Burnout-depression overlap: a review

Exhaustion Disorder in Primary Care: A Comparison With Major Depressive Disorder and Adjustment Disorder

Exhaustion disorder (ED) was introduced to the Swedish version of the International Classification of Diseases, 10th edition (ICD-10) 2005. Primarily characterized by general fatigue and cognitive deficits, ED has become one of the most common mental health diagnoses in Sweden. Little is still known regarding the discriminative validity of the ED diagnosis and how it relates to other diagnostic constructs. The study aimed to investigate the discriminative validity of ED compared with two similar diagnoses, major depressive disorder (MDD) and adjustment disorder (AD). Using data from a sample of patients with a principal diagnosis of either ED (n = 352), MDD (n = 99), or AD (n = 302), we compared demographic and clinical variables and scores on self-report symptom scales. Results showed that ED patients were of a higher age and had a higher frequency of sickness absence than MDD and AD patients. There was a substantial overlap of symptoms between ED and MDD, only differing on two of nine self-report symptom scales, with ED patients rating lower work ability d = -0.37 and alcohol consumption d = -0.57. Compared with AD patients, ED patients reported more severe symptoms in every symptom domain. Given the prevalent use of ED diagnosis, its diagnostic validity and clinical usefulness merit further attention.

Delayed onset of depressive symptoms in deployed Dutch military personnel: Identifying distinct psychological, biochemical, and genetic pre-deployment profiles

BACKGROUND

Depression is common in the military, with research highlighting variability in depressive symptom development after deployment. This report builds on previous findings to explore differences in pre-deployment psychological, biochemical, and genetic variables across distinct depressive symptom trajectories, with a particular focus on the delayed-onset-increasing trajectory.

METHODS

A sample of 846 military personnel deployed to Afghanistan (2005-2008) was categorized into resilient (66 %, n = 558), intermediate-stable (20 %, n = 173), symptomatic-chronic (9 %, n = 74), and delayed-onset-increasing (5 %, n = 41) trajectories from pre- to 10 years post-deployment. Differences in pre-deployment characteristics (e.g., psychological, biochemical, and genetic) among the depression trajectories were examined using a non-parametric multivariate analysis.

RESULTS

Individuals in the delayed-onset-increasing trajectory had higher general mental health symptom scores than those in the resilient trajectory, but lower scores on fatigue, burnout, and personality factors than the symptomatic-chronic trajectory. No differences were found between the delayed-onset-increasing and the intermediate-stable trajectory. The symptomatic-chronic and resilient trajectories showed significant different scores across most pre-deployment psychological characteristics compared to the other trajectories. For the biochemical and genetic variables no significant differences were found.

CONCLUSIONS

Our study found that pre-deployment characteristics do not distinguish the delayed-onset-increasing trajectory from the intermediate-stable trajectory, with differences emerging post-deployment likely due to negative life events. Individuals vulnerable in one aspect of mental health may be at risk across multiple psychological domains, highlighting the need to focus on a broader range of symptoms to support vulnerable military personnel and enhance resilience.

Urine Metabolomic Patterns to Discriminate the Burnout Levels and Night-Shift-Related Stress in Healthcare Professionals

Burnout syndrome, which significantly impacts both individual and societal quality of life, is primarily characterized by three key criteria: depersonalization, emotional exhaustion, and low personal accomplishment, all linked to work-related stress. Purpose: Comparative evaluation of urine metabolite patterns that may discriminate the burnout levels and the effects of night shifts on healthcare professionals. The Maslach Burnout Inventory survey was administered to 64 physicians and nurses working day and night shifts, with scores for each criterion recorded. Methods: Urine samples were collected, and metabolomic patterns were analyzed using UHPLC-QTOF-ESI+-MS technology. This analysis employed both untargeted and semi-targeted metabolomics, coupled with multivariate and ANOVA statistics, utilizing the online Metaboanalyst 6.0 platform. Partial Least Squares Discriminant Analysis (PLSDA) was performed, along with VIP values, Random Forest graphs, and heatmaps based on 79 identified metabolites. These were further complemented by biomarker analysis (AUC ranking) and pathway analysis of metabolic networks. Results: The findings highlighted the biochemical effects of night shifts and their correlation with burnout scores from each dimension. Conclusions: This study demonstrated the involvement of three major metabolic pathways in diagnosing burnout: lipid metabolism, particularly related to steroid hormones (cortisol, cortisone, and androsterone metabolites); energetic metabolism, involving long-chain acylated carnitines as transporters of free fatty acids, which play a role in burnout control; and a third pathway affecting catecholamine metabolism (neurotransmitters derived from tyrosine, such as dopamine, adrenaline, and noradrenaline), as well as tryptophan metabolism (serotonin and melatonin metabolites) and amino acid metabolism (including aspartate, arginine, and valine).

Predictive value of burnout complaints and depressive symptoms for medically certified sickness absence among physicians in Sweden: a 1 year follow-up observational study

OBJECTIVE

This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden.

DESIGN

A 1 year follow-up panel cohort observational study-the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February-May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March-May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey.

SETTING

Swedish primary and specialist healthcare.

PARTICIPANTS

At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up.

PRIMARY AND SECONDARY OUTCOME MEASURES

ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment Tool (BAT-23) was used to measure burnout, including a burnout total score and scores for the four symptom dimensions of exhaustion, mental distance, emotional impairment and cognitive impairment. Depressive symptoms were assessed using the Symptom Checklist-core depression (SCL-CD6). Associations between baseline burnout and depressive symptoms and subsequent ACMCSA were estimated with logistic regression analyses.

RESULTS

ACMCSA was found in 9% of the participating physicians. In the sample, 4.7% had severe burnout complaints, and 3.7% had depressive symptoms. Burnout (OR=2.57; 95% CI=1.27 to 5.23) and the burnout symptom dimensions emotional impairment (OR=1.80; 95% CI=1.03 to 3.15) and cognitive impairment (OR=2.52; 95% CI=1.12 to 5.50) were associated with a higher likelihood of subsequent ACMCSA. Depressive symptoms were not associated with ACMCSA when adjusted for severe burnout complaints and other covariates.

CONCLUSION

This study demonstrates the distinction between burnout and depressive symptoms, particularly in predicting future ACMCSA. Early intervention targeting exhaustion and burnout may mitigate symptom development and reduce the risk of ACMCSA.

Internalized Shame Experiences and Burnout in General Surgery Residents

OBJECTIVE

General surgery residents have high rates of professional burnout, characterized by depersonalization, emotional exhaustion, and reduced sense of personal accomplishment. While shame experiences in surgical residency have been sparsely studied, there are no studies evaluating internalized shame states in surgical residents. This study quantifies internalized shame in surgical residents and its association with burnout. We hypothesized that higher levels of internalized shame would be associated with higher odds of burnout.

DESIGN

This cross-sectional study was conducted via an anonymous survey consisting of demographic information, the Maslach Burnout Inventory (MBI), and the Experience of Shame Scale (ESS), both validated measures. Multivariable logistic regression was used to determine the association between ESS and MBI scores, controlling for age, sex, relationship and parental status, and resident seniority level.

SETTING

The survey was distributed among United States general surgery residency programs via email through the Association of Program Directors in Surgery.

PARTICIPANTS

Categorical general surgery residents were invited to participate.

RESULTS

122 general surgery residents responded to the survey. Respondents were 61.48% female (n = 75), with a median age of 31 (IQR 29-32) and distributed across postgraduate years. On multivariable logistic regression, increased ESS scores were significantly associated with higher odds of burnout (OR 1.11, 95% CI 1.06-1.16, p < 0.001).

