Burnout-depression overlap: a review

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.

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.

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.

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.

[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.

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.

Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial

Importance

Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed.

Objective

To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians.

Design, Setting, and Participants

This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022.

Interventions

Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness.

Main Outcomes and Measures

The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis.

Results

Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly.

Conclusions and Relevance

The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement.

Trial Registration

ClinicalTrials.gov Identifier: NCT05036993.

Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors

OBJECTIVE

Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons.

METHODS

This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p ​< ​0.05).

RESULTS

The survey's response rate was 20 ​% (n ​= ​358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 ​%) and 94 ​% were men. Of those surveyed, 50 ​% reported a burnout episode more than once per year, 60 ​% depersonalization when treating patients at least yearly, 13 ​% anhedonia, 11 ​% a depressive mood more than half of the month or almost every day, and 61 ​% weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p ​= ​0.012), fewer years as a specialist (p ​= ​0.037), fear of lawsuits (p ​< ​0.001), a non-healthy diet (p ​= ​0.003), non-doing recreational activities (p ​= ​0.004), depersonalization when treating their patients (p ​< ​0.001), weariness (p ​< ​0.001), anhedonia (p ​< ​0.001), depressive mood (p ​< ​0.001), and career dissatisfaction (p ​< ​0.001). The logistic regression demonstrated that fear of lawsuits (p ​< ​0.001), weariness at the end of a workday (p ​= ​0.016), and anhedonia (p ​= ​0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p ​< ​0.001).

CONCLUSION

Over 50 ​% of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 ​% of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor.

LEVEL OF EVIDENCE

Level III.

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.

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

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

Explaining depression in the language of burnout: Normative reasons for depression in place of deterministic causes

In recent years, there has been renewed interest in diversifying the understanding and discussion about the causes of depression to move beyond biomedical determinism-a view that biomedical factors are the ultimate cause of an individual's depression. There is increasing emphasis on diversity in how people seek to articulate the causes of depression to incorporate non-biomedical dimensions. Furthermore, the biomedical understanding of depression has been increasingly questioned due especially to emerging limitations in pharmacotherapy. These shifts encourage social analyses that explore what narratives as to the causes of depression are constructed and presented with relative plausibility in different contexts and why and how. By analysing published memoirs of individuals diagnosed with depression in Japan, this study aims to provide fresh insights into narratives around the causes of depression. It illustrates how memoirs portray depression and its perceived causes in characteristic ways in a nation that adopts Western diagnostic systems, biomedical therapeutics and other relevant technologies. I will show that 'burnout' is the dominant theme in the Japanese data, diverging from the predominantly biomedical narrative in Western societies. This burnout narrative depicts depression as the somewhat unfortunate but unsurprising result of overwork arising from individual active adaptations to structural features of the Japanese work culture. I argue that reasons, rather than causes, articulate the making of the burnout narrative by revealing the interplay between the structural and individual and ultimately enrich the understanding of depression. The paper concludes with a call for exploring the shifting relationship between illness and normalcy that the burnout narrative implies. I suggest that further studies could explore how the boundaries between normalcy and illness are enacted and re-enacted and to what avail through public discourse and through shifting diagnostic schemata in the context of different national norms and practices.

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.

Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study

BACKGROUND

Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout.

METHODS

In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model.

RESULTS

Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048).

CONCLUSION

The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.

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

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

The Mental Health of Elite-Level Coaches: A Systematic Scoping Review

BACKGROUND

Elite-level coaches are exposed to multiple performance, organisational and personal stressors which may contribute to reduced mental health and wellbeing. This systematic scoping review examined the current body of evidence to explore what is known about the mental health of elite-level coaches (i.e. wellbeing and mental ill-health), the risk and protective factors that influence coach mental health, and the relationship between mental health and coaching effectiveness.

METHODS

The review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken and updated in September 2022 using six electronic databases.

RESULTS

12,376 studies were identified and screened, with 42 studies satisfying the inclusion criteria. Despite the paucity of high-quality research, findings indicated that 40% of the included studies examined themes connected to wellbeing, with 76% assessing the nature or prevalence of mental ill-health in elite-level coaches. Among studies exploring mental ill-health, coach burnout was the primary focus, while scant research examined symptoms associated with clinical disorders (e.g. anxiety and depression). Overall, psychological outcomes for elite-level coaches were shaped by risk and protective factors operating at the individual, interpersonal, organisational and societal level. Preliminary evidence was also found to suggest that poor mental health may contribute to reduced coaching effectiveness. It is proposed that coaching effectiveness could therefore be employed as a 'hook' to engage elite-level coaches in greater consideration of their mental health needs.

CONCLUSION

Alongside the development of methodologically robust research, there is a need to examine dynamic individual (e.g. psychological skills), interpersonal (e.g. strong social supports) and organisational (e.g. workload) factors that aim to preserve the mental health and optimise the efficacy of elite-level coaches.

