Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians

Mental health status in healthcare workers during COVID-19 pandemic: An online questionnaire study in the southwest Iran

OBJECTIVES

This study aimed to evaluate Mental Health Status, such as stress, anxiety, or depression symptoms, during the Covid-19 pandemic in healthcare workers at Ahvaz Jundishapur University of Medical Sciences.

METHODS

This study is an online cross-sectional study conducted on healthcare professionals at Ahvaz Jundishapur University of Medical Science from November 25, 2020, to March 30 2021. PHQ9 and Kessler collected outcome variables of depression, anxiety, and psychological distress questionnaires.

RESULTS

In total, 2552 healthcare workers in 24 hospitals and 212 Comprehensive health centers were enrolled in this study. The mean age of participants was 37.94 ± 8.07 years, and 25.3% were male. There was a significant difference between the mean Kessler and PHQ9 Scale scores on males and females (P< 0.001). Also, the results showed a significant difference between depression, anxiety, and stress and working in the intensive care unit. According to the result of the Kessler scale, 27% of participants had moderate to severe. Most respondents (65.5%) in all professions had moderate to severe mental distress scores according to the Kessler scale. The logistic regression model results illustrated the relationship between depression and anxiety with gender, workplace, support from families, and collogue job satisfaction, and feeling the stress of media coverage of COVID-19 were statistically significant (P< 0.05).

CONCLUSIONS

The present study revealed that medical and health workers suffer from mental health problems. In this study, up to one-fifth of medical staff had stress, anxiety, or depression symptoms, and more than half had psychological distress. Low educational level, lack of family support, lack of colleague's support, and being a female were the significant risk factors for stress, anxiety, and psychological distress in medical staff.

COVID-19 psychological impact in general practitioners: A longitudinal study

INTRODUCTION

COVID-19 may have negatively impacted the mental health of front-line healthcare workers, including general practitioners (GPs). This study sought to assess the psychological impact (stress, burnout and self-efficacy) of the COVID-19 outbreak in French GPs.

METHODS

We carried out a postal-based survey of all GPs who worked in the French region of Normandy (departments of Calvados, Manche and Orne) from the exhaustive database of the Union Régionale des Médecins libéraux (URML Normandie) as of 15th April 2020 (one month after the first French COVID-19 sanitary lockdown). The second survey was conducted four months later. Four validated self-report questionnaires were used at both inclusion and follow-up: Perceived Stress scale (PSS), Impact of Event Scale-revised (IES-R), Maslach Burnout Inventory (MBI) and General Self-Efficacy scale (GSE). Demographic data were also collected.

RESULTS

The sample consists of 351 GPs. At the follow-up, 182 answered the questionnaires (response rate: 51.8%). The mean scores of MBI significantly increased during follow-up [Emotional exhaustion (EE) and Personal accomplishment, P<0.01]. Higher burnout symptoms were found at the 4-month follow-up in 64 (35.7%) and 86 (48.0%) participants (43 and 70 participant at baseline), according respectively to EE and depersonalisation scores (P=0.01 and 0.09, respectively).

CONCLUSION

This is the first longitudinal study that has shown the psychological impact of COVID-19 in French GPs. Based on validated a self-report questionnaire, burnout symptoms increased during follow-up. It is necessary to continue monitoring psychological difficulties of healthcare workers especially during consecutive waves of COVID-19 outbreak.

Burnout and Disengagement at Work Among Health Professionals-Interrelations and Associations With Stress Indicators and Job Resources

OBJECTIVE

The aim of the study is to explore common risk and protective factors of burnout and disengagement at work among healthcare workers.

METHODS

Cross-sectional survey data of 1232 health professionals and employees of five public hospitals and rehabilitation clinics collected in 2015/16 in German-speaking Switzerland were used and analyzed. Different stress measures and job resources were studied as predictors of burnout and work engagement.

RESULTS

Burnout was found to be largely explained by work stress (β = 0.22) and particularly by general stress (β = 0.54) whereas work engagement was only marginally determined by these stress indicators. Job autonomy or supervisor support on the other hand had no protective effect on burnout at all but a fairly strong predictive effect on work engagement (β = 0.27/0.23).

CONCLUSION

Burnout turned out to be mainly stress-induced whereas work engagement emerged largely as a result of job autonomy and supervisor support.

Prevalence and Risk Factors of Burnout Syndrome during COVID-19 Pandemic among Healthcare Providers in Thailand

Objective

To study prevalence, risk factors, and consequences of the COVID-19 pandemic related to Burnout syndrome (BOS) among Thai healthcare providers (HCPs) during the COVID-19 pandemic.

Methods

We performed a cross-sectional study among HCPs, involved in caring for patients during the pandemic in two periods (1st period, May-Jun 2021, and 2nd period, Sep-Oct 2021). Data were distributed using electronic questionnaires. BOS was defined if respondents exhibited a high level of at least one domain in the Maslach Burnout Inventory criteria. The primary outcome was prevalence of BOS.

Results

Altogether, 2,027 and 1,146 respondents were enrolled in the 1st and 2nd periods, respectively. Most respondents were female (73.3, 68.2%). The top three job positions were physicians (49.2, 58.9%), nurses (41.2, 30.6%), and nursing assistants (4.8, 6.5%), respectively. No difference was found in overall prevalence of Burnout syndrome during the 1st and 2nd periods (73 vs. 73.5%, p=0.80). Using multivariate analysis, significant risk factors for Burnout syndrome in both periods were (1) living with family (odds ratio (OR) 1.3 and 1.5), (2) tertiary care hospital (OR 1.92 and 2.13), (3) nurse (OR 1.38 and 2.29), (4) nursing assistant (OR 0.92 and 4.81), (5) salary ≤40,000 THB (OR 1.53 and 1.53), (6) >20 patients per shift (OR 1.55 and 1.88), (7) >6 shifts after hours monthly (OR 1.26 and 1.49), and (8) ≤1 rest day weekly (OR 1.3 and 1.4).

Conclusion

We found a high prevalence of Burnout syndrome among Thai HCPs during the pandemic. Knowing those risk factors may provide a strategy to BOS during the pandemic.

Explaining and addressing the limitations in usefulness of available estimated prevalence figures relating to burnout in family doctors: Evidence from a systematic scoping literature review

Burnout in family doctors (FDs) affects their well-being, patient care, and healthcare organizations, and is considered common worldwide. However, its measurement has been so inconsistent that whether the widely divergent prevalence figures can be meaningfully interpreted has been questioned. Our aim was to go further than previous systematic reviews to explore the meaning contribution and usefulness of FD-burnout prevalence estimates. Worldwide literature was systematically reviewed using Levac's scoping framework, with 249 papers undergoing full-text review. Of 176 studies measuring burnout, 78% used the Maslach Burnout Inventory (MBI), which measures burnout as now defined by the World Health Organization. We, therefore, concentrated on the MBI. Its burnout measurement was markedly inconsistent, with prevalence estimates ranging from 2.8% to 85.7%. Researchers made prevalence claims relating to burnout severity and implied diagnoses based on participants' MBI scores, even though the MBI has not been validated as a clinical or diagnostic tool. Except when comparisons were possible between certain studies, prevalence figures provided limited meaning and added little to the understanding of burnout in FDs. Our review revealed a lack of research-supported meaningful information about the prevalence of FD burnout and that care is required to avoid drawing unsubstantiated conclusions from prevalence results. This paper's overall purpose is to propose how obtaining meaningful prevalence estimates can begin, which are recognized as key to developing improved prevention policies and interventions. Researchers must adopt a consistent means to measure burnout, use the MBI as its authors intended, and explore making progress through quantitative and qualitative collaboration.

