Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol

Unmasking the triad of burnout, absenteeism, and poor sleep among healthcare workers during the third wave of COVID-19 pandemics. Results from the national AMADEUS study

BACKGROUND

Burnout and absenteeism are prevalent among healthcare workers, reflecting prolonged work-related stress and dissatisfaction with their job. Identifying poor sleep as a contributing factor can assist in developing targeted interventions. This study explored the relationship between burnout, absenteeism, and sleep among healthcare workers.

METHODS

A nationwide online cross-sectional study was conducted among healthcare professionals in France during the third wave of COVID-19, from May 2021 to June 2021. Recruitment strategies included outreach through social and professional networks and email invitations. Burnout was assessed using the Maslach Burnout Inventory, absenteeism through self-reported days absent in the preceding 12 months, and sleep quality using the Pittsburgh Sleep Quality Index. The association between burnout, absenteeism, and poor sleep was analyzed using multivariate logistic regression, accounting for individual and professional variables. The study also explored various sleep dimension abnormalities.

RESULTS

Of 10,087 healthcare workers, 55.2 % reported burnout, 20.5 % absenteeism, and 64.8 % poor sleep. Burnout and absenteeism were more frequent in individuals with poor sleep compared to those with good sleep (74.2 % vs. 25.8 % and 75.6 % vs. 24.4 %, respectively). The multivariate analyses confirmed the associations between burnout, absenteeism, and poor sleep (Adjusted Odds Ratio [aOR] = 2.15, 95 % CI [1.97-2.35], p < 0.001; and aOR = 1.49, 95 % CI [1.32-1.67], p < 0.001, respectively).

INTERPRETATION

The study highlighted the intricate relationship between burnout, absenteeism, and poor sleep among healthcare professionals, informing workforce management and policy decisions to foster a supportive work environment and enhance their well-being.

Cumulative lifetime stressor exposure impairs stimulus-response but not contextual learning

Greater exposure to stressors over the life course is believed to promote striatum-dependent over hippocampus-dependent learning and memory processes under stressful conditions. However, little research in this context has actually assessed lifetime stressor exposure and, moreover, it remains unknown whether greater cumulative lifetime stressor exposure exerts comparable effects on striatum-dependent learning and hippocampus-dependent learning in non-stressful contexts. To investigate this issue, we used the Stress and Adversity Inventory for Adults (Adult STRAIN) and Multicued Search Task to investigate the relation between cumulative lifetime stressor exposure and striatum-dependent stimulus-response learning and hippocampus-dependent contextual learning under non-stressful conditions among healthcare professionals (N = 205; 157 females, 48 males; Age: M = 34.23, SD 9.3, range 20-59 years). Individuals with moderate, but not low, cumulative lifetime stressor exposure exhibited impaired learning for stimulus-response associations. In contrast, learning for context associations was unrelated to participants' lifetime stressor exposure profiles. These results thus provide first evidence that cumulative lifetime stressor exposure may have negative consequences on human striatum-dependent stimulus-response learning under non-stressful environmental conditions.

Associations Among Social Jet Lag, Sleep-Related Characteristics, and Burnout of Nurses in Tertiary Hospitals

To investigate the status of social jet lag (SJL) through sociodemographic factors among clinical nurses and examine the correlation with burnout. There has been relatively little research on the possible factors resulting in SJL among nurses in China and its role in burnout. A multicenter cross-sectional study recruited 596 nurses from 7 Chinese hospitals. Online questionnaires were delivered to assess sociodemographics, shift work, SJL, chronotypes, and the burnout of nurses. Nurses had severe levels of SJL. The number of children, forms of employment, specialty area, length of professional service, and chronotypes were the main predictors of SJL. Moreover, SJL affected burnout (emotional exhaustion and deindividuation), and reducing the nurses' SJL could relieve their burnout. Additional evidence-based interventions indicate that reducing the SJL is essential as the nurses are suffering severe job burnout.