CONCLUSIONS

General surgery residents experience high rates of internalized shame (median ESS score 54.5, IQR 43-69), and shame states are significantly associated with increased odds of experiencing burnout. Interventions to minimize internalized shame experiences may help mitigate the high rates of burnout found in general surgery residents.

A Scoping Review of Prevention Classification in Mental Health: Examining the Application of Caplan's and Gordon's Prevention Frameworks (2018-2024)

Mental health prevention is a global priority owing to the increasing burden of mental disorders exacerbated by global crises such as the COVID-19 pandemic, climate change, economic instability, and armed conflicts. These crises have heightened the need for effective preventive strategies addressing mental health across different life stages and populations. To structure and classify such strategies, Caplan's and Gordon's frameworks have been widely used, with one focusing on disease progression and the other on population risk. Although both frameworks are frequently used in mental health prevention, their application in clinical trials remains unexplored. This review addresses this gap by examining how Caplan's and Gordon's frameworks have been applied in mental health prevention, identifying research gaps, and exploring their potential for their combined application to enhance prevention strategies. A scoping review was conducted following PRISMA-ScR guidelines. Studies were selected based on predefined criteria and the data were synthesized. The search spanned PubMed, Scopus, APA PsycArticles, and PubPsych, covering peer-reviewed clinical trials, including randomized controlled trials, published between 2018 and 2024 in English or German. Eligible studies classified interventions based on Caplan's framework, which focuses on disease stage (primary, secondary, tertiary), or Gordon's framework, which categorizes prevention by population risk (universal, selective, indicated). Studies had to focus on mental health prevention, include populations relevant to mental health and well-being, and report mental health or well-being outcomes. Of the 40 included studies, six applied Caplan's framework, 30 applied Gordon's framework and three used a modified classification based on Gordon's approach. One study applied both frameworks, highlighting that their complementary use is rare. Studies were conducted in 19 countries, with the highest number from Germany (n = 8), the USA (n = 8), and the Netherlands (n = 6), across four continents (Asia, n = 5; Australia, n = 5; Europe, n = 22; North America, n = 8). Gordon's framework was applied more frequently, particularly in universal (n = 15) and indicated prevention (n = 12), while Caplan's framework was used mainly in primary prevention (n = 4). Depression (n = 25), anxiety (n = 21), stress (n = 8), and general mental health (n = 8) were the most frequently assessed outcomes. The studies targeted diverse populations, including children (n = 7), adolescents (n = 8), children and adolescents (n = 1) parents and their children or adolescents (n = 2), university students (n = 6), working adults (n = 7), older adults (n = 1), and adults without specifying (n = 8). This review highlights the underutilized potential of integrating Caplan's and Gordon's frameworks in mental health interventions. Two application examples illustrate how these frameworks can be combined to structure prevention strategies more effectively. Future research should explore combining these frameworks to enhance prevention strategies and address the emerging global health challenges.

Burnout among South African nurses during the peak of COVID-19 pandemic: a holistic investigation

BACKGROUND

The wellbeing of health care workers (HCWs) has been an ongoing challenge, especially within low and middle-income countries (LMICs) such as South Africa. Evidence suggesting that HCWs are increasingly stressed and burned out is cause for concern. Nurses in particular have been impacted physically, mentally and psychosocially during the recent COVID-19 pandemic. This may leave a disproportionate consequence, affecting various aspects of their wellbeing, thereby justifying a need for a more holistic investigation of the wellbeing of South African nurses and their coping mechanisms during the peak of the pandemic.

METHODS

This was a cross-sectional study design. Online self-reported questionnaires were administered in six hospitals, sampled purposively and conveniently from three South African provinces. Using STATA 18.0, the Wilcoxon Ranksum test at 5% alpha compared the wellbeing and coping mechanisms of nursing staff and nursing management during COVID-19's peak. Univariable and multivariable linear regression analyses were performed to determine factors associated with burnout in nurses, at a 95% confidence interval (CI). Validated scales measuring burnout, coping, resilience, as well as mental and physical health were utilised.

RESULTS

Of 139 participants, 112(97.4%) were females, with 91(82%) and 20(18%) being nursing staff and management respectively. The median age of the participants was 43.3 years (n = 112), with a practising duration of 12 years (n = 111). There was a significant difference in the burnout score between nursing staff and nursing management (p = 0.028). In the univariable linear regression model, burnout was significantly (p < 0.05) associated with the Brief COPE Inventory (BCI), Conor-Davidson Resilience Scale (CDRS), Global Mental and Health Scale (GMHS), Global Physical and Health Scale (GPHS) and Hospital Anxiety and Depression Scale (HADS), as well as occupation. In the multivariable linear regression model, burnout was significantly associated with the CDRS [Coeff.=0.7, 95%CI 0.4; 0.9], GMHS [Coeff.=-2.4, 95%CI -3.2; -1.6], GPHS [Coeff.2.1, 95%CI 1.3; 2.9], and HADS [Coeff.=0.7, 95%CI 0.2; 1.2].

CONCLUSION

Investigating multiple aspects of wellbeing in this study, it's shown that coping and resilience may not be key factors in promoting the wellbeing of South African nurses. However, effective mental health interventions are crucial and should be prioritised to mitigate burnout during future health emergencies. Future studies examining the associations between general health, coping and resilience may help generate further evidence towards holistic interventions aimed at promoting nurses' wellbeing.

CLINICAL TRIAL NUMBER

Not applicable.

State and trait markers to define the continuum of affective disorders

Recently a substantial body of biological evidence, converging data from biochemistry, neurophysiology, pharmacology, immunology, and neuroimaging has been collected to underpin the concept of continuum of affective disorders. Overall, it is comprised of two dimensions. One is clinical, which spans from major depressive disorder to bipolar spectrum, with mixed and sub-threshold states. The other dimension is causal, based mainly on evidence about the heterogenous etiological structure of mood disorders, including organic and exogenous brain disorders (such as multiple sclerosis, neurodegenerative diseases, intoxications) manifested in prodromal stages with affective disturbances, and "functional" or endogenous mood disorders. This Special Issue will explore the trait and state complex markers which define the continuum of affective disorders in both causal and clinical perspective.

Prevalence and risk factors of burnout syndrome among public health personnel in the Errachidia Province (Morocco)

BackgroundPublic health workers in the Errachidia province (Morocco) are confronted with a multitude of professional challenges that may precipitate burnout syndrome (BOS). Nevertheless, epidemiological studies in Morocco investigating this syndrome and its associated risk factors remain limited.ObjectiveTo identify burnout syndrome characteristics among health staff and investigate the main factors associated with the development of this syndrome.MethodsAn exhaustive cross-sectional study was implemented, with a target group of 750 health personnel. The Maslach Burnout Inventory test was used to assess burnout status. Binary Logistic regression was applied to estimate the risks associated with various socio-demographic, economic, and work-related environmental factors. The study was carried out in early 2019.ResultsAmong the 503 health personnel employed in public establishments who completed the distributed and validated forms (response rate = 67.1%), a noteworthy prevalence of burnout (63.22%) was identified. This prevalence signifies a genuine state of emotional, physical, and mental exhaustion among medical and paramedical staff in the study area. The final adjusted logistic model revealed a significant association between burnout and the urban setting, female gender, and nursing profession. Furthermore, our findings indicated that, despite some autonomy, health workers experienced a lack of recognition from the hierarchy, and operated in understaffed structures with a predominant focus on medical rather than social tasks. Such conditions increase the burnout risk.ConclusionsThe status of burnout among healthcare professionals is determined by a complex interplay of risk and protective factors. Effective management strategies are essential to improve the well-being of this population.

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study

BACKGROUND

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched.

