Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study

The Effects of Job Stress on Burnout and Turnover Intention: The Moderating Effects of Job Security and Financial Dependency

(1) Background: The hospitality industry is known for exposing employees to work stress, which can lead to work-related burnout and high turnover rates. This study aims to examine the relationships between work stress, work-related burnout, and turnover intention. It also explores the mediating role of work-related burnout and the moderating role of job security and financial dependence. (2) Methods: A cross-sectional survey was conducted among 494 hotel employees working in five-star hotels in Belek and Manavgat, Türkiye, using a moderated mediation research model. The study found that work stress increases work-related burnout, which in turn increases turnover intention. Additionally, work-related burnout was found to mediate the relationship between work stress and turnover intention. Furthermore, it was found that perceived job security moderates the relationship between work stress levels and work-related burnout. Additionally, the variable of financial dependence was found to moderate the relationship between employees' levels of work-related burnout and their turnover intentions. Similarly, the study found that the financial dependence variable moderates the effect of work-related burnout on employees' turnover intention. Additionally, the study found that employees' perception of job security moderates the impact of work stress on work-related burnout. In conclusion, the study suggests that positive perceptions of job security can mitigate the impact of work stress on work-related burnout. Similarly, the impact of work-related burnout on turnover intention diminishes as the degree of financial dependence rises.

Trends in burnout and related sick leave duration in working-age adults followed in general practices in Germany between 2012 and 2022

AIMS

This study investigated burnout trends and related sick leave duration in working-age adults followed in general practices in Germany.

METHODS

Participants were aged 20-65 years and were diagnosed with burnout in one of 442 general practices in this country in 2012-2014, 2016-2018, and 2020-2022. The prevalence of burnout and the duration of sick leave in all practices were compared between 2012-2014 and 2016-2018 and between 2016-2018 and 2020-2022. The association between diagnosis years (i.e., 2012-2014, 2016-2018, and 2020-2022) and long-term sick leave (i.e., more than 42 days of sick leave) was investigated using adjusted logistic regression.

RESULTS

The study included 39,793, 46,708, and 50,721 patients diagnosed with burnout in the periods from 2012 to 2014, 2016-2018, and 2020-2022, respectively, and the prevalence of burnout in all patients was 3.6%, 3.8%, and 3.6% during these three periods. This prevalence increased significantly in people aged 61-65 years and those with a Charlson Comorbidity Index of ≥1. The mean (SD) sick leave duration in the population of people with burnout rose from 24.1 (41.9) days in the period of 2012-2014 to 36.2 (65.6) days in the period from 2020 to 2022. Finally, compared with 2012-2014, burnout diagnosed in 2016-2018 and 2020-2022 was associated with higher odds of long-term sick leave.

CONCLUSIONS

In view of these findings, it is clear that public health measures are urgently needed to improve burnout prevention in Germany.

An Exploratory Study of Psychological Distress, Professional Quality of Life, Effort-Reward Imbalance, and Turnover Intention of Hospital Nurses during the COVID-19 Pandemic

This exploratory study aimed to identify factors that may influence nurses' turnover intentions during the COVID-19 pandemic. The data were collected during January 2023 from 250 nurses and analyzed using descriptive statistics, t-test, ANOVA, Scheffe, Pearson's correlation, and multiple regression analysis. Among the sociodemographic and clinical characteristics, nursing care and working with personal protective equipment significantly impacted the turnover intention. Among the independent variables, compassion satisfaction, burnout, effort-reward ratio, and psychological distress were significant, with an explanatory power of 43.3%. Among the subjects, 86.4% (216 people) showed a moderate or high burnout level because of the COVID-19 pandemic, and burnout seemed to have a significant impact on turnover intention. Therefore, to lower the turnover intention of nurses, burnout should be prevented, and managers should create an environment where nurses can receive a balanced reward for their efforts.

The impact of COVID-19 lockdown on the quality of life of Chinese football referees: the chain mediating role of occupational stress and job burnout

BACKGROUND

COVID-19 lockdown measures have had a great negative impact on the development of sports competition in China, as well as on the quality of life of football referees. This study aims to explore the impact of lockdown measures implemented in response to the COVID-19 pandemic on the quality of life of football referees in China and its mechanism of action.

METHODS

The Impact of Event Scale-Revised (IES-R), the Effort-Reward Imbalance Scale (ERI), the Maslach Burnout Inventory General Survey (MBI-GS), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). The scale was used from August to September 2022. Using an online questionnaire, 350 questionnaires were sent out and 338 were returned, for a return rate of 96.57%. Invalid questionnaires were excluded, and 307 football referees with referee grades in 29 provinces registered with the CFA were surveyed. SPSS 24.0 and Mplus 8.0 were used for data analysis and structural equation model testing in this study.

RESULTS

The results showed that the COVID-19 lockdown had no significant impact on the quality of life of Chinese football referees. However, the COVID-19 lockdown can affect the quality of life of Chinese football referees through occupational stress or job burnout. Occupational stress and job burnout also play a chain intermediary role between the COVID-19 lockdown and the quality of life of Chinese football referees. In addition, this study further explores the quality of life by dividing it into four dimensions (physical, social, psychological, and environmental). The results show that all four dimensions satisfy the chain mediation model.

CONCLUSIONS

Therefore, the quality of life of Chinese football referees can be improved by reducing their occupational stress and job burnout during the COVID-19 lockdown.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

The relation between routines for shiftwork scheduling and sickness absence at a Norwegian hospital: A cross-sectional study

BACKGROUND

Shift work is associated with negative health outcomes. Routines for scheduling of shift work can help reduce negative health outcomes of shift work and improve work-life balance and social well-being for nurses working shift work.

OBJECTIVE

To investigate the association between organizational units' routines for shift work scheduling and nurses' sickness absence at the unit level.

DESIGN

Cross-sectional study design combining quantitative questionnaire data on shift work scheduling routines with data of mean percentage of sickness absence at the unit, mean level of exhaustion at the unit, mean age and percentage of women working at the unit.

PARTICIPANTS

A total of 126 leaders at organizational units with nurses working shift work schedule at Oslo University Hospital answered a questionnaire about shift work scheduling.

MEASURES

Three aspects of health-promoting shift work scheduling (fatigue-reducing scheduling, organizational health measures, and individual adaptation) and the extent to which operational considerations were made during shift work scheduling were used as independent variables. Covariates were mean age of nurses at each unit, mean percent female nurses, and mean exhaustion at unit level. Percent sickness absence was used as a dependent variable.

