Burnout and Depression in Portuguese Healthcare Workers During the COVID-19 Pandemic-The Mediating Role of Psychological Resilience

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2021 Jan 16

PMID 33451083

Citations 59

Authors

Carla Serrao

Ivone Duarte

Luisa Castro

Andreia Teixeira

Affiliations

Soon will be listed here.

Abstract

During the COVID-19 pandemic, healthcare workers (HCW) have been exposed to multiple psychosocial stressors. Resilience might protect employees from the negative consequences of chronic stress. The aim of this study was to explore the mediating role of resilience in the relationship between depression and burnout (personal, work-related, and client-related). A cross-sectional study was performed using an online questionnaire distributed via social networks. A survey was conducted comprising standardized measures of resilience (Resilience Scale-25 items), depression (subscale of Depression Anxiety Stress Scales-21 items), and burnout (Copenhagen Burnout Inventory Scale-19 items). A total of 2008 subjects completed the survey, and a hierarchical regression model was estimated for each burnout dimension. The results revealed that depression had not only a directed effect on personal, work- and client-related burnout, but also an indirect small effect on it through resilience. Psychological resilience played a partial mediating role between depression and all burnout dimensions. This partial mediation suggests that there may be other possible variables (e.g., social connection, self-compassion, gratitude, sense of purpose) that further explain the associations.

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References

Di Giuseppe M, Gemignani A, Conversano C . Psychological Resources Against the Traumatic Experience of Covid-19. Clin Neuropsychiatry. 2021; 17(2):85-87. PMC: 8629078. DOI: 10.36131/CN20200210. View

Joyce S, Shand F, Tighe J, Laurent S, Bryant R, Harvey S . Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open. 2018; 8(6):e017858. PMC: 6009510. DOI: 10.1136/bmjopen-2017-017858. View

Xiao X, Zhu X, Fu S, Hu Y, Li X, Xiao J . Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation. J Affect Disord. 2020; 274:405-410. PMC: 7236675. DOI: 10.1016/j.jad.2020.05.081. View

Schaufeli W, Greenglass E . Introduction to special issue on burnout and health. Psychol Health. 2012; 16(5):501-10. DOI: 10.1080/08870440108405523. View

McKinley N, McCain R, Convie L, Clarke M, Dempster M, Campbell W . Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. BMJ Open. 2020; 10(1):e031765. PMC: 7045750. DOI: 10.1136/bmjopen-2019-031765. View

Treglown L, Palaiou K, Zarola A, Furnham A . The Dark Side of Resilience and Burnout: A Moderation-Mediation Model. PLoS One. 2016; 11(6):e0156279. PMC: 4918953. DOI: 10.1371/journal.pone.0156279. View

Tan B, Chew N, Lee G, Jing M, Goh Y, Yeo L . Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020; 173(4):317-320. PMC: 7143149. DOI: 10.7326/M20-1083. View

West C, Dyrbye L, Sinsky C, Trockel M, Tutty M, Nedelec L . Resilience and Burnout Among Physicians and the General US Working Population. JAMA Netw Open. 2020; 3(7):e209385. PMC: 7333021. DOI: 10.1001/jamanetworkopen.2020.9385. View

Lovibond P, LOVIBOND S . The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995; 33(3):335-43. DOI: 10.1016/0005-7967(94)00075-u. View

10.

Hjemdal O, Vogel P, Solem S, Hagen K, Stiles T . The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents. Clin Psychol Psychother. 2010; 18(4):314-21. DOI: 10.1002/cpp.719. View

11.

Maslach C, Schaufeli W, Leiter M . Job burnout. Annu Rev Psychol. 2001; 52:397-422. DOI: 10.1146/annurev.psych.52.1.397. View

12.

Albott C, Wozniak J, McGlinch B, Wall M, Gold B, Vinogradov S . Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg. 2020; 131(1):43-54. PMC: 7199769. DOI: 10.1213/ANE.0000000000004912. View

13.

Gao T, Ding X, Chai J, Zhang Z, Zhang H, Kong Y . The influence of resilience on mental health: The role of general well-being. Int J Nurs Pract. 2017; 23(3). DOI: 10.1111/ijn.12535. View

14.

Gasparro R, Scandurra C, Maldonato N, Dolce P, Bochicchio V, Valletta A . Perceived Job Insecurity and Depressive Symptoms among Italian Dentists: The Moderating Role of Fear of COVID-19. Int J Environ Res Public Health. 2020; 17(15). PMC: 7432196. DOI: 10.3390/ijerph17155338. View

15.

Wagnild G, Young H . Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993; 1(2):165-78. View

16.

Shanafelt T, Bradley K, Wipf J, Back A . Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002; 136(5):358-67. DOI: 10.7326/0003-4819-136-5-200203050-00008. View

17.

Keeton K, Fenner D, Johnson T, Hayward R . Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007; 109(4):949-55. DOI: 10.1097/01.AOG.0000258299.45979.37. View

18.

Shechter A, Diaz F, Moise N, Anstey D, Ye S, Agarwal S . Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020; 66:1-8. PMC: 7297159. DOI: 10.1016/j.genhosppsych.2020.06.007. View

19.

Wankowicz P, Szylinska A, Rotter I . Assessment of Mental Health Factors among Health Professionals Depending on Their Contact with COVID-19 Patients. Int J Environ Res Public Health. 2020; 17(16). PMC: 7459704. DOI: 10.3390/ijerph17165849. View

20.

Koutsimani P, Montgomery A, Georganta K . The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol. 2019; 10:284. PMC: 6424886. DOI: 10.3389/fpsyg.2019.00284. View