Burnout among psychiatrists in Milan: a multicenter survey

The imposter phenomenon in psychiatrists: relationships among compassion fatigue, burnout, and maladaptive perfectionism

BACKGROUND

The imposter phenomenon is the unwillingness to acknowledge one's triumphs, which is common among doctors. Research on the imposter phenomenon among mental health professionals is limited, and the relationship between imposter phenomenon, burnout, and compassion fatigue has not been studied. The current study intended to test a hypothesized model of the specific impact paths among burnout, compassion fatigue, maladaptive perfectionism, and imposter phenomenon among mental health professionals.

METHODS

A descriptive, cross-sectional online survey was conducted from June 2023 to September 2023. The sample (n = 160) consisted of psychiatrists. A path analysis was used to test the relationships among study variables and assess model fit.

RESULTS

A strong correlation was found between the imposter phenomenon and burnout and compassion fatigue when controlling age and months of work for both genders. Maladaptive perfectionism, directly and indirectly, affected the imposter phenomenon through burnout and compassion fatigue.

CONCLUSION

This study found that burnout and maladaptive perfectionism impact the imposter phenomenon in psychiatrists. To mitigate the effects of the imposter phenomenon on mental health professionals, societal norms that contribute to burnout and perfectionism must be reassessed.

Burnout, working alliance, and ward atmosphere: A multisite study of mental health professionals and patients with schizophrenia

This study examined the association between burnout, psychological distress, ward atmosphere, and working alliance (WA) among mental health workers treating patients with schizophrenia spectrum disorder (SSD). Data were collected from 345 patients with SSD and 151 mental health workers across 98 residential facilities (RFs) as part of the DiAPAson project from October 2020 to October 2021. Participants were excluded from the study if they exhibited patient-operator matching errors, dropped out, or had many missing Maslach Burnout Inventory (MBI) scores. The final sample included 282 patients and 155 healthcare workers. Burnout was assessed using the MBI. Psychological distress was evaluated with the 12-item version of the General Health Questionnaire. WA and ward atmosphere were evaluated with the WA Inventory and the Ward Atmosphere Scale, respectively, in both staff and patients. Sociodemographic and clinical data was also collected and analysed. Burnout was associated with a less supportive ward atmosphere, a weaker WA, and higher staff distress. Severe psychiatric symptoms evaluated with Brief Psychiatric Rating Scale in patients were also linked to staff burnout levels. Discrepancies in the perceptions of the ward atmosphere and the WA were observed between staff and patients, with patients reporting better perceptions in both domains. Our findings highlight the complex dynamics of well-being within psychiatric care settings, emphasizing the importance of role clarity, professional autonomy, and a positive ward atmosphere in mitigating burnout. Interventions focused on such factors may help support mental health professionals involved in SSD patient care. ISRCTN registry ID ISRCTN21141466.

Relationship between organizational commitment, working environment, and burnout in clinical nurses

BACKGROUND

Burnout is a mental condition caused by chronic emotional or psychological stress. Organizational commitment is always an important issue in the field of organizational development of clinical nurses. The study aimed to assess the association between organizational commitment, work environment, and burnout in clinical nurses.

MATERIALS AND METHODS

This is a correlational descriptive study that was conducted from November 2021 to January 2021 on 456 clinical nurses at the Hazrat Rasul Akram University Hospital in Iran. The convenience sampling method was used. Data were collected using socio-demographic and work-related data collection sheet, the Working Environment Scale (WES-10), the Organizational Commitment Questionnaire (OCQ), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Data were analyzed by the Statistical Package for the Social Sciences (SPSS) version 23.

RESULTS

The overall results showed that the mean score of organizational commitment was 29.87 ± 8.19, the mean score of burnout was 91.98 ± 17.40, and the mean score of work environment satisfaction was 24.62 ± 7.53. There were negative and significant relationships between organizational commitment with burnout (r = -0.324, P < 0.001) and work environment satisfaction (r = -0.440, P < 0.001). Also, there was a positive and significant relationship between work environment satisfaction with burnout (r = 0.386, P < 0.001).

CONCLUSION

The nursing profession is widely recognized as one of the most stressful professions, often characterized by high rates of staff turnover, absenteeism, and burnout. The result of this study highlights the importance of positive work conditions for ensuring the commitment and well-being of clinical nurses.

The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study

BACKGROUND

A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.

METHODS

An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.

RESULTS

A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.

CONCLUSIONS

The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Scoping Review

BACKGROUND

Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels.

OBJECTIVE

This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services.

METHODS

This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O'Malley and Levac, Colquhoun, and O'Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol.

RESULTS

A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS.

CONCLUSIONS

Studies mostly included physicians (34/55, 61.8%) and nurses (24/55, 43.6%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population.

Prevalence of burnout among psychiatrists: A systematic review and meta-analysis

BACKGROUND

Burnout is a consequence of chronic occupational stress exposure. Psychiatrists are prone to burnout due to specific work-related factors. This study examined the burnout prevalence among psychiatrists.

METHODS

The study protocol was registered in PROSPERO (CRD42020204615). We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, Web of Science, ClinicalTrials.gov, and OpenGrey for relevant publications. Random-effect meta-analysis was performed. We used subgroup analysis and meta-regression to reveal any association of geographical region, survey year, participants' age, gender, and response rate with burnout.

