High Levels Of Burnout Symptoms Research Articles

Healthcare worker burnout during a persistent crisis: a case-control study.

During the immediate outbreak of the COVID-19 pandemic, burnout symptoms increased among healthcare workers. Knowledge is needed on how early symptoms developed during the persistent crisis that followed the first pandemic wave. To investigate if high levels of burnout symptoms during the first pandemic wave led to high burnout and depressive symptoms up to a year later, and if participation in psychological support was related to lower levels of symptoms. A longitudinal case-control study followed 581 healthcare workers from two Swedish hospitals. Survey data were collected with a baseline in May 2020 and three follow-up assessments until September 2021. The case group was participants reporting high burnout symptoms at baseline. Logistic regression analyses were performed separately at three follow-ups with case-control group assignment as the main predictor and burnout and depression symptoms as outcomes, controlling for frontline work, changes in work tasks and psychological support participation. One out of five healthcare workers reported high burnout symptoms at baseline. The case group was more likely to have high burnout and depressive symptoms at all follow-ups. Participation in psychological support was unrelated to decreased burnout and depressive symptoms at any of the follow-ups. During a persistent crisis, healthcare organizations should be mindful of psychological reactions among staff and who they place in frontline work early in the crisis. To better prepare for future healthcare crises, preventive measures on burnout are needed, both at workplaces and as part of the curricula in medical and nursing education.

Burnout as a multidimensional phenomenon: how can workplaces be healthy environments?

Abstract Purpose Burnout was already a significant problem before the pandemic, but in the aftermath became a serious concern and a public health and occupational health priority. This study had two aims. First, we investigated how different healthy workplace dimensions and other health individual-level variables are related to burnout. Second, we examined differences in terms of presenteeism, absenteeism, and quality of life between employees who report burnout symptoms and those who do not. Methods Participants were 1702 Portuguese employees from various organizations; 69.68% were female, age ranged from 18 to 72 years (mean = 43.25 years, SD = 10.40). Almost half of the participants (49.9%; 851 participants) reported having at least one burnout symptom. Results Participants reported that they have felt exhausted (43.7%), irritated (34.5%) and sad (30.5%) always or very often in the last 4 weeks. Regression analysis revealed that the global score on burnout symptoms was negatively related to leadership engagement, psychosocial work environment, personal health resources, health behaviours, and satisfaction with salary. In addition, the global score on burnout symptoms was positively related to worker involvement, enterprise community involvement, perceived stress, and screen time at work. Furthermore, females tend to report a higher level of burnout symptoms compared to males. In addition, burnout has an impact on sickness absenteeism, presenteeism, and quality of life. Conclusions Our findings have an important contribution to understanding and promoting a healthier work environment, and reinforce the need for measures and policies to promote mental health, manage stress, and prevent burnout in the workplace.

When a Crisis Hits, Send in the Psychologists? A Latent Transition Analysis of Help-Seeking Behavior Among Swedish Healthcare Workers During the COVID-19 Pandemic

During a crisis, there is limited time to plan support initiatives for healthcare workers and few resources available to ensure that they engage with them. Using the context of the recent COVID-19 pandemic, this study aimed to investigate help-seeking behaviors among healthcare workers in relation to psychological support initiatives offered to them. Data from a Swedish longitudinal survey following healthcare workers from early (N = 681) to mid-pandemic (N = 396) were analyzed using latent class and transition analyses. We found three patterns of healthcare workers’ help-seeking behavior that applied to both time points: (1) engaging with different forms of group-based support, (2) not participating in any kind of offered support, and (3) only having been offered information-based support. The availability of support declined during the mid-pandemic. Group support users were primarily nurses and frontline workers, with higher levels of burnout symptoms. Our findings suggest that healthcare organizations should limit their implementation of psychological support during a crisis to a few key formats based on social support. Promoting participation from all staff groups may enhance the inclusivity, effectiveness, and sustainability of the support.

Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study.

The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation. In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.