Beliefs about stress moderate the association between COVID-19-related work demands and burnout symptoms in physicians

The present study set out to investigate the role of different stress beliefs (positive and negative beliefs about stress, as well as perceived control) on the association between central COVID-19-related work demands and burnout symptoms in physicians during the second lockdown of the SARS-CoV-2 pandemic. N = 154 practicing physicians (mean [SD] age = 37.21 [9.43] years]; 57.14% female) participated in our cross-sectional German-wide online survey and answered questions about sociodemographic factors, their current work situation, their stress beliefs, and their current burnout symptoms. Moderation analyses revealed significant interaction effects between stress beliefs and specific COVID-19-related work demands on the prediction of burnout symptoms, most consistent with respect to perceived control. Positive believes about stress and its controllability were cross-sectional associated with reduced, negative believes about stress however with enhanced associations between COVID-19-related work demands and burnout symptoms. This finding indicates, if confirmed by longitudinal research, the potential of the usage of stress beliefs in prevention programs for physicians in order to mitigating negative effects of chronic stress.

A simplified measure of burnout symptoms among paramedics - an exploratory analysis of a Hungarian sample

BACKGROUND

Burnout is still one of the leading mental health problems. According to research results over the past decades, healthcare workers, including paramedics, are considered a high-risk group. In concordance with these results, the available resources need to prioritize monitoring paramedics' mental health.

METHODS

In our study, we investigated whether the available test batteries measuring burnout could be reduced while maintaining their effectiveness. We reduced the 21-item Burnout Measurement and the 8-item version of the Psychosomatic Symptom Scale using the data of 727 Hungarian paramedics. We selected the top four items of the questionnaires that were significantly correlated with the original Burnout Measure Index and the Psychosomatic Scale Index. The classification efficiency of the shortened list of items was based on the initial risk categories of the Burnout Measure and its sensitivity was analyzed using Binary Logistic regression and ROC curves. We then used Two-Step Cluster Analysis to test the ability of the shortened Burnout Measure Index to develop new risk categories. The reliability indicators were also explored.

RESULTS

The results show that the Burnout Measurement can be reduced to 4 items with a classification efficiency of 93.5% in determining the level of burnout. The 5-item reduction of the Psychosomatic Symptom Scale can classify subjects to the appropriate intervention level for burnout with an efficiency of 81.6%. The ROC analysis suggests that the shortened questionnaires have an excellent separative ability to discriminate between the initial risk groups. Three new risk categories were also identified as a result of the cluster analysis.

CONCLUSION

The shortened scales may be proven effective in resource management, which could significantly quicken the assessment of burnout in the future. The abbreviated scale is also suitable for classifying subjects into risk categories. However, further research is needed to see whether the shortened scales can be used as a diagnostic tool.

Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study

Long duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.

The prevalence of occupational burnout and its individual and situational predictors among addiction therapists

This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group.

Stress at Work and Well-being Before and During the COVID-19 Pandemic: A 1-Year Longitudinal Study in Switzerland

OBJECTIVE

The aim of the study is to analyze the development of conditions at work and health-related variables (notably exhaustion) in Switzerland longitudinally before and during the COVID-19 pandemic.

METHODS

Questionnaire data were collected from a population-based sample of 1,553 employees in February 2020 and 1 year later. Health and well-being associated with ( a ) working conditions in general and ( b ) COVID-19-specific predictors such as worries about being infected and conditions for working at home were analyzed using analysis of (co)variance and multiple regression.

RESULTS

Conditions at work and well-being were stable overall, even indicating slight improvements, notably for men compared with women. Both an index representing stressors and resources at work in general (Job Stress Index) and a COVID-19-related demand index showed consistent effects on health and the effect of COVID-19-related demands was stronger if the Job Stress Index deteriorated than when it improved.

Association of Emotional Exhaustion With Career Burnout Among Early-Career Medical Oncologists: A Single-Institution Study

PURPOSE

Burnout is a psychological occupational syndrome defined by the Maslach Burnout Inventory (MBI) as emotional exhaustion, depersonalization, and a low sense of personal accomplishment. We sought to characterize the prevalence of burnout among early-career medical oncologists at The University of Texas MD Anderson Cancer Center (MDACC).

METHODS

For this institutional review board-approved study, an electronic survey was developed for Assistant Professors in the MDACC Division of Cancer Medicine. All participants were involved directly in patient care. Our survey included questions assessing self-reported burnout, nine questions validated in the abbreviated MBI, and 31 questions to assess potential contributors to burnout. Each question was scaled 1-5, with higher scores associated with higher burnout. Descriptive statistics were used to estimate the prevalence of burnout, and logistic regression analyses were performed to identify contributing factors.

