coronavirus (2019-nCoV) situation Report-17 [EB\/OL]. 2019. Available: https:\/\/www.who.int\/docs\/defaultsource\/coronaviruse\/situation-reports\/20200206-sitrep-17-ncov.pdf"},{"key":"2025121403274793000_13.11.e068333.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.01.009"},{"key":"2025121403274793000_13.11.e068333.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7755-4","article-title":"Prevalence of burnout and associated factors among general practitioners in Hubei, China: a cross-sectional study","volume":"19","author":"Gan","year":"2019","journal-title":"BMC Public Health"},{"key":"2025121403274793000_13.11.e068333.4","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1093\/fampra\/cmy116","article-title":"Part-time in general practice-a remedy to a time-based problem","volume":"36","author":"Strazdins","year":"2019","journal-title":"Fam Pract"},{"key":"2025121403274793000_13.11.e068333.5","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1016\/S0140-6736(20)30122-7","article-title":"Quality of primary health care in China: challenges and recommendations","volume":"395","author":"Li","year":"2020","journal-title":"Lancet"},{"key":"2025121403274793000_13.11.e068333.6","unstructured":"State Council, Central Committee of the Communist Party of China . Guidance of the state Council on the establishment of a general practitioner system. 2011. Available: http:\/\/www.gov.cn\/zwgk\/2011-07\/07\/content_1901099.htm"},{"key":"2025121403274793000_13.11.e068333.7","unstructured":"National HaFpCotpRoC . China Health Statistics Yearbook in 2020 [in Chinese]. Beijing: Peking Union Medical College Press, 2021."},{"key":"2025121403274793000_13.11.e068333.8","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0002"},{"key":"2025121403274793000_13.11.e068333.9","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-13-436","article-title":"International developments in revenues and incomes of general practitioners from 2000 to 2010","volume":"13","author":"Kroneman","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2025121403274793000_13.11.e068333.10","doi-asserted-by":"crossref","unstructured":"Limb M . GP leaders vow to secure more money for general practice. BMJ 2016:i624. doi:10.1136\/bmj.i624","DOI":"10.1136\/bmj.i624"},{"key":"2025121403274793000_13.11.e068333.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-018-0809-3","article-title":"Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark","volume":"19","author":"N\u00f8r\u00f8xe","year":"2018","journal-title":"BMC Fam Pract"},{"key":"2025121403274793000_13.11.e068333.12","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1192\/pb.bp.116.054247","article-title":"Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors","volume":"41","author":"Imo","year":"2017","journal-title":"BJPsych Bull"},{"key":"2025121403274793000_13.11.e068333.13","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000844"},{"key":"2025121403274793000_13.11.e068333.14","doi-asserted-by":"publisher","DOI":"10.1108\/13522750610640530"},{"key":"2025121403274793000_13.11.e068333.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00814-2"},{"key":"2025121403274793000_13.11.e068333.16","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-325","article-title":"How does burnout affect physician productivity? A systematic literature review","volume":"14","author":"Dewa","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2025121403274793000_13.11.e068333.17","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X701261"},{"key":"2025121403274793000_13.11.e068333.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h4152","article-title":"Doctors' leaders call for warning system for GP burnout","volume":"351","author":"O\u2019Dowd","year":"2015","journal-title":"BMJ"},{"key":"2025121403274793000_13.11.e068333.19","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X664270"},{"key":"2025121403274793000_13.11.e068333.20","first-page":"69","article-title":"The research progress of the career pressure of general doctors in my country","volume":"27","author":"Xie Haizheng","year":"2016","journal-title":"Public Health and Prevention Medicine"},{"key":"2025121403274793000_13.11.e068333.21","unstructured":"Zhang Tieshan LD . Medical staff is burnout-a question that cannot be ignored. Chinese Hospital Management 2004:5\u20137."},{"key":"2025121403274793000_13.11.e068333.22","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/fampra\/cmab106","article-title":"The psychological impact of COVID-19 among primary care physicians in the province of Verona, Italy: a cross-sectional study during the first pandemic wave","volume":"39","author":"Lasalvia","year":"2022","journal-title":"Fam Pract"},{"key":"2025121403274793000_13.11.e068333.23","unstructured":"Cohen S , Williamson GM . Perceived stress in a probability sample of the United States. The Social Psychology of Health: Claremont Symposium on Applied Social Psychology 1988."},{"key":"2025121403274793000_13.11.e068333.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.anr.2012.08.004"},{"key":"2025121403274793000_13.11.e068333.25","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv324"},{"key":"2025121403274793000_13.11.e068333.26","unstructured":"Wang Zhen WY , Zhi-guo W . Reliability and validity of Chinese version of stress perception scale. 