The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis

The Serial Mediation Effect of COVID-19 Anxiety and COVID-19 Burnout on the Relationship Between the Fear of COVID-19 and COVID-19 Quality of Life in Nurses

There is growing interest in the association between COVID-19-related stressors and quality of life. This study aimed to extend current knowledge by investigating the potential mediating roles of COVID-19 anxiety and COVID-19 burnout in the association between fear of COVID-19 and COVID-19 quality of life in nurses. A total of 300 nurses were selected by convenience sampling approach from a training and research hospital serving as a pandemic hospital in Turkey. COVID-19 anxiety, COVID-19 burnout, and COVID-19 quality of life data were collected using the self-reported questionnaires using both online and paper-and-pencil versions of the questionnaires. Structural equation modeling was used to conduct serial multiple mediation analysis. We found statistically significant associations among fear of COVID-19, COVID-19 anxiety, COVID-19 burnout, and COVID-19 quality of life. Serial multiple mediation analysis revealed that the association of fear of COVID-19 with COVID-19 quality of life was partially mediated by COVID-19 anxiety and COVID-19 burnout. These results indicate that the association of fear of COVID-19 with COVID-19 quality of life in nurses may be changed through COVID-19 anxiety and COVID-19 burnout, which appear to play serial multiple mediating roles in this association. These findings enrich our understanding of the associations among these psychological factors and suggest that focusing solely on fear of COVID-19 without considering the mediating effects of COVID-19 anxiety and COVID-19 burnout might not be adequate for reducing the COVID-19-impact on the quality of life among nurses.

Sensitivity analysis of human error in the steel industry: exploring the effects of psychosocial and mental health risk factors and burnout using Bayesian networks

Introduction

Human error and the high rates of fatalities and other occupational accidents in the steel industry are of significant global relevance. The aim of this study was to investigate the effect of psychosocial, mental health, and burnout risk factors on human error probabilities in an industrial environment using Bayesian networks.

Methods

This cross-sectional study was conducted in 2023. The participants were 252 employees of a steel company. Error probabilities related to the tasks of participants were estimated using the Human Error Assessment and Reduction Technique (HEART). Other data was collected using a survey that consisted of demographic information, the Maslach Burnout Inventory, Depression Anxiety Stress Scales, and a short version of the Copenhagen Psychosocial Questionnaire. A theoretical model was drawn in GeNIe academic software (version 2.3).

Results

The results showed that all the studied variables were able to significantly affect the distribution of human error probabilities. Considering a distribution of 100% for the high state of these variables, the results showed that the greatest increases in error probability were related to two burnout dimensions: emotional exhaustion (29%) and depersonalization (28%). All the variables, with a probability of 100%, increased the probability of high human error probabilities by 46%.

Conclusion

The most important variables in terms of their effect on human error probabilities were burnout dimensions, and these variables also had a mediation effect on the psychosocial and mental health variables. Therefore, preventive measures to control human error should first focus on managing the risks of burnout in workers. This, in turn, can also reduce the effect of psychosocial risk factors and mental health problems on human error in the workplace.

The influence of different conflict management styles on depressive symptoms in employees: the mediating role of emotional exhaustion

Although some studies have found that conflict management styles impact employees' levels of depression, the expressions of employees' depressive symptoms under various conflict management styles and the underlying mechanisms remain to be elucidated. In this study, a total of 1,312 employees were gathered through an online survey to examine their current depressive status. Drawing on the conservation of resources theory, the mediating role of emotional exhaustion in the association between conflict management style and employee depression was further explored. The findings revealed that the prevalence of moderate to severe depression among the workers was 13.9%. Employees with different conflict management styles displayed distinct depression scores. The high coordination style group exhibited a significantly lower depression score compared to the high concession style group. Emotional exhaustion played a mediating role in the impact of both the coordination style and the concession style on employees' depression. It can be seen that the mental health needs of the workplace are imminent. The intervention measures to improve the mental health of employees in the working environment should take into account the cultivation of the coordination style of employee conflict management, reduce their emotional exhaustion, and stay away from depression through the acquisition of constructive and positive coping styles.

Profiles of teachers' emotional labour during COVID-19 and the consequences on mental health: A comparison between online and offline teaching

BACKGROUND

Despite increasing attention on emotional labor in teacher well-being research, person-centered studies are relatively scarce, particularly concerning the emotional labor of online teaching during COVID-19 and its effects on teachers' non-work-related mental health.

OBJECTIVE

This study aims to address these gaps by examining emotional labor profiles and their consequences on job satisfaction, depression, and anxiety among Chinese teachers involved in either online or offline teaching during October-December 2022.

METHODS

Two samples of teachers were analyzed altogether: one engaged in online teaching (N=605) and the other in offline teaching (N=394). Latent profile analysis was used to identify emotional labor profiles based on three strategies: surface acting, deep acting, and expression of naturally felt emotions.

RESULTS

A total of four subgroups of emotional workers were identified: natural expressors, actors, flexible regulators, and authentic regulators. Significant differences were found between online and offline teaching, with a higher proportion of actors and fewer flexible regulators in the online condition, suggesting that the screen acts as a barrier to authentic emotional display. Among the four classes, actors scored lowest on job satisfaction and highest on depression and anxiety, whereas authentic regulators were the most adaptive, especially in online settings.

CONCLUSIONS

The findings highlight the impact of online teaching on teachers' emotional labor profiles and mental health, with practical implications for optimizing online teaching environments and supporting teacher well-being.

The network analysis of anxiety, depression and academic burnout symptom relationships throughout early, middle, and late adolescence

BACKGROUND

Previous research has explored the associations between anxiety, depression, and academic burnout primarily from a variable-level perspective. However, there is limited understanding of which symptoms might play a significant role in anxiety, depression, and academic burnout among adolescents at different stages.

METHODS

This study included 7,286 adolescents aged 10 to 18. Questionnaires assessed participants' anxiety, depression, and academic burnout. Network analysis was conducted on the overall sample and segmented by early, middle, and late adolescence to explore relationships between symptoms and variations in symptom expression across these stages, aiming to propose effective interventions targeting anxiety, depression, and academic burnout symptoms in early, middle, and late adolescence.

RESULTS

The study found that "feeling that studying is meaningless" emerged as a core symptom in the overall sample. Additionally, "acting or speaking slowly" emerged as a core symptom in early adolescence, while "the thought of dying or hurting" and "feeling bad about yourself, letting your family down" were prominent in middle adolescence, and "easily annoyed or irritable" and "feeling tired" may be prioritized in late adolescence. The varying central symptoms across different adolescent stages suggest the need for targeted interventions.

CONCLUSION

These findings underscore the importance of interventions tailored to specific symptoms to meet the unique needs of adolescents at different developmental stages.

A longitudinal examination of the psychometric properties of the English perceived stress scale- four (PSS-4) in mental health counsellors using item response theory

We examined the longitudinal psychometric properties of the Perceived Stress Scale - 4 items version (PSS-4) using item response theory with a sample of 361 mental health counsellors. Participants completed the PSS-4 at three timepoints at six-month intervals in a one-year period. There were 290 participants who (80.3%) identified as female, 51 (14.1%) identified as male, eight (2.2%) identified as gender variant/non-conforming, seven (1.9%) wrote in their own gender identity (e.g., genderqueer, gender expansive), three (0.8%) identified as Transgender male, and two (0.6%) did not respond to the item. The racial and ethnic backgrounds were as follows: White (87.3%), Multiracial (5.5%), Latino or Hispanic or Spanish (2.8%), Black or African American (1.4%), Asian (0.8%), Middle Eastern (0.8%), and five did not respond to the item (1.4%). We found unidimensionality evidence of the PSS-4 across all three timepoints and response categories were monotonically ordered. We also found that across all timepoints, the average person location was lower than the average item location, suggesting that the PSS-4 may not be well-targeted for this sample of mental health counsellors. We observed no significant interactions between timepoints, hours worked per week, and length of employment. Implications of the findings, including a discussion of the utility of the PSS-4 as a global measure of stress and with mental health counsellors.

