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Work-related stress and its associated factors among primary care doctors in Malaysia during the COVID-19 pandemic

BMC Primary Care volume 26, Article number: 4 (2025) Cite this article

Abstract

Background

In Malaysia, the recent COVID-19 pandemic had increased the workload of all health professionals, especially primary care doctors (PCDs). Hence, this study aimed to determine the level of work-related stress and factors associated with higher levels of work-related stress among PCDs in Malaysia during this pandemic.

Methods

A cross-sectional study was conducted online using Google Forms™. Sociodemographic as well as work and workplace data were collected. The Job Demand Inventory, Physicians’ Lack of Professional Autonomy, and Health Professions Stress Inventory questionnaires were used to assess the job demand score, job autonomy score, and the level of work-related stress, respectively. Multiple linear regression was performed to determine the significant factors associated with higher work-related stress.

Results

A total of 301 PCDs participated in this study with the majority being female (76.1%), Malay (67.8%), married (73.1%), medical officers (68.8%), and worked in urban (70.4%) and public primary care clinics (83%). The mean (SD) score for work-related stress was 62.8 (18.4), (score range 0-120). PCDs who had any degree of worry about being alienated by friends and relatives because of close contact with COVID-19 patients had higher work-related stress levels compared to PCDs who did not have any worry [rarely (b = 10.23, 95% CI:5.57, 14.89), sometimes (b = 10.41, 95% CI:5.68, 15.13), often (b = 10.12, 95% CI:4.16, 16.08), and always (b = 14.65, 95% CI:7.43, 21.89)]. The other significant factor was higher job demand scores (b = 1.13, 95% CI:0.91, 1.35). In contrast, PCDs who always received support from supervisors at their workplace were found to have lower work-related stress levels compared to those who did not receive any support (b=-5.65, 95% CI:-10.38, -0.93).

Conclusions

The level of work-related stress among Malaysian PCDs during the COVID-19 pandemic was higher compared to American PCDs and Malaysian physicians before the pandemic but lower compared to Australian emergency physicians during the pandemic. Urgent measures to address the above-mentioned associated factors should be implemented as another pandemic may be just around the corner.

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Background

According to the United States’ National Institute of Occupational Safety and Health (NIOSH), work-related stress or job stress is defined as the harmful physical and emotional responses that occur when the requirements of a job do not match the capabilities, resources, or needs of the worker [1]. A study in Canada found that the prevalence of work-related stress among healthcare workers (HCWs) and the general population was around 45% and 31%, respectively [2]. The same study revealed that the prevalence of stress was higher ranging from 58 to 64% specifically for family physicians, specialist physicians, laboratory technicians and nurses. In Nigeria, the most stressful area of specialisation reported among doctors was radiotherapy with the prevalence of 66.7% [3]. This was followed by surgery (60.0%), obstetrics and gynaecology (58.3%), internal medicine (53.9%), ear, nose and throat (42.8%), ophthalmology (40%), primary care (33.3%) and paediatrics (31.8%) [3]. In contrast, a study done in Jordan found that compared to other physician groups, primary care physicians had a higher prevalence of work-related stress [4]. Nevertheless, primary care practice has been an increasingly stressful field in medicine according to several studies [5,6,7].

Studies had shown that prolonged work stress is the major reason for work-related delay, absenteeism, hypertension, musculoskeletal disorders, cardiovascular disorders and substance use [8,9,10,11]. On top of that, it is a major cause of mental disturbance and staff turnover [9, 10]. It also reduces organizational commitment, job satisfaction, quality of care and organizational productivity [12,13,14,15,16]. There were also evidence linking work-related stress to suicide [17, 18]. A narrative review on the topic of ‘suicide among doctors’ found that suicide risk among doctors is believed to be five to seven times higher than in the general population [19]. Anaesthesiologists, general practitioners, and psychiatrists are common specialties with high suicide rates [19]. Being a primary care physician is a stressful job that can lead to high burnout rate [20]. To a lesser extent, repercussions on the quality of patient care, medical errors, and patient–physician relationships had been reported [21,22,23,24].