RESULTS

Thirty-six studies involving 5481 participants were included. The prevalence of overall burnout was 25.9% [11.1%-40.7%] as measured by a Maslach Burnout Inventory (MBI) and 50.3% [30.9%-69.8%] as measured by a Copenhagen Burnout Inventory (CBI). The pooled prevalence was 43.5% [27.9%-59%] for high emotional exhaustion (EE), 28.2% [17.5%-38.9%] for high depersonalization (DP), and 32.4% [3.4%-61.3%] for low personal accomplishment (PA). The mean scores of 22-item MBI subscales were 21.51 [18.64%-24.38%] for EE, 6.57 [5.53%-7.62%] for DP, and 31.83 [25.73%-37.94%] for PA. European psychiatrists revealed (p = 0.045) lower EE score (20.82; 95% CI 7.24-24.41) measured by 22-item MBI compared to their non-European colleagues (24.99; 95% CI 23.05-26.94). Other results include mean scores for 16-item MBI-General Survey, burnout rates, and scores in CBI subscales.

LIMITATIONS

The main limitation was high heterogeneity in terms of statistics, screening methods, burnout definitions, and cut-off points utilized in included studies.

CONCLUSIONS

Burnout is highly prevalent among psychiatrists. Future research should focus on finding consensus on burnout screening, longitudinal evaluation of psychiatrists' burnout predictors, and development of effective intervention strategies.

Loneliness, Complaining and Professional Burnout of Medical Personnel of Psychiatric Wards during COVID-19 Pandemic-Cross-Sectional Study

BACKGROUND

Professional burnout in the medical community has been present for a long time, also among mental health professionals. The aim of the study was to examine the links between loneliness, complaining and professional burnout among medical personnel in psychiatric care during a pandemic. Loneliness and complaining of the medical staff are not documented in the literature well enough.

METHODS

Oldenburg Burnout Questionnaire, the Loneliness Scale, the Complaint Questionnaire and author's questionnaire. The respondents: 265 medical employees-doctors (19.2%), nurses (69.8%), paramedics (4.9%), medical caregivers (5.7%).

RESULTS

Loneliness and complaining are significant predictors of exhaustion. The model explains 18% of exhaustion variance. Loneliness, complaining and job seniority are also predictors of disengagement; the model allows to predict 10% of the variance of disengagement. Women are more prone to complain. Complaining significantly correlates with direct support from management. A high rate of loneliness correlates, in a statistically significant way, with worse work organization, less management support, worse atmosphere in the team and with more irresponsible attitudes of colleagues.

CONCLUSIONS

Loneliness and complaining can be used to predict occupational burnout. Women and people without management support complain more often. Loneliness is connected with bad work organization and bad cooperation in a team.

Burnout and job satisfaction of psychiatrists in China: a nationwide survey

BACKGROUND

Despite a significant shortage of psychiatrists in China, an ever-increasing number of psychiatrists in China are experiencing burnout and job dissatisfaction and considering leaving their jobs. Yet, to our knowledge, there have been no nationwide studies to date that examined both burnout and job dissatisfaction of psychiatrists in China. Therefore, this study evaluated burnout and job dissatisfaction of psychiatrists in China, and identified relevant characteristics.

METHODS

We conducted a nationwide, cross-sectional survey in March 2019. Psychiatrists from all tertiary psychiatric hospitals in China were invited to participate. The Maslach Burnout Inventory-Human Service Survey and the short version of the Minnesota Satisfaction Questionnaire were used to measure burnout and job satisfaction. Data on socio-demographic and occupational characteristics were collected. Multivariate logistic regression was conducted to identify socio-demographic and occupational characteristics associated with burnout and job satisfaction.

RESULTS

In total, 4520 psychiatrists from tertiary psychiatric hospitals in China completed the questionnaire. Overall, 38.4% of respondents met the criteria for burnout and 35.6% were dissatisfied with their jobs. Being male, more years of practice, having no leadership role, and longer working hours per week were significantly associated with burnout and job dissatisfaction. Lower monthly pay was significantly associated with job dissatisfaction but not burnout. Moreover, burnout was significantly associated with job dissatisfaction.

CONCLUSIONS

Our data suggest a high rate of burnout and job dissatisfaction among psychiatrists in China. In order to preserve and strengthen the mental health workforce, proactive measures are urgently needed to mitigate burnout and job dissatisfaction among psychiatrists in China.

Burnout prevalence among European physicians: a systematic review and meta-analysis

PURPOSE

Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool.

METHODS

A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout.

RESULTS

From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition.

CONCLUSION

Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.

Relationship Between Job Satisfaction and Burnout Based on a Structural Equation Model

OBJECTIVES

To understand the relationship between job burnout and job satisfaction for medical workers and analyse the influencing factors.

METHODS

We used two scales to examine medical workers in Hengyang mental hospitals. Multivariate logistic regression and structural equation model were used to evaluate the relevant factors of job satisfaction, and the relationship between job satisfaction and job burnout.

RESULTS

The total job satisfaction was at the moderate level. For job burnout was in the middle burnout level. Job satisfaction can have a negative prediction function for job burnout (direct effect -0.684). The relevant factors of job burnout and job satisfaction was as follows: nature of the work, pay, benefits and communication impacted job satisfaction and job burnout.

CONCLUSIONS

The current level of job satisfaction is relatively low, job satisfaction has a negative effect on job burnout.

The influence of maladaptive coping modes, resilience, and job demands on emotional exhaustion in psychologists

Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed online measures of job demands, EE, resilience, and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.

Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace

Background

Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes.

Methods

In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female.

Results

Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB.

Conclusions

Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia

BACKGROUND

Health care personnel (HCP) who demonstrated close contact with Corona virus disease (COVID-19) patients might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among HCP with a higher risk for psychological trauma.

METHODS

This study was a cross-sectional study using secondary data from an online assessment, which was conducted 1 month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from HCP in the higher risk group and the lower risk group were analyzed.

