Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study

  1. Max Denning
  2. Ee Teng Goh
  3. Benjamin Tan
  4. Abhiram Kanneganti
  5. Melanie Almonte
  6. Alasdair Scott
  7. Guy Martin
  8. Jonathan Clarke
  9. Viknesh Sounderajah
  10. Sheraz Markar
  11. Jan Przybylowicz
  12. Yiong Huak Chan
  13. Ching-Hui Sia
  14. Ying Xian Chua
  15. Kang Sim
  16. Lucas Lim
  17. Lifeng Tan
  18. Melanie Tan
  19. Vijay Sharma
  20. Shirley Ooi
  21. Jasmine Winter Beatty
  22. Kelsey Flott
  23. Sam Mason
  24. Swathikan Chidambaram
  25. Seema Yalamanchili
  26. Gabriela Zbikowska
  27. Jaroslaw Fedorowski
  28. Grazyna Dykowska
  29. Mary Wells
  30. Sanjay Purkayastha
  31. James Kinross

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Abstract

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49–2.95), nurse (OR 1.38; 95% CI 1.04–1.84), and ‘other clinical’ (OR 2.02; 95% CI 1.45–2.82); being redeployed (OR 1.27; 95% CI 1.02–1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98–2.99), anxiety (OR 4.87; 95% CI 3.92–6.06) and depression (OR 4.06; 95% CI 3.04–5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51–0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22–0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

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  1. Version published to 10.1371/journal.pone.0238666
  2. ScreenIT

    SciScore for 10.1101/2020.07.16.20155622: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics: Institutional ethical approval was obtained for data collection in the United Kingdom and Poland by the Imperial College Research Ethics Committee (ICREC) Ref:20IC5890, and Singapore by the National Healthcare Group Domain Specific Research Board (NHS DSRB) Ref 2020-00598.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Ethics: Institutional ethical approval was obtained for data collection in the United Kingdom and Poland by the Imperial College Research Ethics Committee (ICREC) Ref:20IC5890, and Singapore by the National Healthcare Group Domain Specific Research Board (NHS DSRB) Ref 2020-00598.
    National Healthcare
    suggested: None
    TX: StataCorp LP).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    LIMITATIONS: There are some limitations to our approach. The countries investigated are well stratified by: Covid-19 death rate (figure 3), gross domestic product and geographic region (Western Europe, Eastern Europe and Asia-Pacific). However, the use of convenience sampling (a combination of social media and targeted email communications), means it is difficult to estimate a response rate, possible response bias and external validity. However, this study recruited a large number of respondents in a multi-centre, international population with a diverse range of healthcare workers. The results are therefore likely to be internally valid and associations between covariates reliable. Our sample was 72% female, suggesting a gender biased response, however these figures are broadly in line with the demographics of the healthcare workforce in the countries studied(61, 62). There was wide variation in the number of respondents between countries and an overrepresentation of nurses in the Polish cohort, however these were both controlled for in the multivariate regression analyses. While the OLBI has many good psychometric qualities, a clinical cut-off for when someone is considered “burned out” has been an issue of debate(63). The cut-off values used in this study to describe prevalence are based on findings from a Swedish group as correlated with clinician-diagnosed burnout(64, 65). The same cut-off values have been adopted in multiple other studies(28-30). Given the high prevalenc...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.07.16.20155622v1 on medRxiv