METHODS

Questionnaire data on shift work scheduling routines was merged with information on average age of employees in the unit, ratio female nurses, and units' average score on exhaustion. Multivariable linear regression analyses were used to assess the contribution of routines for shift work scheduling after controlling for mean level of exhaustion, average age, and proportion of women at each unit.

RESULTS

The factors "fatigue reducing scheduling", "organizational health measures" and "operational considerations" had no observed total effect on mean sickness absence. Individual adjustment in shift work scheduling had a direct negative association with sickness absence after controlling for other shift work scheduling routines, exhaustion, age, and gender.

CONCLUSIONS

There is a relationship between the units' routines for shift work scheduling and mean sickness absence at the unit, and the possibility of individual adjustment was the only aspect of shift work scheduling that had an above-zero association with sickness absence.

Surviving and thriving - a mixed-methods study of staff experiences of occupational wellbeing in a psychiatric place of safety service

BACKGROUND

Under the S136 of the UK Mental Health Act, people experiencing a mental health crisis may be taken to a locally agreed location (Place of Safety) by police for urgent assessment. Research has shown that mental health professionals (MHPs) face high levels of burnout, but we know very little about the particular challenges staff who work in extreme clinical settings such as a Place of Safety service face.

AIM

This study aimed to fill this gap by exploring the wellbeing experiences of staff in a Place of Safety service.

METHOD

A mixed-methods approach was used, with quantitative data on job satisfaction (Job Satisfaction Survey) and burnout (Maslach Burnout Inventory-Human Services Survey) and qualitative data from focus groups. Purposive sampling was used. Qualitative data was analysed using thematic analysis and descriptive statistics were calculated for the quantitative data.

RESULTS

Twenty staff scored within the moderate range for emotional exhaustion, depersonalisation and personal accomplishment, and in the satisfied range for job satisfaction. Three overarching themes were identified: (i) united as insiders, (ii) surviving and thriving, and (iii) narratives of coping.

CONCLUSIONS

Despite unique setting-related stressors, participants showed comparable levels of wellbeing to other MHPs. Implications are discussed.

"Each week feels like a mountain": The impact of COVID-19 on mental health providers' wellbeing and clinical work

The SARS-CoV-2 (COVID-19) pandemic has placed a tremendous strain on healthcare providers. Although there is a burgeoning body of literature on how COVID-19 has impacted frontline healthcare workers (i.e., providers treating COVID-19 patients), little attention has been dedicated to second-line workers (i.e., providers treating the mental health of people impacted by COVID-19). In this paper, we present findings from a thematic analysis of open text responses (n = 136) examining how COVID-19 shaped both the wellbeing of second-line workers, specifically mental health providers, as well as their clinical work in the early months of the COVID-19 pandemic in the United States. Results indicated that mental health providers were experiencing significant COVID-19-related burnout and poor physical and mental health outcomes. Participants described diminished negative effects on the quality of their clinical care from the burnout and trauma associated with COVID-19. Many also demonstrated resilience, identifying the duality of both negative (e.g., exhaustion) and positive (e.g., pride in helping others) meaning derived from their second-line work experiences. We conclude with recommendations for preventing and addressing burnout among mental health professionals in the era of COVID-19 and subsequent health emergencies.

It Is Not the Virus Exposure: Differentiating Job Demands and Resources That Account for Distress during the COVID-19 Pandemic among Health Sector Workers

A cross-sectional study of 3860 health-sector workers across two data collections was conducted to identify the predictive power of different job demands and job resources during the COVID-19 pandemic based on four indicators of distress (COVID-19 traumatic stress, burnout, generalised anxiety, and depression) among health-sector workers. Exploratory and confirmatory factor analyses, measurement invariance checks, and structural equation models were used to evaluate the dimensionality and the effect of the job demands and resources on distress indictors. The identified job demands were workload, confinement, loss, and virus exposure, while the identified job resources were self-efficacy, momentary recuperation, and meaning making. Loss and workload predicted the distress indicators best, while confinement and virus exposure mainly predicted COVID-19 traumatic stress and were less important for the other distress outcomes. Self-efficacy and meaning making negatively predicted distress, while momentary recuperation, controlled for the other demands and resources, was positively related to the distress indicators. Of the typical pandemic-related demands and resources, the experience of loss due to COVID-19 infection was the most important predictor of distress outcomes. Confinement, and especially the awareness of virus exposure, were far less important predictors.

IMPACT: Evaluation of a Controlled Organizational Intervention Using Influential Peers to Promote Professional Fulfillment

OBJECTIVE

To determine the effects of a popular opinion leader (POL)-led organizational intervention targeting all physicians and advanced practice providers (APPs) working within clinic groups on professional fulfillment (primary outcome), gratitude, burnout, self-valuation, and turnover intent.

PATIENTS AND METHODS

All 20 Stanford University HealthCare Alliance clinics with ≥5 physicians-APPs were matched by size and baseline gratitude scores and randomly assigned to immediate or delayed intervention (control). Between July 10, 2018, and March 15, 2019, trained POLs and a physician-PhD study investigator facilitated 4 interactive breakfast or lunch workshops at intervention clinics, where colleagues were invited to discuss and experience one evidence-based practice (gratitude, mindfulness, cognitive, and behavioral strategies). Participants in both groups completed incentivized annual assessments of professional fulfillment, workplace gratitude, burnout, self-valuation, and intent to leave as part of ongoing organizational program evaluation.

RESULTS

Eighty-four (75%) physicians-APPs at intervention clinics attended at least 1 workshop. Of all physicians-APPs, 236 of 251 (94%) completed assessments in 2018 and 254 of 263 (97%) in 2019. Of 264 physicians-APPs with 2018 or 2019 assessment data, 222 (84%) had completed 2017 assessments. Modal characteristics were 60% female, 46% White, 49% aged 40 to 59 years, 44% practicing family-internal medicine, 78% living with partners, and 53% with children. Change in professional fulfillment by 2019 relative to average 2017 to 2018 levels was more favorable (0.63 points; effect size = 0.35; P=.001) as were changes in gratitude and intent to leave among clinicians practicing at intervention clinics.

CONCLUSION

Interventions led by respected physicians-APPs can achieve high participation rates and have potential to promote well-being among their colleagues.

Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance - A General Population Study

Background

We investigated whether stress-related exhaustion (chronic or short-term, and co-occurring with depression or not) is related to cognitive performance and whether polygenic cognitive potential modifies these associations.

Methods

The participants were from the Young Finns Study (N = 541-1273). Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial learning, reaction time, sustained attention, and executive function. Cognitive performance and depression were assessed in 2011, and exhaustion in 2001, 2007, and 2011. A polygenic score for cognitive potential was calculated based on a GWAS on intelligence.