The Effects of Dysfunctional Workplace Behavior on Teacher Emotional Exhaustion: A Moderated Mediation Model of Perceived Social Support and Anxiety

Dysfunctional workplace behavior (DWB) is a prevalent phenomenon in schools, which has adverse consequences for teachers and students. In addition to the known negative implications, little is known about the mechanism through which DWB functions. The purpose of this study was to explore the effects of DWB on teacher emotional exhaustion (EE) and understand whether perceived social support (PSS) moderates the mediating effect that anxiety has on the relationship between DWB and EE. A battery of measurement tools was administered to 249 English as a foreign language (EFL) teachers in Iran. Moderated mediation regressions were used to analyze survey data. Results indicated that anxiety mediated the relationship between DWB and EE. Additionally, it was found that PSS moderated the direct relationship between DWB and anxiety; and the indirect relationship between DWB and EE. DWB was more strongly associated with an increased incidence of anxiety and EE in teachers with low levels of PSS. Results highlight the need to understand the intervening factors and sources of EE to actively identify, assess, and control teachers' behavioral and mental health risk factors. Given the significant role of emotions in teacher well-being, it is imperative to develop effective interventions (e.g., promoting PSS and positive workplace behaviors) in order to optimize teachers' emotional and behavioral health.

Adaptation and Validation of School Burnout Inventory-Bangla and Its Predictive Factors Among Adolescents

School burnout (SB) among adolescents is a growing concern, yet there has been limited research in Bangladesh. This study aims to address this gap by validating the School Burnout Inventory (SBI) in Bangla and investigating the predictive factors of SB among high-school-going adolescents in Bangladesh. The study employed a cross-sectional design, recruiting participants from various high schools across urban and rural areas. Data were collected through self-reported questionnaires, which included information related to demographics, COVID-19, school burnout, daytime sleepiness, insomnia, and depression. The SBI-Bangla demonstrated high reliability and validity. The mean score of SB was 20.26 (±7.84). Significant differences in SB levels were observed across different age groups, grades, locations, mother's education levels, smoking status, and self-reported COVID-19 infection status. Multiple linear regression identified age (B = 0.647, p = .010), location (B = -1.043, p = .034), depression (B = 0.270, p < .001), daytime sleepiness (B = 0.208, p < .001), and insomnia (B = 0.662, p < .001) as significant predictors of SB. The final model explained 12.3% of the variance in SB scores. Enhancing sleep hygiene and addressing psychological issues may help reduce academic burnout. This study provides valuable baseline data that can inform future research and policy formulation aimed at reducing adolescent SB in Bangladesh.

The Relationship between Resiliency, Psychological Empowerment, and Teacher Burnout across Different Genders: A Psychological Network Analysis

Teacher burnout is one of the main reasons leading to decreased teaching performance and occupational mental health issues among teachers, drawing widespread global attention. Previous research has found that both resiliency and psychological empowerment can alleviate teacher burnout, yet there is no study simultaneously examining the relationships between resiliency, PE, and teacher burnout. Furthermore, previous studies have found gender differences in teacher burnout but have not examined the moderating effects of resiliency and psychological empowerment by gender group. Additionally, traditional analytical methods may overlook the compositional connections between these variables. To bridge this gap, we employed psychological network analysis to evaluate the psychological network of teachers with burnout across different genders. Findings indicate: (1) Female teachers exhibit a stronger link between their sense of departmental control and burnout, while male teachers show a stronger connection between solving instructional challenges and burnout. (2) Patience in male teachers' approach to teaching may enhance connections with their environment, and mastering job-relevant skills can boost male teachers' job happiness. (3) Female teachers' "I feel connected to others" demonstrates higher bridge centrality. In comparison, male teachers' "My work is vital to me" shows higher bridge centrality, indicating deeper connections with other symptom clusters. This study reveals the complex interactions among the factors of teacher burnout and investigates how gender differences influence the associations between these factors and burnout, by not only filling gaps in previous research but also offering new perspectives and strategies for understanding and intervening in teacher burnout, especially in the context of gender differences.

Burnout and moral injuries after foreign deployment among medical personnel of the German armed forces: a pre-post study

Introduction

Given a high amount of workplace stressors, burnout syndrome, as a depression-related syndrome, is highly relevant for medical service soldiers. This study aims to examine their effects with regard to moral injuries and personal values following foreign deployment.

Materials and methods

This longitudinal study included 91 soldiers of the German Armed Forces Medical Service. Participants completed the Maslach Burnout Inventory (MBI) and the Portrait-Value-Questionnaire (PVQ) before and after a foreign deployment as well as the Moral Injury Scale (SMBE) after deployment. Analysis has been conducted using t-tests to assess potential changes in MBI and PVQ scales between pre-test - t1 (2-4 weeks before deployment) and post-test - t2 (up to 6 months after deployment). In addition, correlations were examined between moral injuries (MI) after deployment and MBI scores at t1 and t2 as well as between personal values (PVQ t1) and MBI scores at t1 and t2.

Results

The MBI subscales showed mild to moderate burnout symptoms at both pre- and post-tests, with a slight deterioration during the study period, albeit not significant. There were no significant mean differences in PVQ between measurement points. Nevertheless, PVQ self-direction and tradition at t1 correlated negatively with MBI INV at t2 (PVQ SD r = -.21, p = .043) and MBI PA at t2 (PVQ TR r = -.23, p = .027). Furthermore, the subscale PVQ power at t1 correlated positively with MBI PA at t2 (PVQ PO r = .28, p = .006), meanwhile PVQ universalism at t1 correlated positively with MBI INV at t1 (PVQ UN r = .25, p = .018). Furthermore, positive correlations were found between moral injuries at t2 (SMBE total score, SMBE_Sub1, SMBE_Sub2) and MBI subscales Emotional Exhaustion (EE; r = -.54, p = .001), Depersonalization (DP; r = .38, p = .001), and Involvement (INV; r = .30, p = .004) before and after the deployment period. No correlation was found between MI and MBI subscale Personal Accomplishment (PA).

Conclusion

The results indicate that medical service soldiers exhibit mild to moderate burnout symptoms even before deployment. Significant associations between moral injuries and burnout were found in 3 out of 4 MBI subscales (EE, DP, INV). There was a significant association with a stronger moral injury and higher burnout levels, persisting both before and after the study period. Furthermore, our results suggest that personal value orientations might be meaningful predictors of burnout. Hence, causal questions regarding general work stress among medical service soldiers should be further explored in more detailed studies. Further research could lay the foundation for future approaches in psychotherapy as well as primary and secondary prevention in this field.

The Effectiveness of Group Interpersonal Therapy on Burnout Among Long-Term Care Workers

OBJECTIVE

Burnout syndrome can have a negative impact on people who work in occupations that require close interaction with others, contributing to a decline in their psychological well-being. This study aimed to examine the effectiveness of Group Interpersonal Therapy (IPT-G) in reducing burnout among care workers for older adults in a Turkish long-term care facility.

METHODS

The study employed a pretest-post-test randomised experimental design. Fifty care workers scoring 27 or above on emotional exhaustion and 10 or above on depersonalisation subscales of the Maslach Burnout Inventory (MBI) were randomly assigned to the intervention or control group for 8 weeks. The study utilised the World Health Organization (WHO) Group Interpersonal Therapy for Depression manual as a guide. The post-test was conducted immediately after the last session of the intervention.

RESULTS

In comparing pre- and post-test scores of the intervention group, a statistically significant difference was found in overall burnout scores (pretest M = 74.10, post-test M = 63.08, p < 0.001; d = 1.12). Additionally, emotional exhaustion scores (pretest M = 30.99, post-test M = 24.89, p < 0.001; d = 1.11) and depersonalisation scores (pretest M = 12.76, post-test M = 8.53, p < 0.001; d = 1.69) exhibited significant differences. However, no significant difference was observed in personal accomplishment scores (p > 0.05). The control group had no significant differences concerning the overall burnout scores and all three subscales (p > 0.05).

