Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions

Study of glucose homeostasis in burnout cases using an oral glucose tolerance test

Burnout is caused by long term psychosocial stress and has, besides the fatigue and mental health burden, been associated with increased risk of adverse physical health, such as for example type 2 diabetes. This study aims to investigate the glucose and insulin levels in individuals with stress related burnout, by assessing these metabolic markers in response to a standard oral glucose tolerance test (OGTT). 38 cases with burnout (13 men and 25 women) and 35 healthy controls (13 men and 22 women) in the age 24-55 were included in the study. The burnout group overall did not differ from healthy controls in glucose or insulin levels during the OGTT. However, the burnout cases who reported more severe burnout symptoms exhibited significantly higher levels of both glucose and insulin levels during the OGTT compared to burnout cases reporting lower severity of symptoms. Furthermore, the group of burnout cases who reported symptoms of depression exhibited higher insulin levels during OGTT compared to the burnout cases without depressive symptoms. The observed higher levels in the burnout cases with most severe symptoms indicate an increased diabetic risk in these patients and it may be of importance to follow glucose and insulin levels in individuals with more severe symptoms of burnout i.e. to perform an OGTT.

Reduced interleukin-6 stress reactivity in male physicians with occupational burnout

Occupational burnout is associated with an elevated risk of cardiovascular events, but the mechanisms underlying this connection have rarely been studied. Low grade inflammation with interleukin (IL)-6 as a key player has been postulated as a possible link between low-grade inflammation and cardiovascular events. Another possibility could be attenuated inflammatory responses to stress reflecting a dysregulated innate immune response. The aim of this study was to examine the relationship between burnout and IL-6 reactivity to acute stress in physicians with burnout. Sixty male physicians were recruited, 30 with burnout, assessed with the Maslach Burnout Inventory, and 30 without burnout. Participants underwent the Trier Social Stress Test, inflicting uncontrollability, and social evaluative threat. Blood samples for IL-6 measurements were taken five times at predefined intervals during stress. Repeated measures analysis of covariance was conducted across the five time points, adjusting for age. IL-6 reactivity over time was significantly lower in physicians with burnout compared to their matched healthy counterparts (F(1.90, 108.10) = 4.88, p = 0.010) during stress. Confirming these results, there was also a significantly lower area under the curve with respect to increase in physicians with burnout compared to those without burnout (F(1, 57) = 4.99, p = 0.029). This study suggests that burnout is associated with lowered IL-6 reactivity in male physicians with burnout. An attenuated innate immune response in burnout complies with increased allostatic load such that dysfunctional stress responses might increase the risk of cardiovascular events in the long term.

Athlete burnout and biomarkers: An exploratory, longitudinal N-of-1 study

Burnout is an increasingly common problem among athletes. In addition to negatively affecting mental health, burnout may also be related to changes in physiological functioning. Research outside of sport suggests that the hypothalamus-pituitary-adrenal (HPA) axis, immune, anabolic, and cardiovascular systems, in particular, may be affected. However, few studies have explored the relationship between burnout and biomarkers of these systems in athletes. Consequently, the aim of the present multidisciplinary study was to explore the relationship between athlete burnout and acute and chronic biomarkers using a longitudinal N-of-1 design. Following a pre-registered protocol with open data, code, and materials, in two athletes, we examined burnout and acute salivary biomarkers (cortisol, testosterone, dehydroepiandrosterone-sulphate [DHEA-S], secretory Immunoglobulin A [sIgA], and C-reactive protein) in 12 samples over six months. In another two athletes, we examined burnout and chronic biomarkers from hair and blood (hair cortisol, glycated haemoglobin [HbA1c], triglycerides, total cholesterol, high-density lipoprotein cholesterol, and DNA methylation in the BDNF, SLC6A4, and NR3C1 genes) in six samples over 12 months. Dynamic regression modelling showed that burnout symptoms predicted decreased testosterone and developed simultaneously with decreases in DHEA-S and sIgA. Visual analyses suggested that burnout symptoms also developed in conjunction with increases in HbA1c and SLC6A4 methylation and preceded increases in hair cortisol and BDNF methylation. Our findings provide a preliminary "physiological fingerprint" that could help explain athlete burnout development and consequences which can be used to guide future theory and research in this area.

The Relationships Between Spirituality, Tendency to Forgive, Social Support, and Posttraumatic Stress Disorder Symptoms and Stress Among Female Survivors of Sexual Assault

Over the past few years, there has been a growing awareness of the extent and consequences of sexual assault. Sexual assault has long-term consequences for the survivor's mental health and brings into question the resources available to survivors for dealing with the consequences of the assault. The positive effects of spirituality and forgiveness on mental health are well documented; however, few studies have examined how sexual assault survivors use spiritual beliefs and forgiveness to cope with posttraumatic stress disorder (PTSD) and stress symptoms. Social support is another resource that has been found to contribute substantially to positive adaptation among trauma survivors. Nevertheless, conflicting results were found regarding the effect of social support on the recovery of sexual assault survivors. Since these resources have a significant impact on individuals who have experienced trauma, the purpose of this study was to examine how these resources relate to the levels of PTSD symptoms and general stress among female survivors of sexual assault. Two hundred and four (N = 204) participants completed a demographic questionnaire and questionnaires about forgiveness, social support, spirituality, PTSD symptoms, and stress. Higher levels of forgiveness, spirituality, and social support were associated with lower levels of PTSD symptoms and stress. A two-step hierarchal regression showed that education, financial status, age at the time of the assault, forgiveness, and social support each contributed significantly to the explained variance of PTSD symptoms. The variability in reported stress could be explained by education, financial status, age at the time of the assault, forgiveness, and spirituality. The study's findings point to the unique roles of forgiveness, spirituality, and social support as beneficial resources for coping with sexual assault. These findings also shed further light on the ways in which these resources can be used to cope with a variety of types of distress.

The impact of night shifts on the physical and mental health of psychiatric medical staff: the influence of occupational burnout

BACKGROUND

The mental health of mental health care professionals has become a key area of research due to the increasing demands and stressors inherent in the work environment. This study explored the relationship between night shift work stress, burnout, social support, and physical and mental health among psychiatric medical staff.

METHODS

A cross-sectional survey was conducted among 244 psychiatric medical staff at a psychiatric specialty hospital in eastern Taiwan. The study utilized validated instruments, including the Effort-Reward Imbalance Questionnaire, the Maslach Burnout Inventory, the Social Support Scale, and the SF-12 Health Survey, to measure work stress, burnout, social support, and health outcomes. Descriptive statistics, Pearson correlation, and hierarchical regression analyses were employed to assess the relationships among these variables and the moderating effects of social support.

RESULTS

The findings revealed significant positive correlations between work stress and occupational burnout (r = 0.42, p < 0.001) and negative correlations with physical and mental health (r = - 0.23, p < 0.001). Occupational burnout is a negative significant predictor of physical and mental health (β = -0.533, p < 0.001). Additionally, higher levels of social support were associated with better health outcomes (r = 0.18, p < 0.01), although its moderating effect on the relationship between stress and health was not significant.

CONCLUSION

This study highlights the significant impact of night shifts on the physical and mental health of psychiatric medical staff. The findings suggest that interventions to reduce the negative impacts of night shifts are crucial, such as improving shift systems, increasing organizational support, and providing targeted mental health programs. These measures will help enhance night shift workers' health and job satisfaction, improving the overall quality of health care services.

Theoretical construction of nurses' work situation conflict: a system hierarchical model

BACKGROUND

Conflicts at work are inevitable and can negatively affect an individual's mental health. This research was based on the theoretical sources of conflict at work, explored nurses' work situation conflict as well as their types, along with their causes and consequences.