On March 11, 2020, the World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) to be a pandemic [25]. This pandemic had increased the workload of most health care workers including PCDs. A study in Spain found that the workload of PCDs had increased from 48.6% before COVID-19 to 66.1% during this pandemic [26]. Similar findings were reported among general practitioners in the United Kingdom (UK) [27]. This workload increase include performing more home visits and facing time pressure [26]. PCDs also need to be involved in COVID-19 vaccination programmes as well as conducting teleconsultations [27]. As a result, Vamvakas et al. found that healthcare professionals including doctors in Greece had higher work-related stress during the COVID-19 pandemic compared to pre-COVID-19 [28]. A study in Japan found that almost 30% of physicians including primary care doctors had exacerbation of stress during the COVID-19 pandemic compared to the pre-COVID-19 period [29].

According to the theoretical model of job-demand-control (JDC), work-related stress arises when job control is low and job demand is high [30]. In this model, the term “job demand” refers to the amount of workload or responsibilities placed upon an individual. Job demand can also be seen as representing the psychology stressors in the work environment including number of interruptions, pressure among others, presence of conflicting demands and turnover or reaction time based on work amount or concentration that is typically required. The term “job control” is defined as the amount of control a person has over his or her work responsibilities or range of decision-making freedom available to the worker facing those demands [31].

During the COVID-19 pandemic, several sociodemographic factors were found to be associated with work-related stress among doctors. According to a study in Türkiye, physicians who were female, of younger age, having a lifetime psychiatric disorder and working in frontline roles had higher scores of stress [32]. A similar finding was seen among Health Care Workers (HCWs) including doctors working in China where those who were females and working in frontline positions had higher scores of stress [33]. In addition, several studies showed that work and workplace factors such as insufficient access to personal protective equipment (PPE) [34, 35], and lower support from supervisors [32] contributed toward work-related stress.

In Malaysia, primary care doctors include general practitioners (GPs), medical officers (MOs) and Family Medicine Specialists (FMS) are the ones who provide general medical care to patients [36]. They were also heavily involved in the detection, management and prevention of patients during the COVID-19 pandemic. Published studies on work-related stress among PCDs in Malaysia during the pandemic are scarce. Therefore, this study aimed to assess work-related stress and its associated factors among PCDs in Malaysia during the COVID-19 pandemic.

Materials and methods

Study design and population

A cross-sectional study was conducted among PCDs in Malaysia using an online questionnaire. The study population was fully registered PCDs who had been practising in primary care settings either in public or private clinics or in university health clinics. PCDs with only a basic medical degree were defined as PCDs without a postgraduate qualification in Family Medicine. On the other hand, those who did have a postgraduate qualification in Family Medicine, such as a Master of Family Medicine, Membership of the Royal College of General Practitioners (MRCGP) UK, Diploma in Family Medicine, or Fellowship of the Royal Australian College of General Practitioners (FRACGP), were defined as PCDs with postgraduate qualifications. FMS are defined as PCDs who specialized in primary care, practising either in public health clinics, private clinics or university health clinics. In contrast, MOs and GPs are PCDs who had not yet specialized in primary care, practising in public health/university health clinics and private clinics respectively. The PCDs were approached through the three main PCD associations in Malaysia, which were the Malaysian Primary Care Network (MPCN), the Malaysian Family Medicine Specialists Association (FMSA), and the Academy of Family Physicians Malaysia (AFPM). Invitations via e-mail and social media with a link to the study information sheet and questionnaires were sent to PCDs through these associations. The inclusion criteria were PCDs who had full registration with the Malaysia Medical Council (MMC), had working experience of six months or more in a primary care setting in Malaysia, and worked in a primary care setting during the study period. Those who had an active depressive disorder or anxiety disorder diagnosed by a medical practitioner or were not actively practising in a primary care setting for the past six months were excluded. Only those who met the inclusion and exclusion criteria and agreed to participate in the study were included.