2015;35:1448\u201351."},{"key":"2025121403274793000_13.11.e068333.27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/2331205X.2016.1237605","article-title":"Diagnosing burnout among healthcare professionals: can we find consensus","volume":"3","author":"Doulougeri","year":"2016","journal-title":"Cogent Medicine"},{"key":"2025121403274793000_13.11.e068333.28","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/15533506211039682","article-title":"Transition to independent surgical practice and burnout among early career general Surgeons","volume":"29","author":"Firdouse","year":"2022","journal-title":"Surg Innov"},{"key":"2025121403274793000_13.11.e068333.29","doi-asserted-by":"crossref","DOI":"10.1186\/s12955-018-1001-0","article-title":"Test-retest reliability and measurement error of the Danish WHO-5 well-being index in outpatients with epilepsy","volume":"16","author":"Schougaard","year":"2018","journal-title":"Health Qual Life Outcomes"},{"key":"2025121403274793000_13.11.e068333.30","doi-asserted-by":"publisher","DOI":"10.1159\/000376585"},{"key":"2025121403274793000_13.11.e068333.31","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X685261"},{"key":"2025121403274793000_13.11.e068333.32","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X685285"},{"key":"2025121403274793000_13.11.e068333.33","doi-asserted-by":"publisher","DOI":"10.1080\/10705500802222972"},{"key":"2025121403274793000_13.11.e068333.34","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1037\/pas0000191","article-title":"Reliability and validity of the brief resilience scale (BRS) Spanish version","volume":"28","author":"Rodr\u00edguez-Rey","year":"2016","journal-title":"Psychol Assess"},{"key":"2025121403274793000_13.11.e068333.35","unstructured":"Ren Yujia LY , Lu Qunbo TR , Zeng Qian YH , et al . Reliability and validity of simple resilience scale in Chinese community elderly people. 2021;29:721\u20134."},{"key":"2025121403274793000_13.11.e068333.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-13484-3","article-title":"Occupational stress and associated factors among general practitioners in China: a national cross-sectional study","volume":"22","author":"Feng","year":"2022","journal-title":"BMC Public Health"},{"key":"2025121403274793000_13.11.e068333.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-018-0886-3","article-title":"Potential correlates of burnout among general practitioners and residents in Hungary: the significant role of gender, age, Dependant care and experience","volume":"19","author":"Adam","year":"2018","journal-title":"BMC Fam Pract"},{"key":"2025121403274793000_13.11.e068333.38","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(12)60729-6","article-title":"Ending violence against doctors in China","volume":"379","year":"2012","journal-title":"Lancet"},{"key":"2025121403274793000_13.11.e068333.39","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e5730","article-title":"Violence against doctors in China","volume":"345","author":"Hesketh","year":"2012","journal-title":"BMJ"},{"key":"2025121403274793000_13.11.e068333.40","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006719","article-title":"Workplace violence against nurses in Chinese hospitals: a cross-sectional survey","volume":"5","author":"Jiao","year":"2015","journal-title":"BMJ Open"},{"key":"2025121403274793000_13.11.e068333.41","unstructured":"Association CMD . White paper on medical practitioners in China in 2017. 2017."},{"key":"2025121403274793000_13.11.e068333.42","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00420-008-0307-3","article-title":"Factors on working conditions and prolonged fatigue among physicians in Japan","volume":"82","author":"Wada","year":"2008","journal-title":"Int Arch Occup Environ Health"},{"key":"2025121403274793000_13.11.e068333.43","doi-asserted-by":"publisher","DOI":"10.1258\/1355819021927647"},{"key":"2025121403274793000_13.11.e068333.44","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1161\/CIRCULATIONAHA.118.036637","article-title":"To fight burnout, cardiologists look to change health system","volume":"138","author":"Kuehn","year":"2018","journal-title":"Circulation"},{"key":"2025121403274793000_13.11.e068333.45","first-page":"16","article-title":"Physician well-being: improving office efficiency","volume":"471","author":"Salzberg","year":"2018","journal-title":"FP Essent"},{"key":"2025121403274793000_13.11.e068333.46","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/13814788.2021.1982889","article-title":"To prevent being stressed-out: allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study","volume":"27","author":"B\u00e9k\u00e9si","year":"2021","journal-title":"Eur J Gen Pract"},{"key":"2025121403274793000_13.11.e068333.47","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2010.01.002"},{"key":"2025121403274793000_13.11.e068333.