Research LettersThe causal links between stress and burnout in a longitudinal study of UK doctors
Summary
Burnout and stress are common, linked problems in health-care workers. We aimed to clarify their causal associations. We assessed stress and the three components of burnout (emotional exhaustion, depersonalisation, and low personal accomplishment) using structural equation modelling in a 3-year longitudinal study of a representative sample of 331 UK doctors. Emotional exhaustion and stress showed reciprocal causation: high levels of emotional exhaustion caused stress (β=0·189), and high levels of stress caused emotional exhaustion (β=0·175). High levels of personal accomplishment increased stress levels (β=0·080), whereas depersonalisation lowered stress levels (β=−0·105).
References (5)
- IC McManus et al.
Are UK doctors particularly stressed?
Lancet
(1999) - C Maslach et al.
Job burnout
Annu Rev Psychol
(2001)
Cited by (294)
Investigating influential factors and mechanisms of surgical resident well-being using social network analysis
2024, American Journal of SurgeryBurnout and depression in General Surgery residents affect patient care and drive attrition. Few impactful interventions exist, in part because little is known about influential drivers and mechanistic relationships.
Residents from 16 general surgery programs completed published well-being scales in January 2021. Social network analysis demonstrated influential relationships between factors, and path analysis revealed drivers of burnout and depression.
300 residents completed the survey (34% response rate). Workplace demand and mindfulness influenced depressive symptoms and emotional exhaustion, mediated by perceived stress. Mindfulness increased personal accomplishment, mediated by psychological well-being (p < 0.05 for all results). All mediated effects were greater than direct effects.
This study yielded a quantitative conceptual model of mechanistic relationships affecting well-being in surgical residency, identifying stress and psychological well-being (measuring sense of purpose) as central mediators, and triangulating workplace demand and mindfulness as potentially high-yield interventional targets for reducing burnout and depression in surgical residency.
Acute Biological Changes in Gynecologic Surgeons during Surgery: A Prospective Study
2023, Journal of Minimally Invasive GynecologyTo assess changes in biological measures of acute stress in surgeons during surgery in real-world settings
A prospective cohort study.
A tertiary teaching hospital.
8 consultant and 9 training gynecologists.
A total of, 161 elective gynecologic surgeries of 3 procedures: laparoscopic hysterectomy, laparoscopic excision of endometriosis, or hysteroscopic myomectomy.
Changes in surgeons’ biological measures of acute stress while undertaking elective surgery. Salivary cortisol, mean and maximum heart rate (HR), and indices of the HR variability were recorded before and during surgery.
From baseline to during surgery over the cohort, salivary cortisol decreased from 4.1 nmol/L to 3.6 nmol/L (p = .03), maximum HR increased from 101.8 beats per min (bpm) to 106.5 bpm (p <.01), root mean square of standard deviation decreased from 51.1 ms to 39.0 ms (p <.01), and standard deviation of beat-to-beat variability decreased from 73.7 to 59.8 ms (p <.01). Analysis of individual changes in stress by participant-surgery event by paired data graphs reveal inconsistent direction of change in all measures of biological stress despite stratification by surgical experience, role in surgery, level of training, or type of surgery performed.
This study measured biometric stress changes at both a group and individual level in real-world, live surgical settings. Individual changes have not previously been reported and the variable direction of stress change by participant-surgery episode identified in this study demonstrates a problematic interpretation of mean cohort findings previously reported. Results from this study suggest that either live surgery with tight environment control or surgical simulation studies may identify what, if any, biological measures of stress can predict acute stress reactions during surgery.
Burnout in oral medicine and orofacial pain residents
2023, Journal of the American Dental AssociationThe authors sought to identify the prevalence of burnout in oral medicine (OM) and orofacial pain (OFP) residents and investigate potential contributing factors.
A cross-sectional questionnaire-based study was conducted. An anonymous 22-item online survey was emailed to the residents of all Commission on Dental Accreditation–accredited OM and OFP residency programs in the United States. Abbreviated Maslach Burnout Inventory was included to gauge the following details of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. Questions also addressed the impact of residency program characteristics, work-life balance, and possible discrimination or abuse on burnout.