METHODS

This study used participatory observation and interview methods to study nurses. Participatory observations of nurses' work were conducted in hospitals, and interviews were conducted with nurses. Data were collected through participatory observation and interviews, and data were analyzed through grounded theory.

RESULTS

Nurses' work situation conflicts included five levels of specific situational conflict types-interpersonal, social, unit, family, and task-as well as 12 conflict manifestations. Specifically, these types and manifestations include (1) interpersonal conflict, including conflicts with leaders, colleagues, and clients; (2) professional status conflict, including conflicts with professional recognition and professional respect; (3) conflict of interest, including conflicts with income, professional development, ideas and systems; (4) family role conflict, including family incident versus work conflicts; and (5) self-task conflict, including work requirement, work task, and work intensity conflicts. At the same time, it was found that the conflicts between different systems could be transformed into each other under certain conditions, and work situation conflict would affect the work efficiency, sense of value, professional enthusiasm, professional expectations, professional detachment, professional interest, and physical and mental exhaustion of nurses.

CONCLUSION

This study found a hierarchical level model of nurses' work situation conflict. And this study has brought new insight to the management of conflicts in the current nurses' working situation and to creating a healthy, harmonious and efficient nursing working situation. It provides a new perspective for nurses' occupational safety and mental health intervention.

Does high perceived stress over the past month alter cortisol reactivity to the Trier Social Stress Test?

BACKGROUND

Theories highlight the important role of chronic stress in remodeling HPA-axis responsivity under stress. The Perceived Stress Scale (PSS) is one of the most widely used measures of enduring stress perceptions, and no previous studies have evaluated whether greater perceptions of stress on the PSS are associated with cortisol hypo- or hyperactivity responses to the Trier Social Stress Test (TSST).

OBJECTIVE

To examine if high perceived stress over the past month, as measured by the PSS, alters cortisol and subjective acute stress reactivity to the TSST in healthy young adults.

METHODS

Five studies across three laboratories involving healthy young adults (N = 585) were conducted. Participants were exposed to the TSST, and cortisol levels and subjective stress responses were measured. Studies 1-2 served as exploratory, and Studies 3-5 as explanatory, with pre-registered hypotheses.

RESULTS

Higher PSS scores were consistently associated with greater acute subjective stress perceptions during the TSST across four out of five studies. Meta-analytic results revealed that higher perceived stress on the PSS was associated with blunted cortisol reactivity to the TSST. This cortisol hyporeactivity effect was more pronounced in studies using a combined speech and arithmetic TSST protocol compared to a speech-only protocol. Depressive symptoms did not significantly alter cortisol reactivity effects in these studies.

CONCLUSION

Persistent high perceived stress over the past month may be associated with greater acute stress perceptions and blunted cortisol reactivity to the TSST. These findings highlight the potential importance of persistent perceived stress in HPA-axis responses to acute stress in healthy young adults, with potential implications for understanding stress-related health risks. Further research is needed to explore the underlying mechanisms and extend findings to diverse populations.

The association between hair cortisol and burnout is moderated by age, psychosocial, and immunological markers

Background

Exhaustion and depersonalization are the core symptoms of the occupational burnout. However, burnout is not an all-or-nothing phenomenon, but can occur in a milder to moderate form in otherwise healthy employees. In the last two decades hair cortisol concentrations (HCC) were increasingly related to the cumulative effect of psychosocial stress at work. We analyzed data of the Dortmund Vital Study (Clinicaltrials.gov: NCT05155397) to explore the relationship of HCC and burnout symptoms. Moreover, we asked whether the HCC - burnout association was moderated by work ability, chronic stress, neuroticism, depressive symptoms, and stress-related immunological biomarkers such as T cell concentration, CD4/CD8 cell ratio, and proinflammatory cytokines TNF- α, IL-6, and IL-18.

Methods

Burnout was assessed by the Oldenburg Burnout Inventory (OLBI), and the Maslach Burnout Inventory (MBI-D) in 196 working adults aged between 20 and 65 years (mean age 42.2 years). Several self-reported variables and biomarkers were collected.

Results

The results showed an association between HCC and the burnout measures. A series of moderator analyses revealed that the association between HCC and burnout symptoms was substantial for low work ability, high chronic stress level, high neuroticism level, and mild to moderate depressive symptoms. Immunological markers moderated the HCC - burnout association for high concentrations of T cells, low CD4/CD8 ratio and low IL-6, IL-18 and TNF-α concentrations. These interactions were moderated by age showing the largest impact in middle-aged to older individuals.

Conclusions

The present findings shed light on the complex interaction between burnout symptoms and work ability, chronic stress, personality, and the endocrinological and immunological responses across the working lifespan. These parameters should be considered when assessing the risk for developing burnout and validating the diagnosis of burnout.

Trial registration

ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397.

Adaptation of the Shirom-Melamed Burnout Measure in Parents of Turkish Pediatric Oncology Patients

OBJECTIVES

This study was conducted to adapt the Shirom-Melamed Burnout Measure (SMBM) in parents of Turkish pediatric oncology patients.

METHODS

This methodological and descriptive study was conducted with 184 parents of pediatric oncology patients from December 2023 to July 2024. Data was collected face to face interviews via an information form and the SMBM. Translation processes, expert opinions, and content validity were meticulously addressed. Data analysis was utilized by IBM SPSS Statistics and AMOS 25.

RESULTS

The mean age of parents was 37.02 ± 8.20, and 94.6% of the parents were mothers. The scale demonstrated high validity (content validity index = 0.97) and excellent internal consistency (Cronbach's alpha = 0.91). The Exploratory Factor Analysis revealed a 4-factor structure, explaining 67.60% of the variance. A modified 4-factor 19-item model of the provided excellent model fit (chi-square/df = 1.946, RMSEA = 0.072, GFI = 0.861, CFI = 0.932, IFI = 0.933, RFI = 0.849, NFI = 0.871, TLI = 0.920).

CONCLUSIONS

The Turkish scale with 4-factor 19-item is a valid and reliable tool can be used to determine the burnout level of parents of pediatric oncology patients.

IMPLICATIONS FOR NURSING PRACTICE

Healthcare providers should use the SMBM to assess parental burnout, develop targeted support programs, and evaluate the impact of caregiving on parents' well-being.

The ways to avoid abusive supervision: the moderating effects of the characteristics of supervisors and subordinates on abusive supervision

Following the recent emphasis on supervisory interactions in abusive supervision, this study explains why and how supervisors' job insecurity and authoritarianism are related to abusive supervision and how subordinates' characteristics, agreeableness and negotiating resistance interact with the effects of supervisors' characteristics. We conducted a field study with 261 supervisor and subordinate dyads in South Korea, and the study findings confirmed that supervisors' authoritarianism is positively related to abusive supervision and that the effect is enhanced when subordinates are highly agreeable and display resistant behaviors. The study contributes to the leadership literature, particularly on abusive supervision and personality. Moreover, our findings have practical implications for employees to manage their work relationships with their supervisors or subordinates.