RESULTS

A higher percentage of HCP experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group's HCP to present with moderate and severe depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 2.01-13.89; p < 0.05), 1.36 (CI: 0.09-1.96; p >  0.05), and 3.92 (CI: 2.08-7.40; p < 0.05) times higher, respectively. The probability for patient-induced burnout is 2.13 (CI: 1.51-3.007; p < 0.05) times higher and highest among the other burn out dimensions. The depressive symptoms complained were similar between groups: loneliness, sleep disturbances, difficulty concentrating, and inability to initiate activities. Loneliness demonstrates the highest logit value among the symptoms.

CONCLUSIONS

HCP with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Psychological well-being should be considered for high-risk HCP. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.

[Burnout Among Physicians Working in Psychiatric and Psychosomatic Care]

OBJECTIVE

Burnout is considered to be a major risk factor that can contribute secondary disorders due to persistent work related stress. International studies showed that physicians working in psychiatric care are more frequently affected by burnout than physicians working in somatic care. Studies from Germany are lacking.

METHODS

In a cross-sectional study all physicians 40 years and younger and registered with the State Chamber of Physicians of Saxony, Germany, received an anonymous paper-pencil questionnaire. Burnout was measured using the Maslach Burnout Inventory.

RESULTS

Physicians working in psychiatric/psychosomatic care did not differ from physicians working in somatic care regarding the subscales emotional exhaustion and depersonalization. Physicians working in psychiatric/psychosomatic care reported higher personal accomplishment. Working in psychiatric/psychosomatic care was associated with a lower likelihood for a high degree of burnout on the subscale personal accomplishment.

CONCLUSION

Previous studies suggesting a higher prevalence of burnout among physicians working in psychiatric care could not be confirmed.

Physician burnout in Nigeria: a multicentre, cross-sectional study

BACKGROUND

Healthcare workers are a burnout-prone occupational group and the prevalence is particularly high among physicians. With the prevailing low physician-patient ratio in Nigeria which has worsened with the recent wave of physician emigration, among other socio-economic constraints; a setting for high physician burnout may have been nurtured. Our survey set out to determine the prevalence of burnout among physicians practicing in Nigeria, ascertain the factors that were associated with the development of burnout and evaluate the respondents' perceived impact of physician burnout on patient safety.

METHODS

We used the Oldenburg burnout inventory as the measurement tool for burnout in the cross-sectional study conducted between November and December, 2019 among physicians in five tertiary health institutions in Nigeria. A 5- point Likert-type scale was used to evaluate the participants rating of their perceived impact of physician burnout on patient safety. Data entry and analysis were done using IBM Statistical package for social sciences software version 25 and the level of statistical significance was determined by a p value < 0.05.

RESULTS

The response rate was 61% (535/871), and burnout prevalence was 75.5% (404/535). Majority of the physicians (74.6%) perceive that physician burnout could impact patient safety. Physicians' professional grade, age and years in practice, but not specialty, gender or marital status were associated with the exhaustion domain, whereas only the physicians' age was associated with the disengagement domain of burnout. No socio-demographic or work-related characteristics determined overall burnout in our respondents.

CONCLUSION

Physician burnout in Nigeria is high and pervasive, and this should alert physicians to be wary of their general and mental health status. Public health policy should address this development which has implications for patient safety, physician safety and healthcare system performance.

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.

Study of burnout syndrome, job satisfaction and related factors among health care workers in rural areas of Southeastern Iran

Background

Burnout syndrome is a Psycho-somatic state resulting from prolonged exposure to job stressors that leads to negative self-concept, Job dissatisfaction and lack of communication with the client. Rural health centers because of lack of facilities and lack of knowledge of the service users are characterized by a high level of work-related stress, a factor known to increase the risk of burnout syndrome. The purpose of this study was to determine burnout syndrome and Job Satisfaction among health care workers in rural areas of southeastern Iran.

Methods

This is a cross-sectional study that has been conducted among 225 of the healthcare workers with more than five years of experience using simple random sampling method. Data were collected by a Maslach's burnout inventory and Smith's job satisfaction questionnaire. Data were analyzed using dependent and independent t-test, one-way ANOVA and Pearson correlation coefficient.

Results

The results of this study showed that the rate of burnout and job satisfaction score in health centers in rural areas was moderate. In job satisfaction, the highest score was related to the colleague and the lowest score was related to salaries and benefits. The emotional exhaustion had a negative significant effect on job satisfaction (p < 0.01).

Conclusion

Considering the importance of rural community health, burnout status of health care workers should be improved. It is necessary to provide appropriate interventions to decrease stress relating to role conflict, professional communications, factors related to the families and work load.

Burnout and occupational stressors among non-medical occupational health staff

BACKGROUND

The work required to assist individuals in improving their mental health is stressful and known to be associated with burnout. In Japanese companies, non-medical occupational health (OH) staff often take the role of maintaining and improving workers' mental health. However, few studies have examined burnout in this population.

AIMS

To assess the relationship between burnout and occupational stressors among non-medical OH staff.

METHODS

We conducted a cross-sectional study of OH staff who had participated in mental health seminars between 2016 and 2018. Occupational stressors were assessed using the Japanese version of the Job Content Questionnaire. Burnout was assessed using the Japanese version of the Maslach Burnout Inventory.

RESULTS

We administered the survey to 230 non-medical OH staff, of which 188 completed the questionnaire. According to a hierarchical multiple linear regression analysis, high job demands were associated with greater emotional exhaustion, depersonalization and personal accomplishment. Greater job control was associated only with higher personal accomplishment. Lower job support was associated with greater emotional exhaustion and depersonalization.

CONCLUSIONS

The present study found relationships between occupational stressors and burnout dimensions among OH staff. To avoid burnout among non-medical OH staff, it is important to take measures against occupational stressors, especially job demands and low levels of job support.