Study tools

The questionnaire consisted of four main parts: sociodemographic, work, and workplace details, assessment of job demand, assessment of job control, and assessment of work-related stress. The first part of the questionnaire consisted of questions on the participants’ sociodemographic, work, and workplace details including age, gender, qualification, workplace locality, place of practice, experience, the time needed to reach the workplace and the number of patients seen per day.

The second part consisted of measuring participants’ job demands. The Job Demand Inventory (JDI) [37] by McGlone and Chenoweth was the tool chosen for this purpose. This tool has 15 items. The items of the Job Demand Inventory are scored on a five-point Likert scale, with responses ranging from low demand (1 point) to high demand (5 points). The scoring is based on the total score ranging from 15 to 75. Higher scores indicate higher job demand. This inventory has good internal consistency reliability (Cronbach’s alpha = 0.79) [37].

This was followed by a section measuring participants’ job control. The Physicians’ Lack of Professional Autonomy (PLPA) [38] questionnaire had been used for this purpose. It has two domains which are clinical autonomy (7 items) and administrative autonomy (5 items). Each item is graded according to a four-point Likert scale as always, usually, sometimes, and never. The scoring is based on the total score ranging from 12 to 48. Higher scores indicate lesser job control. The Cronbach’s alpha value for this questionnaire is 0.81 for the administrative autonomy domain and 0.54 for the clinical autonomy domain when utilized among primary care physicians [38].

Finally, the Health Professions Stress Inventory (HPSI) [39] by Wolfgang was used to assess work-related stress levels. It has four domains which are personal recognition (8 items), responsibilities for patient care (7 items), conflicts at work (8 items), and professional uncertainty (7 items). The inventory has 30 items with a Likert-type scale. Each item is scored in the range of 0 to 4 points. The scoring is based on the total score ranging 0-120. Higher scores indicate higher work-related stress levels. The HPSI has good internal consistency with a Cronbach’s alpha coefficient of 0.88 [39].

The permission to use these questionnaires was obtained from their developers. The questions were converted into an online format (Google Forms™) which was then pre-tested among 19 PCDs in a university-based primary care clinic to assess their internal consistency reliability. The JDI, PLPA, and HPSI questionnaires were found to have moderate to good internal consistency reliability. The overall Cronbach alpha values for the JDI, PLPA, and HPSI questionnaires were 0.87, 0.78, and 0.96, respectively. These 19 PCDs were not invited to the actual study.

Sample size calculation

The sample size was calculated using the Statulator application for “Sample Size for Estimating a Single Mean” from http://statulator.com/SampleSize/ss1M.html. The sample size was determined based on the pilot study which found that the standard deviation of stress among primary care physician was 22. At the confidence level of 0.95 and precision or margin error of 3, the estimated sample size was 210. The sample size calculation also needed to account for multiple linear regression analysis (MLR). Bujang et al. proposed that a sample size of at least 300 can serve as a simple rule of thumb for establishing an adequate sample size for MLR especially for data obtained in observational research such as cohort, cross-sectional, and case control studies [40]. Therefore, the minimum sample size required in this study was 300 PCDs.

Participant recruitment, sampling method, and data collection

Convenience sampling was utilized until the target sample size was achieved involving all the PCDs in Malaysia. This method was conducted using an online questionnaire through Google Forms™. The online questionnaire was chosen as the platform to conduct the survey as physical access to many places including health care facilities were restricted during the COVID-19 pandemic in Malaysia. The participant recruitment was carried out for a total of four months between 1st March 2022 to 30th June 2022. The background and objectives of this study were explained to the council members of FMSA, AFPM, and MPCN after they were approached. This was followed by requesting them to send an invitation through email and social media messaging services to all their members including a link to the study information sheet and the questionnaires. Those who agreed to participate needed to tick a “consent” box before he or she was able to proceed with the online questionnaire form. Participants are only given access to the questionnaire once they had fulfilled the inclusion and exclusion criteria by ticking the boxes in the online questionnaire form. Reminders were sent after two- and four-week intervals from the first invitation.