CONCLUSION

The IPT-G used in this study effectively decreased burnout among care workers in a long-term care facility in Türkiye. In addition, the participants reported high satisfaction with the IPT-G program.

IMPLICATIONS FOR PRACTICE

Our results support the usefulness of the IPT-G program for care workers in long-term care facilities considering adding it to their occupational health management. This research aimed to determine whether IPT-G successfully decreased care worker burnout. Future research focusing on various types of healthcare workers in long-term care facilities and examining factors such as burnout, job satisfaction and self-efficacy could provide more information on the effects of IPT-G.

Job burnout and anxiety among medical staff: A latent profile and moderated mediation analysis

BACKGROUND

Due to work pressure, work intensity, and the impact of emergencies such as the epidemic, job burnout and mental health problems among medical staff have become increasingly prominent.

OBJECTIVES

Our study aims to characterize the patterns of burnout in Chinese medical staff, explore the profile differences on anxiety and self-esteem, examine whether the differences in these profiles on anxiety were mediated by self-esteem, and investigate whether this mediating process was moderated by positive coping styles among medical staff.

METHODS

Data were collected from 602 medical staff in China by a convenient sampling method. A latent profile and moderated mediation analysis were performed.

RESULTS

Latent profile analysis on three burnout dimensions [emotional exhaustion, cynicism, and professional efficacy] indicated two burnout profiles: low burnout (82.47% of the sample) and high burnout (17.53%). Medical staff with a low burnout profile had lower levels of emotional exhaustion and cynicism than those with a high burnout profile. It was also determined that self-esteem mediates burnout and anxiety in both high- and low-burnout medical staff. The moderating role of positive coping styles was also identified (β = 0.30, 95%CI: 0.058-0.550).

CONCLUSIONS

The identification of two distinct burnout patterns (low burnout and high burnout) provides clinical administrators with clear goals for individualizing support and interventions for medical staff with different levels of burnout. Furthermore, attention should be given to self-esteem and positive coping styles, as they act as potential mediators and moderators of medical staff's mental health problems.

Impact of burnout on depression among nurses at a private hospital in Johannesburg, South Africa

BACKGROUND

 Burnout is a syndrome that is understood as emanating from chronic workplace stressors that have not been managed successfully. Little is known about the causes of burnout among nurses in South Africa. The study aimed to determine the prevalence of burnout and its impact on depression and assess the relationship between burnout and depression among nurses at a Johannesburg private hospital.

METHODS

 Nurses at a private hospital in Johannesburg were asked about their exposure to depression and burnout using a closed-ended questionnaire as part of a quantitative, cross-sectional study design. A p-value 0.05 was considered statistically significant. The respondents were selected using the simple-random sampling method. The collected data were analysed using IBM-SPSS version 28.

RESULTS

 The study involved 112 nurses, of whom 95 (84.8%) were females. Most of the nurses, that is, 56 (50.0%) were registered nurses. Emotional exhaustion (p = 0.001) and depersonalisation (p = 0.001) were significantly associated with depression. Work experience (p = 0.001) and depersonalisation (p = 0.002) had an impact on depression.

CONCLUSION

 The study revealed a high prevalence of burnout among nurses at a Johannesburg private hospital. The study found that depression was significantly associated with emotional exhaustion and depersonalisation. The study also found that work experience and depersonalisation have an impact on depression.Contribution: The study's recommendations can help mitigate burnout and improve the well-being of nurses, ultimately enhancing the quality of healthcare services provided at the hospital.

Mental issues, internet addiction and quality of life predict burnout among Hungarian teachers: a machine learning analysis

BACKGROUND

Burnout is usually defined as a state of emotional, physical, and mental exhaustion that affects people in various professions (e.g. physicians, nurses, teachers). The consequences of burnout involve decreased motivation, productivity, and overall diminished well-being. The machine learning-based prediction of burnout has therefore become the focus of recent research. In this study, the aim was to detect burnout using machine learning and to identify its most important predictors in a sample of Hungarian high-school teachers.

METHODS

The final sample consisted of 1,576 high-school teachers (522 male), who completed a survey including various sociodemographic and health-related questions and psychological questionnaires. Specifically, depression, insomnia, internet habits (e.g. when and why one uses the internet) and problematic internet usage were among the most important predictors tested in this study. Supervised classification algorithms were trained to detect burnout assessed by two well-known burnout questionnaires. Feature selection was conducted using recursive feature elimination. Hyperparameters were tuned via grid search with 10-fold cross-validation. Due to class imbalance, class weights (i.e. cost-sensitive learning), downsampling and a hybrid method (SMOTE-ENN) were applied in separate analyses. The final model evaluation was carried out on a previously unseen holdout test sample.

RESULTS

Burnout was detected in 19.7% of the teachers included in the final dataset. The best predictive performance on the holdout test sample was achieved by random forest with class weigths (AUC = 0.811; balanced accuracy = 0.745, sensitivity = 0.765; specificity = 0.726). The best predictors of burnout were Beck's Depression Inventory scores, Athen's Insomnia Scale scores, subscales of the Problematic Internet Use Questionnaire and self-reported current health status.

CONCLUSIONS

The performances of the algorithms were comparable with previous studies; however, it is important to note that we tested our models on previously unseen holdout samples suggesting higher levels of generalizability. Another remarkable finding is that besides depression and insomnia, other variables such as problematic internet use and time spent online also turned out to be important predictors of burnout.

Testing the Impacts of Rational-Emotive Couple Intervention in a Sample of Parents Seeking Divorce

Marital burnout has not been extensively studied despite its huge consequences on family wellbeing and quality of family life. This study, using randomised-controlled trial, tested the impact of rational-emotive couple intervention on marital burnout in a sample of parents seeking a divorce. A total of 67 parents who participated during the rational-emotive couple intervention (RECI) were assessed using the marital burnout scale, Beck depression inventory, and parent rational and irrational beliefs scale. Crosstabulation, multivariate test analysis, and bivariate analysis were used to analyse the data collected. Results show a significant reduction of marital burnout in RECI group participants, and significant improvement was maintained at the follow-up stage. The result of the group and gender interaction effect shows no significant interaction effect of group and gender on participants' marital burnout at Time two and Time 3, respectively. The results indicate that a decrease in parents' irrational beliefs accounts for marital burnout among couples seeking a divorce. Marital burnout is positively associated with depression among couples seeking a divorce. This study concludes that the RECI is an effective intervention that reduces marital burnout which is a direct consequence of irrational beliefs which later metamorphose into depressive symptoms.

Strategies of Well-being Training and Resilience

As cardiothoracic surgeons, we face frequent challenges to our well-being and our ability to function as our best selves. Building personal resilience is an important way to help us manage these challenges. Here, the authors outline the scope of the problem, the consequences of burnout, and offer 4 strategies to train ourselves to be more resilient: (1) Pursuit of fulfillment, (2) Cultivation of community and belonging, (3) Mitigation of microstresses and avoiding feelings of overwhelm, and (4) Building a "resilience bank account."

A Self-Assessment Tool for Helping Identify Police Burnout Among Investigators of Child Sexual Abuse Material

Introduction

Law enforcement professionals who investigate crimes involving child sexual abuse material face increased risk of mental health challenges, including burnout. This study aims to develop a data-driven self-assessment tool for law enforcement personnel exposed to child sexual abuse material. The tool assesses burnout symptoms and related mental health issues, offering a proactive approach to identifying and supporting individuals at risk.

Methods

A mixed-methods investigation involved 500 police investigators and forensic examiners across the U.S. The study utilized a convenience sample recruited through various channels connected with the National Criminal Justice Training Center.