Association between residential noise exposure and burnout among healthcare workers in Taiwan: a cross-sectional study

Few studies have explored the association between residential noise exposure and burnout. In this study, we investigated the association between residential noise exposure and burnout prevalence among 5416 health-care workers in Taiwan from 2012 to 2017. Burnout was evaluated using the Mandarin version of the Copenhagen Burnout Inventory by considering both continuous and binary measures. We applied ordinary Kriging models to calculate the annual average residential noise exposure at an individual level. Multivariable linear regression models and logistic regression models were employed. Restricted cubic splines were used to explore dose-response relationships. The median age of the health-care workers was 31.5 years. In the multivariable linear regression models, exposure to residential noise (per 1 dBA) was associated with increases in personal burnout and work-related burnout scores by 1.59 ± 0.25 and 1.38 ± 0.20, respectively. In the multivariable logistic regression models, the adjusted odds ratios were 1.24 (95% confidence interval [CI]: 1.16, 1.32) for personal burnout and 1.19 (95% CI: 1.13, 1.26) for work-related burnout per 1-dBA increase in residential noise exposure. Linear dose-response associations of burnout with residential noise level were detected. Our findings suggest that exposure to residential noise may increase the risk of burnout among health-care workers.

Burnout and Attention Failure in STEM: The Role of Self-Control and the Buffer of Mindfulness

Drawing on self-regulatory strength models of self-control, this research examined the relationship between burnout and attentional processes for STEM (science, technology, engineering, and mathematics) students. Using data from participants in STEM, burnout was found to be associated with higher levels of off-task thinking, also known as mind-wandering. Further, self-control acted as a mediator in the relationship between burnout and mind-wandering such that higher levels of burnout predicted poor self-control that subsequently increased the mind's tendency to wander. Additionally, mindfulness buffered the relationship between burnout and mind-wandering such that burnout had the most detrimental impact on attention for those students who were low in mindfulness. Using the Johnson-Neyman approach, results reveal the upper limits for the moderating impact of mindfulness. Results and implications for science and practice are discussed with a special grounding for students in the STEM context.

Tiredness of Life - Conceptualizing a Complex Phenomenon

A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.

Factors associated with chronotype, job burnout, and perceived stress among nurses in Chinese tertiary hospitals: A multicenter cross-sectional study

Shift work is a recognized work pattern for nurses worldwide. The disruption of shift workers' biological clocks usually leads to sleep disorders and affects their awareness at work. Eveningness and occupational stress might be effective in causing burnout syndrome. Therefore, this study aimed to evaluate the chronotype, job burnout and perceived stress among Chinese tertiary hospital nurses, and understand the predictors of circadian rhythm in this group. Between July and September 2020, 23 hospitals were randomly selected from 113 tertiary hospitals in Hunan Province. Twenty-five percent of the nurses working in each hospital were targeted for selection. 28.1% and 17.6% of nurses reported eveningness type and morningness type, respectively. The scores for emotional exhaustion, depersonalization, and perceived stress of eveningness nurses were higher than those of morningness counterparts. Eveningness nurses also reported a lower sense of personal accomplishment. Risk factors of eveningness included being under 30 years old, never exercising, having the stressors of late-night shifts and career development, higher levels of emotional exhaustion, sleep latency, sleep duration, and hypnotic use. Shifts may be unavoidable for nurses, nevertheless, understanding the predictors and related factors of chronotype for nurses is necessary for nursing educators and managers to develop a reasonable shift system and appropriate measures to assist nurses in adjusting their work.

Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review

BACKGROUND

The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers.

OBJECTIVE

This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs).

METHODS

A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies.

RESULTS

The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ≥12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements.

CONCLUSIONS

With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation.

COVID again? Health workers' burnout and turnover intentions: possible impacts of coronavirus-induced anxiety and first-level servant leaders

PURPOSE

Building on social exchange and leader-member exchange theories, this paper aims to propose a model of the impact of coronavirus-induced anxiety on health-care professionals' burnout and turnover intention through the mediation role of servant leadership.

DESIGN/METHODOLOGY/APPROACH

This model was examined by adopting partial least square-based structural equation modeling using data collected from 271 health professionals (doctors, nurses, midwives and analysts) from Turkey.

FINDINGS

The findings of the research illustrate that coronavirus-induced anxiety is positively associated with burnout and turnover intention. Furthermore, servant leadership mediates the relationship between coronavirus-induced anxiety, burnout and turnover intention. Yet, according to factor loadings, the mediating role of servant leadership is not strong (β : 0.035 and 0.053, respectively).

RESEARCH LIMITATIONS/IMPLICATIONS

First, this study targeted the health-care professionals from Turkey. Therefore, this population may not be able to provide general information on the topic. Thus, this study suggests that the subject be addressed in other populations as well. Second, the data were self-reported by the participants. Although common method bias and social desirability bias were not an issue in this study, it should be known that the results are based on the subjective judgments of the participants. Third, this study was limited to investigating the mediating role of servant leadership only.

PRACTICAL IMPLICATIONS

This study gives much beneficial information to both administrators and organizations by mirroring highly stressed workers' inside throughout statistically results. Hence, it is assumed that the findings will help leaders to cope with several difficult situations, especially in crisis moments. As the chaotic circumstances occurred, achieving organizational goals became more and more difficult. To do this, some leaders play critical roles for members like servant leaders by contributing uniquely spiritual dimensions.

SOCIAL IMPLICATIONS

Struggling with the COVID-19 pandemic has aggravated the health-care professionals' existing mental health and has loaded more agitation on them. According to Mozes (2021), suicide cases among nurses have doubled the number of women in the general population. Thus, leaders should do something to lower those ratios. This study points out that servant leaders could break down those unwanted issues by decreasing burnout and turnover intention rates of health workers. Barbuto and Wheeler (2006) highlighted this situation by creating a dimension called "The Natural Desire to Serve Others."

ORIGINALITY/VALUE

To the best of the authors' knowledge, to date, this study is the first to examine the mediating role of servant leadership in the effect of coronavirus-induced anxiety on burnout and turnover intention. Furthermore, this research reveals that servant leadership may play a role in avoiding burnout and turnover intention in the health sector.

A network analysis of exhaustion disorder symptoms throughout treatment

BACKGROUND

Stress-induced Exhaustion Disorder (ED) is associated with work absenteeism and adverse health outcomes. Currently, little is known regarding how the symptoms of ED are interrelated and whether the patterns of symptoms influence treatment outcomes. To this end, the current study applied network analyses on ED patients participating in a multimodal intervention.

METHODS

The first aim of the study was to explore the internal relationships between exhaustion symptoms and identify symptoms that were more closely related than others. A second aim was to examine whether the baseline symptom network of non-responders to treatment was more closely connected than the baseline symptom networks of responders, by comparing the sum of all absolute partial correlations in the respective groups' symptom network. This comparison was made based on the hypothesis that a more closely connected symptom network before treatment could indicate poorer treatment outcomes. Network models were constructed based on self-rated ED symptoms in a large sample of patients (n = 915) participating in a 24-week multimodal treatment program with a 12-month follow-up.

RESULTS

The internal relations between self-rated exhaustion symptoms were stable over time despite markedly decreased symptom levels throughout participation in treatment. Symptoms of limited mental stamina and negative emotional reactions to demands were consistently found to be the most closely related to other ED symptoms. Meanwhile, sleep quality and irritability were weakly related to other exhaustion symptoms. The symptom network for the full sample became significantly more closely connected from baseline to the end of treatment and 12-month follow-up. The symptom network of non-responders to treatment was not found to be more closely connected than the symptom network of responders at baseline.

CONCLUSIONS

The results of the current study suggest symptoms of limited mental stamina and negative emotional reactions to demands are central ED symptoms throughout treatment, while symptoms of irritability and sleep quality seem to have a weak relation to other symptoms of ED. The implications of these findings are discussed in relation to the conceptualization, assessment, and treatment of ED.