The Mental Health of Health Care Workers in the UK During COVID-19: The Prevalence of Anxiety, Depression, and Stress

Introduction

The COVID-19 pandemic had a significant impact on the mental health of health care workers (HCWs).

Aim

This study investigated the mental health of HCWs working in Leicester, UK during COVID-19.

Settings

Two hospital trusts in Leicester, UK.

Methods

An online survey was sent to HCWs in two trusts in July 2020. The Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 scale (PHQ-9) were used to measure the prevalence rates of anxiety and depression. The Perceived Stress Scale-14 (PSS-14) was used to measure levels of perceived stress. Other questions were used to identify the prevalence of increased alcohol intake and possible risk factors.

Statistical Analysis Used

Chi-square test, independent sample t-test, ANOVA, and logistic regression.

Results

A total of 1009 HCWs completed the survey. Using a cutoff score of 5 (mild symptoms), for both GAD-7 and PHQ-9, 80.2% of participants had at least one condition and 71.5% had both. Using the cutoff score of 10 (moderate/severe symptoms), 27.2% had at least one condition and 27.25% had both conditions. In addition, 37.5% of those who did not report pre-existing mental health conditions now have at least one condition. About 33.6% of participants reported an increase in alcohol consumption. A number of risk factors were identified: having less social support, not feeling supported at work, and poor pre-existing mental health.

Conclusions

The pandemic had a significant impact on mental health of HCWs. Health organizations need to monitor and address these emerging effects.

The global prevalence of burnout among general practitioners: a systematic review and meta-analysis

BACKGROUND

Burnout among general practitioners (GPs) has attracted the attention of more and more researchers. An adequate understanding the prevalence and related factors of burnout to prevent and reduce burnout is necessary. This study systematically measured the global prevalence of burnout among GPs.

METHODS

Eligible original studies were identified from the PubMed, Ovid Embase, Ovid Medline (R), and Web of science databases. We searched the full-time period available for each database, up to 30 September 2021. The adjusted prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study-level characteristics were estimated via subgroup analyses and meta-regression.

RESULTS

A total of 16 cross-sectional studies with 7,595 participants were included. The pooled burnout rate showed 37%, 28%, and 26% of general GPs suffer from high emotional exhaustion (EE), high depersonalization (DP), and low personal exhaustion (PA), respectively. Groups comparisons found that high EE, high DP, and low PA rate data obtained from 2001 to 2009, high DP rate data obtained from Europe, low PA rate data obtained from high-quality studies had much higher rates.

CONCLUSIONS

This study demonstrated the prevalence of burnout in the GPs and alert health managers to tailor their strategies to retain this community. Targeted initiatives are needed to provide adequate GPs' well-being and maintain primary health care.

Análise da produção científica sobre a síndrome de burnout em médicos da atenção primária

Introdução: A síndrome de burnout é um transtorno adaptativo ao estresse crônico no ambiente laboral, com consequências tanto na saúde e na qualidade de vida do profissional quanto em sua organização e desempenho no trabalho. Médicos de todas as especialidades estão vulneráveis ao desenvolvimento da síndrome de burnout. Aqueles que atuam na atenção primária à saúde – generalistas e médicos de família e comunidade – parecem apresentar maior risco, visto que estão expostos a diversos estressores no trabalho. As pesquisas sobre a síndrome de burnout em médicos da atenção primária à saúde vêm ganhando destaque nos últimos 20 anos, e a escassez de estudos no Brasil dificulta a caracterização do real impacto dessa síndrome nesses profissionais. Objetivo: Revisar a literatura na busca por publicações relacionadas à síndrome de burnout em médicos da atenção primária à saúde e analisá-las, sistematizando as áreas de interesse. Métodos: Revisão narrativa da literatura sobre a síndrome de burnout em médicos da atenção primária à saúde, por meio de busca sistematizada nas bases eletrônicas PubMed e Scientific Electronic Library Online (SciELO), utilizando os seguintes descritores: "burnout, professional", "physicians, primary care" e "physicians, family". A busca foi realizada em outubro de 2018 e possibilitou a identificação de 192 publicações, das quais 55 foram incluídas na análise e categorizadas quanto a ano de publicação, país de origem, desenho do estudo e áreas de interesse. Resultados: A maior parte dos estudos era do tipo observacional descritivo transversal, metodologia utilizada em 40 trabalhos. Também foram identificadas duas revisões sistemáticas de estudos observacionais, dois estudos descritivos qualitativos, dois estudos longitudinais de coorte, dois ensaios clínicos randomizados, dois artigos de opinião, dois editoriais, um ensaio temporal, uma série temporal e um estudo de caso. Identificamos uma variedade de temas investigados sobre a síndrome de burnout em médicos da atenção primária à saúde, mas são frequentes estudos observacionais que descrevem a prevalência da síndrome nesses profissionais e as diversas variáveis de associação. As mais frequentemente estudadas são as sociodemográficas e as relacionadas ao ambiente laboral ou ao profissional. Percebe-se escassez de estudos que levantem dados epidemiológicos em médicos da atenção primária à saúde no Brasil, passo importante para o conhecimento de como essa síndrome se comporta em nosso meio. Conclusões: Fazem-se necessárias pesquisas de prevalência e sobre o impacto da síndrome de burnout nos médicos da atenção primária à saúde, que investiguem principalmente fatores relacionados ao ambiente e ao processo laboral. Ensaios clínicos podem prover evidências no combate eficaz ao burnout. Estudos qualitativos podem levantar dados sobre as motivações dos profissionais, além de comportamentos, opiniões e expectativas, direcionando estratégias para o enfrentamento dessa síndrome.

Curvilinear relationship between burnout and work engagement among staff in community services for the elderly: A correlation study

Objective

To investigate whether there is a curvilinear relationship between burnout and work engagement among staff in Chinese community services for the elderly.

Methods

A stratified whole-group random sampling method was used to survey 244 staff members from eight communities in two cities. Data were collected using the Maslach Burnout Inventory scale (MBI) and the Utrecht Work Engagement Scale- 9 (UWES- 9). The curve estimation method explored the functional model of burnout and work engagement scales.

Results

Two hundred forty-four staff members completed the survey. Burnout, depersonalization (DP), and personal accomplishment (PA) were found to be related to work engagement in a cubic function (R² = 0.166, P < 0.05), (R² = 0.061, P < 0.05), and (R² = 0.2230, P < 0.05), respectively. There was no statistically significant relationship between emotional exhaustion (EE) and work engagement (P > 0.05). “Personal Accomplishment” is related to work engagement in a U-shaped curve.

Conclusions

There was a cubic function relationship between burnout and work engagement, where “personal accomplishment” was related to work engagement in a U-shaped curve. Therefore, the government and related service organizations should understand the impact of different levels of burnout on work engagement and take targeted measures to alleviate burnout and improve work engagement by targeting emotions and stroke.