Results

High stress-related exhaustion, especially chronic, was associated with slower reaction time. Only clinical levels of depression were related to slower reaction time. Polygenic cognitive potential did not modify these associations. There were no differences in cognitive performance between individuals with co-occurring exhaustion and depression vs. those with only either condition.

Conclusion

Stress-related exhaustion, especially if chronic, seems to relate to slower reactions. Co-occurring exhaustion and depression may not have additive effects on cognitive performance. High polygenic cognitive potential may not protect from or predispose to harmful effects of exhaustion or depression on reaction time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10354-z.

Occupational Burnout Is Linked with Inefficient Executive Functioning, Elevated Average Heart Rate, and Decreased Physical Activity in Daily Life - Initial Evidence from Teaching Professionals

Burnout is becoming a global pandemic jeopardizing brain health, with a huge impact on quality of life, available workforce, and the economy. Knowledge of the impact of burnout on cognition, physiology, and physical activity (PA) in daily life allows for an improved understanding of the health consequences and everyday ramifications of burnout. Twenty-eight volunteers participated in a three-day recording of daily physiology and PA, including heart rate (HR) and daily steps, with a wearable device. They filled in questionnaires screening for burnout (BBI-15), depression (BDI), and executive functions (EFs) in daily life (BRIEF-A). The subjects with burnout had more challenges in EFs, higher average HRs and lower numbers of steps in daily life than those without it. The BBI-15 scores correlated positively with the BDI scores and BRIEF-A indices and negatively with the awake HR variability (HRV) and daily steps. The metacognition index correlated negatively with the HRV. In conclusion, burnout is linked with compromised EFs along with alterations in cardiac physiology and PA in daily life. Such alterations may be easily detected with wearable devices, opening possibilities for novel biomarkers of burnout and other neuropsychiatric disorders. We suggest that physical activity and heart and brain health are intimately intertwined and that burnout interacts with each of them bidirectionally.

Job Crafting and Burnout as Predictors of Food Safety Behaviors in the Foodservice Industry

This study aimed to investigate whether job crafting, burnout, and work engagement predict food safety behaviors in the foodservice industry. It was a cross-sectional study conducted in Cuiabá (Brazil) among foodservice workers. Four instruments were used among foodservice workers for the examination: (a) job demands and resources, (b) job satisfaction, (c) burnout, and (d) work engagement. Food safety practices were measured using a validated risk-based checklist. Partial least squares structural equation modeling was used to test the hypothesis model. In this study, 22 restaurants and 302 foodservice workers were examined. It was found that the “job demands-resources” model was valid for foodservice workers, i.e., burnout was strongly predicted by job demands (β = 0.550; p < 0.001); job resources were a positive predictor of work engagement (β = 0.258; p < 0.001); and burnout was a negative predictor of work engagement (β = −0.411; p < 0.001). Food safety violations were predicted by job crafting (β = −0.125; p = 0.029) and burnout (β = 0.143; p = 0.016). The results indicate that mitigating burnout and increasing job crafting can be important supporting strategies to improve food safety behaviors.

Higher allostatic load in work-related burnout: The Regensburg Burnout Project

BACKGROUND

Burnout and chronic work stress have been linked to various negative health outcomes. While the mechanisms underlying this interplay are still unclear, the allostatic load (AL) model was suggested to demonstrate a possible biological pathway. However, previous studies provided divergent results regarding the association between burnout and AL, probably also due to the heterogeneity of selected samples. Therefore, the aim of the present study was to examine differences in AL between a conceptually strictly specified group of individuals suffering from burnout (BO group) and a healthy comparison group (HC group).

METHODS

After a multi-stage recruitment procedure with strict inclusion criteria based on burnout symptomatology and pathogenesis, the BO group (n = 56) was compared to the HC group (n = 65) regarding an index of AL. The AL-index included 14 parameters: high-sensitivity c-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), fibrinogen, d-dimer, plasminogen activator inhibitor 1 (PAI-1), glycosylated hemoglobin (HbA1c), high-density lipoprotein (HDL) cholesterol, total cholesterol to HDL cholesterol ratio (TC/HDL), dehydroepiandrosterone-sulphate (DHEA-S), systolic blood pressure (SBP), diastolic blood pressure (DBP), waist-hip ratio (WHR), and body fat percentage.

RESULTS

The BO group showed significantly higher AL-scores in comparison to the HC group. This effect remained significant after adjusting for sex, age, and smoking status. Additionally, burnout symptoms (assessed with the Maslach Burnout Inventory; MBI), MBI-subscales emotional exhaustion and depersonalization as well as chronic work stress (assessed with the effort-reward imbalance questionnaire) were significantly associated with higher AL-scores.

CONCLUSIONS

Consistent with our hypothesis, we detected higher AL-scores in the BO compared to the HC group, indicating a greater cumulative physiological burden in individuals suffering from burnout. Given the high heterogeneity in individuals experiencing burnout symptoms, future studies may focus on well-specified subgroups, when examining the association between burnout and psychophysiological dysregulations.

Impact of autonomic regulation on burnout and performance in thoracic surgery residents

Objective

This study sought to determine the feasibility of collecting physiologic data in thoracic surgery residents and whether it would correlate with burnout and burnout with performance.

Methods

This was a prospective study of thoracic surgery residents over a 5-month period. Participants were evaluated with a wearable biometric device (heart rate variability and sleep) and the Maslach Burnout Inventory. Resident performance was quantified using Accreditation Council for Graduate Medical Education Milestones (scale, 1-5) normalized to program-designated targets (3 for postgraduate year 6 or lower residents and 4 for postgraduate year 7 residents).

Results

The cohort consisted of 71% female participants (5/7) with 86% of residents having 1 or more children. High levels of emotional exhaustion (median, 30 [interquartile range, 20-36], where >26 is high) and high levels of depersonalization (median, 16 [interquartile range, 14-22], where >12 is high) were common, but personal accomplishment was also uniformly high (median, 43 [interquartile range, 41-46], where >38 is high). There was a significant correlation between heart rate variability and emotional exhaustion (r(12) = 0.65, P = .01) but not depersonalization (P = .28) or personal accomplishment (P = .24). Depersonalization and personal accomplishment did not correlate with resident performance (P = .12 and P = .75, respectively); however, increased emotional exhaustion showed a significant correlation with higher resident performance during periods when burnout was reported (r(6) = 0.76, P = .047).

Conclusions

Dynamic measurement of resting heart rate variability may offer an objective measure of burnout in thoracic surgery residents. Thoracic surgery residents who report high levels of burnout in this cohort maintained the ability to meet program-designated milestones at or above the level expected of their postgraduate year.