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.01.011"},{"key":"2025121403274793000_13.11.e068333.49","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/sleep\/32.2.189","article-title":"The direction of longitudinal associations between sleep problems and depression symptoms: a study of twins aged 8 and 10 years","volume":"32","author":"Gregory","year":"2009","journal-title":"Sleep"},{"key":"2025121403274793000_13.11.e068333.50","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-7358(00)00083-0"},{"key":"2025121403274793000_13.11.e068333.51","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.jsmc.2013.04.007","article-title":"Insomnia comorbid to severe psychiatric illness","volume":"8","author":"Soehner","year":"2013","journal-title":"Sleep Medicine Clinics"},{"key":"2025121403274793000_13.11.e068333.52","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-011-0433-1"},{"key":"2025121403274793000_13.11.e068333.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2007.10.014"},{"key":"2025121403274793000_13.11.e068333.54","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017361","article-title":"What are the sources of stress and distress for general practitioners working in England? A qualitative study","volume":"8","author":"Riley","year":"2018","journal-title":"BMJ Open"},{"key":"2025121403274793000_13.11.e068333.55","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmx130"},{"key":"2025121403274793000_13.11.e068333.56","first-page":"234","article-title":"Stress, burnout, and strategies for reducing them: what\u2019s the situation among Canadian family physicians","volume":"54","author":"Lee","year":"2008","journal-title":"Can Fam Physician"},{"key":"2025121403274793000_13.11.e068333.57","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.cpr.2016.11.007","article-title":"Resilience to emotional distress in response to failure, error or mistakes: a systematic review","volume":"52","author":"Johnson","year":"2017","journal-title":"Clin Psychol Rev"},{"key":"2025121403274793000_13.11.e068333.58","doi-asserted-by":"publisher","DOI":"10.2190\/PM.47.4.b"},{"key":"2025121403274793000_13.11.e068333.59","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp15X687133"},{"key":"2025121403274793000_13.11.e068333.60","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690893"},{"key":"2025121403274793000_13.11.e068333.61","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-015-3235-4"},{"key":"2025121403274793000_13.11.e068333.62","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2010.310"},{"key":"2025121403274793000_13.11.e068333.63","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.10.045"},{"key":"2025121403274793000_13.11.e068333.64","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254795","article-title":"Prediction of well-being and insight into work-life integration among physicians using machine learning approach","volume":"16","author":"Nishi","year":"2021","journal-title":"PLoS One"},{"key":"2025121403274793000_13.11.e068333.65","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-016-0108-9","article-title":"Workload, mental health and burnout indicators among female physicians","volume":"14","author":"Gy\u0151rffy","year":"2016","journal-title":"Hum Resour Health"},{"key":"2025121403274793000_13.11.e068333.66","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2020.567201","article-title":"From resilience to burnout: psychological features of Italian general practitioners during COVID-19 emergency","volume":"11","author":"Di Monte","year":"2020","journal-title":"Front Psychol"},{"key":"2025121403274793000_13.11.e068333.67","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s11845-021-02513-6","article-title":"Impact on mental health of the COVID-19 outbreak among general practitioners during the sanitary lockdown period","volume":"191","author":"Lange","year":"2022","journal-title":"Ir J Med Sci"},{"key":"2025121403274793000_13.11.e068333.68","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-016-1407-9"},{"key":"2025121403274793000_13.11.e068333.69","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211223","article-title":"Prevalence of burnout among German general practitioners: comparison of physicians working in solo and group practices","volume":"14","author":"Dreher","year":"2019","journal-title":"PLoS One"},{"key":"2025121403274793000_13.11.e068333.70","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002792","article-title":"Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China","volume":"5","author":"Xu","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025121403274793000_13.11.e068333.71","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X692561"},{"key":"2025121403274793000_13.11.e068333.72","unstructured":"NHS . General practice forward view, Secondary General practice forward view. 2016. Available: https:\/\/www.england.nhs.uk\/gp\/gpfv"},{"key":"2025121403274793000_13.11.e068333.73","doi-asserted-by":"crossref","first-page":"iv36","DOI":"10.1093\/eurpub\/ckaa128","article-title":"The importance of teamwork climate for preventing burnout in UK general practices","volume":"30","author":"Galleta-Williams","year":"2020","journal-title":"Eur J Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-068333","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:28:00Z","timestamp":1765711680000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-068333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":73,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,30]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjopen-2022-068333"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-068333","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}