Data entry and statistical analysis

The latest IBM® Statistical Package for Social Sciences (SPSS) software (IBM Corp., Armonk, NY, USA) was used to perform data entry and statistical analysis. The sociodemographic, work and workplace factors, job demand, job control and work-related stress levels were described as descriptive statistics. For continuous data with normal distribution, mean with standard deviations (SD) were used. On the other hand, for the non-normally distributed data, median and interquartile ranges (IQR) were used. Frequencies and percentages were used to describe categorical data. To determine the association between sociodemographic, work and workplace factors, job demands and job control with work-related stress, inferential analysis was performed. Univariate analysis was conducted using simple linear regression. Following this analysis, factors with a P-value of < 0.25 were analysed using multiple linear regression. The backward method was used for the analysis. All the assumptions of the model which include linearity, independence, normality of the response, homoscedasticity, fit of independent numerical variables, and interactions between each independent variable were checked. Statistical significance was taken at P < 0.05.

Results

Characteristics of respondents

A total of 302 primary care doctors responded to the online questionnaire. Out of 302, 301 (99.7%) fulfilled the inclusion and exclusion criteria, consented, and completed the questionnaire (Fig. 1). From the total of 301 PCDs, the mean age (SD) was 37.8 (7.7) years old. The majority of the respondents were Malay (67.8%), female (76.1%), married (73.1%), medical officers (68.8%), and worked in an urban (70.4%) and public primary care clinics (83%) (Table 1).

Fig. 1
figure 1

Flow chart of the study

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Table 1 Sociodemographic details and work and workplace factors of participants (n = 301)
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Job demand, job control, and work-related stress scores among primary care doctors

The overall mean (SD) for the JDI score was 62.99 (8.04) while the overall mean (SD) for the PLPA score was 28.89 (5.45). The overall mean (SD) HPSI score was 62.8 (18.38) (Table 2).

Table 2 Mean score for Job Demand Inventory, Physicians’ Lack of Professional Autonomy and Health Professions Stress Inventory of participants (n = 301)
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Factors associated with work-related stress

Table 3 shows the results of the univariate analysis using simple linear regression. From this analysis, the factors that had a P-value of < 0.25 include age, postgraduate qualification, designation, workplace, time to reach workplace, number of patients seen in an average working day, number of suspected or confirmed COVID-19 patients seen in an average working day, average time spent for one regular patient consultation, average time spent in clinical audit/research activity per week, degree of feeling afraid of getting COVID-19 infection at the workplace, degree of feeling afraid of spreading COVID-19 infection to family members or household contacts from the workplace, degree of feeling worried about being alienated by friends and relatives because of close contact with COVID-19 patients, frequency of receiving support from the supervisor at the workplace during COVID-19, JDI score and PLPA score. All these factors were then included in multiple linear regression analyses as these factors were also found to be significant factors associated with work-related stress level among PCDs based on existing literature.

Table 3 Simple linear regression analyses on the factors associated with work-related stress (HPSI) among PCDs
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Table 4 shows factors associated with work-related stress level among PCDs based on multiple linear regression analysis. Three factors were significantly associated with the HPSI score, explaining 36% of the variation (R2 = 0.36). These factors were: feeling worried about being alienated by friends and relatives because of close contact with COVID-19 patients, frequency of receiving support from the supervisor at the workplace during COVID-19, and JDI score. All assumptions (linearity, independence, normality of the response variable, homoscedasticity, and fit of independent numerical variable) for the multiple linear regression were met. PCDs who had any degree of worry about being alienated by friends and relatives because of close contact with COVID-19 patients had higher HPSI scores compared to PCDs who did not have any worry at all: rarely (b = 10.23, 95% CI: 5.57, 14.89), sometimes (b = 10.41, 95% CI: 5.68, 15.13), often (b = 10.12, 95% CI: 4.16, 16.08), and always (b = 14.65, 95% CI: 7.43, 21.89). On top of that, an increase in the job demand score by 1 (b = 1.13, 95% CI: 0.91, 1.35) would increase their HPSI score by 1.13. On the other hand, PCDs who always received support from supervisors at the workplace (b = -5.65, 95% CI: -10.38, -0.93) were associated with lower HPSI scores compared to those who never received any support from their supervisors.