RESULTS

Among 86 Assistant Professors, 56 (65%) responded to the survey. The mean duration on faculty was 3.1 years. The mean clinical effort was 67% (range, 19-95). Fifty-four percent of respondents self-reported symptoms of burnout including 21% indicating severe burnout. Using the MBI, sentiments of being emotionally drained (54%), fatigued facing another day on the job (45%), and becoming more callous (30%) were especially notable. Twenty-five percent of respondents exhibited severe emotional exhaustion, which was more prevalent (P < .0001) than depersonalization (6%) or lack of personal accomplishment (17%).

CONCLUSION

Burnout exists with high prevalence among early-career medical oncologists, with emotional exhaustion being the most common manifestation of burnout. Interventions focusing on reducing emotional exhaustion are needed to reduce burnout among early-career medical oncologists.

The interplay between mindfulness and caring for bliss on later student burnout

Objectives: While there are good reasons to assume that mindfulness protects against burnout in students, nothing is known about the role of caring for bliss. This study examined whether caring for bliss moderated the relationship between mindfulness at baseline and aspects of burnout approximately 12 weeks later. Participants: Students (n = 92) from a university in the United States. Methods: Online surveys were administered in 2018. Results: Moderated regression analyses, controlling for depressive symptoms and burnout at baseline, revealed that caring for bliss moderated the relationship between earlier mindfulness and two aspects of later student burnout, namely emotional exhaustion and cynicism. Specifically, exhaustion and cynicism were low when students reported either low or high scores on both mindfulness and caring for bliss. No moderating effect was found for academic efficacy. Conclusions: Mindfulness and caring for bliss appear to work synergistically to reduce aspects of student burnout over time.

Burnout en docentes universitarios: evaluación, prevención y tratamiento

El objetivo consistió en evaluar el nivel de burnout en docentes universitarios con el fin de proponer un programa de intervención psicosocial para su prevención y tratamiento. Desde el punto de vista metodológico, el estudio cuantitativo involucró a 1060 docentes universitarios de tres instituciones universitarias de Lima. Se utilizó el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo (CESQT) con alta fiabilidad y estandarizado en varios países, incluyendo Perú. Además, se realizó una revisión de la literatura para fundamentar la necesidad de un programa psicosocial. Los hallazgos muestran los siguientes niveles de burnout, muy bajo: 200 docentes (18,90%), bajo: 298 (28,10%), medio: 297 (28%), alto: 166 (15,70%) y crítico: 99 (9,30%), la alarmante cifra de 265 docentes se encuentra en los niveles alto y crítico, lo cual exige un tratamiento inmediato, al mismo tiempo, un número significativo de docentes debe aprender enfoques preventivos para evitar el burnout, y la literatura científica respalda la importancia de abordar este problema en el contexto académico. El programa contiene acciones específicas de prevención y tratamiento para cada factor del burnout, ilusión por el trabajo, desgaste psíquico, indolencia y culpa, incluyendo estrategias proactivas y actividades para el equilibrio trabajo-familia. Se recomienda sensibilizar a la comunidad educativa sobre el diagnóstico, prevención y atención del burnout, para un entorno académico, saludable y productivo.

Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey

BACKGROUND

Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout.

STUDY DESIGN

An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects.

RESULTS

Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions.

CONCLUSIONS

Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.

Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians

OBJECTIVE

To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians.

PARTICIPANTS AND METHODS

We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures.

RESULTS

Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout.

CONCLUSION

Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.

Burnout and Depression Among Sandwich Generation Caregivers: A Brief Report

Twenty-nine percent of adults in the U.S. care for children, and 12% to 24.3% of those adults are multigenerational caregivers who also provide unpaid care for one or more adults. These adults are considered members of the "sandwich generation," which is a term for multigenerational caregivers who provide care, financial support, and emotional support for both their children and parents. The present study characterized the sandwich generation and examined how sandwich generation caregivers differed from caregivers of children, caregivers of parents, and non-caregivers regarding burnout and depression. We found that sandwich generation caregivers and caregivers of parents reported significantly higher levels of informal caregiving burnout than caregivers of children. Compared to non-caregivers, all caregivers reported significantly higher levels of personal burnout. Burnout is higher in sandwich generation caregivers and those who care for parents than burnout among those who care only for children. Future studies should investigate additional variables that affect burnout.

When a bad day at the golf course is a bad day at the office: occupational stressors, institutional supports, and the mental health of NCAA golf coaches

This study examined the mental health of NCAA collegiate golf coaches. Utilizing the person-environment fit theory and previous literature on coaches' well-being, this study examined four outcomes among 48 participants, namely: depressive and anxiety symptoms, burnout, and job turnover intentions. Results suggested that coaching stressors (e.g., administrative tasks, practice plans, pressure to win) only associate with greater burnout. More consistent evidence showed that workplace stress (e.g., lack of control and autonomy, poor work-family balance) associated with higher levels of all outcomes. Finally, greater perceived organizational support had a beneficial association with each outcome. The findings of the current study suggest golf coaches are at risk of mental health problems because of the stressors of this job. Taken as a whole, athletic departments, coaches, and student-athletes must reconsider norms that overemphasize performance and underemphasize self-care and work-life balance.