Results

Twenty percent of participants exhibited high burnout. The Burnout Self-Assessment Tool demonstrated a sensitivity of 69.6% and specificity of 74.6% at a cut-off point ≥2, correctly classifying 73.6% of the sample. Individuals with scores ≥2 were 3.47 times more likely to be experiencing high burnout than peers with a score of zero, with increasing odds with each additional score. High burnout was associated with longer tenure in current positions.

Conclusions

The Burnout Self-Assessment Tool offers a short and simple self-assessment tool for law enforcement professionals exposed to child sexual abuse material, aiding in the early identification of burnout symptoms. A cut-off point ≥2 provides a data-driven strategy for identifying individuals at increased risk, promoting timely intervention and support to mitigate burnout's adverse effects on mental well-being and professional performance. The Burnout Self-Assessment Tool's sensitivity and specificity balance enhances its utility, providing a proactive approach to address the unique mental health challenges faced by law enforcement personnel combating crimes involving child sexual abuse material.

Sport anxiety and subjective happiness of college athletes: a self-determination theory perspective

Introduction

Sport anxiety not only impacts the performance of college athletes but also influences their psychological well-being. The psychological well-being of sports students is crucial for both academic performance and competition, as they need to balance their academic performance with professional athletic training.

Method

Based on self-determination theory, this study examines the relationship between various factors in sport anxiety (somatic anxiety, worry, and concentration disruption) and subjective happiness, as well as the mediating role of need satisfaction in this relationship. A total of 835 college athletic students participated in the study, completing the Sport Anxiety Scale-2, Basic Psychological Needs Satisfaction Scale-in General, and Subjective Happiness Scale.

Results

An analysis of gender differences revealed that female participants scored significantly higher on somatic anxiety (t = -2.21, df = 833, p = 0.028, Cohen's d = -0.155) and worry (t = -3.17, df = 833, p = 0.002, Cohen's d = -0.223) compared to males. In the analysis by sport type, participants engaged in team sports scored significantly higher on somatic anxiety (t = 2.70, df = 833, p = 0.007, Cohen's d = 0.187), Worry (t = 1.97, df = 833, p = 0.049, Cohen's d = 0.136), and concentration disruption (t = 2.73, df = 833, p = 0.007, Cohen's d = 0.189) than those in individual sports. Additionally, in the analysis by grade level, freshman college athletes exhibited significantly lower sport anxiety compared to sophomore athletes [F(4, 830) = 4.06, p = 0.003, η p 2 =0.019]. The mediation analysis revealed that concentration disruption in sport anxiety is significantly and negatively related to subjective happiness. Additionally, need satisfaction (competence, autonomy, and relatedness) mediates the relationship between worry, as well as concentration disruption in sport anxiety and subjective happiness.

Discussion

Future research should build on the current study by employing longitudinal designs and integrating multiple objective measures to further explore the relationship between sport anxiety and subjective happiness.

A study on the relationship and path between mental health and burnout of Chinese athletes

Background

This study aims to explore the relationship and influencing pathways between mental health indicators and athlete burnout among Chinese competitive athletes.

Methods

A cross-sectional study was conducted on 501 elite Chinese athletes from several national and provincial sports teams. Generalized Anxiety Disorder Scale (GAD-7) was used to measure anxiety, Patient Health Questionnaire (PHQ- 9) was used to measure depression, Athlete Psychological Strain Questionnaire (APSQ) was used to measure perceived stress, and Athlete Burnout Questionnaire (ABQ) was used to measure burnout. The results were derived using reliability testing, descriptive statistics, correlation analyses, and structural equation modeling.

Results

The following results were obtained: (a) the clinical detection rates of anxiety and depression in this sample were within normal levels, but the detection rate of perceived stress (78.64%) was relatively high; (b) all three mental health indicators were significantly correlated with athlete burnout; (c) in our model, there was a direct path with APSQ directly contributing to 69.95% of the variance in athlete burnout, and two indirect paths with APSQ exerting an indirect effect through depression or/and anxiety accounting for 30.05% of the variance.

Conclusion

The findings revealed the psychological characteristics of Chinese competitive athletes and the direct and indirect effects of the APSQ on burnout. Future research should actively promote the international development and application of burnout assessment tools, conduct more comprehensive studies on athlete mental health monitoring, and intensify efforts in athlete education, treatment, and support services, as well as strategies for athlete's coping stress.

Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador

BACKGROUND

A meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout.

OBJECTIVE

The current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes.

METHODS

A total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item.

RESULTS

The results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador.

CONCLUSION

The networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.

Compassion Fatigue in Emergency Medicine: Current Perspectives

Compassion fatigue (CF), or loss of ability to empathize or feel compassion for others for whom one cares, is a growing concern for emergency physicians (EP). EPs, by the nature of their jobs, work under unpredictable conditions at odd hours with high levels of exposure to traumatic events. They are placed under substantial psychological, physical, and cognitive pressure, with little opportunity to recover or reflect. CF occurs when this workplace stress leads to feelings of being overwhelmed, helpless, unsupported, and unable to cope. Additionally, primary traumatic stress from threats of workplace violence and secondary traumatic stress (STS) from witnessing the suffering of others increase the likelihood of developing CF. Unchecked, this progression to CF causes reduction in quality of care to patients, reduction in patient satisfaction, increased levels of EP depression and anxiety, increased levels of EP substance use, and increased attrition from the specialty. To truly improve CF, individuals and organizations should be aware of the contributors to CF: namely, emotional exhaustion, depersonalization, primary and STS, and personal achievement. EPs should maximize their resilience to CF by using cognitive behavioral techniques and mindfulness, taking care of their physical health, seeking meaning and development within their work, developing hobbies outside of work, and creating boundaries between work and home. Organizations should actively address the known drivers of physician burnout: workload and job demands, efficiency and resources, meaning in work, culture and values, control and flexibility, work community, and work-life integration. Organizations should also provide adequate safety within facilities to reduce the threat of primary trauma and should supply adequate support and destigmatization for post-traumatic symptoms for EPs suffering from STS.

A Persian validation of the burnout assessment tool

BACKGROUND

Burnout is an increasing public health concern. Its prevalence has extended across diverse professions globally, posing significant challenges to individuals, organizations, and society. This phenomenon has undermined employee well-being, productivity, and organizational effectiveness, making it a critical concern in contemporary work environments. The present study aimed to examine the adaptation and assess the validity of the Persian version of the Burnout Assessment Tool (BAT).

METHODS

The adaptation process included the translation and back-translation of the BAT. Data were collected on a sample of 580 teachers using the convenience sampling. The BAT-Persian and Utrecht Work Engagement Scale were administered to collect the data. The reliability, factorial structure of the BAT-C and BAT-S, and the convergent and discriminant validity of BAT-C and work engagement were explored.

RESULTS

Confirmatory factor analysis supported a four-factor structure for the core dimensions (BAT-C; exhaustion, mental distance, emotional impairment, cognitive impairment), and a two-factor structure for the secondary dimensions (BAT-S; psychological distress, psychosomatic complaints). In the second-order model, the item loadings on the four factors of BAT-C ranged from 0.35 to 0.85, and on two factors of BAT-S ranged from 0.63 to 0.89. The Persian versions of the BAT-C and BAT-S showed good internal consistency (respectively, α = 0.95 and 0.90). Additional evidence supports the convergent and discriminant validity of the BAT-GR. the BAT-C and its scales were negatively correlated with work engagement and dimensions (i.e., vigor, dedication, and absorption). Moreover, the BAT-S and its scales negatively correlated with work engagement and dimensions.

CONCLUSIONS

This study provided evidence that the Iranian version of BAT represents a reliable and valid tool for measuring burnout in the work context. A reliable and valid tool for assessing burnout in the Iranian workplace enables early detection of employee distress, allowing for timely intervention and support. This means that identifying the signs and symptoms of burnout in the early stages can prevent more severe consequences such as absenteeism, reduced productivity, or turnover.

