Skip to main content

Advertisement

SpringerLink
Log in

A Model of Burnout Among Healthcare Professionals

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Burnout is common and can lead to worse outcomes for both healthcare workers and patients. Our study purpose was to assess the structural relationship among factors that protect against or worsen burnout.

Data Sources and Study Setting

We surveyed healthcare professionals in 15 different Japanese intensive care units during the 3rd wave of the COVID-19 pandemic (March 2021). Surveys assessed burnout (Mini Z 2.0), resilience (Brief Resilience Scale), depressive (PHQ-9) and anxiety (GAD-7) symptoms, job and work environment characteristics, and personal experience with COVID. We explored survey domains with principal component factor analysis and modeled our results using structural equation modeling.

Principal Findings

Among 936 ICU professionals, 24.3% met criteria for burnout. Our model suggested that resilience (β =  − 0.26, 95% CI − 0.32 to − 0.20), teamwork (β =  − 0.23, 95% CI − 0.30 to − 0.16), and feeling safe (β =  − 0.11, 95% CI − 0.18 to − 0.04) reduced burnout. Depression (β =  − 0.32, 95% CI − 0.41 to − 0.23) and anxiety (β =  − 0.20, 95% CI − 0.29 to − 0.10) both decreased resilience as did COVID fear (β = 0.08, 95% CI − 0.14 to − 0.02). In addition to directly reducing resilience, anxiety also indirectly reduced resilience by increasing COVID fear (0.23, 95% CI 0.17 to 0.23), which decreased resilience (β − 0.08, 95% CI − 0.14 to − 0.02).

Conclusions

Burnout is common among Japanese ICU professionals. Resilience, teamwork, and safety are all correlated with reduced burnout. Those who had depression or anxiety or COVID fear had higher degrees of burnout, an effect that appears to be mediated by reduced resilience. These are potential targets for interventions to reduce burnout.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Elbarazi I, Loney T, Yousef S, Elias A. Prevalence of and Factors Associated with Burnout Among Health Care Professionals in Arab Countries: a Systematic Review. BMC Health Serv Res. 2017;17(1):491. doi:https://doi.org/10.1186/s12913-017-2319-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kansoun Z, Boyer L, Hodgkinson M, Villes V, Lançon C, Fond G. Burnout in French Physicians: a Systematic Review and Meta-analysis. J Affect Disord. 2019;246:132-147. doi:https://doi.org/10.1016/j.jad.2018.12.056

    Article  PubMed  Google Scholar 

  3. Karuna C, Palmer V, Scott A, Gunn J. Prevalence of Burnout Among GPs: a Systematic Review and Meta-analysis. Br J Gen Pract. 2022;72(718):e316-e324. doi:https://doi.org/10.3399/bjgp.2021.0441

    Article  PubMed  Google Scholar 

  4. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Burnout Among Physicians: a Systematic Review. Jama. 2018;320(11):1131-1150. doi:https://doi.org/10.1001/jama.2018.12777

    Article  PubMed  PubMed Central  Google Scholar 

  5. Woo T, Ho R, Tang A, Tam W. Global Prevalence of Burnout Symptoms Among Nurses: a Systematic Review and Meta-analysis. J Psychiatr Res. 2020;123:9-20. doi:https://doi.org/10.1016/j.jpsychires.2019.12.015

    Article  PubMed  Google Scholar 

  6. Zgliczyńska M, Zgliczyński S, Ciebiera M, Kosińska-Kaczyńska K. Occupational Burnout Syndrome in Polish Physicians: a Systematic Review. Int J Environ Res Public Health. 2019;16(24) doi:https://doi.org/10.3390/ijerph16245026

  7. West CP, Dyrbye LN, Sinsky C, et al. Resilience and Burnout Among Physicians and the General US Working Population. JAMA Netw Open. 2020;3(7):e209385. doi:https://doi.org/10.1001/jamanetworkopen.2020.9385

    Article  PubMed  PubMed Central  Google Scholar 

  8. Singh P, Aulak DS, Mangat SS, Aulak MS. Systematic Review: Factors Contributing to Burnout in Dentistry. Occup Med (Lond). 2016;66(1):27-31. doi:https://doi.org/10.1093/occmed/kqv119