Six OM and 12 OFP programs (72 residents) were contacted, and 46 residents responded (response rate, 64%). Overall prevalence of burnout was 35% (29% in OM residents, 40% in OFP residents). High EE burnout was noted in 57% of residents, high DP burnout in 11% of residents, and high personal accomplishment burnout in 59% of residents. Working for fewer than 40 hours per week was significantly associated with low DP burnout (P < .05). Moderate to high DP burnout was more prevalent in men and unmarried residents (whether in a relationship or not) were more likely to experience moderate to high EE burnout (P < .05).
Burnout among OM and OFP residents is an emerging concern due to its detrimental effect on the physical and mental well-being of the residents. To the authors’ knowledge, this study is the first to report burnout prevalence in the 2 most recent dental specialties recognized by the American Dental Association in 2020.
Early detection of signs of burnout among residents would allow program faculty and administrators to provide required support and resources.
A systematic review of biological changes in surgeons’ acute stress levels during surgery
2023, Surgery in Practice and ScienceWhile a degree of stress facilitates learning and task performance, excessive stress in surgeons may lead to poor patient outcomes, with maladaptive stress as a risk factor for surgeon burnout or self-harm through mechanisms including substance abuse, and suicide. We aim to systematically review publications investigating how measures of surgeons’ acute biological stress change during surgery.
Medline, Embase, Cochrane library, and The United States, Australian, and European clinical trials registries were searched using the terms stress; surgeon; cortisol; skin conductance; and heart rate. Studies had to report at least one measure of biological stress related to surgery or simulated surgical exercise and have been published between January 1996 to June 2022.
Twenty-eight studies with a total of 433 participants met inclusion criteria with cortisol, heart rate, heart rate variability, and electrodermal activity being reported. Salivary cortisol was measured in four studies with conflicting directional changes reported. Mean heart rate increased in nine studies (by 6-22 beats/minute), however the impact of the physical work of surgery was not reported. Heart rate variability, as measured by low-frequency to high-frequency ratio, was significantly increased in three of six studies. One study measured electrodermal activity reporting significant increase in skin conductance in a simulation setting.
While some biological measures appear able to detect changes in acute stress in surgeons (particularly heart rate), appropriate measures of stress during non-stressful and stressful surgery are yet to be fully identified. Importantly, there are no current pathways for identifying surgeons at risk of burnout or self-harm and this is a critical unmet research need.
This study aims to determine the prevalence of burnout in a sample of Lebanese residents, and to identify its correlates and risk factors compared to local and international data.
A cross-sectional study was conducted at the end of the academic year 2018-2019, between the months of April and July, and targeted residents enrolled at Saint Joseph University, Faculty of Medicine (USJ- FM), in Beirut, Lebanon. Data was gathered via an anonymous online survey which was sent to all the residents through the Faculty administration on their personal email addresses. The questions dealt with demographic and mental health data. The Copenhagen Burnout Inventory (CBI) was used to measure burnout.
25.7% of the residents responded to the survey, two thirds of whom were female. 72.22% of the respondents suffered from personal burnout whereas as 77.78% suffered from work-related burnout. Only 26.39% residents were concerned with patient-related burnout. Money and professional problems were associated with burnout whereas suicidal thoughts were correlated with higher scores. Alcohol consumption was negatively correlated with CBI.
The surveyed residents suffered from burnout which was mainly related to personal and occupational factors. Burnout was not an isolated entity; it should be considered as a whole and described as a subjective experience that varies from one person to another and results from complex biological, psychological and social interactions. It has consequences on the victims’ health and quality of life.
Cette étude vise à déterminer la prévalence de l’épuisement professionnel dans un échantillon d’internes (résidents) libanais, d’identifier des facteurs de risque associés et de comparer les résultats aux données de la littérature internationale.