Prevalence and factors associated with gender incongruence in French healthcare professionals: results from a nationwide survey

OBJECTIVES

The objective of this study was to explore gender incongruence among French healthcare professionals and its associated factors.

STUDY DESIGN

Nationwide online cross-sectional survey.

METHODS

Healthcare professionals were recruited from May 2, 2021, to June 30, 2021, through social networks, professional networks, and email invitations. A multivariate regression model was used to analyze the association between gender incongruence and socio-demographic, professional, mental health, and addiction behavior factors.

RESULTS

The study included 10,325 healthcare professionals, indicating a prevalence of gender incongruence at 2.6% (95% confidence interval [CI]: 2.3-2.9%). In multivariate analyses, we found that healthcare professionals with gender incongruence, when compared to their counterparts, exhibited the following characteristics: they were more frequently male (adjusted odds ratio [aOR] = 1.88, 95% CI: [1.42-2.48], p < 0.001), less frequently physicians (aOR = 0.18, 95%CI: [0.11-0.29], p < 0.001), health executives (aOR = 0.51 [0.34-0.77], p = 0.001), nurses (aOR = 0.47, 95%CI: [0.33-0.68], p < 0.001), and other allied professionals (aOR = 0.33, 95%CI [0.23-0.49], p < 0.001) than nurse assistants, they consumed antidepressants more frequently (aOR = 1.52, 95%CI: [1.02-2.26], p = 0.041) and were more likely to be tobacco smokers (aOR = 1.34 (1.02-1.77), p = 0.035). We did not observe any significant associations with age, hazardous drinking, sustained bullying at the work place, or sexual-orientation-based discrimination (all p > 0.05).

CONCLUSIONS

Gender incongruence should be taken into account at the management, colleague, or institution levels. We found that the professionals reporting gender incongruence consumed more antidepressants and smoked more, which may indicate a certain level of distress that warrants further investigation.

PROTOCOL REGISTRATION

IRB n°C08/21.01.06.93911, CNIL. The protocol was published DOI: 10.1016/j.encep.2021.06.001.

TRIAL AND PROTOCOL REGISTRATION

The protocol was published DOI: 10.1016/j.encep.2021.06.001.

Psychometric validity of the Shirom-Melamed Burnout Measure and the Burnout Assessment Tool: a systematic review

In the absence of internationally recognised standardised criteria, several patient-reported outcome measures (PROMs) have been developed to measure occupational burnout. The aim of this study was to extend our 2021 review of the psychometric validity of five PROMs to the Shirom-Melamed Burnout Measure (SMBM) and the Burnout Assessment Tool (BAT). To do that we ran a systematic literature search in the MEDLINE, PsycINFO, and Embase databases following our previous methodological framework and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). We assessed the level of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guideline. We identified 694 publications on SMBM and 421 on BAT, but the final review includes eight papers on SMBM and three on BAT. Of the seven psychometric properties assessed for SMBM, content, structural, and criterion validity were rated as insufficient, whereas the quality of evidence for construct and internal consistency was high and moderate, respectively. Of the nine psychometric properties assessed for BAT, content, structural, criterion, and construct validity was moderate and internal consistency was high. One limitation of this study is that we did not assess cross-cultural validity, because the number of studies reviewed is too small and content validity can only be assessed based on the original PROM version rather than translation. To conclude, BAT is superior to SMBM in terms of psychometric validity, but the quality of evidence for some properties is low or very low, suggesting a need for additional validation studies.

Sleep timing, workplace well-being and mental health in healthcare workers

INTRODUCTION

Healthcare workers face an elevated risk of burnout, sleep disorders, and mental health issues, potentially stemming from the misalignment of their circadian rhythm due to nonstandard work schedules. This cross-sectional survey aims to examine the connections between sleep timing, workplace well-being (including burnout and absenteeism), and mental health outcomes (specifically depression and poor sleep) in healthcare workers. Additionally, the survey takes into account individual and professional factors, as well as the interaction with work schedules.