AIM

To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives.

METHODS

Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment.

RESULTS

The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction.

CONCLUSIONS

Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

Physician Leadership and Its Effect on Physician Burnout and Satisfaction During the COVID-19 Pandemic

Purpose

Physician burnout is a global issue associated with low job satisfaction, decreased quality of patient care, reduced productivity, and early retirement from clinical practice. We sought to evaluate the impact of the leadership qualities of direct physician supervisors on the burnout and professional satisfaction of the physicians they supervise.

Methods

An online survey was distributed by Email to all staff physicians practicing at a large Canadian academic tertiary care hospital. The primary outcome was the prevalence of burnout and professional satisfaction, assessed using the 2-item Maslach Burnout Inventory and a single item 5-point Likert scale rating, respectively. The secondary outcome was the relationship between composite leadership score and burnout/satisfaction, with leadership assessed by the 12-item Mayo Clinic Participatory Management Leadership Index.

Results

Out of the 1176 physicians surveyed, 383 (32.6%) responded (51.2% male; 41.5% female). Overall, 41.7% of physicians reported at least one symptom of burnout (40.0% reported high emotional exhaustion; 15.3% reported high depersonalization). 40.1% of physicians reported being satisfied with the organization, 26.3% were neutral, and 33.6% were dissatisfied. On multivariate analysis adjusting for age, sex, duration of employment at the institution, and specialty, each one-point increase in composite leadership score was associated with a 3.1% decrease in the likelihood of burnout (p = 0.0017), and a 6.6% increase in the likelihood of satisfaction (p < 0.0001).

Conclusion

Physician burnout is prevalent and positive leadership qualities of direct supervisors decreases the likelihood of burnout in physicians and increases the likelihood of their satisfaction with the organization.

Trial Registration

ClinicalTrials.gov; Identifier: NCT04896307.

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model

Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.

Exploring occupational well-being profiles, outcomes, and predictors among Chinese teachers: A mixed-methods approach using latent profile and decision tree analysis

Understanding the varied profiles of occupational well-being, their outcomes, and predictors is key to formulating effective strategies for enhancing teachers' occupational health and well-being. This study employed latent profile analysis (LPA) to identify distinct occupational well-being profiles and their outcomes among 366 Chinese teachers, and decision tree analysis to explore the factors predicting each profile. The results showed three occupational well-being profiles: burnout, engaged, and burnout-engaged. The "engaged" group exhibited normal ranges for depression and stress, along with mild anxiety. The "burnout" group demonstrated moderate depression and stress, coupled with severe anxiety. The "burnout-engaged" group was near the threshold of mild depression and moderate anxiety. The result of the decision tree model revealed that marital status, teaching experience, income, role as a class teacher, school type, and working hours significantly influenced these occupational well-being profiles. Specific combinations of variables were associated with each occupational well-being profile, offering a nuanced understanding of the risky and protective factors for teacher occupational well-being. By identifying distinct occupational well-being profiles among Chinese teachers and their outcomes, and elucidating the key predictors and their interrelations, this study provides insights into how to quickly screen for teachers in need of help at work, and how to design targeted interventions for different teachers.

Is vital exhaustion distinct? A meta-analytic investigation on the immediate nomological network of vital exhaustion

A multitude of studies have supported that vital exhaustion is an important predictor of physical and psychological well-being, especially in the aftermath of adverse medical events; however, some authors have expressed that vital exhaustion may be repetitive with other popular constructs, namely burnout, fatigue, and depression. We resolve this tension by performing a meta-analysis of 74 sources on the immediate nomological network of vital exhaustion. Our results support that the relations of vital exhaustion with emotional exhaustion (r ¯  = 0.71, ρ ¯  = 0.82, k = 4, n = 1152) and depression (r ¯  = 0.70, ρ ¯  = 0.83, k = 59, n = 30,963) approached the magnitude of its convergent validity correlation (r ¯  = 0.75, ρ ¯  = 0.88, k = 4, n = 1445), suggesting that these constructs share most of their variance. Researchers should reinvestigate whether vital exhaustion relates to outcomes when accounting for these two constructs.

Latent profile analysis of sense of coherence and relationship with meaning of life and professional identity among nursing undergraduate

BACKGROUND

Enhancing nursing undergraduates' sense of coherence is crucial for the growth of the nursing workforce. Yet, existing research primarily examines the aggregate level of sense of coherence among nursing undergraduates and its correlations with other variables, overlooking the individual heterogeneity in nursing undergraduates' sense of coherence in nursing. This study aimed to identify different subgroups of nursing undergraduates' sense of coherence and explore the influencing factors pertinent to each subgroup.

METHODS

A cross-sectional study was conducted from May to June 2020 among 1,251 nursing undergraduates using convenience sampling. Latent profile analysis was employed to identify subgroups of nursing undergraduates' sense of coherence, and multiple logistic regression was utilized to analyze the factors associated with each subgroup.

RESULTS

Four potential subtypes of nursing undergraduates' sense of coherence were identified: low sensitivity-low coping group (25.7%), high sensitivity-high coping group (29.7%), moderate sensitivity-moderate coping group (17.8%), and high sensitivity-low coping group (26.8%). Multiple logistic regression analysis revealed that factors influencing nursing undergraduates' sense of coherence included family financial situation, high school subject choice, religious beliefs, belief in having good interpersonal relationships, meaning in life, and professional identity.

CONCLUSION

The heterogeneity of nursing undergraduates' sense of coherence suggests that nursing educators should provide targeted intervention guidance according to the potential category characteristics of nursing undergraduates' sense of coherence; at the same time, they should strengthen the cultivation of nursing undergraduates' meaning of life and professional identity to improve their level of sense of coherence, so as to promote the growth of the nursing workforce.

Validation of the Arabic Version of the Maslach Burnout Inventory-HSS Among Tunisian Medical Residents (A-MBI-MR): Factor Structure, Construct Validity, Reliability, and Gender Invariance

Background: Burnout is a major problem for physical and mental health of medical residents. The key for maintaining well-being and quality of care of residents is the assessing tool. The study evaluated the psychometric properties of the Arabic version of the Maslach Burnout Inventory Human Services Survey (MBI-HSS) among Tunisian medical residents by assessing its factor structure, construct validity, reliability, and gender invariance. Methods: A total of 552 residents, aged 27.01 ± 1.92, 219 males (39.7%) and 333 females (60.3%) completed the Arabic version of the A-MBI-MR. The exploratory (EFA) and confirmatory factor (CFA) analyses were performed to identify the factor structure, with assessments of internal consistency of the model, including gender measurement invariance. Results: The results indicate a high average variance extracted (AVE > 0.50) and factor loading of the scale, signifying robust construct validity and clearly suggesting that the items serve as essential indicators for assessing several dimensions of burnout. The reliability analysis demonstrates excellent and acceptable internal consistency across all areas of emotional exhaustion, personal accomplishment, and depersonalization (Cronbach's α = 0.95, 0.98, and 0.871) respectively. The CFA confirmed the three-factor structure of the A-MBI-MR, with fit indices indicating an adequate model fit: CFI = 0.945, TLI = 0.938, GFI = 0.951, RMSEA = 0.074, RMSEA CI (0.066, 0.081), RMSEA p-value= 0.000, SRMR = 0.044. Results from the measurement invariance analysis of the MBI scale demonstrated robust invariance between male and female participants. Conclusions: The MBI-MR in Arabic for medical residents is reliable, valid, and effective for measuring burnout levels in Arabic-speaking regions.