TRIAL REGISTRATION

The clinical trial was registered on Clinicaltrials.gov 2017-12-02 (Identifier: NCT03360136).

Understanding physician burnout in Oman: current status, cultural influences and future directions

Amidst the current global surge in physician burnout, a compelling need arises for precisely targeted research and interventions that cater to specific contexts, illuminating a path towards professional well-being. This brief communication analyses recent studies on physician burnout in Oman, critically evaluating the findings, cultural factors, methodological limitations and future growth opportunities. Distinct elements of Omani culture, encompassing attitudes towards mental illness, gender roles and patient expectations, can distinctly influence how burnout presents in this population. Advanced mixed-methods research integrating cultural insights, biomarkers and longitudinal tracking is needed to characterise burnout in Omani physicians. The findings can play a significant role in developing comprehensive interventions, at both a systemic and an individual level, that promote well-being of physicians while specifically aligning with the cultural values of Oman.

The Effect of Shift Working on Dietary Patterns of Healthcare Practitioners during the COVID-19 Pandemic: A Cross-Sectional Study

Background and Objectives: Health professionals' working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.

Clinical teaching self-efficacy positively predicts professional fulfillment and negatively predicts burnout amongst Thai physicians: a cross-sectional survey

BACKGROUND

Clinician teachers (physicians who teach in clinical settings) experience considerable psychological challenges in providing both educational training and patient care. This study aimed to determine the prevalence of physician burnout and professional fulfillment, and to identify internal and external factors associated with mental health outcomes among Thai clinician teachers working in non-university teaching hospitals.

METHOD

A one-time online questionnaire was completed by physicians at 37 governmental, non-university teaching hospitals in Thailand, with 227 respondents being assessed in the main analyses. Four outcomes were evaluated including burnout, professional fulfillment, quality of life, and intentions to quit.

RESULTS

The observed prevalence of professional fulfillment was 20%, and burnout was 30.7%. Hierarchical regression analysis showed a significant internal, psychological predictor (clinical teaching self-efficacy) and external, structural predictors (multiple roles at work, teaching support), controlling for the background variables of gender, years of teaching experience, family roles, and active chronic disease, with clinical teaching self-efficacy positively predicting professional fulfillment (b = 0.29, p ≤.001) and negatively predicting burnout (b = - 0.21, p =.003).

CONCLUSIONS

Results highlight the importance of faculty development initiatives to enhance clinical teaching self-efficacy and promote mental health among Thai physicians.

Hemodynamic and Stress Response After Sound Intervention with Different Headphone Systems: A Double-Blind Randomized Study in Healthy Volunteers Working in the Health Care Sector

Objectives: Two headphone systems using different sound systems were compared to investigate the effects of a sound intervention on cardiovascular parameters, indicators of stress, and subjective feelings. Methods: One hundred volunteers who work in the health care sector reporting elevated workplace-related stress were enrolled and randomized to a 12-min sound intervention (classical music) with either conventional headphones ("MEZE 99 Classic") or with the same-but internally modified-headphone (called "Lautsaenger"). Cardiovascular parameters were measured with the VascAssist2.0, both before and after sound interventions. In addition, participants were asked to complete questionnaires on burnout risk and emotions/stress. Results: The study population consisted mainly of female participants (n = 83), with the majority being students (42%). Median age was 32.5 years (range 21-71). In terms of cardiovascular parameters, a significant reduction in aortic pulse wave velocity, as measure of arterial stiffness, and heart rate was observed within both treatment arms. Both systolic blood pressure and arterial flow resistance were reduced by sound intervention, while these effects were only documented with Lautsaenger. Treatment groups were comparable in terms of subjective feedback by participants: a significant increase in emotional wellbeing was achieved with both headphone systems. Conclusions: A single short-term sound intervention seems to be able to achieve objective cardiovascular improvements in healthy volunteers reporting subjective symptoms of workplace-related stress, using two different headphone systems. Moreover, significant emotional improvement was reported within both arms. Trial Registration: ISRCTN registry 70947363, date of registration August 13, 2021.

Work stress and changes in heart rate variability among employees after first acute coronary syndrome: a hospital-based longitudinal cohort study

Background

Work stress is considered as a risk factor for coronary heart disease, but its link with heart rate variability (HRV) among heart attack survivors is unknown yet. The aim of this study was to investigate associations between baseline work stress and the changes of HRV over one-year after onset of acute coronary syndrome (ACS).

Methods

Hundred and twenty-two patients with regular paid work before their first ACS episode were recruited into this hospital-based longitudinal cohort study. During hospitalization (baseline), all patients underwent assessments of work stress by job strain (JS) and effort-reward imbalance (ERI) models, and were assigned into low or high groups; simultaneously, sociodemographic and clinical data, as well depression, anxiety, and job burnout, were collected. Patients were followed up 1, 6, and 12 months after discharge, with HRV measurements at baseline and each follow-up point. Generalized estimating equations were used to analyze the effects of baseline work stress on HRV over the following 1 year.

Results

After adjusting for baseline characteristics and clinical data, anxiety, depression, and burnout scores, high JS was not associated with any HRV measures during follow-up (all p > 0.10), whereas high ERI was significantly related to slower recovery of 5 frequency domain HRV measures (TP, HF, LF, VLF, and ULF) (all p < 0.001), and marginally associated with one time domain measure (SDNN) (p = 0.069). When mutually adjusting for both work stress models, results of ERI remained nearly unchanged.

Conclusion

Work stress in terms of ERI predicted lower HRV during the one-year period after ACS, especially frequency domain measures.

The influence of burnout on cardiovascular disease: a systematic review and meta-analysis

Background

Burnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease.

Methods

Studies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks.

Results

We included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case-control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions.

Conclusions

Burnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.

Physical and psychosocial work demands associated with pain and disability among skilled male Arab waiters

BACKGROUND

Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP).

OBJECTIVE

To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability.

METHODS

100 skilled male Arab waiters working full-time, aged 18-60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study.

RESULTS

A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5%; shoulders -53%, 78.2%, 94.4%; elbows- 46%, 78.6%, 83.3%; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83%. The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ.

CONCLUSION

Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention.

Job stressors in relation to burnout and compromised sleep among academic physicians in India

BACKGROUND

Burnout among physicians, especially in the academic setting, is an urgent concern, with adequate sleep one of the key focal points.

OBJECTIVE

To identify job stressors contributing to burnout and compromised sleep among academic physicians, using a comprehensive, theory-based instrument, the Occupational Stressor Index (OSI), whose specific form was created 'for physicians by physicians'.

METHODS

This parallel mixed-methods cross-sectional investigation was conducted among 109 physicians employed in a public teaching hospital, Jodhpur, India. Work conditions were evaluated by the physician-specific OSI (part I). The Copenhagen Burnout Index and Pittsburgh Sleep Quality Index (PSQI) were the outcome instruments (part II). Seventy-six physicians completed parts I and II.

RESULTS

The physicians were from wide-ranging specialties, and 82% of the cohort were residents. Mean total OSI scores were 87.4±8.1, with unit-change yielding adjusted odds-ratios (95% confidence-intervals) for personal (1.10 (1.02-1.18)) and work-related burnout (1.12 (1.04-1.22)), and PSQI (1.09 (1.01-1.17)). Significant multivariable associations with burnout and/or sleep indices included: working 7 days/week, lacking work-free vacation, insufficient rest breaks, interruptions, many patients in intensive-care, no separate time for non-clinical duties, pressure to publish, injury/suicide attempts of colleagues/staff, performing pointless tasks. The latter were described as administrative/clerical. Lacking genuine rest breaks was mainly patient-related, further compromised by emergency work and lacking separate time for non-clinical duties. Long workhours and exhausting schedule were cited as most difficult parts of work, while reducing workhours, improving work schedule, and hiring more staff most frequently recommended.

