Work-related instant messaging and calling stress (WRIMCS) among physicians: a novel occupational health risk?

Aim: To assess the association between WRIMC and perceived stress among physicians through the lens of 'occupational context' and psycho-physiological stressors as mediators.

Methods: A cross-sectional study was conducted in Albania in January 2025 including a representative sample of 367 physicians (≈ 66% females; overall response rate: ≈90%). A structured 36-item questionnaire included demographic characteristics, WRIMC exposure and related psycho-physiological stressors and the Perceived Stress Scale (PSS). Multivariable-adjusted ordinal logistic regression was used to assess the direct association between WRIMC-related exposures and PSS scores, whereas mediation analysis was used to assess indirect effects using the perceived impact of work on stress level and psycho-physiological stressors as mediators.

Results: Physicians had moderate-to-high exposure frequencies to work-related phone usage, instant messages and calling, app-based instant messaging, WRIMC beyond work hours, during vacations or after 22:00 o'clock. WRIMC via apps, irritability due to WRIMC interruptions, guilt over not responding to WRIMC and mental fatigue due to WRIMC were identified as ordinal correlates of perceived stress (β = 0.48, β = 0.65, β = 0.33 and β = 0.37, respectively). The perceived impact of work served as a partial mediator (β = 1.07) between WRIMC and PSS scores, though a direct effect of WRIMC on PSS was also observed (β = 2.57). Physicians' age was a negative covariate in both indirect and direct effects.

Conclusions: Physicians are highly exposed to WRIMC which may be associated with certain psycho-physiological stressors. The perceived occupational stress context of instant messaging and calling might represent a significant pathway beyond technostress per se, which may be interconnected with or distinct from work-related stress.