Longitudinal correlates of learning burnout among Chinese adolescents during the COVID-19 pandemic: A cross-lagged panel network analysis

BACKGROUND

Learning burnout as a serious psychological distress problem among adolescents during the COVID-19 pandemic was investigated using the cross-lagged panel network models.

METHODS

A three-wave study using a sample of 11 to 18-year-olds in China was conducted, with baseline data collected in June 2020 (n = 4156) and follow-ups in December 2020 (n = 3209) and August 2021 (n = 2324). Two temporal cross-lagged panel network models were computed to analyze adolescent learning burnout over time.

RESULTS

The predictive pathway of adolescent learning burnout demonstrates significant temporal specificity. In the early outbreak period, Positive thinking, Appreciation of life and Depression are the most influential predictive symptoms. In the normalized epidemic prevention period, Goal planning, Affect control and Positive thinking are the most influential predictive symptoms. However, during this period, the extent to which adolescent learning burnout is predicted by other symptoms in the networks is significantly reduced.

LIMITATIONS

The samples used in this study are not expected to be nationally representative, and therefore the generalizability of the results may be limited.

CONCLUSIONS

These findings highlight the predictive roles of Positive thinking, Appreciation of life, and Depression in adolescent learning burnout and the importance of timely intervention on these symptoms in the early outbreak period of public health emergency similar to the COVID-19 pandemic. Findings also illustrate the essentiality of eliminate unstable factors in the school environment during the normalized epidemic prevention period.

Burnout and its relationship with depressive symptoms in primary school teachers under the "Double Reduction" policy in China

Background

The "Double Reduction" policy requires schools to reduce Chinese students' extracurricular activities and homework to lessen academic stress and improve mental well-being. However, there is limited research on primary school teachers' psychological well-being within the context of the "Double Reduction" policy. This study examined self-reported burnout levels of primary school teachers and investigated the relationship between burnout and depressive symptoms in the context of the "Double Reduction" policy in China.

Methods

A cross-sectional survey recruited 3,199 primary school teachers from 15 cities across China. The teachers' burnout levels were assessed with the Maslach Burnout Inventory, and depressive symptoms were evaluated with the Patient Health Questionnaire depression scale.

Results

Under the "Double Reduction" policy in China, 66.6% of the primary school teachers experience burnout. Individual and work-related characteristics were independently correlated with burnout. These factors included holding a bachelor's degree (OR = 2.244, 95% CI: 1.559-3.230, p < 0.001), being married (OR = 0.598, 95% CI: 0.443-0.807, p < 0.001), being dissatisfied with one's income (OR = 2.602, 95% CI: 2.191-3.090, p < 0.001), and having an intermediate professional title (OR = 1.351, 95% CI: 1.086-1.681, p = 0.007). The correlation coefficients between burnout subscale scores and depressive symptoms were 0.588 for emotional exhaustion, 0.585 for cynicism, and - 0.180 for professional efficacy (all p < 0.001).

Conclusion

Our findings indicate that the prevalence of burnout among primary school teachers in China is exceptionally high, particularly under the "Double Reduction" policy. This situation is correlated with various psychological disorders, including depression. It is crucial to urgently implement psychological interventions for primary school teachers. Specifically, psychological assistance should be targeted at educators who are bachelor degree holders, married, dissatisfied with their income, and holders of an intermediate professional title.

Latent profile analysis of burnout, depression, and anxiety symptoms among Chinese medical staff with frontline anti-epidemic experience in the post-COVID-19 pandemic era

Background

Frontline medical staff's psychological symptoms deserve persistent attention after 3 years of high-pressure and high-intensity work during the pandemic. In addition, the meaning of burnout and its relationship with depression and anxiety have long been debated. This study aimed to identify profiles of these symptoms among Chinese medical staff with frontline anti-epidemic experience, along with their distinguishing characteristics.

Methods

Psychological symptoms of burnout (exhaustion, cynicism, and inefficacy), depression, and anxiety from 989 doctors and 1,105 nurses were explored with latent profile analysis. The R3step method was conducted to analyze the predictive factors of those medical staff's symptoms.

Results

Three symptom profiles were identified for medical staff, with high-level (62.1%), moderate-level (28.9%), and low-level symptoms (9.0%). In the low-level and moderate-level profiles, symptom variables considered had a consistent trend. However, within the high-level profile, the inefficacy of burnout remained at a lower level, and anxiety performed as the most prominent symptom. Variables of gender, age, salary satisfaction, work hours, and work intensity predicted medical staff profiles (p < 0.05).

Conclusion

In the post-COVID-19 era, former frontline Chinese medical staff's psychological symptoms were divided into three latent profiles. Symptoms of burnout, depression, and anxiety did not move in lock-step, indicating that they are different and robust constructs. Targeted intervention strategies should be developed for different subgroups.

Distinguishing risk factors for depression and burnout in parents managing type 1 diabetes mellitus in children

PURPOSE

Identifying factors affecting the mental health of parents with children diagnosed with type 1 diabetes mellitus is crucial in the caregiving process. The aim of this study was to determine the levels of burnout and depression in parents of children diagnosed with type 1 diabetes mellitus, as well as to identify the differential risk factors associated with these conditions.

DESIGN AND METHODS

Data for this cross-sectional and correlational study were collected online from 140 parents between April and June 2024, using the "Information Form", "Burnout Measure Short Version", "Depression Anxiety Stress Scale-21", and "Coping Style Scale". Multiple linear regression analysis was used to identify factors influencing depression and burnout levels.

RESULTS

The majority of parents exhibited symptoms of burnout and depression. Increased levels of stress and anxiety, negative changes in self-care, social life, and career, as well as the use of ineffective coping strategies, heightened the risk for both burnout and depression, while the use of effective coping strategies for stress reduced this risk. On the other hand, a longer duration of the child's illness and family income were distinguishing risk factors for the development of depression, whereas an increase in the parent's perceived competence in diabetes management was a protective factor against burnout.

CONCLUSIONS

These findings suggest that nurses should focus on supporting parents' stress management, diabetes management competence, and the use of effective coping strategies. In doing so, interventions aimed at reducing the risks of depression and burnout can be developed.

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.

Influence path of work-family conflict on primary care physicians' resignation intention: Data from a Chinese cross-sectional survey

BACKGROUND

Primary care physicians and their teams are the leading force in constructing primary medical services, undertaking the critical responsibility of residents' essential health, and also related to realizing the national health goal. However, primary care physicians generally have a high turnover rate due to problems such as high work pressure, low salary levels, and limited career development. Therefore, exploring primary care physicians' resignation intentions plays a vital role in promoting the construction of primary care physicians' health service system.

OBJECTIVE

This study explores the factors influencing the resignation intentions of primary care physicians, specifically examining the roles of work-family conflict, job satisfaction, professional identity, and emotional exhaustion. By understanding these dynamics, the research aims to inform strategies that can enhance the stability and effectiveness of primary care services, ultimately contributing to the improvement of public health infrastructure and achieving national health goals. This investigation will utilize structural equation modeling to analyze the interrelationships among the identified variables, thereby providing a comprehensive framework for addressing the high turnover rates among primary care physicians.

METHODS

This study uses the work-family conflict, job satisfaction, professional identity, and emotional exhaustion scales. The data comes from a cross-sectional survey in Zhejiang Province, China, in 2022. Using SPSS 27 and Mplus8.3 software to analyze 1205 primary care physicians and their team members, the selected cases all answered the relevant questions of resignation intention. The potential relationship among work-family conflict, job satisfaction, professional identity, emotional exhaustion, and family doctor resignation intention was explored by constructing structural equations.