Experienced burnout and teacher–working environment fit: a comparison of teacher cohorts with or without persistent turnover intentions

ABSTRACT This follow-up study compared two teacher cohorts: teachers with and without persistent turnover intentions. Burnout symptoms including exhaustion, cynicism towards the professional community, inadequacy in teacher-student interaction, and perceived teacher–working environment fit in terms of received recognition and constructive work climate were explored. The longitudinal survey data included 1064 teachers from Finnish basic education (grades 1–9, age 7–16), of which 344 (32%) reported persistent turnover intentions in a five-year follow-up. Results showed that teachers with persistent turnover intentions experienced higher levels of burnout symptoms and decreased levels of perceived teacher–working environment fit than teachers with no turnover intentions. Moreover, in a five-year follow-up, a higher level of experienced teacher–working environment fit in the earlier career phase predicted a lower level of experienced cynicism towards the teacher community later in both teacher cohorts. Perceived teacher–working environment fit did not predict experienced exhaustion or inadequacy in teacher-student interaction. The results suggest that the teacher cohorts did not differ in terms of the internal dynamics and interplay between experienced burnout symptoms and perceived teacher–working environment fit. However, teachers with persistent turnover intentions had increased risk of becoming alienated from the professional community and developing burnout.

Self‐perceived clinical competence, gender and workplace setting predict burnout among psychotherapists

AbstractWork‐related stress, or burnout, is elevated among healthcare staff but the specific risk factors for psychotherapists are not clear, which makes it difficult to design interventions to target this population. Therefore, the aim of this study was to investigate a set of background variables and work‐related risk factors for burnout among psychotherapists. Potential protective factors such as level of education, number of years in the profession and access to clinical supervision were investigated. Symptoms of burnout were measured with the Copenhagen Burnout Inventory, and data were collected from 327 psychotherapists. In this group, 62% reported moderate or high levels of burnout symptoms, with significantly higher levels of personal‐ and work‐related burnout than client‐related burnout. Being female, having low self‐perceived competence and working in the public sector were associated with higher levels of burnout. Other factors, such as age, work experience, level of education or having clinical supervision, were not associated with burnout after controlling for gender, perceived competence and workplace setting. These results confirm previous research that underlines the importance of perceived competence and control over one's work environment, and that women are at higher risk of burnout, possibly because of factors outside of work. The importance of perceived competence as a protective factor suggests that methods that increase therapeutic competence may play an important role in countering work‐related stress. In conclusion, there may be a need to continue to develop and integrate specific burnout prevention interventions for psychotherapists.

Slower information processing speed is associated with persistent burnout symptoms but not depression symptoms in nursing workers

ABSTRACT Introduction: Burnout and depression both occur with chronic work-related stress, and cognitive deficits have been found when symptom severity results in work disability. Less is known about cognitive deficits associated with milder symptoms among active workers, and few studies have examined whether cognitive deficits predict persistent burnout and depression symptoms. The goal of this study was to examine the association of information processing speed and executive function performance to burnout and depression symptoms at baseline and 12-month follow-up in a sample of actively working individuals (N = 372). Method: The design was prospective with laboratory cognitive data at baseline, and burnout and depressive symptoms assessed at baseline and monthly follow-ups. Information processing speed and executive functions were assessed in a task-switching paradigm, including single-task reaction time (RT), switching costs, and mixing costs. Burnout was assessed with the Exhaustion subscale of the Oldenburg Burnout Inventory and depression with the Patient Health Questionnaire-9. Results: Slower RT was modestly associated with higher levels of burnout symptoms both cross-sectionally and prospectively, but switching costs and mixing costs were not associated with burnout symptoms. None of the cognitive measures were associated with depression symptoms cross-sectionally or prospectively. Conclusions: Despite statistically significant findings of slowed RT in acute exhaustion-related burnout, the proportion of variance accounted for in the models was small and did not predict clinically significant levels of distress. The absence of statistically significant findings for depression symptoms suggests the cognitive profile associated with the exhaustion dimension of burnout may be distinct from that of depression, which reflects a more heterogeneous symptomatology. Our data suggest the clinical impact of burnout symptoms on actively working individuals is marginal; nonetheless, it is important to screen and intervene on burnout and depression symptoms in the workplace because they can lead to other forms of work impairment.

Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia.

BackgroundBurnout is common among nurses and midwives. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation.MethodsSymptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden's nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11–15 years after graduation. A total of 2474 nurses (62%) consented to participate at follow-up. Burnout was measured using items from the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up.FindingsThe prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression.InterpretationThe results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses’ careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs).FundingAFA Insurance Grant [number 150284].

Chronic diseases, age and gender: examining the contribution to burnout symptoms in a sample of 2075 Canadian workers.