Table 4 Multiple linear regression analyses on the factors associated with work-related stress (HPSI) among PCDs
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Discussion

The mean (SD) HPSI score in our study [62.8 (18.38)] was found to be higher compared to the mean HPSI among PCDs in the United States of America [(46.9 (13.1)] [39] before the pandemic. On top of that, the mean HPSI score among physicians working in public and private hospitals in Malaysia before COVID-19 was 47.1 (95% CI: 42.4, 51.7) and 53.5 (95% CI: 48.2, 58.8), respectively [41], which were lower compared to our study. A lower mean HPSI score of 43.9 (18.0) was also seen among residents and senior doctors working in Mexico City hospitals before the COVID-19 pandemic [42]. However, other studies using the HPSI to measure work-related stress levels are limited, making further direct comparison difficult. A study in Europe found that French PCDs had high levels of work-related stress during the COVID-19 pandemic with nearly half of their PCDs reported being stressed and a third very stressed [43]. Another study in Iraq found that compared to other specialities, PCDs had the highest prevalence of high stress levels during the COVID-19 pandemic [44]. Furthermore, Ortega-Galán et al. found that PCDs in Spain had higher stress levels compared to their colleagues working in hospitals during the COVID-19 pandemic [45]. In fact, in this study, it was found that PCDs had higher stress levels compared to other healthcare workers (nurse and health technicians) working in a primary care setting [45]. They hypothesized that this was due to a lack of resources in their primary care setting [45]. On the other hand, a study done in Australia found that the mean HPSI score among their emergency physicians (EPs) was higher at 89.9 (14.6) during the COVID-19 pandemic [46]. This might be due to prolonged working hours in the emergency department among the EPs [47]. In short, primary care practice had been a stressful field in medicine during the COVID-19 pandemic [27, 48].

In our study, PCDs who perceived that they always received support from their supervisors at the workplace during the COVID-19 pandemic had lower work-related stress levels than those who perceived that they never receive support. Our result was consistent with a study done in Türkiye which showed that lower support from supervisors led to higher stress levels among doctors in Türkiye [32]. The component of good support from supervisors includes good communication with subordinates. A study done among healthcare professionals working in intensive care units (ICUs) found that those who lacks communication with supervisors tend to have higher work-related stress during the COVID-19 pandemic [49]. Since the COVID-19 pandemic involved enormous shifts in workload, new duties, and fast emerging guidelines, a lack of transparency in communication between supervisors and their subordinates contributed to work-related stress [34]. Another component of good support from supervisors was having good leadership. Leadership is critical in fostering an atmosphere that supports the HCWs’ mental health by providing physical assistance, such as PPE and mental health services, as well as gestures of thanks and appreciation [50].

The other significant factor for work-related stress in our study was high job demand during the COVID-19 pandemic as indicated by the JDI scores. This job demand can be in the form of workload. A survey on ‘International Health Policy Survey of Primary Care Physicians’ in 2022 found that more than half of PCDs in 10 high-income countries had their workload increased in the form of greater backlog of patients needing care and higher administrative tasks since the COVID-19 pandemic began [51]. This workload did not stop here as PCDs were also responsible for the COVID-19 vaccination programme [27]. On top of that, they were responsible for the screening and swabbing of persons under investigation (PUI) [48]. In the Malaysian setting, PCDs were also responsible for the running of COVID-19 Assessment Centres (CAC) which functions as a one stop centre for assessment and coordinating care of COVID-19 cases. A CAC was also used to monitor and assess COVID-19 cases at home as well as to identify cases and coordinate referrals to hospitals or Quarantine and Treatment Centres for low-risk COVID-19 cases [Pusat Kuarantin dan Rawatan COVID-19 Berisiko Rendah (PKRC)] admissions [52]. All these tasks were on top of the regular acute and chronic care services that they provide [48].