RESULTS

Work-family conflict can directly and positively affect primary care physicians' resignation intention (β = -0.546, p < 0.001). The results of the mediation model found that job satisfaction, professional identity, and emotional exhaustion were significantly related to work-family conflict, and primary care physicians' resignation intention has a significant mediating effect. It mainly includes six intermediary approaches: one is through the independent intermediary effect of job satisfaction; the second is through the independent intermediary effect of professional identity; the third is through the chain intermediary effect between Job satisfaction and professional identity; the fourth is through the intermediary effect of Job satisfaction and emotional exhaustion chain intermediary; fifth is through the chain intermediary of professional identity and emotional exhaustion; sixth is through the complex chain intermediary of job satisfaction, professional identity, and emotional exhaustion.

CONCLUSION

Primary care physicians have a high score in resignation intention, which deserves continuous attention. Relevant department can help primary care physicians balance work and family roles, provide them with appropriate resources and rewards, as well as a good working environment and career development opportunities, to improve their job satisfaction and professional identity and reduce emotional exhaustion, thereby reducing the risk of resignation intention.

The effect of physical activity on depression: a lagged mediation study of school burnout

PURPOSE

In recent years, the problem of college student suicide has become more and more serious, and depression has become the main root cause, triggering the attention of colleges and universities at home and abroad. Based on the burnout theory, this study explores the intrinsic connection between physical activity, depression and academic burnout. Through two questionnaire surveys, the cross-sectional relationship between physical activity level, depression and academic burnout was analyzed. A parallel mediation model was developed to compare the mediating effects of physical activity and depression. Meanwhile, physical activity grading was quantified to assess the effect on improving academic burnout and depression.

METHODS

A longitudinal study was conducted utilizing a physical education classroom with questionnaires measuring students' physical activity, school burnout, and depression. The test was administered twice, at the beginning and end of the semester, with 305 valid participants each time. SPSS 27.0 was used to process the data, perform descriptive statistics and correlation analyses, and explore the relationships between variables. Multiple linear regression was used to analyze the mediating relationships and lagged effects of physical activity, school burnout, and depression. Finally, the amount of physical activity was graded to examine the effects of different intensities on school burnout and depression.

RESULTS

In a cross-sectional study at two time points, school burnout would serve as a mediator between college students' physical activity depression. We compared the lagged mediating effects of the two groups and found that school burnout (Time 2) had a more significant effect as a mediator. Finally, we graded the amount of physical activity according to the scale and found that only high-intensity physical activity affected depression (Time 2) through school burnout (Time 2).

CONCLUSION

There was temporal stability between physical activity, depression, and school burnout among college students. School burnout fully mediated the relationship between physical activity and depression at different time points and acted as a fully lagged mediator. School burnout at time 2 mediated the relationship between physical activity and depression more than school burnout at time 1. High-intensity physical activity was more effective in reducing depression and school burnout.

A network approach to understanding occupational psychological distress: linking depression, anxiety, and burnout among Chinese healthcare professionals

OBJECTIVES

As a population at high risk for psychological distress, healthcare workers typically experience varying degrees of anxiety, depression, and burnout. Studies have found that depression and anxiety have a negative impact on the mental health domain of burnout in healthcare workers. However, little is known about the symptom-to-symptom interactions between these psychological outcomes. This study aims to elucidate the characteristics of depression, anxiety, and burnout networks among healthcare workers.

METHODS

We recruited 846 healthcare workers from March to April 2023 from three hospitals. A total of 826 healthcare workers completed the General Information Scale, the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16), the Self-rating Anxiety Scale (SAS), and the Burnout Clinical Subtype Questionnaire (BCSQ)-36. The network models were constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network was assessed.

RESULTS

The results showed that the core symptoms in the symptom network mainly included QIDS8 (Energy/Fatigability), SAS3 (Easily upset or frightened), SAS11 (Dizzy), SAS8 (Tiredness), SAS10 (Tachycardia) and BCSQ3 (Worn-out), and the key nodes connecting these symptoms were QIDS2 (Sad mood), SAS20 (Have nightmares), BCSQ3 (Worn-out), SAS8 (Tiredness), QIDS8 (Energy/Fatigability), QIDS4 (Concentration/decision-making) and SAS4 (Madness).

CONCLUSION

Unique pathways of association between burnout, depression, and anxiety were found to exist. Interventions targeting core symptoms can maximize the improvement of depression, anxiety, and burnout, provide a deeper understanding of the relationship between the three conditions, and provide a target and basis for psychological interventions to improve the emotional wellbeing of healthcare workers and enhance their mental health.

Does Academic Burnout Alleviate or Exacerbate Internet Dependence in University Students with Depression and Anxiety?

Purpose

This study aims to investigate whether academic burnout alleviates or exacerbates internet dependence among college students with depression and anxiety. Moreover, it intends to construct a moderated mediation model to examine how academic burnout moderates the relationship between depressive and anxious emotions and internet addiction and how social support mediates this relationship to determine the psychological motivations underlying addiction.

Methods

A questionnaire survey was conducted using the simple random sampling method, which yielded 757 valid responses (response rate: a 93.11% response rate). The sample included 274 males and 466 females, with an average age of 20.90 years (±1.48). Hierarchical regression analysis was employed for data analysis.

Results

Anxiety and depressive symptoms directly affect the internet dependence of university students and indirectly affect it through the mediating role of social support. Academic burnout moderates the relationship between negative emotions and internet addiction, with high levels of academic burnout potentially decreasing the internet dependence of students experiencing negative emotions. We proposed a psychological self-regulation mechanism theory, which posits that learned helplessness may intensify the emotional symptoms of anxiety and depression, which is reflected in reduced internet use behavior.

Conclusion

High levels of academic burnout can exacerbate symptoms of depression and anxiety, significantly reducing students' interest in activities. For these students, a decrease in internet addiction may not be a positive sign; instead, it could indicate worsened depression and anxiety. This finding underscores the need for close monitoring of and intervention implementation for college students experiencing high levels of burnout and symptoms of depression or anxiety.

Validation of the Turkish version of the Chronic Stress Scale: assessing social role-related stressors and their impact on psychopathology

Introduction

Chronic social-role-related stress plays a crucial role in the development and progression of mental and medical disorders, making it an important factor to consider. This study aimed to translate and validate The Chronic Stress Scale (CSS) adapted by Turner for a Turkish population and explore its role in depression, anxiety, and perceived stress.

Methods

A total of 524 participants (mean age 31.59 years, 68% women) were recruited from Koç University and Basaksehir Cam Sakura City Hospitals, including 260 from the general population and 264 with depressive or anxiety disorders. The 51-item CSS was translated into Turkish and validated through reliability and validity analyses, including Cronbach's alpha, exploratory factor analysis, and correlations with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Perceived Stress Scale (PSS-14).

Results

The Turkish CSS showed good internal consistency (Cronbach's alpha = 0.90) and identified 13 dimensions of chronic stress (partner, children, work, loneliness, finances, workload, debt, relationship inoccupancy, family health, residence, family, ex-partner, and others). Dimensions were named based on the content of the items included. Significant correlations were found between CSS and BDI (r = 0.611, p < 0.001), BAI (r = 0.558, p < 0.001), and PSS-14 (r = 0.222, p < 0.001). Discriminant validity revealed significant score differences between clinical and general populations.

Conclusion

The Turkish CSS is a reliable and valid tool for assessing chronic social role-related stressors, supporting its use for both research and practice.

The Mediating Roles of Self-Compassion and Emotion Regulation in the Relationship Between Psychological Resilience and Mental Health Among College Teachers

Background

The compromised well-being of educators engenders a range of educational, social, and economic issues that cannot be adequately addressed through the mere awareness of risk factors. The present research explores the mediating roles of self-compassion and emotion regulation strategies (cognitive reappraisal and expressive suppression) on the relationship between academic teachers' psychological resilience and mental health.