CONCLUSION

Specific working conditions potentially contributory to burnout and compromised sleep among physicians working in academic medicine are identified using a methodologically-rigorous, in-depth approach. These findings inform evidence-based interventions aimed at preserving physician mental health and work capacity.

Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

PURPOSE

Exhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality.

METHODS

The present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67).

RESULTS

Results indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, body mass index, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals.

CONCLUSIONS

Our findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.

Effectiveness of a person-centred eHealth intervention in reducing symptoms of burnout in patients with common mental disorders - secondary outcome analysis of a randomized controlled trial

BACKGROUND

The number of people with common mental disorders (CMDs), especially stress-related disorders, has increased in several countries, including Sweden, during the past decade. Patients seeking care for long-term stress report severe symptoms. Although person-centred care (PCC) has shown several benefits, studies evaluating the effects of a PCC eHealth intervention on patients with CMDs are scarce.

OBJECTIVE

The aim of this study was to compare levels of self-reported symptoms of burnout between a control group receiving treatment as usual (TAU) and an intervention group receiving TAU with the addition of a person-centred eHealth intervention, in patients on sick leave for CMDs.

METHODS

This study reports analysis of a secondary outcome measure from a randomized controlled trial. Patients (n = 209) on sick leave for CMDs were recruited from nine primary health care centres and allocated to either a control group (n = 107) or an intervention group (n = 102). The intervention consisted of phone support and an interactive digital platform built on PCC principles. Self-reported symptoms of burnout were assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ) at baseline and at 3 and 6 months.

RESULTS

Our findings showed changes in SMBQ scores over time in both the control and the intervention group. There was no significant difference in SMBQ scores between the groups; however, a difference in change over time between the groups was observed. The SMBQ scores decreased significantly more in the intervention group than in the controls between 0 and 3 months and between 0 and 6 months. No differences in change between the two groups were seen between the 3- and 6-month follow-ups.

CONCLUSION

This person-centred eHealth intervention for patients on sick leave for CMDs showed a slight initial effect in reducing symptoms of burnout. Taking into account that both groups reported comparable SMBQ scores throughout the study period, the overall effect may be considered limited.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov (Identifier NCT03404583). Date of registration: 19/01/2018. https://clinicaltrials.gov/ct2/show/NCT03404583 .

Occupational stress and depression of Korean employees: Moderated mediation model of burnout and grit

BACKGROUND

The present study investigated an interpersonal model of development of depressive symptoms in employees, where occupational stress affects burnout, which in turn affects risk for depression, and whether this mediation is moderated by grit.

METHODS

A total of 11,421 participants, aged 19 to 65 years, who were employees of 18 private companies and local government organizations in Korea were included. They completed questionnaires, including the Korean version of occupational stress scale, Oldenburg Burnout Inventory, Center for Epidemiologic Studies Depression scale and Grit scale. Mediation and moderation analyses were carried out in the Statistical Package for the Social Sciences PROCESS macro.

RESULTS

The association between occupational stress and depressive symptoms was mediated by exhaustion (b = -0.256, 95 % CI [0.244, 0.268]) and disengagement (b = -0.052, 95 % CI [0.039, 0.065]). Moreover, the effect of exhaustion on depressive symptoms was moderated by each grit, with the effect being stronger for employees with low grit (b = 0.939, p < 0.001 for passion and b = 0.629, p < 0.001 for perseverance) than for those with high grit (b = 0.944, p < 0.001 for passion and b = 0.686, p < 0.001 for perseverance).

LIMITATIONS

The cross-sectional design of the study does not allow causal inferences.

CONCLUSIONS

These findings contribute to the understanding of how occupational stress predicts depressive symptoms in the workplace and provide practical implications for preventing burnout and nurturing grit to protect employees' mental health in the workplace.

Sympathetic nervous system responses to acute psychosocial stress in male physicians with clinical burnout

BACKGROUND

Occupational burnout has been associated with an increased risk of cardiovascular disease, with sympathetic nervous system (SNS) dysfunction as one explanation. This study examined the effects of burnout on responses of SNS activity measures to acute psychosocial stress in male physicians, a population at risk for burnout.

METHODS

Study participants were 60 male physicians, 30 with clinical burnout, assessed with the Maslach Burnout Inventory, and 30 without burnout (controls). All participants underwent the 15-min Trier Social Stress Test. Heart rate, blood pressure, salivary alpha-amylase, and plasma levels of epinephrine (EPI) and norepinephrine were assessed pre-stress, immediately post-stress, and 15 min and 45 min post-stress.

RESULTS

Physicians with burnout and controls differed in EPI changes over time, controlling for age, job stress and anxiety symptoms (F (3,147) = 5.18, p = .002 for 'Time by Group' interaction; η2p = .096). Burnout was associated with a smaller increase in EPI from pre-stress to immediately post-stress (r(54) = -.40, p = .004). The emotional exhaustion dimension of burnout was a significant driver of this effect. The area under the curve with respect to increase in EPI was also smaller in the burnout group (F (1,49) = 6.06, p = .017, η2p = .110). Group differences were not significant for the other SNS activity measures.

CONCLUSIONS

Burnout may be linked to dysfunction of the sympathoadrenal medullary (SAM) system, when exposed to acute psychosocial stress. In keeping with the allostatic load concept, an insufficient SAM stress response in burnout could potentially contribute to cardiovascular disease.

Workplace Bullying Seen from the Perspective of Bystanders: Effects on Engagement and Burnout, Mediating Role of Positive and Negative Affects

The first and original aim of this study was to measure the impact of workplace bullying (WB) seen from the perspective of the witnesses (bystanders) on the work engagement and the burnout of these bystanders. The second aim was to test the mediating roles of affects between WB seen from the perspective of bystanders and two resulting variables, bystanders' work engagement and bystanders' burnout. This study was conducted using self-administered questionnaires with WB bystanders (n = 222) from the Cameroonian health sector. The results indicated that positive and negative affects played mediating roles between WB as seen by witnesses and the two resulting variables, burnout and work engagement. This study offers new avenues for intervention on the issue of WB bystanders. In addition to prevention for victims, witnesses experiencing bullying as bystanders in Cameroon must be supported and accompanied by occupational health services, occupational and psychosocial risk prevention workers, psychologists, as well as human resources.

Exploring physical and biological manifestations of burnout and post-traumatic stress disorder symptoms in healthcare workers: a scoping review protocol

INTRODUCTION

The COVID-19 pandemic has strained the mental and physical well-being of healthcare workers (HCW). Increased work-related stress and limited resources have increased symptoms of anxiety, depression, insomnia and post-traumatic stress disorder (PTSD) in this population. Stress-related disorders have been strongly associated with long-term consequences, including cardiometabolic disorders, endocrine disorders and premature mortality. This scoping review aims to explore available literature on burnout, PTSD, and other mental health-associated symptoms in HCW to synthesise relationships with physiological and biological biomarkers that may be associated with increased risk of disease, creating an opportunity to summarise current biomarker knowledge and identify gaps in this literature.