    Article  CAS  PubMed  Google Scholar 

  9. Shields M, James D, McCormack L, Warren-Forward H. Burnout in the Disciplines of Medical Radiation Science: a Systematic Review. J Med Imaging Radiat Sci. 2021;52(2):295-304. doi:https://doi.org/10.1016/j.jmir.2021.04.001

    Article  PubMed  Google Scholar 

  10. Brscic M, Contiero B, Schianchi A, Marogna C. Challenging Suicide, Burnout, and Depression Among Veterinary Practitioners and Students: Text Mining and Topics Modelling Analysis of the Scientific Literature. BMC Vet Res. 2021;17(1):294. doi:https://doi.org/10.1186/s12917-021-03000-x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alkhamees AA, Assiri H, Alharbi HY, Nasser A, Alkhamees MA. Burnout and Depression Among Psychiatry Residents During COVID-19 Pandemic. Hum Resour Health. 2021;19(1):46. doi:https://doi.org/10.1186/s12960-021-00584-1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Low ZX, Yeo KA, Sharma VK, et al. Prevalence of Burnout in Medical and Surgical Residents: a Meta-analysis. Int J Environ Res Public Health. 2019;16(9) doi:https://doi.org/10.3390/ijerph16091479

  13. Rodrigues H, Cobucci R, Oliveira A, et al. Burnout Syndrome Among Medical Residents: a Systematic Review and Meta-analysis. PLoS One. 2018;13(11):e0206840. doi:https://doi.org/10.1371/journal.pone.0206840

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gérain P, Zech E. Do Informal Caregivers Experience More Burnout? A Meta-analytic Study. Psychol Health Med. 2021;26(2):145-161. doi:https://doi.org/10.1080/13548506.2020.1803372

    Article  PubMed  Google Scholar 

  15. Yang Y, Hayes JA. Causes and Consequences of Burnout Among Mental Health Professionals: a Practice-Oriented Review of Recent Empirical Literature. Psychotherapy (Chic). 2020;57(3):426-436. doi:https://doi.org/10.1037/pst0000317

    Article  PubMed  Google Scholar 

  16. Rothenberger DA. Physician Burnout and Well-Being: a Systematic Review and Framework for Action. Dis Colon Rectum. 2017;60(6):567-576. doi:https://doi.org/10.1097/dcr.0000000000000844

    Article  PubMed  Google Scholar 

  17. Lacy BE, Chan JL. Physician Burnout: the Hidden Health Care Crisis. Clin Gastroenterol Hepatol. 2018;16(3):311-317. doi:https://doi.org/10.1016/j.cgh.2017.06.043

    Article  PubMed  Google Scholar 

  18. Long L, Moore D, Robinson S, et al. Understanding Why Primary Care Doctors Leave Direct Patient Care: a Systematic Review of Qualitative Research. BMJ Open. 12 2020;10(5):e029846. doi:https://doi.org/10.1136/bmjopen-2019-029846

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tawfik DS, Scheid A, Profit J, et al. Evidence Relating Health Care Provider Burnout and Quality of Care: a Systematic Review and Meta-analysis. Ann Intern Med. 2019;171(8):555-567. doi:https://doi.org/10.7326/m19-1152

    Article  PubMed  PubMed Central  Google Scholar 

  20. Giménez Lozano JM, Martínez Ramón JP, Morales Rodríguez FM. Doctors and Nurses: a Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout. Int J Environ Res Public Health. 2021;18(6) doi:https://doi.org/10.3390/ijerph18063280

  21. Golonka K, Mojsa-Kaja J, Blukacz M, Gawłowska M, Marek T. Occupational Burnout and Its Overlapping Effect with Depression and Anxiety. Int J Occup Med Environ Health. 2019;32(2):229-244. doi:https://doi.org/10.13075/ijomeh.1896.01323