This cross-sectional study aims to evaluate the role of chronic diseases, and their interactions with age and gender, on the emotional exhaustion component of the burnout syndrome. Data came from the Salveo Study conducted in 2009-2012. It contained a random sample of 2075 Canadian workers employed in 63 workplaces. Multilevel regression models were estimated. Main effects of chronic diseases were first evaluated, and then age-chronic diseases interactions were tested. Analyses were performed on the total sample and stratified by gender. All analyses were adjusted for work conditions decision latitude, physical and psychological demands, work hours, social support and rewards. Mental and behavioural disorders, diseases of the nervous system, the musculoskeletal system and connective tissue, and genitourinary system are associated with a higher level of burnout symptoms. Associations with mental and behavioural disorders, and diseases of the nervous system are stronger for men than women. Age increases the association of behavioural disorders, diseases of the nervous system, and genitourinary system and burnout. Age may moderate the association of nervous and genitourinary systems diseases with burnout in women. Workplaces must be more proactive to better recognise the role of chronic diseases on burnout and to implement preventive measures. The development of interventions towards specific risk groups is needed.

A cross-sectional study of job burnout, psychological attachment, and the career calling of Chinese doctors

BackgroundThe main objectives of this study were as follows: (1) evaluate the prevalence of burnout syndrome among doctors, (2) establish associations with demographic factors in China, and (3) examine the mediating role of psychological attachment in the relationship between job burnout and career calling.MethodsThis cross-sectional survey was conducted by administering an online questionnaire in May 2016. The survey was performed across Thirty provinces. In total, A total of 3016 Chinese doctors were selected as participants, of which 2617 completed valid questionnaires (effective response rate: 86.77%).ResultsThe overall prevalence of burnout symptoms among Chinese doctors was 85.79%. Little variance was reported for burnout symptoms according to age (Waldχ2 = 6.843, P < 0.05, OR < 1), professional title (Waldχ2 = 13.110, P < 0.05, OR > 1), and daily working hours (Waldχ2 = 7.226, P < 0.05, OR > 1). However, the burnout of Chinese doctors was found to be associated with psychological attachment (B = − 0.6433, P < 0.0001) and career calling (B = 0.3653, P < 0.0001); furthermore, psychological attachment (B = 0.2350, P < 0.001) mediated the relationship between job burnout and career calling.ConclusionBurnout symptoms among Chinese doctors were prevalent and associated with age, professional title, and long working hours. Chinese doctors aged 20–30 experienced a much higher level of burnout symptoms. The longer hours doctors worked, the more likely they were at risk of burnout symptoms, especially among attending physicians. Doctors who endured high-level burnout tended to exhibit decreasing psychological attachment, which threatened their sense of career calling. Finally, this paper proposed related explanations for the function mechanisms based on both theoretical and practical perspectives.

Consequences of Early Career Nurse Burnout: A Prospective Long-Term Follow-Up on Cognitive Functions, Depressive Symptoms, and Insomnia

Background: Burnout is common among nurses and midwifes. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation. Methods: Symptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden’s nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2472 nurses (62%) consented to participate at follow-up. Burnout was measured using the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used multivariable logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up. Findings: The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression. Interpretation: The results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses’ careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs). Funding: AFA Insurance Grant [number 150284]. Declaration of Interests: All authors report no competing interests. Ethics Approval Statement: Ethical permission was given by the Regional Research Ethics Committee at Karolinska Institutet, Stockholm, Sweden (Dnr 01-045), and the Regional Ethics Review Board in Stockholm, Sweden (Dnr 04-587 and for the long-term follow-up Dnr 2016 / 793-32).

Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork.

To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. Semi-structured interviews were conducted with nurses (N=11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.

Burnout Evaluation of Radiation Residents Nationwide: Results of a Survey of United States Residents

Toassess rates of burnout among US radiation oncology residents and evaluate program/resident factors associated with burnout. A nationwide survey was distributed to residents in all US radiation oncology programs. The survey included the Maslach Burnout Index-Human Services Survey (MBI-HSS) as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal accomplishment from MBI-HSS subscale scores. Binomial logistic models determined associations between various residency/resident characteristics and high burnout levels. Overall, 232 of 733 residents (31.2%) responded, with 205 of 733 (27.9%) completing the MBI-HSS. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least 1 of these 2 MBI-HSS subscales. Low rates of personal accomplishment occurred in 12% of residents. Twelve residents (5.9%) reported feeling "at the end of my rope" on a weekly basis or more. On multivariable analysis there was a statisticallysignificant inverse association between perceived adequacy of work-life balance (odds ratio 0.37; 95% confidence interval 0.17-0.83) and burnout. Approximately one-third of radiation oncology residents have high levels of burnout symptoms, consistent with previous oncology literature, but lower levels than those among physicians and residents of other specialties. Particularly concerning was that more than 1 in 20 felt "at the end of my rope" on a weekly basis or more. Targeted interventions to identify symptoms of burnout among radiation oncology residents may help to prevent the negative downstream consequences of this syndrome.