Methods

A total of 405 academic teachers from four colleges in Tabuk City, Saudi Arabia, participated in the study between September and November 2023. The standardized questionnaires measuring psychological resilience (The Brief Resilience Scale- BRS), self-compassion (The Self-Compassion Scale-SCS), emotion regulation (The Emotion Regulation Scale-ERS), and mental health (General Health Questionnaire-12) were used to collect data. The bivariate correlation, regression, and path analysis were employed to investigate their associations.

Results

The findings demonstrated a significant positive impact of psychological resilience on mental health (β=0.39, p<0.001). Self-compassion emerged as a significant positive mediator, strengthening the association between resilience and mental health (β=0.18, p<0.01). Cognitive reappraisal was found to have a positive mediating effect on this relationship (β=0.16, p<0.01), highlighting its functional significance in regulating emotions. Conversely, expressive suppression was found to negatively mediate the relationship, with an indirect effect of β=-0.12 (p<0.05), indicating a maladaptive influence on mental health.

Conclusion

The research emphasizes the significance of fostering self-compassion and adaptive regulatory strategies, like cognitive reappraisal, while mitigating maladaptive approaches, including expressive suppression, in order to enhance the mental health of university educators. These findings underscore the necessity for culturally sensitive mental health interventions within educational institutions in Saudi Arabia.

Perceptions of Justice in Clinical Learning Environments: Development and Validation of an Organizational Justice Measure for Medical Trainees

PURPOSE

This study aimed to develop an instrument to measure medical trainees' perceptions of justice in clinical learning environments.

METHOD

Between 2019 and 2023, the authors conducted a multiyear, multi-institutional, multiphase study to develop a 16-item justice measure with 4 dimensions: interpersonal, informational, procedural, and distributive. The authors gathered validity evidence based on test content, internal structure, and relationships with other variables across 3 phases. Phase 1 involved drafting items and gathering evidence that items measured intended dimensions. Phase 2 involved analyzing relevance of items for target groups, examining interitem correlations and factor loadings in a preliminary analysis, and obtaining reliability estimates. Phase 3 involved a confirmatory factor analysis and collecting convergent and discriminant validity evidence.

RESULTS

In phase 1, 63 of 91 draft items were retained following a content validation exercise gauging how well items measured targeted dimensions (mean [SD] item ratings within dimensions, 4.16 [0.36] to 4.39 [0.34]) on a 5-point Likert scale (with 1 indicating not at all well and 5 indicating extremely well). In phase 2, 30 items were removed due to low factor loadings (i.e., < 0.40), and 4 items per dimension were selected (factor loadings, 0.42-0.89). In phase 3, a confirmatory factor analysis supported the 4-dimensional model ( χ2 = 610.14, P < .001; comparative fit index = 0.90, Tucker-Lewis Index = 0.87, root mean squared error of approximation = 0.11, standardized root mean squared residual = 0.06), with convergent and discriminant validity evidence showing hypothesized positive correlations with a justice measure ( r = 0.93, P < .001), trait positive affect ( r = 0.46, P < .001), and emotional stability ( r = 0.33, P < .001) and negative correlations with trait negative affect ( r = -0.39, P < .001).

CONCLUSIONS

Results indicate the measure's potential utility in understanding justice perceptions and designing targeted interventions.

Investigating workplace bullying (WPB), intention to quit and depression among nurses in the Upper West Region of Ghana

BACKGROUND

Intention to quit among nurses is increasingly recognized as a serious predictor of voluntary turnover. Voluntary turnover on the other hand is a significant factor fueling the shortage of nurses globally which could partly be blamed on negative workplace behaviors including but not limited to workplace bullying. Even though the relationship between workplace bullying and the intention to quit has been studied extensively, little is known about these concepts among nurses in Ghana.

AIM

The purpose of this study was to establish the relationship between workplace bullying among nurses and their intention to quit the profession in the Upper West Region of Ghana. We also determined the relationship between workplace bullying and depression among nurses.

METHODS

We employed a cross-sectional design with 323 nurses recruited through a multistage sampling technique. Data were collected using a structured questionnaire with a 98.5% (N = 318) response rate.

RESULTS

Initial descriptive statistics indicate that 64.4% (n = 203) of the nurses had intentions of quitting the job while 52.1% (n = 164) were depressed at various degrees based on scores on the DASS-21. Further analysis shows a positive linear relationship between WPB and intentions to quit. WPB was also correlated positively with depression among the nurses. This implies that an increased incidence of bullying at work is associated with increased intention to quit and depression among the nurses.

CONCLUSIONS

With over 50% of the nurses in this study intending to quit their jobs, it would be incumbent on nurse managers and other leaders at these health facilities to reconsider the work environment, policies, and leadership to prevent actual voluntary turnover. Managers must also fashion pragmatic strategies aimed at reducing stress and promoting the health and well-being of the nurses.

Association between physician burnout and patient safety: study protocol for an overview of systematic reviews and meta-analyses

INTRODUCTION

Burnout, a disorder caused by chronic stress at work, involves emotional exhaustion, depersonalisation and reduced professional efficacy. The prevalence of burnout appears to be high among physicians worldwide. Burnout may affect different dimensions of healthcare, such as patient safety. Several systematic reviews and meta-analyses have examined the relationship between physician burnout and quality of care, although with some controversial results. To our knowledge, no overview of systematic reviews and meta-analyses has been conducted, specifically evaluating physician burnout, patient safety and other relevant aspects of quality of care. The main objective of this study will be to evaluate the available evidence of the association between physician burnout and patient safety.

METHODS AND ANALYSIS

An overview of systematic reviews and meta-analyses will be carried out. Systematic reviews with or without meta-analyses assessing the relationship between burnout in physicians and quality of care will be included. The primary outcome will be patient safety (ie, the occurrence of any adverse event related to healthcare which could have resulted, or did result, in unnecessary harm to patients). Secondary outcomes will be patient satisfaction and professionalism. Literature searches will be conducted (from their inception onwards) in PubMed/MEDLINE, EMBASE and Cochrane Database of Systematic Reviews. Two researchers will select studies that meet the predefined eligibility criteria and proceed to extract information from each included study. The methodological characteristics, measures of association and qualitative conclusions of the reviews will be assessed. The methodological quality of each review will also be analysed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) tool. A descriptive synthesis will be carried out using evidence tables and graphs.

ETHICS AND DISSEMINATION

The proposed research mainly involves the analysis of existing studies, approval from a research ethics committee is not required. This overview of systematic reviews will help to gain a better understanding of the association between physician burnout and patient safety. Our findings could support future research, recommendations and policies in this area. We plan to publish the full study in a peer-reviewed journal.

REGISTRATION OF THE PROTOCOL

Open Science Framework: https://osf.io/wr73u/.

Early Childhood Education and Early Childhood Special Education Teachers' Perceived Stress, Burnout, and Depressive Symptoms

The current study examines the relationships between teachers' job-demands and resources, perceived stress, job burnout, and depressive symptoms through an online survey administered to early childhood education (ECE: n = 143) and early childhood special education (ECSE: n = 121) teachers in a western state of the United States. Results showed no difference between ECE and ECSE teachers in their levels of job-demands, resources, perceived stress, job burnout, and depressive symptoms. Both ECE and ECSE teachers' job-related stressors were positively related to their perceived stress, and their job commitment was negatively associated with job burnout. However, there were some differences in the correlates of job burnout between ECE and ECSE teachers. For ECE teachers, the number of children with disabilities and their teaching efficacy predicted their job burnout, whereas with ECSE teachers, job-related stressors and the supportiveness of school climate (or the lack thereof) were indirectly related to their job burnout through their perceived stress. The current study suggests that providing professional development for these teachers and enhancing a school's supportive climate will promote the well-being of both ECE and ECSE teachers.