The relationships between teachers' emotional health and stress coping

Introduction

Teaching is a profession that involves challenges to emotional health. Teachers experience high levels of work-related stress, which causes symptoms such as anxiety, depression and burnout. Teachers' mental health affects not only their own well-being, but also the quality of education and student achievement. Coping strategies can effectively improve teachers' emotional health. The aim of this study is to assess the relationship between teachers' emotional health and stress coping.

Methods

The sample consisted of 385 teachers from Lithuania, with an average age of 50.2 (±9.62) years and 24.9 (±11.8) years of school experience. The WHO-5, the Kessler Psychological Distress Scale (K6), the Spanish Burnout Inventory, Educational Version (SBI-Ed) and the Coping Strategies Scale were used in the study.

Results

The study results show that teachers' age, seniority, size of residence, and marital status do not affect their emotional health, but their financial situation and hobbies have a positive impact on enthusiasm. Effective coping strategies such as problem solving, exercise, and hobbies improve emotional well-being, whereas negative coping methods such as self-isolation and alcohol consumption lead to psychological distress and lower enthusiasm at work.

Techno-Stress Creators, Burnout and Psychological Health among Remote Workers during the Pandemic: The Moderating Role of E-Work Self-Efficacy

During the COVID-19 pandemic, remote working was pervasively implemented, causing an increase in technology-related job demands. Concurrently, there was an increase in psychological problems in the occupational population. This study on remote workers tested a moderated mediation model positing burnout, conceptualized according to the Burnout Assessment Tool, as the mediator between techno-stressors and psychological health outcomes and e-work self-efficacy as a protective personal resource. A sample of 225 remote workers filled out anonymous questionnaires measuring techno-stressors, e-work self-efficacy, burnout, and psychological health symptoms (i.e., depressive mood and anxiety symptoms). The data were analyzed using structural equation mediation and moderated mediation models, adopting a parceling technique. The results showed that burnout totally mediated the relationship between techno-stressors and depressive mood, while partially mediating the association between techno-stressors and anxiety symptoms. Moreover, e-work self-efficacy buffered the positive effects of techno-stressors on depressive mood and anxiety symptoms through burnout. The present research attested to the relevance of techno-stressors for the psychological health of remote workers and supported burnout as a mediator of this process, although anxiety symptoms were also directly related to techno-stressors. Moreover, the protective role of domain-specific self-efficacy was confirmed in the realm of remote working. Limitations and practical implications are discussed.

Changes in anxiety and depression among public health workers during the COVID-19 pandemic response

OBJECTIVES

The COVID-19 pandemic has negatively impacted mental health indicators, leading to an increase in symptoms of anxiety and depression in both the general population of adults and children and many occupational groups. This study aims to examine changes in anxiety and depression among a cohort of public health workers in the U.S. during the first year of the COVID-19 pandemic and identify potential risk factors.

METHODS

Longitudinal data were collected from a sub-sample (N = 85) of public health workers in 23 U.S. states who completed two surveys in 2020 and 2021. Information on background characteristics, personal well-being, and work environment as well as validated scales to assess generalized anxiety disorder (GAD), depressive disorder, and burnout was collected. Data were analyzed using Stata Version 17, and significant differences were determined using Pearson's Chi2 and Fisher's Exact tests.

RESULTS

The proportion of those reporting GAD (46.3% to 23.2%) or depression (37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety saw the largest improvement. Persistent depression was associated with sustained burnout, changes in social support, and days worked per week.

CONCLUSION

Public health workers experienced elevated levels of anxiety and depression during the initial pandemic response, but a reduction in these symptoms was observed in the subsequent year after vaccines had become widely available. However, unmet needs remain for ongoing workplace mental health supports to address burnout, as well as for additional emotional supports outside of work for public health professionals.

Burnout and depression: Points of convergence and divergence

BACKGROUND

Debate is ongoing as to whether burnout can be differentiated from depression. This study evaluated whether burnout and depression could be distinguished using a new burnout measure and other variables.

METHODS

Scores on the Sydney Burnout Measure (SBM) were compared between participants with self-diagnosed burnout (BO-all group; n = 622) and clinically-diagnosed depression (DEP-all group; n = 90). The latter group was split into melancholic (DEP-mel; n = 56) and non-melancholic (DEP-nonmel; n = 34) depression subgroups for subsequent analyses. Differences in reporting of depressive symptoms and causal attributions were also evaluated.

RESULTS

While total SBM scores showed poor differentiation, the BO-all group had lower social withdrawal and higher empathy loss subscale scores than the depression groups. Odds ratios were significant for several of the depressive symptoms and causal attribution items when comparing the BO-all group to the DEP-all and DEP-mel groups, while only a few items were significant when comparing the BO-all and DEP-nonmel groups.