Comparison of burnout, anxiety and depressive syndromes in hospital psychiatrists and other physicians: Results from the ESTEM study

AIMS

To compare prevalence and risk factors for burnout, anxiety and depression among hospital psychiatrists and non-psychiatrists.

METHOD

Regional online survey of psychiatric and non-psychiatric hospital physicians was performed including: a job-stress scale, the Hospital Anxiety and Depression Scale (HADS), the Copenhagen Burnout Inventory (CBI), a stressful work relationships list and a six items scale about work-related psychosocial risk factors (PRFs). The client-related burnout scale of the CBI has been changed to an interpersonal burnout scale. Cases were defined by a score of 8+ for the HADS-A/HADS-D and 50+ for the three CBI subscales.

RESULTS

285 psychiatrists and 326 non-psychiatrists participated. The prevalence of depression, personal burnout and work-related burnout did not differ between physicians. Anxiety was lower in psychiatrists and interpersonal burnout was higher in senior psychiatrists. Multivariate analysis showed two main PRFs, common to both groups of physicians: "work intensity and time" was associated with four of the five syndromes and "emotional demands" with the three burnout syndromes. Interpersonal burnout was associated with stressful relationships with leaders, but not with patients.

CONCLUSION

Reducing the workload, improving the management of emotions and increasing managerial skills are important approaches for prevention.

Update on Addressing Mental Health and Burnout in Physicians: What Is the Role for Psychiatry?

PURPOSE OF REVIEW

To highlight an emerging understanding of burnout and physician mental health. This review will provide a discussion of conceptual and diagnostic issues of the burnout syndrome with its relevance to psychiatry, and how psychiatry may interface with other medical disciplines to provide support in creating burnout prevention and treatment programs.

RECENT FINDINGS

Descriptive data of burnout correlations and risk factors are available while an understanding of burnout best practices is lacking but growing. Two recent meta-analyses provide efficacy data along with key subgroup analyses that point to greater efficacy among systemic/organizational over individual level interventions. Among individual interventions, groups work better than individual therapy and the incorporation of Mindfulness-Based Stress Reduction and/or Cognitive Behavioral Therapy modalities provide greater efficacy over other therapies. Ultimately, addressing burnout will be an iterative process specific to institutional cultures and therefore should be thought of as quality improvement initiatives involving leadership to adopt the quadruple aim of physician wellness and to seek institution-specific collaboration and feedback. Psychiatry is uniquely positioned to help change institutional cultures regarding the burnout syndrome, which has been labeled a national crisis. Combinatorial strategies that combine efficacious individual-level interventions with systemic-level interventions that enhance workflow will likely provide the most sustainable model for preventing and treating burnout. Psychiatry should be involved, especially at the level of the liaison psychiatrist to assist with how these types of interventions may be best implemented in specific institutions.

Relationship between Burnout and Mental-Illness-Related Stigma among Nonprofessional Occupational Mental Health Staff

Background

Stigma related to mental illness can be an obstacle affecting the quality of life of people with mental illness. Although mental illness in the workplace is a public problem globally, few studies have investigated the effect of stigma on job-related problems such as burnout.

Aim

This study aimed to clarify the association between mental-illness-related stigma and burnout among nonprofessional occupational mental health staff.

Methods

In this cross-sectional study, nonprofessional occupational mental health staff's perceived mental-illness-related stigma was assessed using Link's Devaluation-Discrimination Scale, and their burnout was assessed using the Maslach Burnout Inventory. The association between stigma and burnout was analyzed by multiple linear regression analysis.

Results

In total, 282 participants completed the questionnaire (response rate: 91.3%). We excluded 54 nurses from the analysis to examine strictly nonprofessional occupational mental health staff. Finally, 228 eligible respondents were surveyed. Multiple linear regression analysis revealed that mental-illness-related stigma was significantly associated with a high degree of depersonalization, which was one of the burnout dimensions. However, the impact of stigma over the depersonalization domain of burnout was minor.

Conclusion

The results suggest that higher perceived mental-illness-related stigma is associated with more severe burnout. It is important to take measures against mental-illness-related stigma to avoid burnout among occupational mental health staff.

Empathy and Burnout - A Cross-Sectional Study Among Mental Healthcare Providers in France

Previous studies have established a correlation between empathy and burnout among healthcare providers. The aim of this study is to explore whether empathy – the ability to understand what another person is experiencing, was related to mental healthcare staffs’ burnout.

We performed a descriptive, cross-sectional, observational study among medical and nursing mental healthcare staff working in the district of Moselle, France. Participants completed a survey including The French versions of the Jefferson Scale of Empathy (JSPE) and The Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

The sample included 241 (n=241) participants (N=420, response rate=51.7%). 187 (77.6%) respondents had low burnout, 43 (17.8%) had intermediate burnout and 11 (4.6%) had high burnout. 41 (17%) had low empathy, 156 (64.7) had moderate empathy and 44 (18.3%) scored high.

Empathy scores were positively correlated with scores of personal accomplishment of the MBI-HSS (r=0.2; p<0.001), but negatively correlated with scores of depersonalization (r=-0.2; p<0.003). Highest means of depersonalization (DP) (M=8.7; SD=6.8; p<0.009) and lowest means of compassionate care (M=40.05; SD=7.9; p=0.0001) were found among forensic psychiatric security units staff.

Participation in the Omega educational program was associated with lower scores of EE on the MBI-HSS survey (mean score 14.7 versus a mean score of 19.7 for nonparticipants).

Empathic mental healthcare providers have lower levels of burnout. Forensic psychiatric staff showed low means of compassionate care and high depersonalization.

Interventions designed to foster attributes and skills such as empathy, resilience, and perception of security may be an essential step in reducing and preventing burnout.