    Article  PubMed  Google Scholar 

  22. Schonfeld IS, Verkuilen J, Bianchi R. Inquiry into the Correlation Between Burnout and Depression. J Occup Health Psychol. 2019;24(6):603-616. doi:https://doi.org/10.1037/ocp0000151

    Article  PubMed  Google Scholar 

  23. Busireddy KR, Miller JA, Ellison K, Ren V, Qayyum R, Panda M. Efficacy of Interventions to Reduce Resident Physician Burnout: a Systematic Review. J Grad Med Educ. 2017;9(3):294-301. doi:https://doi.org/10.4300/jgme-d-16-00372.1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Clough BA, March S, Chan RJ, Casey LM, Phillips R, Ireland MJ. Psychosocial Interventions for Managing Occupational Stress and Burnout Among Medical Doctors: a Systematic Review. Syst Rev. 2017;6(1):144. doi:https://doi.org/10.1186/s13643-017-0526-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dharmawardene M, Givens J, Wachholtz A, Makowski S, Tjia J. A Systematic Review and Meta-analysis of Meditative Interventions for Informal Caregivers and Health Professionals. BMJ Support Palliat Care. 2016;6(2):160-9. doi:https://doi.org/10.1136/bmjspcare-2014-000819

    Article  PubMed  Google Scholar 

  26. Kuriyama A, Sakuraya M, Kinjo M, et al. Burnout and Turnover Intention in Critical Care Professionals During the COVID-19 Pandemic in Japan: a Cross-sectional Survey. Ann Am Thorac Soc. 2022;doi:https://doi.org/10.1513/AnnalsATS.202201-029OC

    Article  Google Scholar 

  27. Aziz S, Arabi YM, Alhazzani W, et al. Managing ICU Surge During the COVID-19 Crisis: Rapid Guidelines. Intensive Care Med. 2020;46(7):1303-1325. doi:https://doi.org/10.1007/s00134-020-06092-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Anesi GL, Lynch Y, Evans L. A Conceptual and Adaptable Approach to Hospital Preparedness for Acute Surge Events Due to Emerging Infectious Diseases. Crit Care Explor. 2020;2(4):e0110. doi:https://doi.org/10.1097/cce.0000000000000110

    Article  PubMed  PubMed Central  Google Scholar 

  29. Linzer M, McLoughlin C, Poplau S, Goelz E, Brown R, Sinsky C. The Mini Z Worklife and Burnout Reduction Instrument: Psychometrics and Clinical Implications. J Gen Intern Med. 2022;37(11):2876-2878. doi:https://doi.org/10.1007/s11606-021-07278-3

    Article  PubMed  PubMed Central  Google Scholar 

  30. Muramatsu K, Miyaoka H, Kamijima K, et al. Performance of the Japanese Version of the Patient Health Questionnaire-9 (J-PHQ-9) for Depression in Primary Care. Research Support, Non-U.S. Gov't. General hospital psychiatry. 2018;52:64–69. doi:https://doi.org/10.1016/j.genhosppsych.2018.03.007

  31. Spitzer RL, Kroenke K, Williams JB, Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7. doi:https://doi.org/10.1001/archinte.166.10.1092

    Article  PubMed  Google Scholar 

  32. Tokuyoshi Y, Moriya M. Development and Validation of the Brief Resilience Scale Japanese Version (BRS-J). The Proceedings of the Annual Convention of the Japanese Psychological Association. 2015;79(0):1EV-055–1EV-055. doi:https://doi.org/10.4992/pacjpa.79.0_1EV-055

  33. Mueller J-OK, W. C. Factor Analysis. Statistical Methods and Practical Issues. . vol 14. Quantitative Applications in the Social Sciences. Sage Publications; 1978

  34. Kline RB. Principles and Practice of Structural Equation Modeling. (Methodology in the Social Sciences). Fourth Edition. Guilford Press; 2016.