Investigating food retail workers' experiences during the COVID-19 pandemic: A case of effort-reward imbalance

Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed.

Geraniol mitigates anxiety-like behaviors in rats by reducing oxidative stress, repairing impaired hippocampal neurotransmission, and normalizing brain cortical-EEG wave patterns after a single electric foot-shock exposure

Anxiety-like conditions can interfere with daily activities as the adaptive mechanism fails to cope with stress. These conditions are often linked with increased oxidative stress, and abrupt neurotransmission and electroencephalography (EEG) wave pattern. Geraniol, a monoterpenoid, has antioxidant and anti-inflammatory activities, as well as brain-calming effects. Therefore, in this study, geraniol was tested for the potential anxiolytic effects in a rat model of anxiety. The rats were exposed to an electric foot shock (1 mA for 1 s) to develop anxiety-like symptoms. Treatment was carried out using geraniol (10 and 30 mg/kg) and the standard diazepam drug. The behavior of the rats was analyzed using the open field test, light-dark test, and social interaction test. Afterward, the rats were decapitated to collect samples for neurochemical and biochemical analyses. The cortical-EEG wave pattern was also obtained. The study revealed that the electric foot shock induced anxiety-like symptoms, increased oxidative stress, and altered hippocampal neurotransmitter levels. The power of low-beta and high-beta was amplified with the increased coupling of delta-beta waves in anxiety group. However, the treatment with geraniol and diazepam normalized cortical-EEG wave pattern and hippocampal serotonin and catecholamines profile which was also reflected by reduced anxious behavior and normalized antioxidant levels. The study reports an anxiolytic potential of geraniol, which can be further explored in future.

Strain and serenity: exploring the interplay of stress, burnout, and well-being among healthcare professionals

Introduction

Stress and burnout can negatively affect performance, mental health, and the overall well-being of healthcare workers. The study aims to examine the prevalence of stress and burnout, and investigate links between stress, burnout, mental state, and well-being among healthcare workers in the Czech Republic.

Methods

A cross-sectional survey was conducted in the Czech Republic, focusing on healthcare professionals working in various healthcare settings. A total of 1,064 healthcare workers participated in the study. A standardized questionnaire battery was used, consisting of the Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS) and Supso-7 measuring mental state. Separate correlation and multiple regression analyses were conducted.

Results

46.24% of the healthcare workers reported high levels of emotional exhaustion, 25.56% reported high levels of depersonalization, 24.15% reported low levels of personal accomplishment, while 11.18% reported high levels of perceived stress. The findings revealed that emotional exhaustion, a core component of burnout, was associated with increased feelings of anxiety and depression. Perceived stress was also linked to anxiety and depression, while personal accomplishment appeared to mitigate depression and support positive psychological well-being.

Conclusion

The study provides promising evidence suggesting that addressing stress and emotional exhaustion, while fostering a sense of personal achievement, could lead to improvements in the mental health and work performance of healthcare workers. These findings highlight the importance of addressing burnout and stress management strategies to support the overall well-being of healthcare professionals.

Evaluating an Autistic Burnout Measurement in Women

This study evaluated the suitability of an unpublished autistic burnout assessment tool, focusing on autistic women. Distinguishing autistic burnout from conditions like depression or anxiety is crucial for effective interventions, emphasizing the need for nuanced research and refined measures in understanding and addressing autistic burnout. The Dutch version of the AASPIRE Autistic Burnout Measure (AABM-NL) was evaluated within a sample of 45 autistic women from the Autism Expertise Center. Preliminary findings of the AABM-NL scores demonstrated promising evidence of good internal consistency and convergent validity. Positive associations were observed between AABM-NL scores and a Likert scale assessing identification with autistic burnout, as well as with an instrument measuring physical and psychological complaints (SCL-90-R; Symptom Checklist-90-Revised). Specifically, anxiety, somatization, cognitive-performance deficits, and depression were correlated with the severity of autistic burnout. There was no significant difference between work status and the severity of autistic burnout, implying no employment-related connection. The AABM-NL effectively differentiated between women with and without autistic burnout, with 62 points as a suitable cut-off point. However, these results may not be generalized to women requiring daily living support, individuals beyond outpatient psychiatric settings, or those in institutionalized populations. The preliminary findings provide empirical evidence supporting the use of the AABM-NL as a potential tool for assessing autistic burnout in women receiving outpatient psychiatric care. Its implementation may contribute to programs aimed at recognizing and preventing autistic burnout in women. Further research is needed to enhance intervention strategies for mitigating the risk of autistic burnout.

Differences in the depression and burnout networks between doctors and nurses: evidence from a network analysis

BACKGROUND

Previous studies have demonstrated a strong association between depression and job burnout among healthcare professionals, but the results have been inconsistent, and there is a lack of in-depth exploration of such a relationship among different healthcare professions. The present study aims to investigate the interrelationships between depression and burnout among Chinese healthcare professionals and whether there are differences in the networks of these symptoms between doctors and nurses.

METHODS

The Maslach Burnout Inventory-General Survey and the 2-item Patient Health Questionnaire were employed to assess job burnout and depression among 3,684 healthcare professionals. The translation has been refined to ensure accuracy and academic suitability. Subsequently, network analysis was conducted on 2,244 participants with a higher level of job burnout to identify core symptoms and explore the associations between job burnout and depression.

RESULTS

The present study showed a network association between lack of interest and pleasure in things and being exhausted from work, excessive tiredness facing work, tendency to collapse at work, and lack of passion for work than before among healthcare professionals, as well as a notable difference in the network association between lack of interest and pleasure in things and lack of passion for work than before between nurses and doctors.

CONCLUSIONS

The depression-burnout network structures differ between doctors and nurses, highlighting the need for targeted intervention measures for both groups.

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Association between anxiety, depression symptoms, and academic burnout among Chinese students: the mediating role of resilience and self-efficacy

BACKGROUND

To explore the associations between anxiety and depression symptoms and academic burnout among children and adolescents in China, and to examine the role of resilience and self-efficacy in addressing academic burnout.

METHODS

A total of 2,070 students in grades 4-8 were recruited from two primary and three middle schools in Shanghai, completed the Elementary School Student Burnout Scale (ESSBS), the Multidimensional Anxiety Scale for Children-Chinese (MASC-C), the Center for Epidemiological Studies Depression Scale (CES-D), the Connor-Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES), with 95.04% effective response rate. Multivariable regression analyses examining the associations between anxiety / depression symptoms and academic burnout (as well as the associations between resilience / self-efficacy and academic burnout) were performed using STATA 16.0 and SmartPLS 3.0.

RESULTS

Anxiety symptoms (β = 0.124, p < 0.01) and depression symptoms (β = 0.477, p < 0.01) were positively correlated with academic burnout. Resilience partially mediated the association between depression symptoms and academic burnout (β = 0.059, p < 0.01), with a mediation rate of 12.37%. Self-efficacy partially mediated the associations between anxiety symptoms and academic burnout (β = 0.022, p < 0.01) and between depression symptoms and academic burnout (β = 0.017, p < 0.01), with mediation rates of 17.74% and 3.56%, respectively. Resilience and self-efficacy together (β = 0.041, p < 0.01) formed a mediating chain between depression symptoms and academic burnout, with a mediation rate of 8.6%.

CONCLUSIONS

Anxiety and depression symptoms were positively associated with academic burnout. Resilience and self-efficacy were found to mediate the associations partially.

Burnout Among Young Adults With Type 1 Diabetes

PURPOSE

The purpose of this qualitative descriptive study was to describe the experience of diabetes burnout in young adults with type 1 diabetes (T1DM). In addition, aims included participant perspectives of risk and protective factors associated with burnout and ways to balance everyday life with diabetes self-management (DSM).