METHODS AND ANALYSIS

This scoping review uses the Arksey and O'Malley six-step scoping review methodology framework. The research team will select appropriate primary sources using a search strategy developed in collaboration with a health sciences librarian. Three reviewers will initially screen the title and abstracts obtained from the literature searches, and two reviewers will conduct independent reviews of full-text studies for inclusion. The research team will be reviewing literature focusing on which burnout and/or PTSD-associated physiological and biological biomarkers have been studied, the methodologies used to study them and the correlations between the biomarkers and HCW experiencing burnout/PTSD. Data extraction forms will be completed by two reviewers for included studies and will guide literature synthesis and analysis to determine common themes.

ETHICS AND DISSEMINATION

This review does not require ethical approval. We expect results from this scoping review to identify gaps in the literature and encourage future research regarding improving biological and physiological biomarker research in HCW. Preliminary results and general themes will be communicated back to stakeholders. Results will be disseminated through peer-reviewed publications, policy briefs and conferences as well as presented to stakeholders to an effort to invest in HCW mental and physical health.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Healthcare worker burnout during the first COVID-19 lockdown in Italy: experiences from an intensive neurological rehabilitation unit

OBJECTIVE

The study aim was to investigate the prevalence of behavioral symptoms and burnout in healthcare workers in an intensive neurological rehabilitation unit in Messina, Italy, during the first COVID-19 lockdown in Italy.

METHODS

Forty-seven healthcare workers (including neurologists, physiatrists, nurses and rehabilitation therapists) were enrolled in this cross-sectional study from February 2020 to June 2020. Participants were administered the following psychometric tests to investigate burnout and related symptoms: the Maslach Burnout Inventory, which measures emotional exhaustion, depersonalization and reduced personal accomplishment; the Zung Self-Rating Depression Scale (SDS); the Pre-Sleep Arousal Scale (PSAS); the Dyadic Adjustment Scale; and the Buss-Perry Aggression Questionnaire (BPAQ).

RESULTS

We found several correlations between test scores and burnout subdimensions. Emotional exhaustion was correlated with SDS (r = 0.67), PSAS-Cognitive (r = 0.67) and PSAS-Somatic (r = 0.70) scores, and moderately correlated with all BPAQ dimensions (r = 0.42). Depersonalization was moderately correlated with SDS (r = 0.54), PSAS-Cognitive (r = 0.53) and PSAS-Somatic (r = 0.50) scores.

CONCLUSION

During the first COVID-19 lockdown in Italy, healthcare workers were more exposed to physical and mental exhaustion and burnout. Research evaluating organizational and system-level interventions to promote psychological well-being at work for healthcare workers are needed.

The Cognitive Control Model of Work-related Flow

Although several models of flow have been proposed that include environmental and trait-based antecedents of the state, elements of cognitive control that enable workers to experience flow and its subsequent outcomes at work have largely been overlooked. This research proposes and provides empirical support for the "Cognitive Control Model of Work-related Flow," which integrates antecedents of flow at work related to the ability to focus concentration of cognitive resources toward experiencing flow at work. Along with flow at work, the model includes the antecedents of grit, flow metacognition, and mindfulness at work and the outcomes of work performance, engagement, and burnout. Findings across three studies (a cross-sectional, a time-lagged, and a one-day experience sampling method study) utilizing MTurk participants provided support for the model, as grit, mindfulness, and flow metacognition predicted flow, and flow predicted subjective performance, engagement, and burnout. Theoretical implications and the potential for developing flow interventions at work are discussed.

Relationship between sleep disturbance and burnout among Chinese urban teachers: Moderating roles of resilience

BACKGROUND

Sleep disturbance and burnout are prevalent among primary and secondary school teachers. Nevertheless, little is known about the relationship between sleep disturbance and burnout, and the mechanisms connecting this link. Our study aimed to explore the relationship between sleep disturbance and burnout among urban teachers, as well as to investigate this influencing mechanism further with resilience as a moderator.

METHODS

14,218 primary and secondary school teachers provided valid data. We assessed demographic information, sleep disturbance, burnout, and resilience. Multivariable logistic regression, Spearman correlation, and moderation analyses were used to evaluate the relationship between sleep disturbance and burnout and the moderating role of resilience.

RESULTS

Of the participants, the prevalence of sleep disturbance and sleep deprivation among teachers was 20.0% and 31.7%, respectively. Additionally, 58.4% of teachers reported moderate or severe burnout, and 15.3% had both sleep disturbance and burnout. Sleep disturbance was significant and positively related to burnout. Resilience was found to moderate the association between sleep disturbance and burnout.

CONCLUSIONS

These findings suggested strong associations between sleep disturbance and burnout. Interventions in improving resilience may protect teachers with sleep disturbance from burnout.

Higher operating theatre temperature during burn surgery increases physiological heat strain, subjective workload, and fatigue of surgical staff

Raising the ambient temperature of the operating theatre is common practice during burn surgeries to maintain the patient's core body temperature; however, the effects of operating in the heat on cognitive performance, manual dexterity, and perceived workload of surgical staff have not been assessed in a real-world context. Therefore, the aim was to assess the real-time impact of heat during burn surgeries on staff's cognitive function, manual dexterity, and perceptual measures (workload, thermal sensation, thermal comfort, perceived exertion, and fatigue) and physiological parameters (core temperature, heart-rate, fluid loss, and dehydration). Ten burn surgery staff members were assessed in CON (24.0±1.1°C, 45±6% relative humidity [RH]) and HOT (30.8±1.6°C, 39±7% RH) burn surgeries (average 150 min duration). Cognitive performance, manual dexterity, and perceptual measures were recorded pre- and post-surgery, while physiological parameters were recorded throughout surgery. HOT conditions did not significantly affect manual dexterity or cognitive function (p > .05), however HOT resulted in heat strain (increased heart-rate, core temperature, and fluid loss: p < .05), and increased subjective workload, discomfort, perceived exertion, and fatigue compared to CON conditions (p < .05). Cognitive function and manual dexterity were maintained in hot conditions, suggesting that operating in approximately 31°C heat is a safe approach for patient treatment. However, job burnout, which is positively correlated with perceived workload, and the impact of cumulative fatigue on the mental health of surgery staff, must be considered in the context of supporting an effective health workforce.

Exploring Physical and Biological Manifestations of Burnout and Post-Traumatic Stress Disorder Symptoms in Healthcare Workers: A Scoping Review Protocol

Introduction

The COVID-19 pandemic has strained the mental and physical well-being of healthcare workers (HCW). Increased work-related stress and limited resources has increased symptoms of anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) in this population. Stress-related disorders have been strongly associated with long-term consequences including cardiometabolic disorders, endocrine disorders and premature mortality. This scoping review aims to explore available literature on burnout, PTSD, and other mental health-associated symptoms in HCW to synthesize relationships with physiological and biological biomarkers that may be associated with increased risk of disease, creating an opportunity to summarize current biomarker knowledge and identify gaps in this literature.

Methods and Analysis

This scoping review uses the Arksey and O'Malley six-step scoping review methodology framework. The research team will select appropriate primary sources using a search strategy developed in collaboration with a health sciences librarian. Three reviewers will initially screen the title and abstracts obtained from the literature searches, and two reviewers will conduct independent reviews of full-text studies for inclusion. The research team will be reviewing literature focusing on which burnout and/or PTSD-associated physiological and biological biomarkers have been studied, the methodologies used to study them and the correlations between the biomarkers and HCW experiencing burnout/PTSD. Data extraction forms will be completed by two reviewers for included studies and will guide literature synthesis and analysis to determine common themes.

Ethics and Dissemination

This review does not require ethical approval. We expect results from this scoping review to identify gaps in the literature and encourage future research regarding improving biologic and physiologic biomarker research in HCW. Preliminary results and general themes will be communicated back to stakeholders. Results will be disseminated through peer-reviewed publications, policy briefs, and conferences, as well as presented to stakeholders to an effort to invest in HCW mental and physical health.