LIMITATIONS

Participants in the depression group were assigned by clinician-based depression diagnoses, rather than by a standardised diagnostic interview, and the group had a relatively small sample size. Participants in the burnout group were self-diagnosed and not assessed for comorbid psychiatric diagnoses.

CONCLUSIONS

There were some nuanced symptoms differences between burnout and depression, but many of the SBM symptoms were not specific to burnout. Results also suggested that burnout overlaps more with non-melancholic than melancholic depression, and that differentiation of burnout and depression may rely more on weighting causal factors over symptoms.

Workers' emotional exhaustion and mental well-being over the COVID-19 pandemic: a Dynamic Structural Equation Modeling (DSEM) approach

The COVID-19 pandemic has presented significant challenges to the workforce, particularly concerning emotional and mental well-being. Given the prolonged periods of work-related stress, unexpected organizational changes, and uncertainties about work faced during the pandemic, it becomes imperative to study occupational health constructs under a dynamic methodological perspective, to understand their stable and unstable characteristics better. In this study, drawing on the Dynamic Structural Equation Modeling (DSEM) framework, we used a combination of multilevel AR(1) models, Residual-DSEM (RDSEM), multilevel bivariate VAR(1) models, and multilevel location-scale models to investigate the autoregression, trend, and (residual) cross-lagged relationships between emotional exhaustion (EmEx) and mental well-being (MWB) over the COVID-19 pandemic. Data were collected weekly on 533 workers from Germany (91.18%) and Italy (8.82%) who completed a self-reported battery (total number of observations = 3,946). Consistent with our hypotheses, results were as follows: (a) regarding autoregression, the autoregressive component for both EmEx and MWB was positive and significant, as well as it was their associated between-level variability; (b) regarding trend, over time EmEx significantly increased, while MWB significantly declined, furthermore both changes had a significant between-level variability; (c) regarding the longitudinal bivariate (cross-lagged) relationships, EmEx and MWB negatively and significantly affected each other from week to week, furthermore both cross-lagged relationships showed to have significant between-level variance. Overall, our study pointed attention to the vicious cycle between EmEx and MWB, even after controlling for their autoregressive component and trend, and supported the utility of DSEM in occupational health psychology studies.

Burnout syndrome and depression in students of a Colombian medical school, 2018

INTRODUCTION AND OBJECTIVES

Burnout syndrome (BS) has been evaluated in few populations of medical students, and its relationship with depression is even less studied. The objective was to determine the frequency of BS in medical students of the Universidad Pedagógica y Tecnológica de Colombia (UPTC), in Tunja, Colombia, as well as its association with depression and other social, economic, demographic, and academic factors.

METHODS

An observational, analytical, cross-sectional study was carried out on 182 UPTC medical students during 2018. The Maslach Burnout Inventory-Student Survey (MBI-SS) was applied, with which 3 components were obtained to determine positive SB. This was crossed in the Stata 15 program for depression and other social, economic, demographic, and academic covariates with the Generalised Linear Model (GLM).

RESULTS

Of 182 respondents, 51.4% were women. The median age was 21 years (20-23 years). 14% had BS, of which 48% had depression. In the multiple regression, BS was significantly associated with a higher frequency of depression (RPa = 5.54; IC95%, 2.36-13.02; P < 0.001) and the feeling of insufficient money (RPa = 4.37; IC95%, 1.95-9.83; P < 0.001), in contrast to a negative association with smoking (RPa = 0.13; IC95%, 0.06-0.30; P < 0.001) and being a woman (RPa = 0.32; IC95%, 0.12-0.82; P = 0.018). The age of onset of marijuana use was not significant.

CONCLUSIONS

BS shows a high association with increased depression and a feeling that the money is not enough at the end of the month, but it showed a negative association with tobacco consumption and being a woman. Such students should be detected to provide them with adequate academic support.

Risk factors for insomnia and burnout: A longitudinal population-based cohort study

Insomnia and burnout are highly prevalent in the general population, calling for understanding of its causes. Taking a broad approach, the aim of this study was to determine various mental and somatic risk factors for development of insomnia and burnout and stratifying for sex and age group. Questionnaire data were used from a Swedish population-based sample aged 18-79 years, from which cohorts without insomnia (n = 1702) and without burnout (n = 1972) at baseline were followed-up after 3 years. Self-reports of eight mental and somatic conditions at baseline were used as independent variables in logistic regression analyses to predict development of insomnia and burnout at 3-year follow-up. All eight studied conditions were significant risk factors for development of both insomnia (odds ratio, OR = 1.62-2.73) and burnout (OR = 2.20-3.21). Burnout and poor self-rated health had the highest ORs for insomnia, and poor self-rated health, anxiety and somatic symptoms had the highest ORs for burnout. The ORs were generally similar between men and women, whereas age groups tended to differ in some of the risk factors. The study highlights the importance of a broad assessment of both mental and somatic conditions in the prevention of insomnia and burnout.