Understanding COVID-19 Halal Vaccination Discourse on Facebook and Twitter Using Aspect-Based Sentiment Analysis and Text Emotion Analysis

The COVID-19 pandemic introduced unprecedented challenges for people and governments. Vaccines are an available solution to this pandemic. Recipients of the vaccines are of different ages, gender, and religion. Muslims follow specific Islamic guidelines that prohibit them from taking a vaccine with certain ingredients. This study aims at analyzing Facebook and Twitter data to understand the discourse related to halal vaccines using aspect-based sentiment analysis and text emotion analysis. We searched for the term "halal vaccine" and limited the timeline to the period between 1 January 2020, and 30 April 2021, and collected 6037 tweets and 3918 Facebook posts. We performed data preprocessing on tweets and Facebook posts and built the Latent Dirichlet Allocation (LDA) model to identify topics. Calculating the sentiment analysis for each topic was the next step. Finally, this study further investigates emotions in the data using the National Research Council of Canada Emotion Lexicon. Our analysis identified four topics in each of the Twitter dataset and Facebook dataset. Two topics of "COVID-19 vaccine" and "halal vaccine" are shared between the two datasets. The other two topics in tweets are "halal certificate" and "must halal", while "sinovac vaccine" and "ulema council" are two other topics in the Facebook dataset. The sentiment analysis shows that the sentiment toward halal vaccine is mostly neutral in Twitter data, whereas it is positive in Facebook data. The emotion analysis indicates that trust is the most present emotion among the top three emotions in both datasets, followed by anticipation and fear.

Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

The recent COVID-19 pandemic impacted healthcare professionals psychologically. They were unprepared to handle such a powerful and unknown virus. Consequently, they had to face situations of extreme distress, developing vicarious traumatization and post-traumatic stress disorder (PTSD). The first one is associated with the "cost of caring" for others and affected persons who constantly are exposed to other sufferings. PTSD is a psychiatric disorder that could affect people who have experienced or witnessed a traumatic event. Post-traumatic stress disorder (PTSD) and correlated symptoms might impact the lives of healthcare professionals at the personal, professional, and relational levels. Furthermore, the pandemic could decrease the empathy of healthcare professionals, influencing their relationship with patients. This review aimed to describe the incidence of PTSD among HPs during the COVID-19 pandemic. We focused on the following aspects: (a) PTSD symptoms and correlated psychological issues, (b) repercussions at working and personal levels, (c) change in empathetic involvement of healthcare professionals.

The psychological impact of COVID-19 among primary care physicians in the province of Verona, Italy: a cross-sectional study during the first pandemic wave

BACKGROUND

Among healthcare professionals working with COVID-19 patients, general practitioners (GPs) are under considerable pressure and may develop adverse mental health outcomes.

OBJECTIVES

To assess mental health outcomes on GPs working during the COVID-19 pandemic and to explore their associations with personal characteristics and features of GP practices.

METHODS

Observational cross-sectional study conducted on a sample of GPs working in Verona province (Italy) during the first pandemic wave. Participants were invited to complete a web-based form addressing socio-demographic and work-related information, previous practice organization, practice re-organization during the COVID-19 pandemic, and a set of measures for post-traumatic stress (IES-R), anxiety (SAS), depression (PHQ-9), and burnout (MBI-GS).

RESULTS

A total of 215 GPs (38.3% of the eligible population) participated. Overall, 44.7% reported COVID-19-related traumatic events; among these, 35.9% (95% CI, 26%‒46%) developed symptoms of post-traumatic distress. Furthermore, 36% (95% CI, 29%‒43%) reported symptoms of anxiety, 17.9% (95% CI, 12%‒23%) symptoms of at least moderate depression, and 25.4% (95% CI, 19%‒32%) symptoms of burnout. Multivariate regressions showed that being quarantined or admitted for COVID-19 was associated with all the mental health outcomes considered. Being female, working in rural settings, and having less professional experience were associated with higher anxiety and depression. The ability to diagnose COVID-19 increased self-perceived professional efficacy, thus contributing to burnout reduction.

CONCLUSION

The high prevalence of adverse mental health outcomes among GPs during the pandemic highlights the importance of timely interventions in this population and promoting targeted preventive actions in the event of future healthcare crises.

Relationship Between Mental Health and Death Anxiety During COVID-19 Pandemic in Dental Staff and Students: A Cross-Sectional Study

OBJECTIVE

We aimed to determine the mental health and death anxiety among dental staff and students in school of dentistry during COVID-19 pandemic.

METHODS

It was a cross-sectional study among students (n = 300) and staff (n = 60) in School of dentistry in Ahvaz University of Medical Sciences during 2020. The instruments were a demographic questionnaire, Death Anxiety Scale, and Kessler Questionnaire. Data was analyze by using SPSS version 22, in all tests, the significance level was set at <0.05.

RESULTS

The mean age of dental students and personnel was 23.96 and 40.08 years, respectively. The mean scores of death anxiety were higher in dental staff (8.53) than students (6.02) and the mean scores of mental health status were higher in students (14.78) than personnel (9.18). This indicates that death anxiety was higher in Dental staff, while students were in better mental health status. The correlation coefficient between death anxiety and mental health status was 0.366 among students (p < 0.001), while it was 0.429 among dental staff (p < 0.001), showing a medium relationship between death anxiety and mental health in both groups.

CONCLUSION

The overall findings represent a significant but contradictory relationship between mental health status and death anxiety among dental staff and students during the prevalence of COVID-19 pandemic. This suggests the impact of confounding factors in this area, which can be studied by future researchers and policy makers to design health promotion interventions.

Nurses' Physical and Psychological Symptoms During the first COVID-19 Lockdown in Italy: a Nationwide Cross-Sectional Study in Stem Cell Transplantation Setting

BACKGROUND AND OBJECTIVE

Northern Italy was one of the first European territories to deal with the Coronavirus Disease 2019 (COVID-19) outbreak. Drastic emergency restrictions were introduced to contain the spread and limit pressure on healthcare facilities. However, nurses were at high risk of developing physical, mental, and working issues due to professional exposure. The aim of this cross-sectional study was to investigate these issues among nurses working in Italian hematopoietic stem cell transplant (HSCT) centers during the COVID-19 pandemic.

METHODS

Data were collected online immediately after the first "lockdown" period in order to investigate the prevalence of physical issues, sleep disorders, and burnout symptoms and explore correlations with COVID-19 territorial incidence in Northern Italian regions versus Central and Southern Italian regions.

RESULTS

Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey. Depression, cough, and fever were more frequently reported by nurses working in geographical areas less affected by the pandemic (p=0.0013, p<0.0001, and p=0.0005 respectively) as well as worst sleep quality (p=0.008). Moderate levels of emotional exhaustion (mean±SD -17.4±13.0), depersonalization (5.3±6.1), and personal accomplishment (33.2±10.7) were reported without significant differences between territories.

CONCLUSIONS

different COVID-19 incidence among territories did not influence nurses' burden of symptoms in the HSCT setting. However, burnout and insomnia levels should be considered by health care facilities in order to improve preventive strategies.

Prevalence of Burnout among General Practitioners: A Systematic Review and Meta-Analysis

Background Burnout is a work-related syndrome documented to have negative consequences for general practitioners (GPs) and their patients. Our objective was to conduct a systematic review and meta-analysis of the literature to provide an estimate of how widespread this phenomenon is.

AIM

To review the existing literature concerning studies published up to December, 2020, on the prevalence of burnout amongst GPs in general practice, to determine GP burnout estimates worldwide.

DESIGN AND SETTING

Systematic literature search and meta-analysis.