Psychiatrist burnout: a meta-analysis of Maslach Burnout Inventory means

BACKGROUND

Doctors are known to have poor mental health compared with the general population. Psychiatrists are exposed to a number of unique stressors that may increase the risk of poor mental health. The aim of this study was to undertake a meta-analysis of burnout rates in psychiatrists.

METHODS

Electronic databases (including MEDLINE, PsycINFO and Embase) were searched. Only studies published since 1999 and using the 22-item Maslach Burnout Inventory were included in the analysis. A meta-analysis was conducted using the Comprehensive Meta-Analysis software.

RESULTS

A total of 11 studies, across nine publications, were included in the final analysis. Studies were significantly heterogenous but there was no indication of publication bias. The pooled mean for emotional exhaustion was 22.03 (95% confidence interval (CI): 19.71-24.34, tau = 3.74). For depersonalisation, the pooled mean was 7.41 (95% CI: 5.91-8.90, tau = 2.45). The pooled mean for personal accomplishment was 30.00 (95% CI: 24.75-35.27, tau = 8.87).

CONCLUSIONS

The high level of psychiatrist emotional exhaustion is a significant concern. Further research is needed to consider the role of modifiable risk factors in the aetiology of psychiatrist burnout.

Personal resilience in psychiatrists: systematic review

Aims and methodThe concept of personal resilience is relevant to physician well-being, recruitment and retention, and to delivering compassionate patient care. This systematic review aims to explore factors affecting personal resilience among psychiatrists, in particular, those that may impair well-being and those that facilitate resilience practice. A literature search was performed of the Ovid®, Embase®, CINAHL and PsycINFO databases, using keywords to identify empirical studies involving psychiatrists that examined resilience, stress and burnout from the past 15 years. RESULTS: Thirty-three international English language studies were included, showing that a combination of workplace, personal and non-workplace factors negatively and positively influenced well-being and resilience.Clinical implicationsGiven that workplace factors were the most commonly cited, it would appear that any resilience package that predominantly targets interventions at the workplace level would be particularly fruitful. Future research, however, needs to address the absence of a universal measurement of well-being and its moderators so that any potential interventions are better evaluated.Declaration of interestNone.

Psychological Support for Health Professionals: An Interpretative Phenomenological Analysis

Background: The work of health care professionals (HCPs) exposes them to emotionally difficult situations, anxiety, suffering and death, so they are at risk of burnout.

Objectives: To describe HCPs’ experiences of a psychological support intervention and its influence on the daily work of a sample caring for patients with neuromuscular and chronic respiratory illnesses.

Methods: This exploratory, descriptive, qualitative study was carried out at the Respiratory Rehabilitation Unit of IRCCS Santa Maria Nascente, in Milan, Italy. Semi-structured interviews with a purposive sample of 10 HCPs were subjected to interpretative phenomenological analysis (IPA).

Results: Five related themes emerged: psychological support; repeating the experience; relationships; the role of homework; competences. HCPs perceived that the intervention influenced their daily life, giving them a secure base and a new perspective on their professional role.

Conclusion: Psychological support interventions may not be appropriate for all HCPs, but they may help some HCPs to handle the demands of a stressful work life. Further studies are needed to determine its efficacy in reducing stress and prevent burnout.

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 in mental health professionals: A systematic review and meta-analysis of prevalence and determinants

This study aimed to estimate the level of burnout in mental health professionals and to identify specific determinants of burnout in this population. A systematic search of MEDLINE/PubMed, PsychINFO/Ovid, Embase, CINAHL/EBSCO and Web of Science was conducted for original research published between 1997 and 2017. Sixty-two studies were identified as meeting the study criteria for the systematic review. Data on the means, standard deviations, and prevalence of the dimensions of burnout were extracted from 33 studies and included in the meta-analysis (n = 9409). The overall estimated pooled prevalence for emotional exhaustion was 40% (CI 31%-48%) for depersonalisation was 22% (CI 15%-29%) and for low levels of personal accomplishment was 19% (CI 13%-25%). The random effects estimate of the mean scores on the Maslach Burnout Inventory indicate that the average mental health professional has high levels of emotional exhaustion [mean 21.11 (95% CI 19.98, 22.24)], moderate levels of depersonalisation [mean 6.76 (95% CI 6.11, 7.42)] but retains reasonable levels of personal accomplishment [mean 34.60 (95% CI 32.99, 36.21)]. Increasing age was found to be associated with an increased risk of depersonalisation but also a heightened sense of personal accomplishment. Work-related factors such as workload and relationships at work, are key determinants for burnout, while role clarity, a sense of professional autonomy, a sense of being fairly treated, and access to regular clinical supervision appear to be protective. Staff working in community mental health teams may be more vulnerable to burnout than those working in some specialist community teams, e.g., assertive outreach, crisis teams.

Burnout in Indian Psychiatrists

BACKGROUND

Individuals associated with service providing and decision-taking are prone for stress leading to burnout.

AIM

The aim of this study is to find out the details of burnout among Psychiatrists in India.

MATERIALS AND METHODS

Copenhagen Burnout Inventory (CBI) with structured biodata sheet was sent to the representative sample of psychiatrists by e-mail. Basic statistical analysis was done to find out prevalence, analyze response pattern, and differences between those with and without burnout.

RESULTS

The number of psychiatrists that responded to survey was 110-81 (74%) male and 29 (26%) female. The number of burnout cases in one or other spheres was 51 in 35 psychiatrists accounting for the prevalence of 46%. 32% of psychiatrists have burnout. Four psychiatrists have burnout in all three dimensions, nine in two dimensions, and 22 in one dimension. Personal burnout topped in the three dimensions (63%) followed by work burnout (24%). Patient burnout was least at 14%.

