High prevalence of burnout syndrome among medical and nonmedical residents during the COVID-19 pandemic

  1. Rebeca da Nóbrega Lucena Pinho
  2. Thais Ferreira Costa
  3. Nayane Miranda Silva
  4. Adriana Ferreira Barros-Areal
  5. André de Matos Salles
  6. Andrea Pedrosa Ribeiro Alves Oliveira
  7. Carlos Henrique Reis Esselin Rassi
  8. Ciro Martins Gomes
  9. Dayde Lane Mendonça da Silva
  10. Fernando Araújo Rodrigues de Oliveira
  11. Isadora Jochims
  12. Ivan Henrique Ranulfo Vaz Filho
  13. Lucas Alves de Brito Oliveira
  14. Marta Alves Rosal
  15. Marta Pinheiro Lima
  16. Mayra Veloso Ayrimoraes Soares
  17. Patricia Shu Kurizky
  18. Viviane Cristina Uliana Peterle
  19. Ana Paula Monteiro Gomides
  20. Licia Maria Henrique da Mota
  21. Cleandro Pires de Albuquerque
  22. Cezar Kozak Simaan
  23. Veronica Moreira Amado

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Abstract

Since the beginning of the COVID-19 pandemic, health professionals have been working under extreme conditions, increasing the risk of physical and mental illness. We evaluated the prevalence of burnout and its associated factors among postgraduate student residents in health professions during the global health crisis.

Methods

Healthcare residents were recruited from all across Brazil between July and September 2020 through digital forms containing instruments for assessing burnout (Oldenburg Burnout Inventory (OLBI)), resilience (brief resilient coping scale (BRCS)) and anxiety, stress and depression (depression, anxiety and stress scale (DASS-21) and Patient Health Questionnaire (PHQ-9)). Additionally, the relationships between burnout and chronic diseases, autonomy and educational adequacy in the residency programme, personal protective equipment (PPE), workload and care for patients with COVID-19 were evaluated. The chi-square test, Student’s t test, Pearson’s correlation test and logistic regression were performed.

Results

A total of 1,313 participants were included: mean (standard deviation) age, 27.8 (4.4) years; female gender, 78.1%; white race, 59.3%; and physicians, 51.3%. The overall prevalence of burnout was 33.4%. The odds (odds ratio [95% confidence interval]) of burnout were higher in the presence of pre-existing diseases (1.76 [1.26–2.47]) and weekly work > 60 h (1.36 [1.03–1.79]) and were lower in the presence of high resilience (0.84 [0.81–0.88]), autonomy (0.87 [0.81–0.93]), and educational structure (0.77 [0.73–0.82]), adequate availability of PPE (0.72 [0.63–0.83]) and non-white race (0.63 [0.47–0.83]). Burnout was correlated with anxiety (r = 0.47; p < 0.05), stress (r: 0.58; p < 0.05) and depression (r: 0.65; p < 0.05).

Conclusions

We observed a high prevalence of burnout among residents during the COVID-19 pandemic. Individual characteristics and conditions related to the work environment were associated with a higher or lower occurrence of the syndrome.

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  1. Version published to 10.1371/journal.pone.0267530
  2. ScreenIT

    SciScore for 10.1101/2022.04.12.22273783: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study was approved by a local research ethics committee and the National Research Ethics Committee (Comitê de Ética em Pesquisa/Comissão Nacional de Ética em Pesquisa – CEP/CONEP), available at https://plataformabrasil.saude.gov.br/, under registration number CAAE: 33493920.0.0000.5558.
    Consent: All participants signed and received a copy of the informed consent form via e-mail.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisThe sample size was calculated considering the objectives of the longitudinal study, which is still in progress [9] and seeks to establish the incidence of burnout and identify its predictors among residents during the COVID-19 pandemic, corresponding to a cross-sectional evaluation of data obtained at the baseline of a longitudinal follow-up study.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The analyses were conducted in SPSS 25.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    Other factors related to training, such as the high demand for learning in relatively short periods of time and the strict supervision of behaviour (limitation of autonomy), represent additional risks for residents compared to physicians [32]. The low perception of PPE availability also had an impact on the development of burnout in our study. Consistent with this finding, a study conducted to identify factors that contribute to burnout among health professionals during the COVID-19 pandemic found that available and adequate PPE was considered a protective factor for burnout and that a lack of PPE was a causative agent of stress [1]. The mean BRCS score was numerically lower (suggesting a lower degree of resilience) among nonmedical residents than among medical residents, although the difference did not reach statistical significance (Table 2). However, when evaluating the proportions of individuals with low resilience, there was a significant difference between the groups, with a higher frequency of low resilience among non-physicians (Table 3). Regarding the limitations of the study, we recognize the possibility of selection bias towards individuals who agreed to participate in the study. The findings do not necessarily reflect the reality of individuals who chose not to participate. However, participation is voluntary in any clinical study. Thus, the possibility of not reflecting those who chose not to participate is inherent to any survey and not only to this study. In ad...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.12.22273783v1 on medRxiv