Historicizing psychedelics: counterculture, renaissance, and the neoliberal matrix

In this essay, I would like to suggest that the historical transition of psychedelics from an association with counterculture to becoming part of the mainstream is related to the rise of what late cultural theorist Mark Fisher termed "capitalist realism"-the notion that there is no alternative form of social organization and, as such, capitalism simply is reality. For Fisher, the economic and political project of neoliberalism was the main agent behind this re-instauration of capitalist hegemony after its de-stabilization by the convergence of several radical forces at the end of the 1960s and early 70s, of which psychedelic "consciousness-expansion" was one. Thus, historicizing psychedelics within the shifts in political economy and culture associated with the "collective set and setting" of neoliberalism can serve both to understand the current shape and operations of the psychedelic "renaissance" as well as help us retrieve these substance's lost political potential. Concretely, this essay argues that such potential was not inherent to psychedelics but embedded in the political economy of the New Deal order, which supported both the formation of discourses, demands, and hopes based on "the social" and, relatedly, the idea that "the personal is political." As neoliberalism displaced this object of reference in favor of individualism, the personal was de-linked from the political and the dreams-and the threats-of psychedelic utopianism were successfully defused and forgotten. In the process, concretely, the anti-work and collective dimensions of the psychedelic counterculture have been all but lost as psychedelics have returned to enhance or treat individual brains-while leaving capitalist society unchallenged. In light of our ecological and social predicaments, the famous context-dependence of psychedelics can be a powerful reminder that, contra individualism, the social and political traverse the personal-and thus that to change the self in line with the psychedelic values of love and connection ultimately requires changing the world.

Burnout and depression: A cross sectional study among health care workers providing HIV care during the COVID-19 pandemic in Malawi

Health care workers (HCWs) in eastern Africa experience high levels of burnout and depression, and this may be exacerbated during the COVID-19 pandemic due to anxiety and increased work pressure. We assessed the prevalence of burnout, depression and associated factors among Malawian HCWs who provided HIV care during the COVID-19 pandemic. From April-May 2021, between the second and third COVID-19 waves in Malawi, we randomly selected HCWs from 32 purposively selected PEPFAR/USAID-supported health facilities for a cross-sectional survey. We screened for depression using the World Health Organization Self Report Questionnaire (positive screen: score≥8) and for burnout using the Maslach Burnout Inventory tool, (positive screen: moderate-high Emotional Exhaustion and/or moderate-high Depersonalization, and/or low-moderate Personal Accomplishment scores). Logistic regression models were used to evaluate factors associated with depression and burnout. We enrolled 435 HCWs, median age 32 years (IQR 28-38), 54% male, 34% were clinical cadres and 66% lay cadres. Of those surveyed, 28% screened positive for depression, 29% for burnout and 13% for both. In analyses that controlled for age, district, and residence (rural/urban), we found that screening positive for depression was associated with expecting to be infected with COVID-19 in the next 12 months (aOR 2.7, 95%CI 1.3-5.5), and previously having a COVID-19 infection (aOR 2.58, 95CI 1.4-5.0). Screening positive for burnout was associated with being in the clinical cadre (aOR 1.86; 95% CI: 1.2-3.0) and having a positive depression screen (aOR 3.2; 95% CI: 1.9-5.4). Reports of symptoms consistent with burnout and depression were common among Malawian HCWs providing HIV care but prevalence was not higher than in surveys before the COVID-19 pandemic. Regular screening for burnout and depression should be encouraged, given the potential for adverse HCW health outcomes and reduced work performance. Feasible interventions for burnout and depression among HCWs in our setting need to be introduced urgently.

Examining the links between burnout and suicidal ideation in diverse occupations

Introduction

It is uncertain whether burnout is associated with suicidal ideation among workers not in health care services. The aim of this study was to identify how burnout and suicidal ideation are linked among employees in various occupations and whether depression affects this link.

Methods

This cross-sectional study collected data from 12,083 participants aged 19-65 years from 25 companies and public institutions who underwent workplace mental health screening. Burnout and depression were assessed using both the Oldenburg Burnout Inventory and the Center for Epidemiologic Studies Depression Scale. Suicidal ideation was assessed by a self-rated questionnaire from the Korea National Health and Nutrition Examination Survey.

Results

Exhaustion but not the cynicism dimension of burnout was associated with increased odds of suicidal ideation after adjustment for depression and other covariates (odds ratio [OR] = 1.47, 95% CI = 1.26-1.72). The association of exhaustion with suicidal ideation was significant in both depressed (OR = 1.36, 95% CI = 1.14-1.61) and not depressed (OR = 1.77, 95% CI = 1.13-2.76) participants. In exhausted participants, insufficient job control, an unfavorable occupational climate, low educational level, and depression were associated with increased odds of suicidal ideation.

Conclusion

Exhaustion is linked with risk of suicidal ideation in employees not in health care service, regardless of depression status. Exhausted employees, particularly those having poor job resources, should be recognized as an at-risk group.

