Association of Burnout With Depression and Anxiety in Critical Care Clinicians in Brazil

Abstract

IMPORTANCEIt is unclear whether burnout, anxiety, and depression constitute the same or different constructs. Better understanding of these constructs is important for diagnosis and treatment for intensive care unit (ICU) clinicians. OBJECTIVE To determine the associations and distinctiveness of burnout, depression, and anxiety in a sample of ICU clinicians. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used baseline data from the ICU Visits Study, a cluster-randomized crossover clinical trial conducted from April 2017 to July 2018 in 36 mixed public and private nonprofit ICUs in Brazil. ICU clinicians, including day-shift physicians, nurses, nurse technicians, and physiotherapists working in an ICU at least 20 hours per week, were enrolled. Data were analyzed from December 27, 2019, to October 10, 2020. MAIN OUTCOMES AND MEASURES The main outcome measures were burnout, depression, and anxiety measured with the Maslach Burnout Inventory (MBI; range, 0-6, with high scores indicating more burnout) and the Hospital Depression and Anxiety Scale (HADS; range, 0-3, with higher scores indicating more depression or anxiety). Internal consistencies were satisfactory. RESULTS The total sample included 715 ICU clinicians (median [interquartile range] age, 34.8 [30.2-39.3] years; 520 [72.7%] women), including 96 physicians (13.4%), 159 nurses (22.2%), 358 nurse technicians (50.1%), and 102 physiotherapists (14.3%). Clinicians reported low levels of emotional exhaustion (mean [SD] score, 1.84 [1.18]), depersonalization (mean [SD] score, 0.98 [1.03]), and personal accomplishment (mean [SD] score, 5.05 [0.87]) on the MBI, and similarly low levels of depression (mean [SD] score, 0.54 [0.40]) and anxiety (mean [SD] score, 0.70 [0.45]) on the HADS.Confirmatory factor analyses consistently showed improved fit separating latent burnout dimensions from depression and anxiety. An exploratory graph analysis combining gaussian graphical model with clustering algorithms for weighted networks suggested 3 clusters, with distinct burnout, anxiety, and depression clusters. This structure was confirmed using a bootstrap with 1000 random samples, in which the 3-cluster solution emerged in 625 samples (62.5%). Both latent variable loadings and network statistics suggested 3 key indicators (ie, feeling burned out from work, worrying thoughts, and reverse-scored reporting feeling cheerful) that can be used for short screening instruments. CONCLUSIONS AND RELEVANCEThese findings suggest that burnout and clinical symptoms of depression and anxiety were empirically distinct in a large sample of ICU clinicians, highlighting the importance of screening for burnout and clinical symptoms to allow fast access to adequate support and treatment in health professionals at high risk of burnout.

Association of 5-item Brief Symptom Rating Scale scores and health status ratings with burnout among healthcare workers

“…Studies have mentioned that physical and mental diseases affect psychological symptoms and burnout 15 , 31 . We excluded participants with uncontrolled chronic diseases and mental and sleep disorders.…”

“…In contrast, a non-linear relationship was found between burnout and age, with employees aged 30–40 having higher burnout than other age group 13 . A systematic review and meta-analysis study have revealed that depression and anxiety could cause burnout among HCWs and different types of workers (such as teachers or firefighters) 15 , 16 . Thus, we suspected that psychological symptoms or severe physical diseases might also affect different burnout domains that are not directly related to emotional changes.…”

Burnout Em Profissionais De Terapia Intensiva: Um Olhar Pré E Pós-Pandemia

“…Burnout nos profissionais envolvidos no cuidado intensivo, sendo os mais apontados: sexo, idade, anos de experiência de trabalho e alta carga horária (FISCHER et. al, 2020;CHUANG, 2016;HU et al, 2016).…”

“…11 terem salários inferiores e sofrerem mais demanda no trabalho (CRUZ, 2019). Seguindo tal sugestão, estudos analisaram também as mulheres no meio hospitalar com um risco para burnout bem maior (FISCHER et. al, 2020;CHUANG, 2016).…”

Síndrome de Burnout em profissionais da saúde no contexto da pandemia por COVID-19: revisão integrativa / Burnout Syndrome in healthcare professionals in the context of the COVID-19 pandemic: integrative review

“…Um estudo realizado no final de 2020 verificou que cerca de 77% dos profissionais de saúde tiveram sintomas relacionados a SB, sendo que mais de 80% destes profissionais atuavam diretamente no enfrentamento à pandemia, o que pode significar um agravamento da doença durante o cenário pandêmico. Destaca-se ainda o fato de que o quadro de saúde dos trabalhadores da linha de frente, reflete também em maiores chances de erros relacionados a assistência o que gera danos aos pacientes e instituição de saúde (FISCHER et al, 2020).…”