METHODS

Young adults with T1DM (N = 11) were recruited through social media platforms and modified snowball sampling and interviewed. Informational redundancy was achieved. Qualitative thematic coding and analysis were conducted within and across transcripts.

RESULTS

Diabetes burnout was described as the willingness to put diabetes and DSM on the "back burner" and let things slide due to exhaustion, frustration, apathy, and the desire to be like everyone else for a while. Risk and protective factors were identified along with strategies to achieve balance of DSM in everyday life.

CONCLUSIONS

This study identified a clear definition of diabetes burnout and acknowledges this concept as distinct and separate from other psychosocial conditions. Health care providers can utilize this information to identify individuals at risk for diabetes burnout and offer more effective support to lessen the overall burden associated with T1DM.

Relationship Between Chronic Health Conditions and Occupational Burnout in the Early Care and Education Workforce

OBJECTIVE

The early care and education (ECE) workforce experiences high rates of poor mental and physical health outcomes, which impact staff well-being and burnout. This study aimed to assess the relationship between chronic health conditions and occupational burnout in ECE Head Start staff working in low-resourced locations.

METHODS

This study administered an 89-item cross-sectional survey to 332 ECE staff employed in 42 Head Start centers in the United States. Staff self-reported on the following 10 chronic health conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, high blood pressure, insomnia, lung disease, and musculoskeletal disorders.

RESULTS

We found that multimorbidity of chronic conditions significantly predicted overall burnout ( B = 2.39, P < 0.01), particularly related to emotional exhaustion ( B = 2.04, P < 0.01).

CONCLUSIONS

Workplace interventions targeting emotional exhaustion related to chronic health conditions are recommended to effectively address occupational burnout among ECE staff.

Quantifying the prevalence and predictors of burnout in emergency medical services personnel

INTRODUCTION

Recently, burnout has amassed considerable attention because of deleterious effects on workers and the work environment. Frequently, EMS clinicians find themselves prone to experiencing burnout, yet little is known about etiologies in this population.

OBJECTIVE

To estimate prevalence and predictors of burnout in EMS clinicians.

METHODS

This was a cross-sectional survey study of nine EMS agencies from North Carolina selected based on geography and population. Emergency medical technicians (EMTs), advanced EMTs, and paramedics were included. Emergency medical responders and air medical personnel were excluded if those positions were a primary occupational function. The Professional Quality of Life (ProQOL) Scale was used to assess burnout. Parametric and nonparametric testing was used to assess factors potentially affecting burnout. Factors significant in univariate analyses were included in a hierarchical linear regression model to determine unique predictors of burnout while controlling for confounders. The area under the curve (AUC) of the receiver operating characteristic (ROC) was used to determine model predictability.

RESULTS

A total of 686 EMS clinicians completed the survey. Overall, 57.3% (n = 393) were likely to have burnout. Of the 328 respondents who were likely to have burnout, 254 (77.4%) and 211 (75.1%) also were identified as likely to suffer from compassion fatigue or vicarious trauma, respectively. Overall, 152 (22.2%) were likely to suffer from all three stress disorders, 118 (56.5%) of which scored high enough to potentially produce immune system dysregulation. Prior suicidal thoughts ((sr2 = 0.042, p < 0.001), attempts (sr2 = 0.025, p < 0.001) or the presence of vicarious trauma (sr2 = 0.040, p < 0.001) accounted for 4.2%, 2.5%, and 4.0% of model variance, respectively. Years of field experience (sr2 = 0.035, p < 0.001) and credential level (sr2 = 0.011, p = 0.005) accounted for 4.6% of model variance. Finally, a respondent's experience or knowledge of debriefing (sr2 = 0.008, p = 0.023); experiencing adversity in childhood in the form of familial mental illness, depression, or suicide (sr2 = 0.009, p = 0.016); or the incarceration of a family member (sr2 = 0.010, p = 0.011) accounted for a combined 2.7% of model variance. Model predictability showed an AUCROC of 81.5%.

CONCLUSIONS

This study showed a nearly 60% prevalence of occupational burnout in the group of EMS clinicians surveyed, making burnout of considerable concern in this population. Further study is needed to address occupational factors that contribute to burnout in EMS clinicians.

The interaction of occupational stress and job burnout on depressive symptoms in railway workers in Fuzhou city

BACKGROUND

To explore the relationship between occupational stress, burnout and depressive symptoms among railroad workers in Fuzhou, and to analyze the interaction of burnout and occupational stress on depressive symptoms.

METHODS

In this study, 861 railway employees of Fuzhou railway bureau were randomly selected from January to April, 2022. Occupational stress inventory revised edition (OSI-R), China job burnout inventory (CMBI) and Symptom Checklist-90 (SCL-90) were used to investigate the occupational stress, job burnout and depressive symptoms of railway workers. Interactions associated with depressive symptoms were assessed by linear hierarchical regression analysis and SPSS macros (PROCESS).

RESULTS

Occupational stress, job burnout and depressive symptoms accounted for 50.58%, 93.47%, and 11.19% of the study population, respectively. There were intergroup differences between age, marriage status, and length of service (P < 0.05). Occupational stress and job burnout are the main risk factors for depressive symptoms (OR: 2.01, 95% CI: 1.17-3.45; 1.94, 1.69-2.23, respectively). More importantly, further analysis of the interaction between occupational stress and job burnout showed that those with high levels of job burnout had a high-risk effect on depressive symptoms at high levels of occupational stress.

CONCLUSION

Occupational stress and job burnout are risk factors for depressive symptoms among railroad workers in Fuzhou City. The interaction of job burnout and occupational stress increases the risk of depressive symptoms.

A systematic literature review of the stereotype content model in the fields of psychology and marketing: main themes examined in the literature and an agenda for future research in marketing

The stereotypes content model indicates that two traits (i.e., warmth and competence) govern individuals' impression formation. The great variety of research that has used this theory since the early 2000s leads to a need for a structured overview of prior findings. The goal of this study is to provide a concise map of research streams and present a research agenda. We conducted a systematic literature review of 955 articles. A bibliographic coupling analysis showed four clusters, i.e., (1) the general theoretical foundations of the SCM, (2) the societal impact of key stereotypes (with emphasis on gender), (3) research in clinical psychology and child development, and (4) marketing. Taking a closer look at research in marketing (using co-occurrence analysis), six research streams were identified, including research on branding, country-of-origin, front-line service providers, prosocial consumer behavior, perception of endorsers, and, more recently, on artificial intelligence (AI). The review presents key findings and research gaps across these topics. Finally, we reviewed the few articles that, although not falling into these streams, opened important research veins. This process provided the essential information to present a promising and complete research agenda, to continue building knowledge with impactful implications in different contexts.

Job stress and burnout among Finnish municipal employees without depression or anxiety

BACKGROUND

Job burnout is associated with job stress but also with mental health symptoms, depression and anxiety.

AIMS

This study aims to evaluate the effect of job stress on burnout without the effect of depression and anxiety.

METHODS

A cross-sectional study was conducted in 2015 among 673 employees (88% female) from four public service sectors in Pori, Finland. Job burnout was assessed with the Bergen Burnout Indicator (BBI-15). Job stress was assessed by combining psychological risk factors (demand control, effort rewards and mental workload). Respondents who reported symptoms of depression and anxiety were excluded from the analyses.

RESULTS

Of the eligible study subjects (n = 617), 10% reported symptoms of at least mild burnout but only 1% severe burnout. The burnout symptoms varied from 6% to 21% by sector of public service. Job burnout was cumulatively associated with job stress factors. One job stress factor increased the risk of burnout 2-fold (relative risk [RR] 2.13; confidence interval [CI] 0.97-4.68), two factors 6-fold (RR 6.56; 2.92-14.8Or), and three factors even more (RR 23.5; CI 8.67-63.8). Similar trends were observed in the analysis of job burnout components (exhaustion, cynicism and professional inadequacy).