Energy Availability, Mental Health, and Sleep Patterns of Athletic Trainers

CONTEXT

Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs).

OBJECTIVE

To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional).

DESIGN

Cross-sectional study.

SETTING

Free living in occupational settings.

PATIENTS OR OTHER PARTICIPANTS

A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States.

MAIN OUTCOME MEASURE(S)

Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality.

RESULTS

Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances.

CONCLUSIONS

Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care.

The effects of becoming a physician on prescription drug use and mental health treatment

There is evidence that physicians disproportionately suffer from substance use disorder and mental health problems. It is not clear, however, whether these phenomena are causal. We use data on Dutch medical school applicants to examine the effects of becoming a physician on prescription drug use and the receipt of treatment from a mental health facility. Leveraging variation from lottery outcomes that determine admission into medical schools, we find that becoming a physician increases the use of antidepressants, anxiolytics, opioids, and sedatives. Increases in the use of antidepressants, anxiolytics, and sedatives are larger among female physicians than among their male counterparts.

Student Burnout in Children and Adolescents: The Role of Attachment and Emotion Regulation

In an effort to explain the factors contributing to the development of student burnout, a construct that has received attention in relation to academic outcomes, including burnout, is emotion regulation. Further, attachment theory has been used to explore the variations in the use of particular emotion regulation strategies, and attachment has received support as a contributing factor. The aim of the study is to explore the role of attachment security and emotion regulation strategies associated with student burnout symptoms in a sample of 602 Romanian children and adolescents (55% female) aged 8-16 (M = 10.45) from 18 schools. A secondary objective was to explore the gender differences in burnout symptoms. The results show that attachment security negatively predicts student burnout symptoms. Further, a higher attachment security positively predicts the use of adaptive emotion regulation strategies, which, in turn, are negatively related to student burnout. Emotion regulation strategies mediate the relationship between attachment and burnout symptoms. No gender differences have been identified. The study has practical implications for both parents and specialists, bringing to attention the importance of secure attachment in children, which could further encourage the use of adaptive emotion regulation strategies.

Neuroticism, perfectionism, and emotion suppression in burnout: Implications for cognitive functioning

This study aimed to investigate the relationship between burnout and cognitive functions, particularly memory, attention, and executive functions, which have been found to be negatively affected in most studies. However, the results are not consistent across studies, and there is often a discrepancy between self-reported cognitive function and objective assessment. Two possible explanations for this discrepancy are the heterogeneous profiles of individuals in burnout and their personality traits. The study administered neuropsychological tests and questionnaires to 29 participants with clinical burnout to assess their cognitive functions and the impact of perfectionism, neuroticism, and emotion suppression on subjective and objective cognitive scores. The main findings showed little or no deterioration in memory or executive functions, despite patients reporting severely impaired executive function. The study found that neuroticism and perfectionism were related to poorer self-reported executive function, while emotion suppression was related to better self-reported executive function. No relationship was found between personality traits and neuropsychological test scores, indicating a discrepancy between self-perception and objective evaluation.

A Relational Workforce Capacity Approach to Trauma-Informed Care Implementation: Staff Rejection Sensitivity as a Potential Barrier to Organizational Attachment

This study explores the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among mental health agencies transitioning to Trauma-Informed Care (TIC), which is currently outside the focus of most research. Specifically, this study examines: (1) whether staff rejection sensitivity predicts organizational attachment; (2) whether staff turnover intentions account for the association between rejection sensitivity and organizational attachment; and (3) whether those associations hold once taking into account staff demographic factors (gender, race and ethnicity, education, and income)? Around 180 frontline workers in three Northeastern U.S. mental health agencies responded to surveys collected between 2016 and 2019 using the organizational attachment, rejection sensitivity and turnover intention measures, and their previous TIC training experience. Rejection sensitivity was significantly associated with organizational attachment (β = -0.39, p < 0.001), accounting for 6% of its variance in organizational attachment. The relationship between these variables retained significance, and staff education significantly predicted organizational attachment, with higher education predicting lower levels of organizational attachment (β = -0.15, p < 0.05), accounting for 22% of its variance. This study concludes that TIC transitioning mental health agencies' staff with a higher rejection sensitivity are more likely to express lower organizational attachment and higher intent-to-turnover.

Exploring University and Healthcare Workers' Physical Activity, Diet, and Well-Being During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic affected well-being and health behaviors, especially among healthcare workers and employees in other fields. This is of public health concern because health behaviors and well-being influence long-term negative health outcomes. The purpose of this study was to explore health behaviors and well-being among university and medical center staff during COVID-19.

METHODS

EMPOWER (Employee Well-being during Epidemic Response) was a three-wave observational study (wave 1: 1,994; wave 2: 1,426; wave 3: 1,363) measuring health behaviors and well-being of university and medical center staff. Surveys were disseminated online to all employees between April and September 2020. Descriptive statistics explored trends across waves for health behaviors (physical activity [PA], diet), and well-being (mental well-being [MWB], depression, anxiety, and stress). Logistic regressions explored associations between health behaviors and well-being factors adjusting for demographics and clinical role. Interactions explored moderation by clinical role.