Strengths and Limitations of This Study

This will be the first scoping review to assess the current understanding of the biologic and physiological impact of burnout on healthcare workers. The target population is restricted to healthcare workers; however, identified research gaps may be used to guide future studies in other high-burnout occupations and industries.This scoping review will be guided by the Arksey and O'Malley six-step methodological framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review checklist.Both peer reviewed manuscript and pre-prints/abstracts will be evaluated, but studies that have not been peer reviewed will be notated in the summary table. Conference abstracts are excluded.Preliminary and final themes and results identified by this scoping review will be communicated to stakeholders, including hospital staff and HCW, to ensure agreement with our interpretation and to convey knowledge gained with our population of interest.This review will advance the field's current understanding of mechanisms connecting the burnout and pathogenic stress to biologic and physiologic outcomes in healthcare workers and provide researchers with gaps in the literature to inform opportunities for future research.

Fatigue, Work Overload, and Sleepiness in a Sample of Spanish Commercial Airline Pilots

Commercial aviation pilots are an occupational group that work in particular conditions, with frequent schedule changes, shift work, unfavorable environmental conditions, etc. These circumstances can lead to fatigue, work overload (WO), and daytime sleepiness, factors that can affect their health and safety. This study aimed to assess the prevalence and the association between these parameters in a sample of Spanish commercial airline pilots. The Raw TLX, Fatigue Severity Scale, and the Epworth Sleepiness Scale questionnaires were administered in a sample of 283 participants. The relationships of the total scores between all the questionnaires were studied by the chi-square test and the risk scores (odds ratio) were calculated. Different models using multiple linear regression were carried out to evaluate the effects of WO, fatigue, and daytime sleepiness, among the total scores, age, and flight hours. Additionally, the internal consistency of each questionnaire was estimated. A total of 28.2% presented WO above the 75th percentile, with mental and temporal demand the dimensions with the greatest weight. A total of 18% of pilots presented fatigue, 15.8% moderate sleepiness, and 3.9% severe sleepiness. We observed an association among WO, fatigue, and daytime sleepiness, important factors related to pilot health and aviation safety.

Third-Generation Behavioural Therapies in the Context of Neurodevelopmental Problems and Intellectual Disabilities: A Randomised Clinical Trial with Parents

The purpose of this study was to examine how 14 parents of children with autism and intellectual impairments responded to an Acceptance and Commitment Therapy (ACT)-based psychological flexibility intervention programme. A randomised clinical trial was conducted. Parents were randomly assigned to the training programme group (n = 8) or waiting list group (n = 6). The treatment effect was measured using the 6-PAQ, PSS-14, GHQ-12, and WBSI questionnaires. Changes in interactions were assessed through self-recording, including a baseline to observe the previous functioning. Measures were taken before and after the application of the intervention programme and three months later. After that, the control group was switched to the psychological flexibility programme condition. After the programme's implementation, we could see a reduction in stress and the tendency to suppress unwanted private events. The impacts also appeared to apply to family interactions, resulting in a rise in positive interactions and a decrease in unfavourable ones. The results led us to think about the importance of psychological flexibility for the parents of children with chronic conditions, facilitating a reduction in the emotional impact derived from parenting and the emission of behaviours that promote the harmonious development of the diagnosed child.

Positive faultlines: an unconventional perspective on team compositional dynamics

Purpose

Faultline literature has been extensively examined for its effect on various outcomes. Barring a few exceptions, this research has primarily inferred the adverse impact of such splits. The purpose of this theoretical paper is to assert that these divisions can also be formed based on positive psychological capacities, which will cause a divide, but eventually help increase performance.

Design/methodology/approach

This paper offers a conceptual model that links employee psychological capital with the faultline literature and suggests its impact on team performance. It also explores the positive moderating effect of time and team goal orientation.

Findings

The study asserts that there will be an initial divide, but the positive faultlines will improve team performance. Several propositions are formulated that provide the opportunity for further examination.

Originality

This paper makes a contemporary and important conceptual contribution to the faultline literature by proposing a new notion: “positive faultlines.” To view the effect of faultlines from a positive perspective, a pioneering endeavor is made to explore the impact of employees’ psychological capital in teams. By integrating the faultline literature with positive organizational behavior, this study offers an alternative line of thinking on team compositional dynamics.

Too stressed to de-stress? The experience of work stress and recovery among attorneys during the COVID-19 pandemic

It is well-established that legal professionals experience high stress and often high rates of associated health problems. Much less is known about attitudes and behaviours around stress prevention in this occupation. Our study examined views of stress and recovery among 131 U.S. attorneys. In open-ended data, attorneys commonly expressed that their job is very demanding, and it impacts their health. Many respondents felt it was important to manage their stress but had difficulty doing so. Quantitative analyses showed that attitudes about stress (stress-related comparisons, viewing stress as achievement, stress-related impression management, and stigma around stress concerns) demonstrated several significant relationships with perceived stress, recovery experiences, remorse for relaxation, and work-family conflict. Our findings suggest that practical interventions to support the health and well-being of legal professionals may need to target the workload norms, as well as attitudes and beliefs about the normalness of high stress and insufficient recovery.

Psychometric validation of the Chinese version of the Shirom-Melamed Burnout Questionnaire among parents of children with cancer

PURPOSE

Although burnout recently emerged as a harmful syndrome in parents, no instrument has been validated to suitably assess burnout among parents of children with cancer in China. In this study, we aimed to psychometrically validate the Shirom-Melamed Burnout Questionnaire (SMBQ) among Chinese parents of children with cancer.

DESIGN AND METHODS

We conducted a cross-sectional survey of 380 parents of children with cancer to psychometrically validate the SMBQ. Content validity, construct validity, convergent validity, discriminant validity, criterion-related validity, diagnosis accuracy, internal consistency, and test-retest reliability were evaluated.

RESULTS

The Chinese version of the SMBQ demonstrated adequate internal consistency, good test-retest reliability, good content validity, excellent convergent and discriminant validity, and appropriate criterion-related validity. Using the parental burnout assessment as a reference criterion, the area under the curve was 0.903. The optimal cut-off point for the SMBQ was 4.833. The factor model of the SMBQ used in Chinese parents of children with cancer had a good fit. The survey revealed that Chinese parents of children with cancer experienced a high level of burnout (3.86 ± 1.03).

CONCLUSIONS

The Chinese version of SMBQ was reliable and valid for assessing burnout in parents of children with cancer. Parents of children with cancer experienced a high level of burnout in China.

IMPLICATIONS FOR PRACTICE

This SMBQ can be used in Chinese clinical and research settings to investigate burnout in parents who have children with cancer. Further research could examine the predictive validity and validity.

Social, lifestyle, and health status characteristics as a proxy for occupational burnout identification: A network approach analysis

Background

Occupational burnout is a type of psychological syndrome. It can lead to serious mental and physical disorders if not treated in time. However, individuals tend to conceal their genuine feelings of occupational burnout because such disclosures may elicit bias from superiors. This study aims to explore a novel method for estimating occupational burnout by elucidating its links with social, lifestyle, and health status factors.

Methods

In this study 5,794 participants were included. Associations between occupational burnout and a set of features from a survey was analyzed using Chi-squared test and Wilcoxon rank sum test. Variables that are significantly related to occupational burnout were grouped into four categories: demographic, work-related, health status, and lifestyle. Then, from a network science perspective, we inferred the colleague's social network of all participants based on these variables. In this inferred social network, an exponential random graph model (ERGM) was used to analyze how occupational burnout may affect the edge in the network.