CONCLUSIONS

Burnout, though not very high, is to be taken seriously by Indian psychiatrists and protective and preventive measures are in order.

Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions

Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.

Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

BACKGROUND

Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.

OBJECTIVES

To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.

METHOD

Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).

RESULTS

The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.

CONCLUSION

Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Associations between Age, Years in Post, Years in the Profession and Personal Experience of Mental Health Problems in UK Mental Health Nurses

Nurses' mental health is of paramount importance, both in terms of patient safety and the sustainability of the workforce. Age, years in the profession, in post and personal experience or exposure to mental health problems are relevant to the mental health nursing workforce crisis in the United Kingdom. This study aimed to determine the relationship between age, years in the profession and post and self-reported experience of mental health problems using an online cross-sectional survey of 225 UK mental health nurses. Number of years in post was inversely correlated with overall experience of mental health problems, particularly living with someone else with mental health problems. Those with experience of living with someone with mental health problems had significantly fewer years of professional experience than those without. This article discusses possible explanations for this phenomenon and makes the case for future research on the topic.

The relationship between sluggish cognitive tempo and burnout symptoms in psychiatrists with different therapeutic approaches

Burnout is a serious problem for psychiatrists that has implications for clinical practice and personal health. While burnout is known to affect cognitive functions, no studies have examined the relationship between sluggish cognitive tempo (SCT) and burnout. This study aimed to examine this relationship and related factors as socio-demographic, occupational environment in psychiatrists. Participants(n=201, aged between 25 and 52 years,57.7% female) completed socio-demographic information form, Maslach Burnout Inventory and SCT Scale. According to our results, we have shown that total burnout scores and emotional exhaustion (EE) scores were significantly higher in psychiatrists with SCT. SCT scores were positively correlated with mean total burnout, EE, and depersonalization scores. We did not find any differences between subgroups according to departments, therapeutic approaches and gender. In conclusion, we want to highlight that psychiatrists with SCT were more proneness to general burnout symptoms and were more emotionally exhausted regardless of their therapeutic approach or their profession as adult or child/adolescent psychiatrists.

Career satisfaction and work stressors in psychiatrists and psychiatry trainees in Australia and New Zealand

OBJECTIVE

To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

METHODS

In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees).

RESULTS

A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. 'Too much work to do in too little time' emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents.

CONCLUSIONS

The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.

Dual role as a protective factor for burnout-related depersonalization in oncologists

PURPOSE

This study compared self-reported burnout between dual-role oncologists (oncologists who also do psychosocial work) and single-role oncologists, to explore if dual role is protective against or a risk factor for burnout.

METHODS

Dual-role oncologists from across China (n = 131) were consecutively recruited via the Chinese Psychosocial Oncology Society and asked to identify single-role oncologist peers (n = 168) working in the same institution. Participants completed an anonymous online questionnaire, which included measures of demographic and work characteristics, Maslach Burnout Inventory-Human Services Survey, the Short Version Effort-Reward Inventory, the Job Demands-Resources (JD-R) Scales, and Work and Meaning Inventory. Fully adjusted multivariate analyses compared burnout scores for the 2 groups.

RESULTS

Group analysis revealed single-role participants' scores indicated significantly poorer performance than dual-role participants for depersonalization (DP), work-family conflict (JD-R demands scale), and decision authority (JD-R scale). Single-role participants showed an increased risk of DP. Higher effort-reward imbalance ratio predicted greater DP in single-, dual-role and pooled participants, and emotional exhaustion (EE) in pooled- and dual-role participants. Overcommitment was independently associated with EE in all 3 groupings, with JD-R scores among pooled- and dual-role groups, while higher decision authority scores were associated with decreased EE. Work and Meaning Inventory was associated with a decreased risk of DP among pooled and dual-role participants.

CONCLUSION

Differences in burnout-related DP scores between dual- and single-role oncologists are consistent with a protective effect from a psychosocial orientation in oncologists.

[Work satisfaction and exhaustion among psychiatrists in psychiatric emergency services]

BACKGROUND AND AIM

Psychiatric emergency services (PES) have recently occupied a new and growing place in the landscape of mental health services. However, few data are available on the way psychiatrists practice in the PES. Our aim was to survey psychiatrists working in PES, focusing on their job satisfaction and the theoretical models they use in their everyday practice.

METHOD

We sent a survey to a sample of 508 psychiatrists working in PES in France.

RESULTS

Two hundred and thirty-seven psychiatrists returned the survey, yielding a response rate of 47%. On a 0 to 10 scale, the mean level of job satisfaction was 6.7 (SD: 1.92). Participants reported that facing a variety of clinical situations and playing a key-coordinating role in the mental health system were the two most specific features of emergency psychiatry. The main sources of dissatisfaction were organizational issues and stressful clinical experiences, including violence or hostility. Sixty-three percent (n=150) of participants reported using more than two theoretical models in their practice, while the use of crisis models was reported by almost 40% of them. When assessed for suggestions to improve the PES, the majority of participants indicated that efforts should be focused on organizational factors.

CONCLUSION

While emergency psychiatry could appear as an ungrateful practice, the majority of psychiatrists who responded to our survey reported satisfaction with their work and highlighted its unique particularities. Future research and collaborations are needed to identify organizational models of PES and their better integration in mental health networks.

Burnout and Doctors: Prevalence, Prevention and Intervention

Doctors are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. Burnout has far-reaching implications on doctors; patients and the healthcare system. Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. Burnout among doctors also increases risk of depression; anxiety; sleep disturbances; fatigue; alcohol and drug misuse; marital dysfunction; premature retirement and perhaps most seriously suicide. Sources of stress in medical practice may range from the emotions arising in the context of patient care to the environment in which doctors practice. The extent of burnout may vary depending on the practice setting; speciality and changing work environment. Understanding dynamic risk factors associated with burnout may help us develop strategies for preventing and treating burnout. Some of these strategies will be reviewed in this paper.