The Effects of Strain-Based Work-Parenting Conflict on Dual Income Couples' Energy

(1) Background: Gender differences between men's and women's parenting roles are well-documented as the "second shift". We examined the main effects and interaction of work distress and parenting distress with energy (i.e., vigor) in a sample of 310 dual-income, different-sex couples with kids married for approximately nine years. (2) Methods: We used actor-partner interdependence modeling (APIM) to examine how spouses' distress was associated with their energy. (3) Results: For both wives and husbands, there were negative associations between the actor's parenting distress and their energy level and between the actor's work distress and their energy level. However, only wives experienced a significant interaction of work and parenting distress such that high levels of both forms of distress were associated with low levels of energy, indicating that only wives experience this form of work-family conflict. (4) Conclusions: When women experience more strain at home than men, they may need more time to recover from their work and family duties. If they cannot do so, they will have less energy to carry out their responsibilities and may be at a higher risk of future adverse health outcomes.

Determining the direction of prediction of the association between parasympathetic dysregulation and exhaustion symptoms

Stress-related exhaustion symptoms have a high prevalence which is only likely to increase further in the near future. Understanding the physiological underpinnings of exhaustion has important implications for accurate diagnosis and the development of effective prevention and intervention programs. Given its integrative role in stress-regulation, the parasympathetic branch of the autonomic nervous systems has been a valid starting point in the exploration of the physiological mechanisms behind exhaustion. The aim of the present study was to examine the directionality and specificity of the association between exhaustion symptoms and vagally-mediated heart rate variability (vmHRV), a relatively pure measure of parasympathetic tone. Exhaustion symptoms and vmHRV were measured at four annually assessment waves (2015-2018) of the Dresden Burnout Study. A total sample of N = 378 participants who attended at least two of the four annual biomarker measurements were included in the present analyses. Cross-lagged multi-level panel modelling adjusting for various covariates (e.g., age, sex, BMI) revealed that vmHRV was meaningfully predictive of exhaustion symptoms and not vice versa. In addition, these effects were specific for exhaustion symptoms as no effect was shown for the other burnout sub-dimensions, or for depressive symptoms. Our findings indicate a clear link between exhaustion symptoms and vmHRV which may hold great potential for both enhancing the diagnosis and treatment of exhaustion symptoms.

The association between fear of malpractice and burnout among Chinese medical workers: The mediating role of legal consciousness

BACKGROUND

As a major reason for defensive medicine, the status and effect of "fear of malpractice" among Chinese medical staff is an important topic that needs to be studied. Our study investigated fear of malpractice among Chinese medical workers, assessed its association with burnout, and explored the mediating role of legal consciousness between these factors.

DESIGN

A quantitative, cross-sectional study.

SETTING

All respondents were investigated using a self-report questionnaire. Demographic characteristics and measurements including a fear of malpractice scale, and a burnout and legal consciousness scale were employed. The effect of fear of malpractice on burnout was examined by carrying out a binary regression analysis. A mediation model was used to test the mediating role of legal consciousness.

PARTICIPANTS

The study sample included 1031 doctors and nurses (297 male and 734 female; age = 36.3 ± 8.98).

RESULTS

The average score of fear of malpractice was 20.97 ± 5.34. Respondents with higher levels of fear of malpractice were more prone to burnout ([OR] = 2.865; 95% CI 1.942-4.226). Legal consciousness partially and negatively mediated the effect of fear of malpractice on burnout.

CONCLUSION

High levels of fear of malpractice were found among Chinese medical workers, and this fear had a significant effect on burnout. Legal consciousness may be a resource that can alleviate burnout.

Perceived procedural justice and psychological flourishing among mental health professionals in Macao: a moderated mediation model

This study aimed to examine whether and how organizational factors (i.e., procedural justice) are associated with psychological flourishing, an optimal mental state. Path analysis was conducted among 195 Chinese mental health professionals (females = 69%; Mean age = 30 years) in Macao, and results showed that emotional exhaustion partially mediated the positive association between procedural justice and psychological flourishing, whereas emotion regulation significantly diminished the effects of procedural injustice on emotional exhaustion. Our findings highlight the emotional mechanisms underlying the influence of organizational procedures on employees' wellbeing, and wellness programs for enhancing employees' emotional regulation skills are recommended.

Predicting physician burnout using clinical activity logs: Model performance and lessons learned

BACKGROUND

Burnout is a significant public health concern affecting more than half of the healthcare workforce; however, passive screening tools to detect burnout are lacking. We investigated the ability of machine learning (ML) techniques to identify burnout using passively collected electronic health record (EHR)-based audit log data.

METHOD

Physician trainees participated in a longitudinal study where they completed monthly burnout surveys and provided access to their EHR-based audit logs. Using the monthly burnout scores as the target outcome, we trained ML models using combinations of features derived from audit log data-aggregate measures of clinical workload, time series-based temporal measures of EHR use, and the baseline burnout score. Five ML models were constructed to predict burnout as a continuous score: penalized linear regression, support vector machine, neural network, random forest, and gradient boosting machine.

RESULTS

88 trainee physicians participated and completed 416 surveys; greater than10 million audit log actions were collected (Mean [Standard Deviation] = 25,691 [14,331] actions per month, per physician). The workload feature set predicted burnout score with a mean absolute error (MAE) of 0.602 (95% Confidence Interval (CI), 0.412-0.826), and was able to predict burnout status with an average AUROC of 0.595 (95% CI 0.355-0.808) and average accuracy 0.567 (95% CI 0.393-0.742). The temporal feature set had a similar performance, with MAE 0.596 (95% CI 0.391-0.826), and AUROC 0.581 (95% CI 0.343-0.790). The addition of the baseline burnout score to the workload features improved the model performance to a mean AUROC of 0.829 (95% CI 0.607-0.996) and mean accuracy of 0.781 (95% CI 0.587-0.936); however, this performance was not meaningfully different than using the baseline burnout score alone.

CONCLUSIONS

Current findings illustrate the complexities of predicting burnout exclusively based on clinical work activities as captured in the EHR, highlighting its multi-factorial and individualized nature. Future prediction studies of burnout should account for individual factors (e.g., resilience, physiological measurements such as sleep) and associated system-level factors (e.g., leadership).

Health-related attitudes, behaviors and burnout in intern medical officers and their effects on self-reported patient care in a developing country

Background

Intern Medical Officers (IMOs) in Sri Lanka face significant challenges due to heavy patient load and scarcity of resources.

Aims

To assess IMOs' level of burnout, associated factors and the effects on self-reported patient care in comparison to post-intern Relief House Officers (RHOs).