RESULTS

Most participants reported same/healthier changes in PA (54-65%) and diet (57-73%) and decreased MWB across waves (62%-69%). Nonclinical workers were less likely than clinical workers to experience worse MWB and moderate/severe anxiety and stress (odds ratios [ORs] ranged from 0.38 to 0.58 across waves and well-being outcomes). Participants who maintained/increased PA and diet were less likely to experience worse well-being (ORs ranged from 0.44 to 0.69 across waves and well-being outcomes). Interactions by clinical role were not significant.

CONCLUSION/APPLICATION TO PRACTICE

Maintaining/increasing health behaviors during COVID-19 may be protective of mental health/well-being in some healthcare workers. These findings support health promotion efforts focused on maintaining or improving diet and PA.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

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.

Building community at work: An exploratory study in healthcare system management

Recent scholarship has demonstrated that experiences in the community (i.e., a sense of community [SOC] and a SOC responsibility) can enhance employee psychological and behavioral outcomes. Recent evidence also shows that the experiences of the community are better able to predict employee outcomes compared to long-regarded management and public management constructs. However, very little empirical evidence exists on antecedent conditions that help build community experiences at work. To evaluate this gap, we conducted interviews with executive leaders, and focus groups with administrative leaders, across four major facilities in a large nonprofit healthcare system that is headquartered in Pennsylvania, United States. The study confirmed the propositions of the Community Experience Model, and explored organizational conditions that appear to build community experiences. The findings help frame factors that scholars can empirically test in future studies, and assist executives, human resource professionals, and managers throughout an organization, in building community at work.

Burnout among labor and birth providers in northern Tanzania: A mixed-method study

Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally, and is especially worrisome in settings with a shortage of healthcare workers and resources. The goal of this study is to explore the experience of burnout in a population of labor and delivery (L&D) providers in Tanzania. We examined burnout using three data sources. A structured assessment of burnout was collected at four time points from a sample of 60 L&D providers in six clinics. The same providers participated in an interactive group activity from which we drew observational data on burnout prevalence. Finally, we conducted in-depth interviews (IDIs) with a subset of 15 providers to further explore their experience of burnout. At baseline, prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One- and three- months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped providers realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors. Burnout was prevalent among a sample of L&D providers in northern Tanzania. However, a lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health. Previously validated burnout measures cannot adequately assess burnout without a discussion of the context.

Exploring the validity of the Sydney Burnout Measure

This study aimed to examine the convergent validity of a new measure of burnout, the Sydney Burnout Measure (SBM) by comparison against the field standard measure - the Maslach Burnout Inventory (MBI). A second aim was to consider burnout's association with psychological distress. 1483 dental professionals completed the two burnout measures as well as two measures of psychological distress. The overall correlation between total scores on the two measures (and on shared constructs) was high, and thus the convergent validity of the SBM was supported. Further, the SBM and MBI total scores correlated highly with total scores on the two measures of distress. Exploratory structural equation modelling (ESEM) also identified substantial overlap between the measures, especially in relation to the exhaustion subscales of the burnout measures and their overlap with psychological distress items. While future research is required to determine which burnout measure and its associated burnout definition is most valid, our findings argue for further consideration of how burnout may best be conceptualized, as well as whether the syndrome is worthy of elevation to mental disorder status.

Organizational cultures that support community: Does the competing values framework help us understand experiences of community at work?

Recent evidence has shown that when employees experience perceptions of community at work (i.e., a sense of community and a sense of community responsibility), psychological well-being and behavioral engagement improve (e.g., greater job engagement, organizational citizenship, and leadership). Recent evidence also shows that experiences of community, as a motivational state, are better able to predict employee outcomes compared to a series of factors that have long been studied in the general management (i.e., affective organizational commitment, organizational identity) and in the public management literature (i.e., public service motivation). However, we know less about the conditions that lead to perceptions of community experiences at work. One recent qualitative investigation exposed a series of organizational conditions that appear to stimulate perceptions of community at work including C-Suite leadership support, organizational structure and context, characteristics of connection, managerial, job, and work unit characteristics, and responsibilities of human resource management professionals. The present study extends this study by empirically investigating organizational cultural conditions that are associated with perceptions of community at work. We test the ability of the Competing Values Framework, which includes constructs of Hierarchy, Market, Adhocracy, and Clan organizational cultures, and their ability to predict perceptions of the community. Findings showed that clan culture was most associated with perceptions of community in general and that clan culture within a department plays an important role in perceiving community at work. This study helps scholars understand cultural conditions that can lead to psychological experiences of community, it begins to frame cultural factors that scholars can empirically test in future studies, and it assists executives and managers in conceiving approaches to building cultures of community at work.