Une étude transversale a été menée à la fin de l’année universitaire 2018-2019, entre les mois d’avril et de juillet, auprès d’internes inscrits à la Faculté de Médecine de l’Université Saint Joseph (USJ-FM), Beyrouth, Liban, toutes spécialités confondues. Les données ont été recueillies par le biais d’un questionnaire anonyme en ligne ayant reçu l’approbation d’un Comité d’Éthique et qui a été envoyé aux participants par courrier électronique via l’administration de la Faculté. Le questionnaire comprend deux parties. La première consiste en des questions élaborées par les chercheurs à partir des données retrouvées dans la littérature et portant sur des données générales, démographiques, sociales et en rapport avec les antécédents de santé mentale. La deuxième correspond à une échelle de mesure de l’épuisement professionnel: le Copenhagen Burnout Inventory (CBI). Un consentement informé et éclaire a été obtenu de tous les participants avec une garantie que les réponses données n’auront aucune répercussion sur le parcours académique ou professionnel. Les données ont été analysées selon une approche statistique descriptive.
25,7 % des internes questionnés ont répondu à l’enquête, dont environ 2/3 de femmes. 6,9 % sont suivis par un professionnel en santé mentale, 4,2 % sont traités par des antidépresseurs et 40,3 % ont déclaré avoir eu des idées suicidaires. 7 % prennent des tranquillisants sans prescription médicale. 72,22 % des participants souffrent d’un épuisement personnel tandis que 77,78 % rapport un épuisement en rapport avec le travail. Seuls 26,39 % des internes ont soulevé un épuisement en rapport avec les usagers du système de soins. Les problèmes financiers et professionnels sont associés au burn-out alors que les idées suicidaires sont corrélées à des scores plus élevés sur le CBI. La consommation d’alcool est négativement corrélée avec le CBI. Nous n’avons pas trouvé d’association entre burnout et l’âge, le sexe, le statut marital, la spécialité, l’année d’études, le nombre de gardes ou d’astreintes, le nombre d’heures de sommeil, la consommation d’autres toxiques, les antécédents psychiatriques personnels ou familiaux.
Les résultats montrent que l’échantillon d’internes questionnés souffre d’un épuisement professionnel important, en rapport principalement avec des facteurs personnels et occupationnels. L’épuisement professionnel ne constitue pas une entité nosographique isolée. Il doit être plutôt considéré comme étant une expérience subjective et individuelle issue d’une intrication complexe entre des facteurs biologiques, psychologiques et sociaux. Il a des répercussions sur la santé mentale et la qualité de vie des personnes qui en souffrent.
DEcrease STress through RESilience training for Students (DESTRESS) Study: Protocol for a randomized controlled trial nested in a longitudinal observational cohort study
2022, Contemporary Clinical TrialsChronic stress and burnout are highly prevalent among academically trained healthcare professionals, negatively affecting their well-being and capacity to engage in their work. Resilience to stress develops early in one's career path, hence offering resilience training to university students in these professions is one approach to fostering well-being and mental health. The aim of this study is to assess whether offering mindfulness-based resilience training to university students in healthcare professions reduces their perceived chronic stress.
The study has a hybrid design combining a longitudinal observational cohort with a nested randomized controlled trial (RCT) with sequential multiple assignment and multistage adaptive interventions while taking participants' preferences into account. All students in healthcare related programmes at the Erasmus University Rotterdam are invited to participate. Within the observational cohort, students with a score of 14 or higher on the Perceived Stress Scale (PSS) are invited to take part in the RCT (n = 706). Eligible participants are randomized to control or active intervention in a ratio of 1:6. Those randomized to the control group and non-randomized participants in the cohort receive passive web-based psychoeducation about chronic stress and burnout through referral to specific websites. Participants randomized to the intervention group receive one of 8 active mindfulness-based interventions. They select a rank order of 4 preferred interventions and are randomized across these with equal probability. Non-response to the intervention is followed by sequential randomized assignment to another intervention, for a total maximum of 3 sequential interventions. All participants receive questionnaires at baseline, before and after each 8-week intervention period, and at 1- and 2-year follow-up. The primary outcome is perceived chronic stress measured with the PSS. Secondary outcomes include mental well-being, burnout, quality of life, healthcare utilization, drug use, bodyweight, mental and physical stress-related symptoms, resilience, and study progress.
Approval from the Medical Ethics Review Committee was obtained under protocol number MEC-2018-1645. The trial is registered in the Netherlands National Trial Register by registration number NL7623, 22/03/2019, https://www.trialregister.nl/.