Methods

A descriptive cross-sectional study was conducted among IMOs and RHOs in two leading tertiary care hospitals in Sri Lanka. The level of burnout was assessed using Maslach Burnout Index. The self-reported health-related attitudes, practices, level of burnout, and their associations with patient care were compared between IMOs and RHOs.

Results

We studied 114 participants (70 (61.4%) IMOs and 44 (38.6%) RHOs). IMOs were not involved in regular exercises (χ²(1) = 19.8, p = 0.000), skipped meals frequently (χ²(1) = 29.3, p = 0.000), and had a poor sleep quality (χ²(1) = 35.7, p = 0.000) compared to RHOs. Overall, 46.5%, 95.5%, and 86.7% of the participants were having moderate-to-high emotional exhaustion, depersonalization, and sense of poor personal achievement. The exhaustion and depersonalization levels were significantly higher among IMOs. Emotional exhaustion was significantly associated with poor sleep (U = 923.0, p = 0.014). Self-reported patient care negatively correlated with exhaustion (r_s(112) =  − 0.263, p = 0.005) and depersonalization (r_s(112) =  − 0.491, p = 0.000), while having positive attitudes correlated with better patient care (r_s(112) = 0.208, p = 0.027).

Conclusions

The prevalence of burnout in IMOs in Sri Lanka is high, which, in turn, negatively correlates with patient care. IMOs face significant challenges in self-care, while their poor sleep perturbs daytime activities and conceivably interferes with patient care. Therefore, we recommend introduction of preventive measures to mitigate burnout in early-career physicians, particularly IMOs, to improve both self and patient care.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-021-02874-y.

Prevalence of Burnout in Portuguese Public Health Medical Residents amid the Response to the COVID-19 Pandemic

<b><i>Introduction:</i></b> Burnout is a psychological syndrome characterized by a state of emotional exhaustion, depersonalization, and a lack of personal accomplishment at the workplace. We aimed to evaluate the prevalence of burnout among Portuguese Public Health Medical Residents during the SARS-CoV-2 virus pandemic. <b><i>Methods:</i></b> Burnout was assessed with the Maslach Burnout Inventory – Human Services Survey, using a zero (never) to six (always) ordinal scale. Sociodemographic and workplace setting data were also collected. Categorical variables were presented as frequencies and percentages, and continuous variables as means and standard deviations (SDs). Chi-squared and independent sample <i>t</i> tests were used to evaluate the distributions of these variables, with a <i>p</i> value of 0.05. <b><i>Results:</i></b> Eighty-three people participated. The average age was 30.46 (±3.91), and 57.8% were female. We found that 77.11% had high levels of emotional exhaustion, 61.4% had high levels of depersonalization, and 44.6% had low levels of personal accomplishment. 32.5% of the participants were experiencing burnout, 30.5% were at high risk, 25.3% were at moderate risk, and 12% were at low risk. Burned-out participants had higher levels of emotional exhaustion (40.63 ± 7.36; mean ± SD) and depersonalization (15.63 ± 5.94; mean ± SD), and lower levels of personal achievement (29.42 ± 7.30; mean ± SD) than their peers. Regarding sociodemographic and work setting-related data, no statistically significant differences were found between professionals with and with no burnout. <b><i>Conclusion:</i></b> The present study shows high scores on all components of burnout and its prevalence among the population studied. Further studies are needed to determine whether this phenomenon was specific to this period.

Hardiness and Burnout in Adult U.S. Workers

OBJECTIVE

Burnout is a costly problem, and it appears to be getting worse due to COVID-related stressors. It is thus important for organizations to find better tools to prevent and mitigate worker burnout.

METHODS

Conditional PROCESS path analysis was used to assess the relation of hardiness to burnout in a representative sample of U.S. workers, with sex and age as potential moderators.

RESULTS

Hardiness is associated with reduced burnout symptoms. Sex did not moderate this relation. A moderating effect for age was observed, with more burnout appearing in younger, less hardy workers.

CONCLUSIONS

Findings suggest hardiness operates similarly for men and women as a buffer against burnout, and that older workers are less vulnerable to burnout. Training programs to increase stress appraisals and coping skills used by more experienced, hardy workers may be beneficial in reducing burnout.

Trends in nursing burnout management in foreign studies (literature review)

This review provides a general foreign overview of the current understanding and  prevalence of professional burnout among medical workers and summarizes the emerging trends in the management of the organization of work of nurses, preventing burnout, and an analysis of practices aimed at preventing burnout. Burnout negatively affects both mental and physical health, as well as increases economic losses and employee turnover.

Burnout depends on factors such as job satisfaction, professional rank, hospital level, gender, professional values, negative emotions, and core competencies.

Burnout syndrome is closely related to compassion fatigue syndrome, compassionate gratification and is part of the broader concept of professional quality of life. Compassion refers to recognition, understanding, emotional resonance, empathic concern and tolerance for the suffering of others, and motivation and action in relationships to help others.

The analysis of foreign literature has shown the relevance of this problem and, first of all, for nurses. The peculiarities of the work of nurses lead to the fact that their burnout is higher than among other medical workers. Various approaches to the management of professional burnout have been proposed. Burnout management can focus on the organization, the individual, or a combination of interventions.

When people have a positive belief system, work involvement, and access to many personal resources, they are less likely to experience stress and burnout.

Nursing burnout has worsened during the COVID-19 period and has exposed new pressing health issues. The COVID-19 pandemic has shown a shortage of nurses and has become a major problem in many countries.

The attitude of the community, the importance and the need for specialized and professional care, especially in situations of great difficulty and suffering, is important for medical personnel. Public sincere gratitude for the work of healthcare professionals will help build compassion for professionals who risk their lives to help people. 

Parents' Emotion Management for Personal Well-Being When Challenged by Their Online Work and Their Children's Online School

Parents' emotional management was highly required during the COVID-19 lockdown, as juggling as their own job moved online and with being a parent of a child whose school was online proved to be a challenge for many. Our sample was restricted to parents who had to work online from their homes while their children had to attend school online, as external imposed conditions. The present study was based on Mayer and Salovey's theory and we aimed to investigate the relationship between parents' emotional intelligence and their ability to manage their emotions during this period, hypothesizing that a higher emotional intelligence and well-developed emotional management abilities contribute to better adjustment to everyday challenges, thus contributing to keeping levels of exhaustion low. The double role played by these adults strained their resources, therefore we were also interested in their level of burnout after almost a year spent in a home turned into office and school. We also investigated the participants' level of flourishing, as described by Ed Diener, as these changes impacted differently on every parent's well-being. The analysis of the data obtained offered us the possibility of issuing a series of recommendations for parents' well-being in such a situation, as the prospect of continuing to work and learn online in future seems very real. The need to set clear boundaries between the roles played in these settings emerged as a main objective of future therapeutic interventions based on positive psychology.