METHOD

Searches of CINAHL Plus, Embase, MEDLINE, PsycINFO, and Scopus were conducted to identify published peer-reviewed quantitative empirical studies in English up to December, 2020, that have used the Maslach Burnout Inventory-Human Services Survey to establish the prevalence of burnout in practising GPs (i.e., excluding GPs in training). A random-effects model was employed.

RESULTS

Wide-ranging prevalence estimates (6% to 32%) for 22,177 GPs across 29 countries were reported for 60 studies included in this review. Mean burnout estimates were as follows: 16.43 (EE); 6.74 (DEP); and 29.28 (PA). Subgroup and meta-analyses documented that country-specific factors may be important determinants of the variation in GP burnout estimates. Moderate overall burnout cut-offs were found to be determinants of the variation in moderate overall burnout estimates.

CONCLUSION

Moderate to high GP burnout exist worldwide. However, substantial variations in how burnout is characterised and operationalised resulted in considerable heterogeneity in GP burnout prevalence estimates. This highlights the challenge of developing a uniform approach, and the importance of considering the GP's work context, to better characterise burnout.

Burnout in French General Practitioners: A Nationwide Prospective Study

Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap^®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences

Introduction:

Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. Objective: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy.

Methods:

A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors).

Results:

Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males.

Conclusions:

This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study’s cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

Burn-out of the Medical Oncology Health Care Professionals and Associated Factors in Tunisia

Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.

Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.

Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).

Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.

Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.

Burnout Status of Italian Healthcare Workers during the First COVID-19 Pandemic Peak Period

The pandemic of 2019 coronavirus disease (COVID-19) has burdened extraordinary psychological stress on the healthcare workforce. The present survey aimed to examine the personal resources and psychological symptoms associated with burnout in 933 healthcare workers in Italy during the COVID-19 outbreak period. Sociodemographic and occupational data, depression, anxiety, burnout, and post-traumatic symptoms, as well as psychological well-being, were cross-sectional assessed through an online questionnaire. A considerable part of the sample scored over the clinical levels of depression (57.9%), anxiety (65.2%), post-traumatic symptoms (55%), and burnout (25.61%). Working in the front-line (p < 0.05), being part of the medical staff (p < 0.05), experiencing lower levels of psychological well-being (p < 0.001), and higher levels of post-traumatic symptoms (p < 0.001) independently explained 38% of burnout variance. The healthcare industry, services, and professionals should be aware of the harmful effects of COVID-19 on healthcare workers and take adequate preventive measures.

Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study)

BACKGROUND

Burnout (BO) among oncology professionals (OP) is increasingly being recognized. Early recognition and intervention can positively affect the quality of care and patient safety. This study investigated the prevalence, work and lifestyle factors affecting BO among OPs in the Middle East and North Africa (MENA).

METHODS

An online survey was conducted among MENA OPs between 10 February and 15 March 2020, using the validated Maslach Burnout Inventory of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), including questions regarding demography/work-related factors and attitudes towards oncology. Data were analysed to measure BO prevalence and risk factors and explore a screening question for BO.

RESULTS

Of 1054 respondents, 1017 participants (64% medical oncologists, 77% aged less than 45 years, 55% female, 74% married, 67% with children and 40% practiced a hobby) were eligible. The BO prevalence was 68% with high levels of EE and DP (35% and 57% of participants, respectively) and low PA scores (49%). BO was significantly associated with age less than 44 years, administrative work greater than 25% per day and the thought of quitting oncology (TQ). Practising a hobby, enjoying oncology communication and appreciating oncology work-life balance were associated with a reduced BO score and prevalence. North African countries reported the highest BO prevalence. Lack of BO education/support was identified among 72% of participants and TQ-predicted burnout in 77%.

CONCLUSIONS

This is the largest BO study in MENA. The BO prevalence was high and several modifiable risk factors were identified, requiring urgent action. TQ is a simple and reliable screening tool for BO.

Caring Advanced Cancer Patients at Home During COVID-19 Outbreak: Burnout and Psychological Morbidity Among Palliative Care Professionals in Italy

CONTEXT

Providing palliative care (PC) at home for patients with advanced cancer has become essential during the COVID-19 emergency. Nevertheless, the home PC professionals (PCPs) faced a challenging situation because of increased number of discharged patients, reduced availability of health-care facilities, and physical/relational barriers between them and patients.

OBJECTIVES

This study aimed to investigate the impact of COVID-19 pandemic on burnout and psychological morbidity among home PCPs in Italy.

METHODS

One hundred and ninety-eight PC physicians and nurses working in home assistance in Italy were invited to participate. The results obtained by the investigation conducted during the COVID-19 emergency (COVID2020) were compared with data collected in 2016 in the same setting (BURNOUT2016). The questionnaires (socio-demographics, Maslach Burnout Inventory and General Health Questionnaire-12) were the same for both the surveys. The PCPs participating in COVID2020 survey (n = 145) were mostly the same (70%) who participated in the BURNOUT2016 study (n = 179).

RESULTS

One hundred and forty-five PCPs participated in the study (response rate 73.2%). During the COVID-19 emergency, home PCPs presented a lower burnout frequency (P < .001) and higher level of personal accomplishment than in 2016 (P = .047). Conversely, the risk for psychological morbidity was significantly higher during the pandemic (P < .001).

CONCLUSIONS

In the age of COVID-19, the awareness of being at the forefront of containing the pandemic along with the sense of responsibility toward their high-risk patients may arouse PCPs' psychological distress, but, on the other hand, this condition may improve their sense of professional satisfaction and personal accomplishment.

Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy

OBJECTIVE

To determine burn-out levels and associated factors among healthcare personnel working in a tertiary hospital of a highly burdened area of north-east Italy during the COVID-19 pandemic.

DESIGN

Observational study conducted from 21 April to 6 May 2020 using a web-based questionnaire.

SETTING

Research conducted in the Verona University Hospital (Veneto, Italy).

PARTICIPANTS

Out of 2195 eligible participants, 1961 healthcare workers with the full range of professional profiles (89.3%) completed the survey.

PRIMARY OUTCOME MEASURE

Levels of burn-out, assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). Multivariable logistic regression analysis was performed to identify factors associated with burn-out in each MBI-GS dimension (emotional exhaustion, EX; professional efficacy, EF; cynicism, CY).

RESULTS

Overall, 38.3% displayed high EX, 46.5% low EF and 26.5% high CY. Burn-out was frequent among staff working in intensive care units (EX 57.0%; EF 47.8%; CY 40.1%), and among residents (EX 34.9%; EF 63.9%; CY 33.4%) and nurses (EX 49.2%; EF 46.9%; CY 29.7%). Being a resident increased the risk of burn-out (by nearly 2.5 times) in all the three MBI subscales and being a nurse increased the risk of burn-out in the EX dimension in comparison to physicians. Healthcare staff directly engaged with patients with COVID-19 showed more EX and CY than those working in non-COVID wards. Finally, the risk of burn-out was higher in staff showing pre-existing psychological problems, in those having experienced a COVID-related traumatic event and in those having experienced interpersonal avoidance in the workplace and personal life.

CONCLUSIONS

Burn-out represents a great concern for healthcare staff working in a large tertiary hospital during the COVID-19 pandemic and its impact is more burdensome for front-line junior physicians. This study underlines the need to carefully address psychological well-being of healthcare workers to prevent the increase of burn-out in the event of a new COVID-19 healthcare emergency.