Results

For demographic variables, age (p < 0.01) and educational background (p < 0.01) were significantly associated with occupational burnout. For work-related variables, type of position (p < 0.01) was a significant factor as well. For health and chronic diseases variables, self-rated health status, hospitalization history in the last 3 years, arthritis, cardiovascular diseases, high blood lipid, breast diseases, and other chronic diseases were all associated with occupational burnout significantly (p < 0.01). Breakfast frequency, dairy consumption, salt-limiting tool usage, oil-limiting tool usage, vegetable consumption, pedometer (step counter) usage, consuming various types of food (in the previous year), fresh fruit and vegetable consumption (in the previous year), physical exercise participation (in the previous year), limit salt consumption, limit oil consumption, and maintain weight were also significant factors (p < 0.01). Based on the inferred social network among all airport workers, ERGM showed that if two employees were both in the same occupational burnout status, they were more likely to share an edge (p < 0.0001).

Limitation

The major limitation of this work is that the social network for occupational burnout ERGM analysis was inferred based on associated factors, such as demographics, work-related conditions, health and chronic diseases, and behaviors. Though these factors have been proven to be associated with occupational burnout, the results inferred by this social network cannot be warranted for accuracy.

Conclusion

This work demonstrated the feasibility of identifying people at risk of occupational burnout through an inferred colleague's social network. Encouraging staff with lower occupational burnout status to communicate with others may reduce the risk of burnout for other staff in the network.

High-Performance Work Systems and Coping Strategies in Regulating Burnout and Safety Workarounds in the Healthcare Sector

The healthcare sector is essential for any country because it indirectly affects its economy. The productivity of land will increase if there is a healthy workforce, and it will enhance its economy, which will, in return, lead to the human welfare of the country. The present quantitative study has investigated the relationship between high-performance work systems (HPWS) on safety workarounds through the role of burnout as mediation, and explored coping strategies as a moderator between burnout and safety workarounds. These constructs play a vital role in efficiently managing different organizational activities to generate better productivity and employee performance, and educate employees about rules that can be used and adopted to ensure a healthy work-life. The data were collected from 550 nurses through a questionnaire in the healthcare sector of Lahore, Punjab (Pakistan). AMOS and SPSS were used to test the direct relationships between the constructs, and analyze the moderation of coping strategies and the mediation effect of burnout. The results have demonstrated the strong moderated mediation of coping strategies and burnout between existing HPWS and safety workarounds. The study of coping strategies would help managers and employees handle job stress and alleviate burnout in the healthcare sector through safety workarounds to increase effectiveness and efficiency.

Family incivility and burnout: a moderated mediation model of life satisfaction and psychological capital

Purpose

This study investigates the relationship between family incivility (FI) and burnout in line with the conservation of resources theory and work–home resources model. The authors also examine the conditional indirect effects of psychological capital (PsyCap) and life satisfaction (LS) in the aforementioned relationship. The purpose of this paper is to address these issues.

Design/methodology/approach

Data were collected using a time-lagged methodological design by administering a structured questionnaire among 296 rural doctors. The collected data were analyzed using PROCESS macro in Statistical Package for the Social Sciences (SPSS) 23.

Findings

The study indicates that FI is an emotional home demand and influences burnout at the workplace through the depletion of LS. At the same time, PsyCap proves to be a vital resource that mitigates the adverse effects of FI and burnout.

Research limitations/implications

This study adds to the work–family and well-being literature by exploring the underlying mechanism through which FI connects to different outcomes. The implications of these findings for applications and extension of the work–home resources model to the family domain is elaborated in detail.

Originality/value

This study is among the first to empirically substantiate the long-term adverse consequences of FI and its potential for negatively affecting the work domain by inducing long-term psychological disorder “burnout.”

The Association between Occupational Stress and Mental Health among Chinese Soccer Referees in the Early Stage of Reopening Soccer Matches during the COVID-19 Pandemic Outbreak: A Moderated Mediation Model

BACKGROUND

The sudden and unpredictable changes caused by the COVID-19 pandemic are a serious threat to the occupational stress and mental health of referees worldwide, which has not attracted widespread attention. The mental health of football referees has a certain influence on their job satisfaction or the accuracy of judgments.

METHODS

This study constructed a moderated mediation model to explore the buffer factors between occupational stress and mental health in Chinese soccer referees in the early stage of reopening soccer matches during the COVID-19 pandemic outbreak. Data from 317 Chinese soccer referees (aged 19-45) were collected through an online questionnaire in September-October 2022. Occupational stress, mental health, job burnout and perceived social support were measured, and moderated mediation model was analyzed.

RESULTS

The results of this study showed that occupational stress was negatively correlated with mental health through the mediating effect of job burnout and the moderated effect of perceived social support after controlling for demographic variables. Specifically, the association between occupational stress and mental health was weaker when perceived social support was higher and stronger.

CONCLUSIONS

The results demonstrate that job burnout and perceived social support played important roles in buffering the negative effects of occupational stress on the mental health of Chinese soccer referees in the early stage of reopening soccer matches during the COVID-19 pandemic outbreak. The findings provide implications for mental health interventions in soccer referees during the public health crises.

Having allies—Experiences of support in people with stress-related exhaustion: A qualitative study

Background

The number of people seeking care for symptoms of exhaustion and stress is a major concern in several countries. The condition is a challenging and life-changing experience, and a deeper understanding of support to help people on sick leave due to stress-related exhaustion in their early stages is needed to facilitate recovery.

Objective

The aim was to explore experiences of support in people with stress-related exhaustion being on sick-leave less than six months.

Method

A qualitative interview study was conducted with 12 participants (7 women and 5 men; aged 25–46 years) who were on sick leave that had not exceeded six months due to stress-related exhaustion. The participants were recruited from public healthcare centres in the western part of Sweden, and the intention was to reach them early in their ongoing sick leave period. The interviews were performed face-to-face and analysed using a phenomenological hermeneutical approach.

Results

The findings show that people affected by stress-related exhaustion struggle to maintain their dignity and define support in terms of allies who acknowledge their personhood and provide them helpful guidance. Participants expressed their needs to be taken seriously by professionals, family, and friends willing to engage in their situation. Lack of empathy and professional knowledge in the clinical encounter induced additional stress.

Conclusions

This study indicates that people affected by stress-related exhaustion need allies from their surrounding networks in their struggle to maintain their dignity. Our findings highlight that it is essential to acknowledge them as persons and establish an alliance to provide appropriate support based on each person’s specific situation, needs and resources. This approach can be facilitated in a partnership, as emphasized in person-centred care (PCC). PCC emphasizes the co-creation of care in partnership between the patient (often with relatives) and health care professionals which may imply a more collaborative view of health care in which patients are engaged as active partners in planning their care.

Impact of Burnout on Daily Activities from an Occupational Therapy Perspective: A Serial Mediation Model with the IDA Scale

BACKGROUND

Burnout syndrome is one of the most frequent health complications among workers. Acknowledging the work perspective as something basic and essential in a person's life means that this disorder can have huge implications in their most basic daily activities.

METHODS

A cross-sectional, quantitative observational design was conducted with data from Spanish workers. A serial mediation model was applied to study the relationship between daily activities and burnout syndrome. For this purpose, the IDA scale was developed.

CONCLUSIONS

The results show us that peoples' work situation has an impact on their daily life. There is quantitative evidence of the impact on daily life occupations and how it further decreases the levels of health and well-being of the person, on their independence and, consequently, on their quality of life.