The biology of burnout: Causes and consequences

OBJECTIVES

Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focussing on mechanisms and physical consequences.

METHODS

We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. 'clinical' burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach.

RESULTS

Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout.

CONCLUSIONS

Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.

Mental illness and suicide among physicians

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.

Workplace bullying, burnout, and resilience amongst perioperative nurses in Australia: A descriptive correlational study

AIM

To investigate workplace bullying, and explore correlations between bullying, burnout, and resilience amongst perioperative nurses in Australia.

BACKGROUND

Workplace bullying in perioperative nursing involves verbal, physical and psychological violence. However, no prior studies have measured Australian perioperative nurses' experiences of workplace bullying nor sought to understand if there is a relationship with burnout, and resilience.

METHODS

A descriptive correlational study was conducted utilising an online survey incorporating four validated instruments. Descriptive statistics and regression models analysed workplace bullying, burnout, and resilience.

RESULTS

Over half of perioperative nurses (n = 158/257, 61%) were exposed to workplace bullying. Consequences included fatigue and exhaustion (n = 129/192, 67%), anxiety (n = 123/192, 64%) and sleeplessness (n = 121/192, 63%). Organisational processes (r = 0.458, p<0.001), bullying acts (r = 0.289, p<0.001) and avoidance and withdrawal at work (r = 0.440, p=0.001) increased burnout. Psychosocial distress (r = -0.216, p<0.001) was associated with decreased resilience.

CONCLUSIONS

Workplace bullying is a persistent issue with negative impacts upon burnout, resilience, and wellbeing.

IMPLICATIONS FOR NURSING MANAGEMENT

The psychological wellbeing of employees can be prioritised by establishing and maintaining an organisational climate of psychosocial safety. Thereby inhibiting the potential of bullying to manifest and positively influencing employee wellbeing to help promote workplace engagement, productivity, and reduce burnout.

Burned out or engaged at work? The role of self-regulatory personality profiles

Employees' responses to work demands are crucially related to their occupational well-being. The present study aimed to identify Big Five personality profiles of working adults and examine their connection to two central responses to work stress: work engagement and burnout. Four latent personality profiles emerged (i.e., overcontroller, undercontroller, reserved and resilient) and, in line with Block (2002) self-regulation theory, related differently to burnout and engagement. Specifically, both under- and overcontrollers experienced higher burnout and lower engagement, whereas resilient experienced higher engagement and lower burnout. Reserved profile members were low in both. The results suggest that management of healthy, engaged workers may be aided by consideration of personality profiles and that Block's self-regulation theory may be a useful framework for connecting personality to occupational well-being.

Occupational Burnout, Psychological Status and Quality of Life in Primary Care Physicians Working in Outpatient Settings

Aim      To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.Material and methods  This cross-sectional study was performed at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.Results This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than "good" and 41.6% of physicians evaluated their health condition lower than "good". Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).Conclusion      The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.

How Radiology Leaders Can Address Burnout

The 2018 Annual Workforce Survey conducted by the ACR Commission on Human Resources demonstrated that, although the majority of radiology practice leaders acknowledge radiologist burnout as a significant problem, only about one in five leaders responded that their practices were either extremely or very effective at addressing physician burnout. Moving forward, leaders will be increasingly held accountable and expected to describe to their teams their reasons for not addressing burnout. In this article, common misperceptions that may contribute to radiology practice leaders not addressing burnout are described, followed by outlining practical skills that leaders should develop to effectively address burnout.

Feasibility, Acceptability, and Preliminary Effectiveness of a Compassion-Centered Team Intervention to Improve Clinical Research Coordinator Resilience and Well-Being

PURPOSE

Oncology clinical research coordinators (CRCs) and team-based coordinator care are critical for the success of clinical trials. However, CRCs typically report elevated anxiety and burnout and many oncology centers have high levels of coordinator attrition. To address the need for a team-based intervention to reduce burnout and promote resilience and cohesion among CRCs, we developed a compassion-centered, team-based intervention, Compassion-Centered Spiritual Health Team Intervention (CCSH-TI).

METHODS

Participants were CRCs working in disease-specific teams within a comprehensive cancer center. CRCs were randomly assigned by team to either participate in four 60-minute sessions of CCSH-TI or receive the intervention after the study. To evaluate whether CCSH-TI is feasible and acceptable, we used a mixed-method approach including self-report questionnaires and a focus group. To evaluate the impact of CCSH-TI, we assessed self-reported resilience, well-being, burnout, and team civility before and immediately after the intervention period (ClinicalTrials.gov identifier: NCT04060901).

RESULTS

Attendance varied by team, but all teams had rates more than 60%. Coordinators rated high levels of credibility of CCSH-TI to improve burnout, and the majority reported that they received benefits, particularly in resilience and stress management, indicating acceptability. Coordinators randomly assigned to CCSH-TI reported an increase in resilience compared with coordinators randomly assigned to the wait-list group (F(41) = 4.53, P = .039).

CONCLUSION

Data from this pilot study indicate that CCSH-TI may be a feasible, credible, acceptable, and effective intervention to augment individual resilience among CRCs. However, the quantitative and qualitative data suggest that more comprehensive and systematic programming is necessary to truly mitigate burnout.

Mediating Effect of Burnout on the Association between Work-Related Quality of Life and Mental Health Symptoms

The purpose of this study was: (1) to assess levels of burnout, work-related quality of life (WRQoL) and mental health symptoms among a sample of active workers living in Portugal; (2) to analyze differences in burnout, WRQoL and mental health symptoms by gender and shift work; (3) to analyze association levels among all variables under study; (4) to determine the predictive effect of burnout and WRQoL on mental health symptoms; and (5) to assess the mediating effect of burnout on the association between WRQoL and mental health symptoms. Eight-hundred and forty-one Portuguese active workers between 18 and 67 years of age participated in this study (Mean = 37.23; SD = 11.99). Results showed that women participants scored higher in burnout and mental health symptoms, and lower in overall WRQoL, than men; additionally, participants who worked in shifts presented higher mental health symptoms. Significant correlations were found for all variables and regression analysis demonstrated that 56% of the overall variance of mental health symptoms was explained by older age, shift work, lower WRQoL, and burnout (exhaustion and cognitive impairment). Finally, the mediation effect of burnout on the association between WRQoL and mental health symptoms was statistically significant. These findings are useful for health professionals and health managers who work in the field of occupational health in identifying variables affecting burnout, WRQoL and mental health symptoms.