Understanding the burnout experience: recent research and its implications for psychiatry

The experience of burnout has been the focus of much research during the past few decades. Measures have been developed, as have various theoretical models, and research studies from many countries have contributed to a better understanding of the causes and consequences of this occupationally-specific dysphoria. The majority of this work has focused on human service occupations, and particularly health care. Research on the burnout experience for psychiatrists mirrors much of the broader literature, in terms of both sources and outcomes of burnout. But it has also identified some of the unique stressors that mental health professionals face when they are dealing with especially difficult or violent clients. Current issues of particular relevance for psychiatry include the links between burnout and mental illness, the attempts to redefine burnout as simply exhaustion, and the relative dearth of evaluative research on potential interventions to treat and/or prevent burnout. Given that the treatment goal for burnout is usually to enable people to return to their job, and to be successful in their work, psychiatry could make an important contribution by identifying the treatment strategies that would be most effective in achieving that goal.

Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey

OBJECT :The object of this study was to identify and quantify predictors of burnout and career satisfaction among US neurosurgeons.

METHODS

All US members (3247) of the American Association of Neurological Surgeons (AANS) were invited to participate in a survey between September and December 2012. Responses were evaluated through univariate analysis. Factors independently associated with burnout and career satisfaction were determined using multivariable logistic regression. Subgroup analysis of academic and nonacademic neurosurgeons was performed as well.

RESULTS

The survey response rate was 24% (783 members). The majority of respondents were male, 40-60 years old, in a stable relationship, with children, working in a group or university practice, and trained in a subspecialty. More than 80% of respondents reported being at least somewhat satisfied with their career, and 70% would choose a career in neurosurgery again; however, only 26% of neurosurgeons believed their professional lives would improve in the future, and 52% believed it would worsen. The overall burnout rate was 56.7%. Factors independently associated with both burnout and career satisfaction included achieving a balance between work and life outside the hospital (burnout OR 0.45, satisfaction OR 10.0) and anxiety over future earnings and/or health care reform (burnout OR 1.96, satisfaction OR 0.32). While the burnout rate for nonacademic neurosurgeons (62.9%) was higher than that for academic neurosurgeons (47.7%), academicians who had practiced for over 20 years were less likely to be satisfied with their careers.

CONCLUSIONS

The rates of burnout and career satisfaction were both high in this survey study of US neurosurgeons. The negative effects of burnout on the lives of surgeons, patients, and their families require further study and probably necessitate the development of interventional programs at local, regional, and even national levels.

Factors related to health-related quality of life among Chinese psychiatrists: occupational stress and psychological capital

BACKGROUND

Psychiatry has been considered as one of the most stressful medical specialities, and psychiatrists are likely to experience impaired health-related quality of life (HRQOL). However, few studies are available in regard to related factors of HRQOL among psychiatrists in China. This study aims to evaluate the condition of HRQOL of psychiatrists and explore its predictive factors, especially the effects of occupational stress and psychological capital.

METHODS

A cross-sectional, multicenter survey was conducted among psychiatrists from different regions of Liaoning province, China, during August 2013-April 2014. Self-administrated questionnaires including the 36-item Short-Form Health Survey (SF-36), the Chinese version Psychological Capital Questionnaire, effort-reward-imbalance (ERI) scale and participants' basic characteristics were distributed to 500 psychiatrists from 10 psychiatric hospitals of 8 major cities in Liaoning province. Overall, 373 psychiatrists became our final research objects. Hierarchical multiple regression analysis (HMR) was performed to explore the predictors of psychiatrists' HRQOL.

RESULTS

The mean (SD) scores of PCS and MCS among psychiatrists were 79.78 (16.55) and 71.50 (19.24) respectively. The mean (SD) of ERR were 0.777 (0.493), and 89 (23.9%) had ERR scores above 1 (ERR > 1). Hierarchical multiple regression analysis showed that, psychiatrists' basic characteristics that significant correlated with PCS and MCS were educational level, turnover intention, and exercise; age, weekly working hours were associated with MCS; psychiatrists' experienced occupational stress (both ERR and overcommitment), and PsyCap were significant predictors for PCS and MCS.

CONCLUSIONS

Chinese psychiatrists experienced relatively good physical QOL but impaired mental QOL, and they experienced high level of occupational stress. For the sake of psychiatrists' HRQOL, the reduction of occupational stress should be implemented. The enhancement of PsyCap could be a new intervention strategy and should be paid attention to in improving HRQOL of psychiatrists. Proportionate occupational reward (money, esteem, career opportunities) to their high work demands, psychological counseling, and stress management courses should be provided to psychiatrists to improve their QOL. PsyCap, as a personal coping resource open to change, should be managed and developed among psychiatrists.

Methodological considerations when translating "burnout"

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.