COVID-19 pandemic-related anxiety, distress and burnout: prevalence and associated factors in healthcare workers of North-West Italy

BACKGROUND

The COVID-19 pandemic caused drastic changes in healthcare and severe social restrictions. Healthcare workers (HCWs) are on the front line against the virus and have been highly exposed to pandemic-related stressors, but there are limited data on their psychological involvement for a large sample in Italy.

AIMS

To investigate the prevalence of anxiety, distress and burnout in HCWs of North-West Italy during the COVID-19 pandemic, and to detect potential psychosocial factors associated with their emotional response.

METHOD

This cross-sectional, survey-based study enrolled 797 HCWs. Participants completed the Impact of Event Scale - Revised, the State-Trait Anxiety Inventory - Form Y and the Maslach Burnout Inventory; demographic, family and work characteristics were also collected. Global psychological outcome, differences among professions and independent factors associated with worst psychological outcome were assessed.

RESULTS

Almost a third of the sample had severe state anxiety and distress, high emotional exhaustion and depersonalisation, and low personal accomplishment. Distress was higher in women and nurses, whereas depersonalisation was higher in men. Family division, increased workload, job changes and frequent contact with COVID-19 were associated with worst psychological outcome. Trait anxiety was associated with significantly higher risk for developing state anxiety, distress and burnout.

CONCLUSIONS

An elevated psychological burden related to the COVID-19 pandemic was observed in HCWs of North-West Italy. The identification of family and work characteristics and a psychological pre-existing condition as factors associated with worst psychological outcome may help provide a tailored, preventive, organisational and psychological approach in counteracting the psychological effects of future pandemics.

Current status of and factors influencing anxiety and depression in front-line medical staff supporting Wuhan in containing the novel coronavirus pneumonia epidemic

Aim

This research aimed to shed light on the relationship between the sociodemographic characteristics of front‐line medical workers and their anxiety and depression, to provide the basis and reference for targeted mental health education and for relevant departments to formulate appropriate policies during the COVID‐19 outbreak.

Methods

This study adopted a convenient sampling method and examined the psychological status of 150 front‐line medical workers from Zhejiang Province with questionnaire surveys using the Hamilton Anxiety and Depression Scale.

Results

The participants had severe anxiety and depression; the top three items under the category of anxiety were genitourinary symptoms, behavior at interview, and respiratory symptoms, whereas the top three items under depression were feelings of guilt, weight loss, and retardation. Among all personal data, the following factors influenced anxiety, in decreasing order: degree of suspicion of being infected when showing associated symptoms, degree of fear of yourself and your family being infected, and the affiliated hospital (p < .05). As for depression, the factors were the degree of suspicion of being infected when showing associated symptoms and the degree of fear of yourself and your family being infected (p < .05).

Conclusion

This study revealed that front‐line medical staff presented symptoms of anxiety and depression when dealing with the COVID‐19 outbreak and the factors influencing their psychological stress. Guiding policies and psychological interventions is crucial to maintaining their psychological well‐being. Different measures may be implemented to solve this problem.

Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak

BACKGROUND

The COVID-19 pandemic in Italy represents a unique threat in terms of psychological distress. This cross-sectional study aims to investigate the psychological health of Italian healthcare professionals during the COVID-19 outbreak. We assessed participants' current psychological distress and coping strategies in the midst of the COVID outbreak (March-April 2020), and also asked them to retrospectively report how they remember feeling before the COVID-19 outbreak (December 2019). We examined associations between psychological distress and coping strategies with mental health and infection perceptions.

METHODS

Self-administered questionnaires were distributed online to healthcare professionals (N = 580) residing in different Italian regions from 26 March to 9 April 2020. The questionnaire measured changes in psychological states, coping strategies, and demographic variables testing variations in mental health and infection risk perception among Italian healthcare workers.

RESULTS

Overall, approximately 33.5 per cent of healthcare professionals in our sample meet the threshold for psychiatric morbidity. Participants perceive their current psychological health to be worse during the COVID-19 emergency outbreak as compared to before the outbreak, and this was especially true among women.

CONCLUSIONS

Both immediate and long-term monitoring psychological assistance services for healthcare workers should be implemented by national institutions to re-establish the psychological well-being and enhance the self-confidence and resilience of hospital personnel.

Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak

Background

The COVID‐19 pandemic in Italy represents a unique threat in terms of psychological distress. This cross‐sectional study aims to investigate the psychological health of Italian healthcare professionals during the COVID‐19 outbreak. We assessed participants’ current psychological distress and coping strategies in the midst of the COVID outbreak (March–April 2020), and also asked them to retrospectively report how they remember feeling before the COVID‐19 outbreak (December 2019). We examined associations between psychological distress and coping strategies with mental health and infection perceptions.

Methods

Self‐administered questionnaires were distributed online to healthcare professionals (N = 580) residing in different Italian regions from 26 March to 9 April 2020. The questionnaire measured changes in psychological states, coping strategies, and demographic variables testing variations in mental health and infection risk perception among Italian healthcare workers.

Results

Overall, approximately 33.5 per cent of healthcare professionals in our sample meet the threshold for psychiatric morbidity. Participants perceive their current psychological health to be worse during the COVID‐19 emergency outbreak as compared to before the outbreak, and this was especially true among women.

Conclusions

Both immediate and long‐term monitoring psychological assistance services for healthcare workers should be implemented by national institutions to re‐establish the psychological well‐being and enhance the self‐confidence and resilience of hospital personnel.

The Psychological and Social Impact of Covid-19: New Perspectives of Well-Being

The recent Covid-19 pandemic has had significant psychological and social effects on the population. Research has highlighted the impact on psychological well-being of the most exposed groups, including children, college students, and health workers, who are more likely to develop post-traumatic stress disorder, anxiety, depression, and other symptoms of distress. The social distance and the security measures have affected the relationship among people and their perception of empathy toward others. From this perspective, telepsychology and technological devices assume important roles to decrease the negative effects of the pandemic. These tools present benefits that could improve psychological treatment of patients online, such as the possibility to meet from home or from the workplace, saving money and time and maintaining the relationship between therapists and patients. The aim of this paper is to show empirical data from recent studies on the effect of the pandemic and reflect on possible interventions based on technological tools.

From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency

During the COronaVIrus Disease 2019 (COVID-19) pandemic in Italy, general practitioners (GPs) are ensuring continued access to primary care for citizens while also absorbing more of the impact of the crisis than most professional groups. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian GPs during the COVID-19 emergency. A group of 102 GPs completed self-administered questionnaires available online through Google Forms, including Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and Coping Inventory for Stressful Situations (CISS). Cluster analysis highlighted four distinct burnout risk profiles: Low Burnout, Medium Risk, High Risk, and High Burnout. The High Burnout group showed both lower Resilience and lower CISS Task-oriented coping strategy than the Medium Risk group and higher IU Prospective than the Low Burnout group. Results of a linear regression analysis confirmed that CISS Emotion-oriented style positively predicted MBI Emotional Exhaustion, CISS Task-oriented and Emotion-oriented emerged as significant predictors (negatively and positively, respectively) of MBI Depersonalization, and Resilience positively predicted MBI Personal Accomplishment. In conclusion, the results showed that the COVID-19 emergency had a significant impact on GPs’ work management. Implementing task-oriented problem management, rather than emotional strategies, appears to protect against burnout in these circumstances. It is possible that the emotions related to the pandemic are too intense to be regulated and used productively to manage the professional issues that the COVID-19 pandemic presents.

COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers

BACKGROUND

The outbreak of COVID-19 has laid unprecedented threats and challenges to health workers (HWs) in Wuhan, China. We aimed to assess the sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on HWs at Tongji Hospital in Wuhan during COVID-19 outbreak.

METHODS

We conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by IES-R, PHQ-9, and GAD-7, respectively. We also designed a questionnaire to assess the perceptions of threat of COVID-19, and the satisfactions of the hospital's support measures. Multivariate logistic regressions were used to identify associated variables of acute stress, depression, and anxiety.

FINDINGS

We received 5062 completed questionnaires (response rate, 77.1%). 29.8%, 13.5% and 24.1% HWs reported stress, depression and anxiety symptoms. Women (odds ratio [OR], 1.31; 95% CI, 0.47-0.97; p = 0.032), years of working >10 years (OR, 2.02; 95% CI, 1.47-2.79; p<0.001), concomitant chronic diseases (OR, 1.51; 95% CI, 1.27-1.80; p<0.001), history of mental disorders (OR, 3.27; 95% CI, 1.77-6.05; p<0.001), family members or relatives confirmed or suspected (OR, 1.23; 95% CI, 1.02-1.48; p = 0.03), hospital-based and department-based care (OR, 0.76; 95% CI, 0.60-0.97; p = 0.024) and full coverage of all departments for avoiding nosocomial infection (OR, 0.69; 95% CI, 0.53-0.89; p = 0.004) were associated with stress.

INTERPRETATION

Women and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the pandemic. In addition, since HWs often have a greater stigma against mental problems than the general public, it is worthwhile to address the needs of the HWs during this pandemic and to provide appropriate psychological supports for those people at high risk of mental problems.

COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers

BACKGROUND

The outbreak of COVID-19 has laid unprecedented threats and challenges to health workers (HWs) in Wuhan, China. We aimed to assess the sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on HWs at Tongji Hospital in Wuhan during COVID-19 outbreak.

METHODS

We conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by IES-R, PHQ-9, and GAD-7, respectively. We also designed a questionnaire to assess the perceptions of threat of COVID-19, and the satisfactions of the hospital's support measures. Multivariate logistic regressions were used to identify associated variables of acute stress, depression, and anxiety.

FINDINGS

We received 5062 completed questionnaires (response rate, 77.1%). 29.8%, 13.5% and 24.1% HWs reported stress, depression and anxiety symptoms. Women (odds ratio [OR], 1.31; 95% CI, 0.47-0.97; p = 0.032), years of working >10 years (OR, 2.02; 95% CI, 1.47-2.79; p<0.001), concomitant chronic diseases (OR, 1.51; 95% CI, 1.27-1.80; p<0.001), history of mental disorders (OR, 3.27; 95% CI, 1.77-6.05; p<0.001), family members or relatives confirmed or suspected (OR, 1.23; 95% CI, 1.02-1.48; p = 0.03), hospital-based and department-based care (OR, 0.76; 95% CI, 0.60-0.97; p = 0.024) and full coverage of all departments for avoiding nosocomial infection (OR, 0.69; 95% CI, 0.53-0.89; p = 0.004) were associated with stress.

INTERPRETATION

Women and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the pandemic. In addition, since HWs often have a greater stigma against mental problems than the general public, it is worthwhile to address the needs of the HWs during this pandemic and to provide appropriate psychological supports for those people at high risk of mental problems.

Burnout syndrome among psychiatrists in Egyptian mental health hospital

Background

Burnout is a special type of work-related stress—a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity (Lancet 388:2272-2281, 2016).

Burnout is a syndrome of state of emotional exhaustion, depersonalization, and feelings of low personal accomplishment (Maslach C and Jackson S, Maslach burnout inventory manual, 1986).

Burnout syndrome leads to severe problems. It may cause psychosomatic problems, family and marital conflicts, and substance misuse and also may result in complications such as late coming and early leaving of employees, quitting, having frequent medical reports, and the lack of productive and constructive ideas and criticism in the occupational settings (Sayil et al, Kriz Dergisi, Cilt 5, Say 1:2 ss.71-77, 1997).

So, we aimed to estimate the rate of occurrence of burnout among a sample of psychiatrists in one of the governmental psychiatric hospitals in Egypt.

Results

Result shows that 56.2% of study sample were males and 43.8% were females. Their mean age was 32 ± 6, and 57.5% were married and 42.5% were single. Mean score of emotional exhaustion was 28.25 ± 10.45 (high). Mean score of depersonalization was 8.5 ± 6.1 (moderate). Mean score of personal accomplishment was 31.78 ± 8.5 (low)

Conclusion

Burnout rate among psychiatrists of Al-Abbassia Hospital is higher than in western countries. Marriage and sleeping in home have protective effects. There is a significant association between high number of working hours per week and quality of the relationship with seniors and burnout.

Prevalence of burnout and associated factors among general practitioners in Hubei, China: a cross-sectional study

Background

High occupational burnout among general practitioners (GPs) is an important challenge to China’s efforts to strengthen its primary healthcare delivery; however, data to help understand this issue are unavailable. This study aimed to investigate the prevalence of burnout and associated factors among GPs.

Methods

A cross-sectional design was used to collect data from December 12, 2014, to March 10, 2015, with a self-administered structured questionnaire from 1015 GPs (response rate, 85.6%) in Hubei Province, Central China. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS). MBI-HSS scores and frequency were analyzed by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Factors associated with burnout among GPs were estimated using a multiple linear regression model.

Results

Of the respondents, 2.46% had a high level of burnout in all three dimensions, 24.83% reported high levels of EE, 6.21% scored high on DP, and 33.99% were at high risk of PA. GPs who were unmarried, had lower levels of job satisfaction, and had been exposed to workplace violence experienced higher levels of burnout. Intriguingly, no statistically significant associations were found between burnout and the duration of GP practice, age, sex, income, practice setting, and professional level.

Conclusion

This is the first study of occupational burnout in Chinese general practice. Burnout is prevalent among GPs in Hubei, China. Interventions aimed at increasing job satisfaction, improving doctor-patient relationships and providing safer workplace environments may be promising strategies to reduce burnout among GPs in Hubei, China.

Work strain and burnout risk in postgraduate trainees in general practice: an overview

Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.

Professional burnout and its correlates in Polish donor transplant coordinators

Job demands-resources (JD-R) model of professional burnout states that job demands predict the feeling of exhaustion, and lack of job resources—disengagement from work. This research project investigated professional burnout and it correlates, including sex, death anxiety, and relationship status in 108 Polish donor transplant coordinators involved in organ, tissue, and cell transplantations. This study employed the Polish version of the Oldenburg Burnout Inventory which follows the JD-R model, the Psychosocial Working Conditions Questionnaire—a Polish instrument based on the model of job stress proposed by Karasek—and the Polish version of the Fear of Death and Dying Questionnaire. The results were suggestive of average levels of job stress and burnout in the studied population, with men being more disengaged than women. Participants who were in relationship had significantly higher levels of exhaustion than those who were single. Exhaustion was positively correlated with years of working as a transplant coordinator but not with participants’ age. Multiple negative correlations were detected between exhaustion/disengagement and different aspects of job control, social support, and well-being. Moreover, positive correlations between different components of fear of death and dying and exhaustion were detected. Our findings, linking fear of death and dying with some aspects of professional burnout in transplant coordinators, suggest that a pre-employment screening for the level of death anxiety in candidates for transplant coordinators could be useful as this job provides chronic exposure to mortality cues.