A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself

Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

COVID-19 illness in relation to sleep and burnout

Background

Sleep habits and burnout have been shown to be associated with increase in infectious diseases, but it is unknown if these factors are associated with risk of COVID-19. We assessed whether sleep and self-reported burnout may be risk factors for COVID-19 among high-risk healthcare workers (HCWs).

Methods

From 17 July to 25 September 2020, a web-based survey was administered to HCWs in six countries (France, Germany, Italy, Spain, UK, USA) with a high frequency of workplace exposure. Participants provided information on demographics, sleep (number of sleep hours at night, daytime napping hours, sleep problems), burnout from work and COVID-19 exposures. We used multivariable linear and logistic regression models to evaluate the associations between sleep, burnout and COVID-19.

Results

Among 2884 exposed HCWs, there were 568 COVID-19 cases and 2316 controls. After adjusting for confounders, 1-hour longer sleep duration at night was associated with 12% lower odds of COVID-19 (p=0.003). Daytime napping hours was associated with 6% higher odds, but the association varied by countries, with a non-significant inverse association in Spain. Compared with having no sleep problems, having three sleep problems was associated with 88% greater odds of COVID-19. Reporting burnout 'every day' was associated with greater odds of COVID-19 (OR: 2.60, 95% CI 1.57 to 4.31, p trend across categories=0.001), longer duration (OR: 2.98, 95% CI 1.10 to 8.05, p trend=0.02) and severity (OR: 3.26, 95% CI 1.25 to 8.48, p trend=0.02) compared with reporting no burnout. These associations remained significant after adjusting for frequency of COVID-19 exposures.

Conclusions

In six countries, longer sleep duration was associated with lower odds of COVID-19, but the association with daytime nap may not be consistent across countries. Greater sleep problems and high level of burnout were robustly associated with greater odds of COVID-19. Sleep and burnout may be risk factors for COVID-19 in high-risk HCWs.

Etiology of Burnout in Canadian Radiologists and Trainees

PURPOSE

There is worsening of burnout symptoms experienced by radiologists and trainees. We explored potential factors that exacerbate burnout symptoms observed in the Canadian radiological community and currently available protective factors as next steps for establishing viable solutions for burnout.

METHODS

An 11-question electronic survey was distributed to Canadian radiologists and trainees through the Canadian Association of Radiologists (CAR). Approval from a local ethics board and the CAR were obtained. The survey contained demographics-related questions as well as questions based on common risk factors for burnout. Qualitative and quantitative analyses were performed.

RESULTS

The survey was distributed to 2200 CAR members, and a response rate of 23.3% was achieved. Most radiologists experienced frequent unexpected high workload with no statistically significant difference by the type of practice. Trainees experienced a statistically significantly (P < .0001) higher frequency of on-call shifts compared to staff radiologists. A statistically significant difference (P < .0001) was observed for perceived threats to career longevity dependent on length of career. Although support mechanisms for radiology were perceived as available, survey commentary suggested inefficiency in their usage and lack of prioritization, which was a trend observed across all types of practice.

CONCLUSIONS

While there is awareness for radiology needs, changes are required at the workplace level to reduce burnout symptoms at their source. Communication between radiologists and hospital administration, as well as among radiology group members, is key to prioritize radiology needs in our imaging-driven era of health care.

Prospective association between burnout and road traffic accidents in teachers

We investigated whether burnout (emotional exhaustion, depersonalization and reduced professional efficacy) is a risk factor for traffic accidents. A prospective cohort study was conducted with 509 school teachers. The teachers were interviewed in 2012-2013, and the Maslach Burnout Inventory was applied. After 2 years, the teachers were interviewed again to determine the occurrence of traffic accidents. Poisson regression models with robust variance were used to adjust the analyses. Relative risks (RRs) and 95% confidence intervals (95%CIs) were calculated to assess changes in c-units in the scores of each Burnout dimension, with c equal to 1, 5 and 10 units. The incidence rate of road traffic accidents at follow-up was 10.8%. After adjustments for sex, age, high workload/exposure to the traffic environment, daily consumption of alcoholic beverages and the other dimensions of burnout, depersonalization was a risk factor for traffic accidents. For each 1- and 10-point increase in the depersonalization score, the risk increased by 8 and 119%, respectively. Emotional exhaustion was not associated with these accidents. Increases in the professional efficacy score increased the risk of traffic accidents. The association of depersonalization with future road traffic accidents reinforces the need for measures to improve teachers' work conditions to reduce burnout.

Relationship between job burnout and somatic diseases: a network analysis

Job burnout, characterized by feelings of exhaustion, cynicism and reduced personal efficacy, has been defined as a risk state for the development of diseases, but its association with somatic diseases is underexplored. Study participants were 5671 respondents (mean age 44.1 years, range 18–70; 38.6% men) to an online survey of job burnout, using a mobile health web application. Respondents provided data on sociodemographic characteristics, symptoms of burnout, measured with the Maslach Burnout Inventory-General Survey, depressive symptoms, measured with the Profile of Mood States, and 11 categories of somatic diseases. Adjusting for age, sex, educational level, depressive symptoms, and all disease categories included, network analysis showed a significant association of high exhaustion with “high blood pressure” and a category of “other chronic somatic diseases”. Low personal efficacy showed a significant association with “chronic lung diseases”. In network analysis, clinically relevant depressive symptoms were also significantly associated with “high blood pressure”, “other chronic somatic diseases” and “skin diseases”. Logistic regression analysis confirmed these associations. Burnout dimensions were significantly associated with an increased risk for somatic diseases, independently of sociodemographic factors and clinically relevant depressive symptoms. This relationship seems particularly evident for the exhaustion dimension of job burnout.

Testing the Intermediary Role of Perceived Stress in the Relationship between Mindfulness and Burnout Subtypes in a Large Sample of Spanish University Students

The burnout syndrome is the consequence of chronic stress that overwhelms an individual’s resources to cope with occupational or academic demands. Frenetic, under-challenged, and worn-out are different burnout subtypes. Mindfulness has been recognized to reduce stress, comprising five facets (observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience). This cross-sectional study aimed to assess the relationship between mindfulness facets, perceived stress, and burnout subtypes in a sample of 1233 students of Education, Nursing, and Psychology degrees from different universities of Valencia (Spain). Structural Equation Modelling (SEM) was computed showing an adequate fit (Chi-square, CFI, TLI, RMSEA, and SRMR). Four mindfulness facets (all but observing) significantly correlated with general second-order mindfulness. Unexpected results were found: Acting with awareness facet was positively associated with frenetic subtype, while the non-reacting facet was positively associated with frenetic and under-challenged subtype. Ultimately, mindfulness facets negatively predicted the perceived stress levels, which in turn, predicted burnout. However, mindfulness plays different roles in the early stages of burnout syndrome (i.e., frenetic and under-challenged).

