Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences Burnout and sex-related differences in healthcare workers

Main Article Content

Alice Silvia Brera
Cristina Arrigoni
Federica Dellafiore
Anna Odone
Arianna Magon
Tiziana Nania
Francesco Pittella
Lorenzo Palamenghi
Serena Barello
Rosario Caruso http://orcid.org/0000-0002-7736-6209

Keywords

burnout, COVID-19, depersonalization, emotional exhaustion, healthcare workers

Abstract

Introduction: Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. Objective: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy. Methods: A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors). Results: Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males. Conclusions: This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study’s cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

Abstract 1320 | PDF Downloads 738 Supplementary files Downloads 61

References

1. Duarte I, Teixeira A, Castro L, et al. Burnout among Portuguese healthcare workers during the COVID-19 pandemic. BMC Public Health. 2020; 20(1):1885.
2. Babamiri M, Alipour N, Heidarimoghadam R. Research on reducing burnout in health care workers in critical situations such as the COVID-19 outbreak. Work. 2020; 66(2):379–380.
3. Biagioli V, Belloni S, Albanesi B, Piredda A, Caruso R. Comment on “The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region” and reflections from the Italian Association of Oncology Nurses. European Journal of Cancer. 2020; 135:8–10. Available from: https://pubmed.ncbi.nlm.nih.gov/32521294/
4. Restauri N, Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. J Am Coll Radiol. 2020; 17(7):921–926.
5. Barello S, Graffigna G. Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an “Epidemic of Empathy” in Healthcare. Front Psychol. 2020; 11:1431.
6. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020; 52:102066.
7. Vizheh M, Qorbani M, Arzaghi SM, Muhidin S, Javanmard Z, Esmaeili M. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. Journal of Diabetes and Metabolic Disorders. 2020; 19(2):1–12.
8. Muller AE, Hafstad EV, Himmels JPW, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Research. 2020; 293:113441.
9. Chong MY, Wang WC, Hsieh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004; 185:127–133.
10. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123–7.
11. Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu Rev Psychol. 2001; 52(1):397–422.
12. Stang A, Standl F, Jöckel KH. Characteristics of COVID-19 pandemic and public health consequences. Herz. 2020; 45:313–315.
13. Kluger DM, Aizenbud Y, Jaffe A, et al. Impact of healthcare worker shift scheduling on workforce preservation during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2020; 41(12):1443–5.
14. Bakker AB, Demerouti E. Job demands-resources theory: Taking stock and looking forward. J Occup Health Psychol. 2017; 22(3):273–285.
15. Wilkinson H, Whittington R, Perry L, Eames C. Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research. 2017; 6:18–29.
16. Arrigoni C, Caruso R, Campanella F, Berzolari FG, Miazza D, Pelissero G. Investigating burnout situations, nurses’ stress perception and effect of a post-graduate education program in health care organizations of northern Italy: a multicenter study. G Ital Med Lav Ergon. 2015; 37(1):39–45.
17. Barello S, Palamenghi L, Graffigna G. Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Res. 2020 Aug; 290:113129.
18. Dyrbye LN, West CP, Shanafelt TD. Defining burnout as a dichotomous variable. J Gen Intern Med. 2009; 24(3):440. Available from: https://link.springer.com/article/10.1007/s11606-008-0876-6
19. Guo Y-F, Yuan-Hui Luo , Lam L, Cross W, Plummer V, Zhang J-P. Burnout and its association with resilience in nurses: A cross-sectional study. Wiley Online Libr. 2017; 27(1–2):441–449. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13952
20. Barello S, Caruso R, Palamenghi L, et al. Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model. Int Arch Occup Environ Health. 2021 Mar 3; 1–11. Available from: https://doi.org/10.1007/s00420-021-01669-z
21. Travado L, Grassi L, Gil F, et al. Physician-patient communication among Southern European cancer physicians: The influence of psychosocial orientation and burnout. Psychooncology. 2005; 14(8):661–670. Available from: www.interscience.wiley.com
22. Senni M. COVID-19 experience in Bergamo, Italy. Eur Heart J. 2020; 41(19):1783–4.
23. Shreffler J, Petrey J, Huecker M. The impact of COVID-19 on healthcare worker wellness: A scoping review. West J Emerg Med. 2020; 21(5):1059–66.
24. Caruso R, Miazza D, Berzolari FG, Grugnetti AM, Lichosik D, Arrigoni C. Gender differences among cancer nurses’ stress perception and coping: An Italian single centre observational study. G Ital Med Lav Ergon. 2017; 39(2):93–99.
25. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. J Vocat Behav. 2010; 77(2):168–85.
26. Sedgwick P. Snowball sampling. BMJ. 2013;347:f7511.
27. Grassi L, Magnani K. Psychiatric Morbidity and Burnout in the Medical Profession: An Italian Study of General Practitioners and Hospital Physicians. Psychother Psychosom. 2000; 69(6):329–334.
28. Graffigna G, Barello S, Bonanomi A. The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model. PLoS One. 2017; 12(6):e0179865.
29. Graffigna G, Barello S, Bonanomi A, Lozza E. Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) Scale. Front Psychol. 2015; 6:274.
30. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008; 15(3):194–200.
31. Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educ Psychol Meas. 2001; 61(2):349–365.
32. Kane GC, Gotto JL, Mangione S, West S, Hojat M. Jefferson Scale of Patient’s Perceptions of Physician Empathy: Preliminary Psychometric Data Clinical Science Clinical Science. Croat Med J. 2007; 48:81–86.
33. Rattray J, Jones MC. Essential elements of questionnaire design and development. Journal of Clinical Nursing. J Clin Nurs. 2007; 16:234–243. Available from: https://pubmed.ncbi.nlm.nih.gov/17239058/
34. Sigatti S, Stefanile C, Menoni E. Per un adattamento italiano del Maslach Burnout inventory (MBI). Boll di Psicol Appl. 1988; 187–188:33–39.
35. Maslach C, Jackson SE, Leiter M. The Maslach Burnout Inventory Manual. First edit. Palo Alto, California: Consulting Psychologists Press; 1986. 1–34 p.
36. Green Glass ER, Burke RJ, Konarski R. Components of Burnout, Resources, and Gender-Related Differences. 1998.
37. Summers EMA, Morris RC, Bhutani GE, Rao AS, Clarke JC. A survey of psychological practitioner workplace wellbeing. Clin Psychol Psychother. 2020; cpp.2509.
38. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001; 86(3):499–512.
39. Assari S. Parental Education Attainment and Educational Upward Mobility; Role of Race and Gender. Behav Sci (Basel). 2018; 8(11):107.
40. Zenasni F, Boujut E, Woerner A, Sultan S. Burnout and empathy in primary care: Three hypotheses. British Journal of General Practice. 2012; 62:346–347.
41. Picard J, Catu-Pinault A, Boujut E, Botella M, Jaury P, Zenasni F. Burnout, empathy and their relationships: A qualitative study with residents in General Medicine. Psychol Heal Med. 2016; 21(3):354–361.
42. Coetzee SK, Laschinger HKS. Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review. Nurs Health Sci. 2018; 20(1):4–15.