  35. Sorbom D. Model Modification. Psychometrika. 1989;(54):371-384.

    Article  MathSciNet  Google Scholar 

  36. Kelley K, Preacher KJ. On effect size. Psychol Methods. 2012;17(2):137-52. doi:https://doi.org/10.1037/a0028086

    Article  PubMed  Google Scholar 

  37. Panagioti M, Panagopoulou E, Bower P, et al. Controlled Interventions to Reduce Burnout in Physicians: a Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(2):195-205. doi:https://doi.org/10.1001/jamainternmed.2016.7674

    Article  PubMed  Google Scholar 

  38. Kunzler AM, Helmreich I, König J, et al. Psychological Interventions to Foster Resilience in Healthcare Students. Cochrane Database Syst Rev. 2020;7(7):Cd013684. doi:https://doi.org/10.1002/14651858.Cd013684

    Article  PubMed  Google Scholar 

  39. Venegas CL, Nkangu MN, Duffy MC, Fergusson DA, Spilg EG. Interventions to Improve Resilience in Physicians who Have Completed Training: a Systematic Review. PLoS One. 2019;14(1):e0210512. doi:https://doi.org/10.1371/journal.pone.0210512

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Cleary M, Kornhaber R, Thapa DK, West S, Visentin D. The Effectiveness of Interventions to Improve Resilience Among Health Professionals: a Systematic Review. Nurse Educ Today. 2018;71:247-263. doi:https://doi.org/10.1016/j.nedt.2018.10.002

    Article  PubMed  Google Scholar 

  41. Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace Interventions to Improve Well-being and Reduce Burnout for Nurses, Physicians and Allied Healthcare Professionals: a Systematic Review. BMJ Open. 2023;13(6):e071203. doi:https://doi.org/10.1136/bmjopen-2022-071203

    Article  PubMed  PubMed Central  Google Scholar 

  42. Miller C, Kim B, Silverman A, Bauer M. A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Serv Res. 2018;18(146). https://doi.org/10.1186/s12913-018-2961-9.

  43. Zaçe D, Hoxhaj I, Orfino A, Viteritti AM, Janiri L, Di Pietro ML. Interventions to Address Mental Health Issues in Healthcare Workers During Infectious Disease Outbreaks: a Systematic Review. J Psychiatr Res. 2021;136:319-333. doi:https://doi.org/10.1016/j.jpsychires.2021.02.019

    Article  PubMed  PubMed Central  Google Scholar 

  44. Better Nurse Staffing Is Key to Alleviating Staff Burnout and Turnover. Am J Nurs. 2023;123(10):14. doi:https://doi.org/10.1097/01.Naj.0000979052.19028.29

  45. Aiken LH, Lasater KB, Sloane DM, et al. Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety. JAMA Health Forum. 2023;4(7):e231809. doi:https://doi.org/10.1001/jamahealthforum.2023.1809

    Article  PubMed  PubMed Central  Google Scholar 

  46. Rotenstein LS, Brown R, Sinsky C, Linzer M. The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19. J Gen Intern Med. 2023;38(8):1920-1927. doi:https://doi.org/10.1007/s11606-023-08153-z

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wontorczyk A, Izydorczyk B, Makara-Studzińska M. Burnout and Stress in Group of Psychiatrists: Workload and Non-professional-social Predictors. Int J Occup Med Environ Health. 2023;36(3):379-395. doi:https://doi.org/10.13075/ijomeh.1896.02147

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. GIM Section, Clement J Zablocki VAMC, Milwaukee, WI, USA

    Jeffrey L. Jackson MD, MPH

  2. Emergency and Critical Care Medicine, Kurashiki Central Hospital, Okayama, Japan

    Akira Kuriyama MD, MPH, PhD

  3. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan

    Kumiko Muramatsu MD, PhD

Authors
  1. Jeffrey L. Jackson MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Kuriyama MD, MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kumiko Muramatsu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akira Kuriyama MD, MPH, PhD.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The opinions expressed are those of the authors and do not reflect those of the Department of Veteran Health Affairs or the US Federal Government.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 37 KB)

Supplementary file2 (DOCX 17 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jackson, J.L., Kuriyama, A. & Muramatsu, K. A Model of Burnout Among Healthcare Professionals. J GEN INTERN MED 39, 373–376 (2024). https://doi.org/10.1007/s11606-023-08514-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-023-08514-8

Search

Navigation