Job Demands-Resources theory and self-regulation: new explanations and remedies for job burnout

Background: High job demands and low job resources may cause job strain and eventually result in burnout. However, previous research has generally ignored the roles of time and self-regulation. Objectives: This theoretical article synthesizes the literature to propose a multilevel model that delineates how acute job strain translates into enduring and severe job burnout. Methods: We integrate self-regulation perspectives in job demands-resources (JD-R) theory to propose that short-term job strain and eventually enduring burnout is the result of consistently high job demands and low job resources - combined with failed self-regulation. Results: The model shows that when employees are confronted with increased job strain, they are more likely to use maladaptive self-regulation strategies, such as coping inflexibility and self-undermining. In addition, when job strain increases, employees are less likely to use adaptive self-regulation strategies, such as job stress recovery and job crafting. It follows that when the job becomes more stressful, stable resources become more important. Organizational resources such as human resource practices and healthy leadership may help employees to regulate their short-term fatigue and avoid enduring burnout. Furthermore, key personal resources like emotional intelligence and proactive personality may help employees to recognize and regulate their fatigue in an effective way. Conclusion: The proposed model of burnout expands JD-R theory and offers important practical implications for the prevention and reduction of burnout.

The Effect of Inquiry-Based Stress Reduction on Teacher Burnout: A Controlled Trial

Burnout is a well-known phenomenon with significant social, biological and economic costs. In particular, teacher burnout is associated with unfavorable mental health outcomes and economic costs due to reduced hours and teacher turnover. This study investigated the effect of an Inquiry-Based Stress Reduction (IBSR) cognitive-reframing program on teacher burnout using a quasi-experimental design. Fifty-three teachers participated in a prospective intervention with a passive control group. The intervention group completed a 12-week IBSR program with 4.5 h of weekly engagement. Relative to control, teachers in the intervention group showed greater improvements in emotional exhaustion (18.8 ± 5.2 to 15.9 ± 5.7 vs. 16.0 ± 4.8 to 17.4 ± 4.8; p = 0.01) and personal accomplishment (21.8 ± 5.0 to 24.6 ± 4.3 vs. 21.9 ± 4.5 to 22.8 ± 4.3; p = 0.04). Significant correlations were found between change in emotional exhaustion and negative affect (positive correlation; r = 0.32; p = 0.034) and between personal accomplishment and perceived stress (negative correlation; r = −0.451; p = 0.002). This study demonstrates the potential of IBSR to improve teacher well-being. Future randomized studies are needed to evaluate the causality of IBSR in reducing burnout among teachers and other high-stress workplaces.

Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions

Burnout in healthcare workers (HCWs) is costly, consequential, and alarmingly high. Many HCWs report not having enough time or opportunities to engage in self-care. Brief, engaging, evidence-based tools have unique potential to alleviate burnout and improve well-being. Three prospective cohort studies tested the efficacy of web-based interventions: Three Good Things (n = 275), Gratitude Letter (n = 123), and the Looking Forward Tool (n = 123). Metrics were emotional exhaustion, depression, subjective happiness, work-life balance, emotional thriving, and emotional recovery. Across all studies, participants reported improvements in all metrics between baseline and post assessments, with two exceptions in study 1 (emotional thriving and happiness at 6 and 12-month post) and study 3 (optimism and emotional thriving at day 7). The Three Good Things, Gratitude Letter, and Looking Forward tools appear promising interventions for the issue of HCW burnout.

Burnout Phenomenon and Its Predictors in Radiology Residents

RATIONALE AND OBJECTIVES

The purpose of this study is to evaluate the prevalence of burnout and its associated risk factors in radiology residents in Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study was conducted in February 2019, and all radiology residents in Riyadh, Saudi Arabia, were invited to complete a survey that contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey) alongside possible predictors of burnout.

RESULTS

A total of 108 responses were received, for a response rate of 49.7%. High overall burnout was reported by 24.1% of respondents, high emotional exhaustion (EE) by 56.5%, high depersonalization by 31.5%, and low sense of personal accomplishment (PA) by 64.8%. The significant predictors of burnout included satisfaction with work/life balance (OR = 0.35, 95% CI = 0.03 to 0.43, p = 0.002) and exercising (OR = 0.31, 95% CI = 0.1 to 1, p = 0.07). Married residents were more prone to have a low sense of PA in addition to dissatisfied residents with hospital staff appreciation (OR = 4.8, 95% CI = 1.48 to 15.5, p = 0.01) and (OR = 0.59, 95% CI = 0.37 to 0.94, p = 0.03), respectively.

CONCLUSION

One-fourth of the radiology residents studied showed high rates of burnout, and more than half the residents reported high rates of EE. The residents scored very poorly in the sense of PA. The radiology residents who were satisfied with their work/life balance had lower burnout rates, in addition to lower EE and a higher sense of PA.

Burnout, but not job strain, is associated with irritable bowel syndrome in working adults

OBJECTIVE

Although stress is an important component of irritable bowel syndrome (IBS) pathophysiology, the possibility that work-related stress is implicated in the pathophysiology of IBS has not been widely studied. This study aimed to examine whether job strain (a combination of high job demands and low control at work) and/or burnout, the outcome of a gradual depletion of energetic resources resulting from chronic exposure to work-related stress, are associated with IBS.

METHODS

Fifty-five patients fulfilling the Rome III criteria for IBS and 214 matched healthy controls (HC) participated in this cross-sectional study. All participants completed a job strain measure, the Shirom - Melamed Burnout Measure (SMBM), and dietary and health questionnaires.

RESULTS

There was no significant difference in the prevalence of job strain between IBS patients and HC (25.5% vs. 23.0%, respectively). Job strain was not associated with increased IBS prevalence (adjusted OR = 1.99, 95% CI: 0.54-7.33). In contrast, the mean burnout score in the IBS group was significantly higher than in HC (2.9 ± 1.1 vs. 2.1 ± 0.8, p < .001). Burnout was associated with a 2.41-fold elevated prevalence of IBS (95% CI: 1.16-5.02), after adjusting for potential confounding variables including job strain. Moreover, the odds of having IBS increased in patients with a high burnout level (adjusted OR = 3.3, 95% CI:1.09-10.03).

CONCLUSION

Burnout, but not job strain, is associated with the prevalence of IBS in working adults.