Risk of burnout among early career mental health professionals

Burnout is a stress-related syndrome that often affects mental health professionals (MHPs) and may have serious consequences on personal well-being as well as on the quality of provided psychiatric care. Established literature shows a high risk to develop burnout among MHPs. Few data are available on the incidence and on the clinical implications of the burnout syndrome in the early phases of MHP professional career. We confirmed the presence of burnout among early career MHPs: early career psychiatrists showed a lower sense of personal accomplishment, while non-medical MHPs tended to have more depersonalization and suffered from higher levels of depression. Specific programmes to identify the presence of the burnout syndrome and to cope with it should be taught within mental health training curricula. Burnout is a stress-related syndrome that often affects professionals working in emotionally loaded and highly interpersonal environments. Mental health professionals (MHPs) are long known to be at high risk to develop the burnout syndrome, but this has rarely been investigated in professionals in an early phase of career. The aim of the present study was to evaluate the presence of the burnout syndrome and of depressive symptoms among early career psychiatrists and 'non-medical' MHPs. One hundred MHPs (including 50 psychiatrists and 50 non-medical MHPs) were screened for the presence of burnout and depression, with the Maslach Burnout Inventory and the Beck Depression Inventory - revised, respectively. The relationships of burnout with socio-demographical and professional characteristics were also explored. We confirmed the presence of burnout among both groups of early career MHPs, but psychiatrists had a significantly higher degree of emotional exhaustion and a lower sense of personal accomplishment, while non-medical MHPs adopted more frequently depersonalization as a coping strategy and had higher scores for depression, which is associated with higher level of burnout. The risk of developing burnout should be properly addressed in training curricula and strategies to overcome it should be systematically taught, in order to promote personal well-being and efficient team work in mental health settings.

Psychiatry career in Brazil: regional disparities, differences and similarities in an international context

This review explores the literature related to career choice of psychiatry in Brazil through selection of scientific articles published in the period from 1999 to 2013 in the MEDLINE and SciELO databases. There are currently 145 medical schools in Brazil, the highest concentration being in the more developed areas. In 2005, there were 6,003 psychiatrists working in Brazil, a rate of 3.3 psychiatrists per 100,000 inhabitants, with unequal distribution across the geographical regions of the country: a rate of 4.5 psychiatrists/100,000 inhabitants in the southern region, and less than one psychiatrist per 100,000 inhabitants in the northern region. The south and south-east regions comprise 56% of the national population and 76% of the residency posts in psychiatry. In 2013, 27% of the residency posts in psychiatry were not filled, particularly in the north and north-east areas, where the shortage of professionals is more pronounced. The number of specialized doctors is far below what is needed to cover the burden attributed to neuropsychiatric disorders in the country. The main hypotheses to explain this imbalance in Brazil are the relatively low exposure to the speciality during undergraduate course work, the stigma attached to mental disorders, and the poor organization of mental healthcare services.

Being satisfied at work does affect burnout among psychiatrists: a national follow-up study from New Zealand

BACKGROUND

Burnout and job satisfaction in psychiatrists has been an area of considerable interest. Longitudinal studies on the subject are lacking, rendering it difficult to establish whether burnout changes with time or whether low job satisfaction may predict high burnout with time in psychiatrists.

AIMS

This longitudinal study of burnout and job satisfaction in a cohort of New Zealand psychiatrists was conducted to examine if initial scores on the Job Diagnostic Survey (JDS) predicted scores on the Maslach Burnout Inventory (MBI) three years later and vice versa.

METHODS

Three questionnaires (a socio-demographic questionnaire, the JDS and the MBI) were sent to all registered psychiatrists in 2008, which included all those who had participated in a study three years earlier. Scores on these three questionnaires were compared for those who had participated in both studies.

RESULTS

The overall number of psychiatrists reporting a high level of emotional exhaustion (EE) did not change across the two phases. The number of psychiatrists reporting high levels of depersonalization (DP) increased from 31 (13%) to 45 (20.2%); the mean DP score for the cohort significantly increased by 17.5% (p < .01). Those reporting reduced personal accomplishment (PA) increased from 90 (37.7%) to 98 (43.9%); the mean PA score for the cohort significantly reduced by 14.5% (p < .001). Low scores on skill variety, task Identity, and feedback of the JDS were significantly correlated with high EE scores three years later, whereas low scores on skill variety were significantly correlated with high scores on DP, and low scores on task significance and feedback were correlated with low scores on PA three years later.

CONCLUSIONS

Paying attention to aspects of job satisfaction may assist us in developing specific interventions for psychiatrists who may score high on different dimensions of burnout.

Universality of physicians' burnout syndrome as a result of experiencing difficulty in relationship with patients

The aim of our work is to present the universality of burnout syndrome among physicians worldwide and to demonstrate selected aspects of the relationship between patients and doctors as a common factor predisposing to burnout. We looked up 20 original pieces of research from the Medline database published in the last 10 years to determine the prevalence of burnout among doctors in different countries. In all quoted works a remarkable percentage of doctors of interventional and non-interventional specialties suffered burnout. Because it is the relationship with patients that constitutes a key denominator for their work, in the discussion we have exposed an important aspect of it, destructive patient games, described on the basis of transactional analysis. Since universal burnout causes a deterioration of doctors' service, for the optimal good of the patient to survive preservation of the doctor's well-being in the patient-doctor relationship is needed everywhere.

Nationwide survey of work environment, work-life balance and burnout among psychiatrists in Japan

BACKGROUND

Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan.

AIMS

The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan.

METHOD

We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used.

RESULTS

Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation.

CONCLUSIONS

A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

Developing psychotherapists' competence through clinical supervision: protocol for a qualitative study of supervisory dyads

BACKGROUND

Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees' practice and their clients' outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature.

METHODS/DESIGN

The study of 16-20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors.

DISCUSSION

The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research.

Burnout and psychiatrists: what do we know and where to from here?

Medicine in most parts of the world is becoming a stressful profession. Psychiatrists represent a high-risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work-related stress. There are reports that entrants in the profession of psychiatrists are decreasing globally. Conceptual issues related to burnout are explored and factors contributing to burnout in psychiatrists are reviewed. Methodologically sound studies are needed to help us understand positive aspects of psychiatry as a profession and the environment psychiatrists work in. Effective treatment programmes for burnout are also needed not only to reduce suffering but also to retain psychiatrists in the profession.