A longitudinal study of hospital workers' mental health from fall 2020 to the end of the COVID-19 pandemic in 2023

Most longitudinal studies of healthcare workers' mental health during COVID-19 end in 2021. We examined trends in hospital workers eight times, ending in 2023. A cohort of healthcare workers at one organization was surveyed at 3-month intervals until Spring 2022 and re-surveyed in Spring 2023 using validated measures of common mental health problems. Of 538 workers in the original cohort, 289 (54%) completed the eighth survey. Repeated-measures ANOVA revealed significant changes in psychological distress (F = 7.4, P < .001), posttraumatic symptoms (F = 14.1, P < .001), and three dimensions of burnout: emotional exhaustion (F = 5.7, P < .001), depersonalization (F = 2.7, P = .01), and personal accomplishment (F = 2.8, P = .008). Over time, psychological distress and depersonalization increased, posttraumatic symptoms and personal accomplishment decreased, and emotional exhaustion fluctuated significantly without net change. Most measures did not improve significantly in the year prior to the declaration of the pandemic's end. The lack of improvement in psychological distress, emotional exhaustion, depersonalization, and personal accomplishment during the period in which COVID-19 case rates declined and public health measures were relaxed is a concerning indication of the chronicity of the impact of the pandemic on healthcare workers.

High overcommitment and low reward as potential predictors for increased depressive symptoms, suicidal ideation, and suicide risk in German veterinarians

Higher rates of depression, suicidal ideation and suicide risk have been reported for veterinarians in Germany. In this study, several demographic and job-related factors were examined to determine whether they could be considered possible predictors of depression, suicidal ideation, and suicide risk. For this purpose, a survey was conducted among veterinarians in Germany. The demographic factors surveyed were gender, age, working status (employed/self-employed), income, field of work (practicing/non-practicing veterinarian), weekly working hours and community size. For assessing job-related factors, the Effort-Reward-Imbalance questionnaire (effort, reward, overcommitment), several subscales of the Copenhagen Psychosocial Questionnaire (quantitative demands, emotional demands, demands for hiding emotions, meaning of work, work-privacy-conflict, thoughts of leaving the job) and the Copenhagen Burnout Inventory were used. A hierarchical logistic regression analysis was performed with the demographic and job-related factors as independent variables and depressive symptoms, suicidal ideation, and suicide risk as dependent variables, respectively. A total of 3.118 veterinarians (78.8% female) between 22 and 69 years (mean age 41.3 years) were included in the study. The factors used resulted in the highest variance explanation for depressive symptoms (57%), followed by suicidal ideation (34%) and suicide risk (23%). Low reward and high overcommitment were found to be the most important predictors of depressive symptoms, suicidal ideation, and suicide risk. Significant relationships with depressive symptoms, suicidal ideation, and suicide risk were also found for burnout, demands for hiding emotions, and thoughts of leaving the job. The results of this study point to opportunities for changes in the veterinary working environment, for the development of prevention and intervention programs for veterinarians, and for the further development of the veterinary curriculum to strengthen the mental health of veterinarians in Germany.

A Narrative Review of Burnout Syndrome in Medical Personnel

Burnout among healthcare workers has been extensively studied since its initial recognition in 1960, with its defining characteristics established by Maslach in 1982. The syndrome, characterized by emotional exhaustion, depersonalization, and low personal accomplishment, is exacerbated by work-related stress and has profound implications for individual and societal well-being.

METHODS

A review of the literature, including PubMed searches and analyses of risk factors and protective measures, was conducted to assess the prevalence, impacts, and biomarkers associated with burnout among healthcare workers. Various instruments for evaluating burnout were examined, including the widely used Maslach Burnout Inventory, alongside specific tools tailored to different occupational populations.

RESULTS

Healthcare workers, particularly physicians, exhibit significantly higher rates of burnout compared to the general population. Factors such as night shifts, workload, and exposure to biohazards contribute to elevated burnout risk. Biomarkers like cortisol, melatonin, and thyroid hormones have been linked to burnout, highlighting physiological implications.

CONCLUSIONS

Burnout poses significant challenges to healthcare systems globally, impacting patient care, worker retention, and overall well-being. Identifying and addressing risk factors while promoting protective factors such as resilience and social support are crucial in mitigating burnout. Further research into prevention strategies and biomarker monitoring is warranted to support the mental and physical health of healthcare workers.

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.

Prevalence of and factors associated with burnout in pediatric urology fellows

INTRODUCTION

The 2016 AUA census found 39% of practicing urologists experienced burnout. Burnout is a syndrome of emotional exhaustion, depersonalization, and decreased feelings of personal accomplishment due to workplace stress. Despite the demands of training, little is known about the prevalence of burnout in pediatric urology fellows.

OBJECTIVE

To determine the prevalence of burnout in pediatric urology fellows and factors associated with higher levels of burnout.

STUDY DESIGN

The Maslach Burnout Inventory (MBI) and an anonymous survey of personal and training characteristics were distributed electronically to pediatric urology fellows in April 2023. The MBI is a standardized and validated 22-item questionnaire used to quantify burnout and is comprised of three subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). As per prior literature, higher scores in EE (>27) or DP (>10) were defined as high burnout. Demographic and training characteristics were compared between fellows with high and low to moderate levels of burnout with t tests and Fischer's exact tests.

RESULTS

The survey response rate was 85% (29/34); 48% clinical fellows, 52% research fellows. Mean age of respondents was 31.4 years (SD 2.6), 59% female, 70% married, and 37% a parent. Mean scores for EE, DP, and PA were 15 (SD 10.2), 4 (SD 4.0), and 39 (SD 10.3), respectively, with no significant difference between year in fellowship. Nineteen percent of fellows met criteria for high burnout and 41% met criteria for moderate to high burnout based on EE or DP scores. Factors significantly associated with high burnout included number nights of call per month and number of projects required to complete in fellowship. Strategies fellows used most to combat burnout included quality time with family and friends, sleep, exercise, and watching TV/movies.

DISCUSSION

Nearly 20% of pediatric urology fellows scored for high levels of burnout and over 40% scored for moderate to high levels of burnout. There appears to be an association with increased call and project workload requirements with increased levels of burnout, and efforts to combat burnout could specifically address these factors. Fellows with more children at home had lower levels of burnout, and many trainees described quality time with family and friends as their preferred strategy to prevent burnout.

CONCLUSION

This survey-based study identifies risk factors for burnout in pediatric urology fellows. Fellows can use the information presented to consider personalized strategies to prevent burnout through training and into their careers.

Stress beliefs moderate the impact of COVID-19 related work stress on depressive, anxiety and distress symptoms in health care workers

Health care workers are at increased risk for mental health issues due to high psychological and physical job demands. According to a recent study, stress beliefs (i.e., believing stress to be detrimental to one's health) might influence physicians' mental health in response to a naturalistic stressor (COVID-19 hospital working conditions). Due to a small sample size and high alpha error inflation, the suggested association needs to be interpreted with caution. The current study aims to replicate those findings in a larger sample. A cross-sectional survey among N = 418 (64.1% female; Median age = 30-39 years) physicians and nurses of a large German medical centre was conducted during the COVID-19 pandemic (May/June 2021). Perception of pandemic related increase of work stress was assessed via self-report. Stress beliefs were assessed with the Beliefs About Stress Scale, and mental health symptoms were assessed with the 21-item Depression Anxiety Stress Scale. Stress beliefs moderated the association between increased work stress and mental health symptoms. Increased work stress was associated with increased depressive, anxiety and distress symptoms only in health care workers with medium (simple slope = 2.22, p < .001; simple slope = 1.27, p < .001; simple slope = 3.19, p < .001) and high (simple slope = 3.13; p < .001; simple slope = 1.66, p < .05; simple slope = 4.33, p < .001) negative stress beliefs. Among health care workers with low negative stress beliefs increased work stress was not associated with increased depressive, anxiety and distress symptoms. This confirms negative stress beliefs as variable of interest in research on the impact of stress on mental health in health care workers.