(P101) Burnout Evaluation of Radiation Residents Nationwide (BERRN): Results of a Survey of United States Residents

Burnout is an increasing problem among U.S. physicians. Up to half experience professional burnout which is associated with many negative consequences, including decreased job satisfaction, increased medical errors, divorce, and even self-harm. Burnout varies widely among residents in different specialties and has been associated with a drop in medical knowledge equivalent to one full year of training. However, burnout has never been formally assessed among U.S. radiation oncology residents. A nationwide survey was sent to all U.S. radiation oncology program directors and coordinators as published by the Association of Residents in Radiation Oncology. The survey included the Maslach Burnout Index (MBI)-Human Services Survey, a validated and widely accepted burnout assessment questionnaire, as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal achievement as measured on MBI subscale scores. Overall, 205 residents responded, representing 28.0% of the 733 radiation oncology residents nationwide. Of the respondents, 31.2% were women. Response by post-graduate year (PGY) was 26.3% PGY-2, 26.8% PGY-3, 21.5% PGY-4, and 25.4% PGY-5. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least one of these MBI subscales. Furthermore, 12% had low rates of perceived personal achievement. Twelve residents (5.9%) reported feeling “at the end of my rope” on a weekly basis or more. Approximately one third of radiation oncology residents have high levels of burnout symptoms. Particularly concerning was that more than one in twenty felt at the end of their rope on a weekly basis or more. Steps should be taken to identify program or resident-specific factors associated with burnout, followed by targeted interventions aimed at addressing modifiable factors to prevent the negative consequences of burnout.

Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices

This study aimed to clarify the differential contributions of situational and individual factors to burnout symptoms experienced by two independent groups of specialist oncology nurses working in oncology hospital units or in hospices. The study involved a group of specialist oncology nurses working in hospital oncology units (n = 59) and a group of specialist oncology nurses working in hospices (n = 33). Participants were invited to provide demographic data, and indicate the clinical setting in which they worked and their work experience; the Italian versions of the Maslach Burnout Inventory (MBI) (a measure of burnout symptoms), the Hospital Anxiety and Depression Scale (HADS) (a measure of anxiety and depression), and the Attachment Style Questionnaire (ASQ) (a measure of relational style) were then administered. The two groups of nurses were well matched for age, work experience, and levels of anxiety and depression. Regarding their relational style, the two groups only differed significantly on two subscales of the ASQ (i.e. "Confidence" and "Relationships as Secondary"). The two groups significantly differed in the levels of all burnout symptoms investigated (emotional exhaustion, depersonalization, and personal achievement), with nurses working in hospital units showing higher levels of burnout symptoms. Interestingly, multivariate regression analyses showed that the institutional factor (clinical setting in which nurses worked) clearly emerged as the only factor that influenced the level of all burnout symptoms, whereas the contribution of individual factors was less significant. These findings help to clarify the differential contributions of institutional and individual factors to burnout symptoms in specialist oncology nurses, and corroborate the need for interventions to contain nurses' burnout symptoms.

Work stress and attentional difficulties: An initial study on burnout and cognitive failures

Professional burnout is a stress-related disorder, having mental exhaustion due to work stress as its most important characteristic. Burned out individuals also often complain about attentional problems. However, it is currently not clear whether such complaints are based on true cognitive deficits or whether they merely reflect the way burned out individuals rate their own cognitive performance. To confirm the cognitive complaints we used a cognitive failure questionnaire (CFQ) to assess the level of self-reported attentional difficulties in daily life. We also measured performance on tasks of sustained attention and response inhibition (the SART and the Bourdon-Wiersma Test). We compared three groups: (1) a group of ‘burned out’ individuals (n=13) who stopped working due to their symptoms and sought professional treatment; (2) teachers at a vocational training institute (n=16) who reported high levels of burnout symptoms but continued to work; and (3) teachers from the same institute (n=14) who reported no burnout symptoms. The level of burnout symptoms was found to be significantly related to the number of cognitive failures in daily life, and to inhibition errors and performance variability in the attentional tasks. To our knowledge, explicit tests of objective cognitive deficits in burned out individuals have not been conducted before. Consequently, this is the first study to indicate that burnout is associated with difficulties in voluntary control over attention and that the level of such difficulties varies with the severity of burnout symptoms.