Quality of Life (QOL) is attracting attention as a concept which pursues the humanity of patients in contrast to conventional treatment which mainly consists of treatment for sustaining life. In particular, as senile dementia is one of the diseases for which a complete cure is not available to date and for which the main goal of medical treatment and care is improvement in QOL, appropriate evaluation of the effectiveness of treatment for elderly people with dementia cannot be employed without evaluating their QOL.
As well, in the field of pharmacoepidemiology, with the development of antidementia drugs for Alzheimer's disease (AD), utilization of a QOL scale in evaluating drug efficacy has become an important subject. Considering the characteristics of dementia, it is not necessarily easy to evaluate how much QOL improvement antidementia drugs bring about, because many patients have difficulty in evaluating themselves. Therefore, in addition to QOL evaluation, utilizing objective evaluation by observing patients'behavior or the scale measuring the patients'preferences should be examined.
Furthermore, maintaining QOL of caregivers is an important issue as this is closely related with QOL of patients themselves. To care for elderly people with dementia, a caregiver such as a patient's family member shoulders significant mental/physical burden, which could lead to “collapse by caring”. Therefore, in evaluating antidementia drugs, it is necessary to take QOL of caregivers as well as the patients themselves into consideration.

OBJECTIVESThe Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout.

METHODSA questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs.

RESULTSPrevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction".

CONCLUSIONSPrevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.