Psychological safety, anxiety, and stress among Swedish primary care physicians: a cross-sectional survey

INTRODUCTION: Psychological safety enables team members to take interpersonal risks without fear of negative consequences. Low psychological safety could be related to psychological distress among primary care physicians, but evidence in this setting remains limited. We assessed anxiety symptoms, perceived stress, psychological safety, and their interrelations in this group. METHODS: A cross-sectional survey was administered to 231 physicians (63.2% women; 131 general practitioners [GPs] and 100 residents). The survey included the Team Psychological Safety Survey, the two-item Generalized Anxiety Disorder scale, the four-item Perceived Stress Scale, and sociodemographic items. Data were analyzed using hierarchical multiple regression models for anxiety and stress, adjusting for gender, training level, and age. Group comparisons by gender and training level were examined as secondary analyses. RESULTS: Of the 231 physicians invited, 111 responded (67.6% women; 62 GPs and 49 residents), yielding a 48% response rate. Among participants, 18.9% screened positive for clinically relevant anxiety symptoms on the GAD-2. Women reported higher levels of anxiety symptoms and lower psychological safety compared with men. Psychological safety was inversely associated with anxiety symptoms and perceived stress, and these associations remained significant after adjusting for demographic factors. CONCLUSIONS: Low psychological safety is associated with more anxiety symptoms and greater perceived stress among primary care physicians. Compared with men, women reported more anxiety symptoms and lower psychological safety. These findings suggest that perceived psychological safety is a relevant correlate of psychological distress among primary care physicians. Longitudinal and qualitative studies are needed to better understand the relationship between psychological safety and psychological distress, and to explore gender-related differences.