**1. Introduction**

Several studies have shown that a large percentage of patients with mental health disorders (MHD) do not receive adequate treatment [1,2]. There could be multiple reasons for this phenomenon; however, the more important ones could be negative attitudes toward help-seeking behavior and various obstacles that emerge when confronted with knowledge or a subjective feeling of these specific medical diagnoses [2–4].

Physicians represent a population group known to have extremely stressful work, high rates of burnout, mental distress and suicide [5–7]. Additionally, the surrounding stigmatization of mental health diagnoses and barriers toward help-seeking could be even more pronounced when compared to other population groups, due to the negative attitudes and behaviors towards MHD, pessimism regarding treatment success, and the specific workplace culture [8]. It could be argued that these remarks could be even more

Furlan, S.; Vilovic, M.; Kumric, M.; Martinovic, D.; Rusic, D.; Rada, M.; Tomicic, M. Mental Health Well-Being and Attitudes on Mental Health Disorders among Family Physicians during COVID-19 Pandemic: A Connection with Resilience and Healthy Lifestyle. *J. Clin. Med.* **2022**, *11*, 438. https:// doi.org/10.3390/jcm11020438

**Citation:** Vilovic, T.; Bozic, J.; Zuzic

Academic Editor: Michele Roccella

Received: 5 December 2021 Accepted: 13 January 2022 Published: 15 January 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

pronounced in family physicians (FPs), as they represent cornerstones of the healthcare system, the point of trusted first contact for general population, and have numerous roles in society [9,10]. In addition, studies have shown that FPs are at higher risk of chronic stress and burnout than most of the other medical practitioners [11,12]. However, it is important to alleviate psychological distress, and to remove barriers to seeking professional help in FPs, due to possible consequences of untreated MHD, as well as observed connections with reduced patient content and treatment adherence, decreased productivity and increased rates of medical errors [13,14].

Rates of MHD were steadily rising over the last decade [15,16]; however, with the emergence of the coronavirus disease 2019 (COVID-19) pandemic, one of the main consequences of the re-structured lifestyle that followed was an additional spike in MHDs, especially in the population of healthcare workers that carry out a large organizational and management burden [17–19]. Therefore, in these demanding times, several countries recognized the problem and established various psychological support systems for this population [20].

Furthermore, to the best of our knowledge, only a few studies addressed help-seeking behaviors and attitudes toward MHDs in the physician population before the pandemic, and none in the primary medicine department [21,22]. Additionally, after the COVID-19 emergence, studies have shown low psychological help-seeking in several different population samples, including students, the general community, and healthcare workers [23–25]. In addition, investigations have shown the importance of appropriate coping with experienced stress, as some of the coping mechanisms can help us reduce stress in a manner that will promote positive psychological outcomes ("adaptive" coping), whereas some of them can lead to even more exacerbated stress in the long term, and promotion of poor mental health outcomes and increased psychopathology symptoms ("maladaptive coping") [26,27]. However, there is a gap in the literature in help-seeking behaviors, stress-coping mechanisms, and experiences and attitudes toward MHDs from FPs, a population which has been substantially affected by the pandemic.

On the other hand, in the scientific literature, more emphasis is being put into investigating positive effects of resilience and healthy lifestyle on physicians' mental health [28,29]. According to some authors, resilience can be considered as one of the most important elements to physicians' well-being [29]. Even though there is no universal definition of resilience suggested in the literature [30], it could be broadly defined as a complex set of responses to traumatic and challenging situations that have fundamentals in three core components—insight, values, and self-care [31]. Further studies have shown that resilience could have some form of protective character regarding MHDs in physicians, however, there is still a scarcity of information of these connections in FP population, especially in COVID-19 pandemic era [11,32,33]. Furthermore, numerous evidence exists on the favorable effects of a healthy lifestyle on the individual's well-being, which could include burnout as well [28,34]. However, there is limited information regarding the following of a healthy lifestyle in FPs, as well as connections to self-reported MHDs, resilience, and burnout. Finally, as previous studies have shown that burnout is closely connected to job satisfaction and various mental health disorders, and that resilience and a healthy lifestyle could be considered as a protective factor against experienced stress and burnout, we deem that it is important to explore probable connections between these constructs, with consideration of the history of mental health disorders in the FP population [28,29,31,33–36].

Therefore, the main goal of this study was to investigate the self-reported mental health disturbance history in a population of FPs, their attitudes toward MHD diagnosis, and stress coping strategies. An additional goal was to estimate current FPs' mental health well-being through levels of burnout, job satisfaction, and satisfaction with life, and to investigate the connections with resilience and a healthy lifestyle.