CONCLUSIONS

Our results indicate that job burnout is also strongly associated with job stress in employees who do not have depressive or anxiety symptoms. As job burnout may precede clinical depression or reduce productivity and well-being at work, it is essential to perform surveys to monitor burnout symptoms among the workforce, and design interventions to prevent remarkable job strain.

The impact of the Systematic Assessment for Resilience (SAR) framework on students' resilience, anxiety, depression, burnout, and academic-related stress: a quasi-experimental study

BACKGROUND

Medical students face significant psychological stress, impacting their academic performance and well-being. The Systematic Assessment for Resilience (SAR) framework is designed to enhance resilience and mitigate stress among medical students, addressing the need for interventions within the assessment system in medical education. The aim of this study was to evaluate the implementation of SAR framework on medical students' resilience, anxiety, depression, burnout, and academic stress.

METHODS

This study employed a quasi-experimental design with pre- and post-testing. It involved the training of course coordinators in implementing the SAR framework and its integration into the daily learning activities. Fourth-year medical students were assessed before and after the intervention using standardized measures of resilience, anxiety, depression, burnout, and academic stress. Data were analyzed using quantitative methods and thematic analysis for qualitative feedback.

RESULTS

Post-intervention, students demonstrated a significant increase in resilience scores (p < 0.001) and a notable decrease in measures of anxiety, depression, and academic stress (p < 0.001). The burnout types were also statistically different (p < 0.001) except client-related burnout (p > 0.05). Qualitative feedback of the course coordinators highlighted an improved learning environment, increased coping strategies, and a more supportive academic culture.

CONCLUSION

The SAR framework significantly contributes to enhancing medical students' resilience and reducing psychological distress. Its implementation suggests a promising approach to fostering a supportive educational environment that not only addresses the psychological challenges faced by medical students but also enhances their academic performance and overall well-being. Further research is warranted to explore the long-term impacts of SAR across different medical education contexts.

The association between problematic internet use and burnout: A three-level meta-analysis

BACKGROUND

Burnout has received considerable attention in recent years because of the adverse consequences for people. Theoretical perspectives propose that problematic internet use is a significant potential risk for burnout. Despite a plethora of studies showing a positive association between problematic internet use and burnout, there remains a contentious debate regarding the extent and direction of this association.

METHODS

This study aims to perform a three-level meta-analysis to evaluate the strength of the relationship between problematic internet use and burnout through a quantitative synthesis of eligible studies published until April 2023.

RESULTS

A total of 42 studies with 54,121 participants and 103 effect sizes were identified. The results indicated a positive, moderate, and significant association between problematic internet use and burnout. Furthermore, the subgroup analysis found that this association was moderated by population, dimension of burnout, and the measure of burnout, however, some study features (i.e., region, type of problematic internet use, gender, and publication year) could not explain the heterogeneity across individual studies.

LIMITATIONS

Studies included in the current meta-analysis mainly used cross-sectional designs, which limited the potential to make inferences on the causal relationship between problematic internet use and burnout.

CONCLUSIONS

Individuals with problematic internet use have exhibited higher levels of burnout. Overall, these findings develop a deeper understanding of this association between problematic internet use and burnout and have implications for the direction of future research and interventions.

Burnout and depression in college students

Research on burnout has garnered considerable attention since its inception. However, the ongoing debate persists regarding the conceptual model of burnout and its relationship with depression. Thus, we conducted a network analysis to determine the dimensional structure of burnout and the burnout-depression overlap. The Maslach Burnout Inventory-Student Survey and Patient Health Questionnaire-9 were used to measure burnout and depression among 1096 college students. We constructed networks for burnout, depression, and a burnout-depression co-occurrence network. The results showed that cynicism symptom was the most central to the burnout network. In the co-occurrence network, depressive symptoms ("anhedonia", "fatigue") and burnout symptom ("doubting the significance of studies") were the most significant in causing burnout-depression comorbidity. Community detection revealed three communities within burnout symptoms, aligning closely with their three dimensions identified through factor analysis. Additionally, there was no overlap between burnout and depression. In conclusion, our findings support a multidimensional structure of burnout, affirming it as a distinct concept separate from depression. Cynicism, rather than exhaustion, plays the most important role in burnout and the burnout-depression comorbidity.

Association Between Global Sleep Quality and Coronary Microvascular Function in Male Physicians With Occupational Burnout

OBJECTIVE

Occupational burnout has been associated with an increased risk of coronary heart disease, although the mechanisms involved are elusive. We investigated whether poor global sleep quality is associated with impaired coronary microvascular function in male physicians, a professional group at increased risk of burnout.

METHODS

Study participants were 30 male physicians with clinical burnout and 30 controls without burnout defined by the Maslach Burnout Inventory. Global sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular functions were quantified with myocardial perfusion positron emission tomography. In multivariable analyses, the interaction between burnout and the PSQI global score was regressed on measures of coronary microvascular function, adjusting for age, body mass index, physical activity, alcohol consumption, and main effects of burnout and PSQI score.

RESULTS

The prevalence of poor sleepers (PSQI score >5) was 40% in the burnout group and 10% in the control group. Adjusting for covariates, burnout-by-global PSQI score interactions were observed for myocardial blood flow (MBF) at rest ( r partial = -0.30, p = .025), endothelium-dependent coronary flow reserve ( r partial = -0.26, p = .062), MBF response ( r partial = -0.30, p = .028), and hyperemic MBF ( r partial = -0.34, p = .012). The global PSQI score was inversely associated with these MBF measures in the burnout group relative to the control group. No significant interactions emerged for endothelium-independent MBF.

CONCLUSIONS

In male physicians with occupational burnout, poor global sleep quality was associated with reduced endothelium-dependent coronary microvascular function, suggesting a mechanism by which burnout may affect cardiovascular health.

Relationship between depression and burnout among nurses in Intensive Care units at the late stage of COVID-19: a network analysis

BACKGROUND

Mental health problems are critical and common in medical staff working in Intensive Care Units (ICU) even at the late stage of COVID-19, particularly for nurses. There is little research to explore the inner relationships between common syndromes, such as depression and burnout. Network analysis (NA) was a novel approach to quantified the correlations between mental variables from the perspective of mathematics. This study was to investigate the interactions between burnout and depression symptoms through NA among ICU nurses.

METHOD

A cross-sectional study with a total of 616 Chinese nurses in ICU were carried out by convenience sampling from December 19, 2022 to January19, 2023 via online survey. Burnout symptoms were measured by Maslach Burnout Inventory-General Survey (MBI-GS) (Chinese version), and depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9). NA was applied to build interactions between burnout and depression symptoms. We identified central and bridge symptoms by R package qgraph in the network model. R package bootnet was used to examined the stability of network structure.

RESULTS

The prevalence of burnout and depressive symptoms were 48.2% and 64.1%, respectively. Within depression-burnout network, PHQ4(Fatigue)-MBI2(Used up) and PHQ4(Fatigue)-MBI5(Breakdown) showed stronger associations. MBI2(Used up) had the strongest expected influence central symptoms, followed by MBI4(Stressed) and MBI7 (Less enthusiastic). For bridge symptoms. PHQ4(Fatigue), MBI5(Breakdown) and MBI2(Used up) weighed highest. Both correlation stability coefficients of central and bridge symptoms in the network structure were 0.68, showing a high excellent level of stability.

CONCLUSION

The symptom of PHQ4(Fatigue) was the bridge to connect the emotion exhaustion and depression. Targeting this symptom will be effective to detect mental disorders and relieve mental syndromes of ICU nurses at the late stage of COVID-19 pandemic.

System-level recommendations for improved wellness for gynecologic oncologists: A Society of Gynecologic Oncology Review

Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.