From our study, PCDs who felt worried about being alienated by friends and relatives due to them having close contact with COVID-19 patients had higher work-related stress levels compared to those who did not. This feeling of discrimination was also seen as a significant factor for stress among HCWs including doctors in Spain [45]. A similar finding was reported among doctors in Egypt including those working in primary health care [53]. This incident of discrimination even occurred during the severe acute respiratory syndrome (SARS) epidemic in 2004, where 20% of the HCWs reported stigma and rejection in their community [54]. This feeling of perceived discrimination might be associated with PCDs awareness over reports of COVID-19-related attacks on healthcare workers and facilities occurred not only in developing countries (Bangladesh, India, Mexico, and Malawi) but also in developed countries (the United States) [55]. HCWs were subjected to social isolation, public insults or harassment, public transport refusal and house eviction in these situations due to fear of harbouring the infection [55]. The worst-case scenario was seen in Egypt where a physician who died from COVID-19 was denied burial by terrified and angry locals due to fear of being infected, causing her family enormous psychological suffering [56]. On top of that, this perceived stigma was due to fear of infection, concern about social judgement, and self-blame or blame of others for being a source of infection or for the consequent adverse outcomes [45]. The other cause was due to ‘infodemic’ which refers to the excessive circulation of misinformation propagated by media on COVID-19 where HCWs might be the source of infection to others [57].

Surprisingly, none of the sociodemographic factors in our study was significantly associated with higher work-related stress. A Malaysian study done before the COVID-19 pandemic found that job designation and gender were significantly associated with work-related stress among physicians working in private and public settings [41]. Junior physicians and medical officers experienced higher work-related stress, probably due to pressure from their superiors [41]. On the other hand, female physicians were found to have higher levels of work-related stress than male physicians probably due to female physicians need to allocate adequate balance between work and family time as they tend to have greater home and parenthood responsibilities [41].

Strengths and limitations of this study

The strength of this study is that it is among the first few that assessed at the work-related stress levels among PCDs in Malaysia during the COVID-19 pandemic. However, there are some limitations in this study. One limitation is that the data were gathered through a cross-sectional design research, which can only explain association and not causation between the independent and dependent variables studied. Next, since convenience sampling via an online recruitment method had been used, there might be risks of selection bias and participation bias, which may affect the generalizability of the results. This method was used as physical access to many places, especially healthcare-related establishments was limited because of the movement restrictions related to COVID-19 here in Malaysia. Nevertheless, efforts were made to reduce this bias by ensuring that invitations were distributed to as many PCDs as possible through the country’s three main PCD associations, via numerous internet and social media platforms, and repeated reminders.

Implication for clinical practice and future research

The findings from this study provide insights into the level of work-related stress and the significant associated factors among PCDs in Malaysia. As such, suitable measures can be taken to tackle these factors.

From our study, suggested measures to reduce work-related stress include having supervisors that can have effective communication with PCDs and possess good leadership skills such as willing to listen to their experiences, discuss about their mental and physical obstacles of their work and take into account their concerns [32]. Suggestions to tackle the feeling of discrimination include ensuring that the mass media spread accurate information on COVID-19 on the mode of transmission and using legislation to protect HCWs from being discriminated against [58]. As for workload, PCDs can be supported by revisiting, postponing, or outsourcing pandemic-related documentation and administrative tasks [59]. In addition, a multidisciplinary approach such as outsourcing vaccination and allocation of seeing COVID-19 cases to other medical disciplines can reduce the workload of PCDs [59].