Psychological health in Palliative Care: Thematic analysis of a psychiatrist's and an art therapist's clinical reflexive journals

BACKGROUND

Patients receiving palliative care often face psychological distress, which can be challenging for clinicians to manage. Therefore, reflexive and visual journaling can be used as powerful techniques for clinician selfreflection and personal development. These journals are a form of practice wisdom, providing insights into psychological health in palliative care.

AIM

This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician's work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians.

DESIGN

Using Gibb's reflective cycle as a framework for journaling, this study employs reflexive and visual journaling through the lenses of a psychiatrist and an art therapist. Journal data were analysed using a thematic analysis approach.

SETTING/PARTICIPANTS

The two first authors journaled 107 clinical encounters and created 36 pieces of response art detailing encounters with patients and their families, and clinical conversations in two palliative care centres.

RESULTS

Patient attributes and the clinical environment were observed to influence psychological health in palliative care. The patient's ability to navigate dying, maintain personhood, exert resilience and experience satisfying relationships contribute to psychological health. A clinical environment comprising clinicians with holistic competencies, systems promoting interdisciplinary collaborations and a values-based culture that promotes patient centricity strengthens the delivery of psychological care.

CONCLUSIONS

Good psychological health in palliative care extends beyond psychopathology and is influenced by the cardinal elements of being human, value systems and systemic elements in the therapeutic environment.

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.

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

BACKGROUND

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.

AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Differentiating 'pure' and comorbid self-identified burnout: Diagnostic and management implications

OBJECTIVE

A previous study identified categorically differing scores on the Sydney Burnout Measure (SBM) between individuals with self-identified burnout with (n = 354) or without (n = 188) a history of mental illness. The current study examined whether the SBM's validity held in both scenarios.

METHOD

The factorial structure and scores on the SBM measure were compared between the two groups.

RESULTS

Similar underlying symptom constructs were identified. The group with a mental illness history had higher general factor scores, suggesting more severe burnout. The group without such a history (and thus a 'purer' burnout state) had higher scores on the empathy loss factor, suggesting its greater specificity to burnout than to other psychological states.

CONCLUSIONS

Burnout appears to be experienced similarly by those with and without a mental illness history as measured by the SBM.

Burnout among Chinese live streamers: Prevalence and correlates

BACKGROUND

The prevalence of burnout among live streamers remains largely unknown. This study aims to investigate the prevalence and factors associated with burnout among Chinese live streamers.

METHODS

A cross-sectional study recruited 343 full-time live streamers from 3 companies in Changsha city. Socio-demographic and occupational characteristics were collected using self-designed items. Job stress was assessed using the Job Content Questionnaire (JCQ-22), while supervisor and coworker support were evaluated using the last 8 items of the JCQ-22. Burnout was assessed using the 17-item Chinese version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

RESULTS

Our findings revealed that 30.6% of live streamers experienced burnout. Lower levels of education (OR = 2.65 and 3.37, p = 0,005 and 0.003), higher monthly income (OR = 10.56 and 11.25, both p = 0.003), being an entertainment-oriented streamer (OR = 2.13, p = 0.028), continuous walking during live streams (OR = 2.81, p = 0.006), significant drop in follower count (OR = 2.65, P = 0.006), live streaming during the daytime (OR = 3.75, p = 0.001), and higher support from supervisors and coworkers (OR = 3.66, p = 0.001) were positively associated with burnout. However, the effects of education and drop in followers on burnout were not significant in the multivariate logistic models (p = 0.321 and 0.988).

CONCLUSIONS

Burnout among Chinese live streamers is associated with income, being an entertainment streamer, engaging in continuous walking during live streams, conducting live streams during the daytime, and experiencing excessive support from supervisors and coworkers.

The importance of recovery and staffing on midwives' emotional wellbeing: A UK national survey

BACKGROUND

There is currently a gap in the evidence on how working practices, such as the ability to take rest breaks, finish on time or intershift recovery influence outcomes.

AIM

The aim of this study was to explore the association of individual characteristics, work-related factors and working practices on emotional wellbeing outcomes of UK midwives.

METHODS

An online cross-sectional survey collated data between September and October 2020. Outcomes explored were work-related stress, burnout, being pleased with their standard of care, job satisfaction and thoughts about leaving midwifery. Univariate analysis identified the explanatory variables to be investigated using multivariable logistic regression.

FINDINGS

A total of 2347 midwives from the four UK nations completed the survey. No standard approach in monitoring safe staffing or in-shift or intershift recovery was found. There were high levels of work-related stress, burnout and thoughts about leaving midwifery, and low levels of job satisfaction, with just half of midwives reporting they were satisfied with the standard of care they could provide. Multivariable regression revealed that working practices variables, generally related to impeded recovery or compounded by staffing issues, had a significant association with poorer emotional wellbeing outcomes.

CONCLUSION

This research has demonstrated an association between impeded recovery, including a lack of formal methods to monitor this, and poorer emotional wellbeing outcomes, and that staffing levels are highly influential in determining outcomes. There is a need to re-evaluate current approaches to job design and how midwives are expected to work.

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.

[Burnout : Symptoms, diagnostics and treatment approaches]

Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.

The effect of socioeconomic status and training programmes on burnout in postgraduate trainees in the United Kingdom: a cross-sectional analysis

PURPOSE

Burnout is described as a state of mental exhaustion caused by one's professional life and is characterised by three domains: emotional exhaustion, depersonalisation, and a reduced sense of accomplishment. The prevalence of stress is high amongst doctors and varies by specialty, gender, trainee level, and socioeconomic status. The authors set out to examine the scale of the problem, as well as to determine the influence of both socioeconomic status and chosen training programme on burnout amongst postgraduate trainees. This would identify at-risk groups and aid in future targeted interventions.

METHODS

Cross-sectional data were obtained, following approval from the General Medical Council, from The National Training Survey, completed annually by all trainees in the United Kingdom. Data were then anonymised and analysed. Burnout scores were derived from the Copenhagen Burnout Inventory and are positively framed (higher scores equal lower burnout).

RESULTS

The questionnaire was completed by 63 122 participants from 2019 to 2020. Mean burnout amongst all trainees was 52.4 (SD = 19.3). Burnout scores from the most deprived quintile was significantly lower compared with those from the least deprived quintile: 51.0 (SD = 20.6) versus 52.9 (SD = 18.9), respectively (P < 0.001). The highest levels of burnout were reported in Internal Medical Training, Emergency Medicine, Obstetrics and Gynaecology, and Core Surgical Training, respectively.

CONCLUSION

Postgraduates from lower socioeconomic backgrounds are more likely to encounter burnout during training. At-risk groups who may also benefit from targeted intervention have been identified, requiring further examination through future studies.

Mental health and burnout during medical school: Longitudinal evolution and covariates

BACKGROUND

Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored.

METHOD

In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models.

RESULTS

Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health.

CONCLUSION

Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression - A cohort study in the total population of Region Stockholm

The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ. The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012-2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014-2022. Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5). The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.

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.