Nurses quality of life, sleep disturbance, and intention to leave critical care units: A cross-sectional moderated mediation analysis

OBJECTIVES

This study aims to explore the complex relationships between personal and demographic factors, intermediary factors such as quality of life (depression, anxiety, stress, burnout), and the mediating impact of sleep disturbance on nurses' intention to leave critical care units.

DESIGN

Cross-sectional quantitative survey.

SETTING

Data were collected from registered nurses at a major university hospital in southern Italy. Seven inpatient critical care units were sampled.

MAIN OUTCOME MEASURES

Intention to leave critical care units.

RESULTS

We included 160 participants recruited over five weeks in May and June 2023. The data showed that most were female, married, and possessed a bachelor's degree in nursing. The mean quality of life score was moderate, while stress, anxiety, and burnout were mild. A significant percentage of nurses reported poor sleep quality. Logistic regression indicates that service length did not significantly impact the intention to leave. The structural equation model showed that stress positively correlated with emotional exhaustion, whereas job quality was negatively associated with emotional exhaustion and the intention to leave. Sleep disturbance did not explain the relationship between stress and emotional fatigue; however, the results revealed that male gender moderated sleep mediation.

CONCLUSIONS

This study investigated factors influencing intention to leave among critical care unit nurses. The results suggest that the role of sleep disturbance should always be considered when assessing the issue. In this chain of causes, sleep disturbance explains the relationship between stress and emotional exhaustion. Furthermore, the strength of this mediation was influenced by gender, particularly by the male gender.

IMPLICATIONS FOR CLINICAL PRACTICE

Stress and emotional exhaustion significantly impact nurses' working quality of life, particularly when sleep quality is taken into account. This leads to a higher intention to leave critical care units. To reduce this tendency, healthcare managers could implement specific evidence-based interventions to promote a good climate of work, which would positively affect stress, emotional exhaustion and sleep disturbance. The likelihood of intention to leave decreased with achieving personal self-fulfilment among nurses.

From magical thinking to suicide: Understanding emergency physicians' psychological struggle

Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking-in this case, the belief that perfection is possible despite evidence to the contrary-leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.

Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review

BACKGROUND

Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions.

METHODS

A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL.

RESULTS

Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation.

CONCLUSIONS

While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.

Conditional reciprocal stressor-strain effects in university students: a cross-lagged panel study in Germany

University students worldwide are facing increasing mental health challenges. Traditional stress models, like the Job/Study Demand-Resources Model, link stressors directly to strain. Yet, recent studies suggest the influence of strain on stressors may be even stronger. Our research explored these reciprocal dynamics among university students, considering social support and mindfulness as potential moderators. We conducted a two-wave panel study with 264 university students. We ran separate cross-lagged panel structural equation analyses for three key health outcomes-emotional exhaustion, depression, and well-being-each paired with perceived study stressors, specifically workload and work complexity. Findings revealed significant stressor and strain effects, with social support notably moderating the impact of emotional exhaustion on workload. These insights challenge traditional stress theories and underscore the importance of mental health support and effective stress management strategies for students, emphasizing the need for proactive mental health initiatives in academic environments.

Prevalence and associated factors of burnout among working adults in Southeast Asia: results from a public health assessment

The COVID-19 pandemic has spotlighted the mental health crisis among employees worldwide. However, burnout research is often industry- or occupation-specific, and limited knowledge currently exists on the prevalence of burnout in the general working population of Southeast Asia. This study aims to examine the prevalence of employee burnout and its associated factors among working adults in Southeast Asia using secondary data. 4,338 full-time employees aged 18-65 years old living in Malaysia, Singapore, Philippines, and Indonesia were assessed for burnout, depression, anxiety, stress, and sociodemographic characteristics as part of an online public health assessment in October 2022. The prevalence of burnout in the region was 62.91%. Burnout was highest among employees in the Philippines (70.71%) and lowest in Malaysia (58.13%). Experiencing burnout was associated with severe or extremely severe depression (AOR = 6.48 [95% CI = 5.06-8.33]), anxiety (AOR = 2.22 [1.74-2.85]), and stress (AOR = 5.51 [4.13-7.39]). Working more than 50 hours a week (AOR = 1.38 [1.04-1.82]) and being very dissatisfied with the job led to higher odds of burnout (AOR = 16.46 [8.99-30.53]). Alarmingly, more than half of working adults in the region are reporting increased levels of burnout, and improving employee mental health and work conditions may be key to improving employee burnout in the region. Findings contribute to existing research on burnout prevalence in the region and provide more comprehensive insights into understanding the factors driving employee burnout in the working population of Southeast Asia 2 years after the onset of the pandemic.

Experiences of a Therapeutic Equine-Assisted Group Intervention for People with Common Mental Disorders on Sick-Leave

Common mental disorders such as anxiety, depression and stress-related disorders are increasing worldwide, resulting in long-term sick leave and lower quality of life. Traditional treatment is often insufficient to facilitate the recovery process, and the need for holistic interventions that enable successful recovery is evident. Equine-assisted interventions have shown promising results in health promotion among people with mental disorders, and further research is needed to implement them within the range of available care. The aim of the study is therefore to describe experiences of a therapeutic equine-assisted group intervention for people with common mental disorders on sick leave. The study has a descriptive qualitative design with an inductive approach. Ten participants with common mental disorders on sick leave were interviewed after participating in a 12-week equine-assisted intervention and the data were analysed with conventional content analysis. The analysis generated the overall theme "The equine-assisted group intervention facilitates recovery," which summons the four categories "The environment of the horses contributes to relaxation and an ability to be in the present," "The presence of the horses facilitates supportive relationships in the group," "Interplay with the horses entails physical activity and bodily improvements" and "Emotional interactions with the horses strengthen inner power." In conclusion, equine-assisted interventions have the potential to facilitate recovery for people with common mental disorders by providing relaxation, promoting the ability to be in the present, cultivating supportive relationships and providing physical activity and bodily improvements as well as emotional interactions that strengthen the participants' inner power.

Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis

INTRODUCTION

Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI.

METHODS

A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023.

RESULTS

Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group.

CONCLUSION

Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective.

IMPLICATIONS FOR PRACTICE

MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

How COVID-19 prevention burnout impacts emotional symptoms among Chinese college students: A moderated mediation model

The current study investigated the relationship between COVID-19 prevention burnout and emotional symptoms (depression and anxiety) among 1,837 Chinese college students and the underlying mechanisms. Results from moderated mediation analysis revealed that the association between COVID-19 prevention burnout and emotional symptoms was mediated by psychological inflexibility (β = 0.20, 95%CI = [0.10, 0.19]). Also, COVID-19 prevention burnout's direct and indirect effects on emotional symptoms were more substantial for students with high susceptibility to emotional contagion than those with low susceptibility. These findings contribute to understanding how COVID-19 prevention burnout relates to emotional symptoms and provide a new perspective for interventions promoting students' psychological flexibility, particularly those with higher susceptibility to emotional contagion.

The burnout-depression conundrum: investigating construct-relevant multidimensionality across four countries and four patient samples

This research seeks to contribute to the ongoing discussion about the distinctive nature of burnout and depression. In a first study, we relied on employee samples from four European countries (N = 5199; 51.27% women; Mage = 43.14). In a second study, we relied on a large sample of patients (N = 5791; 53.70% women; Mage = 39.54) who received a diagnosis of burnout, depressive episode, job strain, or adaptation disorder. Across all samples and subsamples, we relied on the bifactor exploratory structural equation modelling to achieve an optimal disaggregation of the variance shared across our measures of burnout and depression from the variance uniquely associated with each specific subscale included in these measures. Our results supported the value of this representation of participants' responses, as well as their invariance across samples. More precisely, our results revealed a strong underlying global factor representing participants' levels of psychological distress, as well as the presence of equally strong specific factors supporting the distinctive nature of burnout and depression. This means that, although both conditions share common ground (i.e. psychological distress), they are not redundant. Interestingly, our results also unexpectedly suggested that suicidal ideation might represent a distinctive core component of depression.