Further research on work-related stress post pandemic can be performed to assess whether there is any change in the work-related stress levels.

Conclusions

In summary, the level of work-related stress among Malaysian PCDs during the COVID-19 pandemic was higher compared to American PCDs and Malaysian physicians before the pandemic but lower compared to Australian emergency physicians during the pandemic. Factors associated to this stress include feeling worried about being alienated by friends and relatives because of close contact with COVID-19 patients, frequency of receiving support from the supervisor at the workplace during COVID-19, and job demand. Strategies addressing these factors should be implemented to reduce work-related stress among our PCDs.

Data availability

The datasets collected and analysed during the current study are available upon reasonable request from the corresponding author and are subject to data protection laws and regulations.

Abbreviations

AFPM:

Academy of Family Physicians Malaysia

CAC:

COVID-19 Assessment Centres

CI:

Confidence interval

CME:

Continuing Medical Education

COVID-19:

Coronavirus Disease 2019

CPD:

Continuing Professional Development

EPs:

Emergency physicians

FMS:

Family Medicine Specialists

FMSA:

Family Medicine Specialists Association

FRACGP:

Fellowship of the Royal Australian College of General Practitioners

GPs:

General practitioners

HCWs:

Healthcare workers

HPSI:

Health Professions Stress Inventory

ICUs:

Intensive care units

IQR:

Interquartile ranges

JDC:

Job-demand-control

JDI:

Job Demand Inventory

MLR:

Multiple linear regression analysis

MMC:

Malaysia Medical Council

MOs:

Medical Officers

MOH:

Ministry of Health

MPCN:

Malaysian Primary Care Network

MRCGP:

Membership of the Royal College of General Practitioners

MYR:

Malaysian Ringgit

NIOSH:

United States’ National Institute of Occupational Safety and Health

PCDs:

Primary care doctors

PKRC:

Pusat Kuarantin dan Rawatan COVID-19 Berisiko Rendah

PLPA:

Physicians’ Lack of Professional Autonomy

PPE:

Personal protective equipment

PUI:

Persons under investigation

Ref:

Reference group

SARS:

Severe acute respiratory syndrome

SD:

Standard deviations

SPSS:

Statistical Package for Social Sciences

UK:

United Kingdom

WHO:

World Health Organization

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Acknowledgements

The authors would like to thank the developers of the three questionnaires for granting permission to utilise their questionnaires in this study. We also would like to extend our gratitude to the Malaysian Primary Care Network, Malaysian Family Medicine Specialists’ Association, and the Academy of Family Physicians Malaysia for their assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Klinik Kesihatan Sungai Udang, Sungai Udang, Melaka, 76300, Malaysia

    Muhammad Shah Shahrudin

  2. Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia

    Nik Munirah Nik-Nasir & Mohamed-Syarif Mohamed-Yassin

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  1. Muhammad Shah Shahrudin
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Contributions

All authors conceived and designed the research; analysed and interpreted the data. MSS acquired the data and drafted the manuscript. NMNN and MSMY substantively revised the manuscript. All authors approved the submitted version of the manuscript, and agreed to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Corresponding author

Correspondence to Mohamed-Syarif Mohamed-Yassin.

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Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Universiti Teknologi MARA (UiTM) Selangor, Malaysia and the Malaysia Research Ethics Committee (MREC) from the National Medical Research Register (NMRR). The approval reference number from UiTM Research Ethics Committee is [REC/12/2021 (MR/927)] and NMRR Project ID: NMRR ID-21-02232-U2A (IIR).

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Informed consent was obtained from all subjects involved in the study.

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Not applicable.

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The authors declare no competing interests.

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Shahrudin, M.S., Nik-Nasir, N.M. & Mohamed-Yassin, MS. Work-related stress and its associated factors among primary care doctors in Malaysia during the COVID-19 pandemic. BMC Prim. Care 26, 4 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12875-024-02697-7

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BMC Primary Care

ISSN: 2731-4553

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