METHODS

The study encompasses 4,971 healthcare workers from both public and private healthcare facilities in France, including nurses, nursing assistants, and physicians recruited during the third wave of the COVID-19 pandemic. The Maslach Burnout Inventory assesses burnout, the Center for Epidemiologic Studies Depression Scale measures depression, and the Pittsburgh Sleep Quality Index evaluates poor sleep. Sleep timing is categorized into morning, neutral, and evening timing, referred to as midsleep. Multivariate logistic regression analysis is conducted to explore the relationships between sleep timing and burnout, depression, and poor sleep, while adjusting for various factors.

RESULTS

The findings reveal that 56.5% of participants experience burnout, 29.8% report depression, and 64.5% report poor sleep. Nurses and nursing assistants exhibit a higher prevalence of poor sleep. Morning sleep timing is associated with burnout among those with fixed schedules and with depression among those with shift schedules. Among physicians, both morning and evening sleep timing are associated with depression, while morning sleep timing is linked to poor sleep across all subgroups.

INTERPRETATION

This study suggests that the misalignment between healthcare workers' internal circadian rhythm and their work schedules may contribute to an increased risk of burnout, depression, and poor sleep. Occupational health services and policymakers should recognize the potential for enhancing workplace well-being and mental health outcomes by enabling healthcare workers to maintain sleep schedules that accommodate their needs.

Untreated major depression in healthcare workers: Results from the nationwide AMADEUS survey

AIMS

Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes.

DESIGN

The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies-Depression Scale was sent to public and private national healthcare facilities.

RESULTS

Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4-34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow-up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians.

CONCLUSION

Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs.

RELEVANCE TO CLINICAL PRACTICE

Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn-over and globally to improve the wellbeing at work.

Poor sleep is associated with work environment among 10,087 French healthcare workers: Results from a nationwide survey

Poor sleep is a prevalent issue among healthcare workers and can have detrimental effects on their health. Various individual and professional factors, including the work environment, may contribute to poor sleep. However, only a limited number of studies have examined the simultaneous influence of these factors. Hence, we conducted a nationwide survey among graduated healthcare workers in both public and private healthcare facilities in France. The aim was to analyze the association between poor sleep, assessed using the Pittsburgh Sleep Quality Index (>5), and the work environment, evaluated using the Job Content Questionnaire. The study encompassed 10,087 healthcare workers, among whom 6,540 (64.8%) reported experiencing poor sleep. Nurses, health executives, nursing assistants, and other allied healthcare professionals were more likely to experience poor sleep compared to physicians. Through multivariate regression analysis, we identified several aspects of the work environment associated with an increased likelihood of poor sleep. These factors included high speed and quantity of work, high complexity and intensity, high fragmentation and unpredictability, limited decision-making latitude, underutilization of skills, lack of emotional support from colleagues, and sustained workplace bullying. These findings highlight the significance of considering the work environment in addressing sleep issues among healthcare professionals.

Work environment and mental health in nurse assistants, nurses and health executives: results from the AMADEUS study

AIM

To explore work environment and mental health in nurse assistants, nurses and health executives in a national large-scale study.

BACKGROUND

We have data for physicians but not for other healthcare workers categories.

METHODS

6935 participants were recruited between 2021 May and June by professional mailings and professional networks.

RESULTS

All professional categories reported high rates of high psychological demand (>90%), low social support (>60%) burnout (50 to 60%), exposure to potentially morally injurious events (>40%) depression (approximately 30%). Surgery nurses reported the highest exposure to potentially morally injurious events. Major depression was identified in approximately 30% of participants in all categories but less than 10% reported consuming antidepressants. 31 to 49% of participants reported sleep disorders and 16 to 21% reported consuming regularly hypnotics. Physicians reported high hazardous drinking behavior and nurse assistant high smoking rates.

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

Our results suggest that preventing burnout and depression in healthcare workers is a priority. To reach this goal, nursing managers could develop some interventions to reduce psychological demand and increase personal accomplishment and social support between colleagues, prevent sustained bullying at the workplace and health risk behaviors. These interventions should be further developed and evaluated.