The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature

The well-being of the health care workforce has emerged as both a major concern and as a component of the “quadruple aim” to enable the “triple aim” of improving patient experiences, reducing costs, and improving population health. Physician burnout is problematic given its effects on physicians, patients, health care organizations, and society. Using conservation of resources theory as a frame, we conducted a systematic review of the empirical literature on the relationship of physician burnout with physician personal and professional outcomes that includes 43 articles. Nine outcomes were organized into three categories illustrating burnout as a dynamic loss spiral rather than a static end-state. Findings show that emotional exhaustion had the greatest impact with the outcomes explored, while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon, which unfolds over time. Future research and implications of these results are discussed.

Prevalence of burnout among German general practitioners: Comparison of physicians working in solo and group practices

Background

Studies from general practitioner (GP) populations from various European countries show a high prevalence of burnout, yet data from Germany are scarce and there are no data comparing GPs from solo versus group practices.

Methods

This cross-sectional survey addressed all GPs from a German network of family medicine practices comprising 185 practices. Participants were asked to fill in a self-administered questionnaire addressing socio-demographic and job-related characteristics. The German version of the Maslach Burnout Inventory was used to measure the dimensions emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each participant was categorized as having high EE, high DP and low PA following pre-defined cut-offs.

Results

A total of 214 GPs from 129 practices participated: 65.9% male, 24.8% solo practice. Of all GPs, 34.1% (n = 73) scored high for EE, 29.0% (n = 62) high for DP, 21.5% (n = 46) low for PA and 7.5% (n = 16) for all three dimensions. A higher risk for EE was found among female physicians, those unsatisfied with their job, those using few stress-regulating measures regularly and those reporting bad work-life balance. Burnout prevalence was higher in GPs in group than in solo practices (37.9% vs. 28.8% had high EE, 33.1% vs. 18.9% had high DP and 22.8% vs. 18.9% had low PA). A significantly higher prevalence of burnout symptoms was found in group practice employees compared to group practice owners.

Conclusion

Burnout prevalence was higher among physicians in group practices compared to solo practices. In group practices, employed, young, female and part-time working physicians showed a higher burnout risk.

Potential correlates of burnout among general practitioners and residents in Hungary: the significant role of gender, age, dependant care and experience

BACKGROUND

Burnout is increasingly prevalent among general practitioners (GPs) in Hungary, which may lead to functional impairment and, subsequently, to poor quality of patient care. However, little is known about potential predictors of burnout among GPs. The aim of this study was to explore psychosocial correlates of burnout among GPs and residents in Hungary.

METHODS

We collected socio-demographic and work-related data with self-administered questionnaires in a cross-sectional study among GPs (N = 196) and residents (N = 154). We assessed burnout with the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and calculated the mean level of burnout and the proportion of physicians suffering from low, intermediate and high degree of burnout. To identify potential socio-demographic and work-related correlates of burnout among physicians, we determined Spearman's and Mann-Whitney U correlation coefficients and conducted stepwise linear regression analyses. We deployed Mann-Whitney U test to explore gender disparity in the level of burnout between female and male physicians and between general practitioners and residents.

RESULTS

The prevalence of moderate to high level emotional exhaustion, depersonalisation, and impaired personal accomplishment was 34.7, 33.5 and 67.8% as well as 41.0, 43.1, and 71.1% among GPs and residents, respectively. Residents reported significantly lower level of personal accomplishment vs GPs. We identified a significantly higher level of depersonalization among male physicians compared to female physicians. Age correlated negatively with emotional exhaustion and depersonalization and positively with personal accomplishment among GPs. Dependant care was positively associated with burnout among female GPs. Female residents were more likely to report depersonalization. High workload was positively correlated with depersonalization among female GPs. Younger age emerged as the strongest predictor of emotional exhaustion. Male gender and fewer years of experience predicted depersonalization best, and male gender showed a significant predictive relationship with low personal accomplishment.

CONCLUSION

We identified specific socio-demographic and work-related correlates of burnout, which may guide the development of specific and effective organizational decisions to attenuate occupational stress and subsequent burnout as well as functional impairment among GPs, and thus, may improve the quality of patient care.

Explaining burnout and the intention to leave the profession among health professionals - a cross-sectional study in a hospital setting in Switzerland

Background

Burnout and the intention to leave the profession are frequently studied outcomes in healthcare settings that have not been investigated together and across different health professions before. This study aimed to examine work-related explanatory factors or predictors of burnout and the intention to leave the profession among health professionals in general, and nurses and physicians in particular.

Methods

Cross-sectional survey data of 1840 employees of six public hospitals and rehabilitation clinics recorded in 2015/16 in German-speaking Switzerland were used. Multiple logistic and stepwise linear regression analyses were performed to estimate the relative risks (odds ratios) and standardized effects (beta coefficients) of different workloads and work-related stressors on these outcomes and to study any possible mediation between them.

Results

On average, one in twelve health professionals showed increased burnout symptoms and every sixth one thought frequently of leaving the profession. Temporal, physical, emotional and mental workloads and job stresses were strongly and positively associated with burnout symptoms and thoughts of leaving the profession. However, the relative risks of increased burnout symptoms and frequent thoughts of leaving the profession were highest in the case of effort-reward and work-life imbalances. In fact, these two work-related stress measures partly or even largely mediated the relationships between exposures (workloads, job stresses) and outcomes and were found to be the strongest predictors of all. Whereas a work-life imbalance most strongly predicted burnout symptoms among health professionals (β = .35), and particularly physicians (β = .48), an effort-reward imbalance most strongly predicted thoughts of leaving the profession (β = .31–36). A substantial part of the variance was explained in the fully specified regression models across both major health professions and both outcomes. However, explained variance was most pronounced for burnout symptoms of physicians (43.3%) and for frequent thoughts of leaving the profession among nurses and midwives (28.7%).

Conclusions

Reducing workload and job stress, and particularly reward frustration at work, as well as the difficulties in combining work and private lives among health professionals, may help to prevent them from developing burnout and/or leaving the profession and consequently also to reduce turnover, early retirement, career endings and understaffing in healthcare settings.

Prevalence of Burnout Among Physicians: A Systematic Review

Importance

Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.

Objective

To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.

Data Extraction and Synthesis

Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.

Main Outcomes and Measures

Point or period prevalence of burnout assessed by questionnaire.

Results

Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.

Conclusions and Relevance

In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.

Burnout, job satisfaction, and anxiety-depression among family physicians: A cross-sectional study

INTRODUCTION

Physicians are the most burn-outed group among the occupations. Among the physicians, family physicians have the highest burnout rates. Our objective in this study is to determine factors that are effective on work satisfaction of family physicians and their correlations with their burnout, anxiety-depression levels.

SUBJECTS AND METHODS

This cross-sectional descriptive study was carried out in primary health care professionals in region of Southeastern Anatolia from Diyarbakır Turkey. A survey form consists of 74 questions, and which questions burnout, job satisfaction, and anxiety-depression level has been applied on family medicine doctors, supplementary items in a questionnaire. Total of 343 family medicine doctors were reached, and the questionnaires were administered by face-to-face interview. Statistical Package for Social Sciences for Windows 18.0 software was used for statistical analysis.

RESULTS

Work satisfaction of family physicians who are on call lower compared to doctors who are not on call among family physicians who have joined to study (P < 0.005). It is determined that there is negative correlation between work satisfaction level of family physicians and emotional burnout, desensitisation, anxiety and depression point (P = 0.001 r = -0.23, P = 0.015, r = -0.16, P = 0.06, r = -0.124, P = 0.0001, r = -0.23), there is positive correlation between emotional burnout levels and anxiety, depression average points (P = 0.001, r = 0.34, P = 0.0001, r = 0.41), there is positive correlation between anxiety and depression points (P = 0.0001, r = 0.57).

CONCLUSION

The work satisfaction level of family physicians, who are on call and whose financial income expectation is not satisfied, was found low. It is seen that there is strong correlation between inadequacy of work satisfaction with burnout and anxiety, depression. As this can have negative effects on work performance, there is a need to look for solutions to increase work performance of family physicians.

Intervention for Physician Burnout: A Systematic Review

Burnout is an important problem for physicians, with a strong impact on their quality of life and a corresponding decrease in the quality of care with an evident economical burden for the healthcare system. However, the range of interventions used to decrease this problem could be very fragmented and with the aim to shed some light on this issue, this study reviews and summarizes the currently available studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies about intervention on physician burnout. Two authors independently searched into scientific databases to analyze and review the full papers that met the inclusion criteria. As a result, from an initial search of 11029 articles, 13 studies met full criteria and were included in this review. Of the 13 studies presented, only 4 utilized randomized controlled trials, therefore the results should be interpreted with caution. Future interventions should focus on a more holistic approach using a wider range of techniques. According to the studies selected in this review, it appears that a successful intervention for burnout should take into account the broad range of causes incorporating a variety of therapeutic tools.

Factors associated with low vs increased perceived mastery of clinical work over ten years of practice: a prospective study of Norwegian doctors

BACKGROUND

A higher sense of mastery of doctors' clinical work could benefit not only their own mental health but also their work performance and patient care. However, we know little about factors associated with perceived mastery of clinical work among physicians. Our aim was therefore to study characteristics of those with stable low levels and of those with increased levels of mastery over a period of ten years of medical practice.

METHODS

N = 631 doctors were surveyed in their final year of medical school in 1993/94 (T1) and 10 (T2), 15 (T3) and 20 (T4) years later. Low and increased perceived mastery of clinical work were measured between T2, T3 and T4. Response rates for all items measuring low and increased mastery were 238/522 (46%) and 256/522 (49%) respectively. The following explanatory variables were included: demographics, medical school factors, personality and contextual work-related and non-work-related factors.

RESULTS

N = 73 (31%) of the doctors reported stable low mastery from T2 to T4. The following variables were significantly associated with low mastery in the adjusted analyses: vulnerability (OR: 1.30, P < .000, CI: 1.12 to 1.50), drinking alcohol to cope with stress during medical school (OR: 2.66, P = .04, CI: 1.03 to 6.85) and social support (OR: 0.78, P = .002, CI: 0.66 to 0.91). N = 39 (15%) reported increased mastery during the ten-year period from T2 to T4. Perceived job demands (OR: 0.66, P = .02, CI: 0.45 to 0.98) and taking up a leading position (OR: 3.04, P = .01, CI: 1.31 to 7.07) were associated with increased mastery after adjustment.

CONCLUSIONS

Stable low sense of mastery over time is associated with having a vulnerable personality, a history of having used alcohol to cope with stress during medical school and lack of contemporary social support. Conversely, increased sense of mastery is associated with taking up a leading position and having the perception that job demands are decreasing over time. These findings indicate that perceived mastery of clinical work may not be a trait, but a state modifiable over time.

Correlates of professional burnout in a sample of employees of cell and tissue banks in Poland

Job Demands-Resources model proposes that the development of burnout follows excessive job demands and lack of job resources. Job demands are predictive of feeling of exhaustion, and lack of job resources-disengagement from work. This pilot study investigated professional burnout and its correlates in employees of Polish cell and tissue banks, many of whom were involved in procurement and processing of tissues from deceased donors, as it was hypothesized that job burnout in this population might influence the effectiveness of cell and tissue transplantation network in our country. This study utilized the Polish version of the Oldenburg Burnout Inventory (OLBI), which measures the two dimensions of burnout (exhaustion and disengagement), and the Psychosocial Working Conditions Questionnaire (PWC), a Polish instrument used for monitoring psychosocial stress at work. The study sample consisted of 31 participants. Their average time of working in a cell and tissue bank was 13.20 years. Majority of the PWC scales and subscales scores fell in the Average range, and the OLBI results for the Disengagement and the Exhaustion scales were in the Average range. A number of correlations between the Exhaustion or Disengagement and the PWC scales and subscales were detected, majority of which fell in the Moderate range. In spite of the limited number of participants, the results of this pilot study are consistent with the burnout literature reports. Among the detected correlates of professional burnout, it is job-related support which seems to be the most important factor which may influence the efficacy of transplantation network in Poland.

The implications of work-family balance among dual-earner couples

Purpose

The implications of the work-family balance (WFB) of dual-earner couples are well known; however, the extant literature on this topic has failed to adequately explore the context of Sub-Saharan Africa (SSA), specifically Nigeria. The purpose of this paper is to examine the implications of the WFB of dual-earner couples in Nigeria.

Design/methodology/approach

This paper employs a qualitative methodology in order to explore the effect of couples’ dual-earner status on their WFB in an African context by using Nigerian medical practitioners as the empirical focus.

Findings

The findings reveal that the dual-earner status provides some respite from financial hardship and improves family finances, which subsequently enhances WFB. However, the dual-earner status also has negative impacts on WFB in terms of work performance, dysfunctionality, and associated societal problems.

Originality/value

This paper provides insights into the WFB of dual-earner couples in the non-western context of SSA, highlighting the previously unexplored implications of dual-earner status in the context of SSA.

[Burnout in physicians]

BACKGROUND

Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines.

METHODS

A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms.

RESULTS

Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment.

CONCLUSION

Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

Association between insomnia symptoms, job strain and burnout syndrome: a cross-sectional survey of 1300 financial workers

OBJECTIVES

Professional burnout is closely related to work stress but less frequently associated with disturbed sleep. This study determines whether job strain and sleep disturbances are associated risk factors of burnout among financial workers.

DESIGN

Observational study.

PARTICIPANTS

1300 employees (725 female) of a financial company.

PRIMARY MEASURES

Self-reported questionnaires (Maslach Burnout Inventory, Job Content Questionnaire, Sleep questionnaire based on ICSD-3 classification), the Epworth sleepiness scale and the Hospital Anxiety and Depression Scale (HADS).

RESULT

The prevalence of burnout was 10.2% (9.0% moderate and 1.2% severe). 23.3% of workers were considered with high job strain, and 93.1% had a high level of job satisfaction. 16.8% of individuals had insomnia and 97% reported non-restorative sleep. The bivariate analyses demonstrate a higher risk of burnout in participants with insomnia (OR=14.7, 95% CI 9.8 to 21.9), non-restorative sleep (OR=9.9, 95% CI 5.1 to 19.5) and anxiety (OR=10.2, 95% CI 6.8 to 15.3). High job strain was associated with burnout (OR=1.9, 95% CI 1.1 to 3.6). This association was not maintained after adjustment for sleep parameters. Job satisfaction was another independent risk factor for burnout (OR=124, 95% CI 65 to 237).

CONCLUSIONS

In our sample of financial workers, job strain represents a burnout risk factor only if associated with insomnia. Insomnia can be considered as a relevant clinical marker that should be targeted in mental health prevention programmes at the workplace.