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. 2020 Aug 8;10(1):110.
doi: 10.1186/s13613-020-00722-3.

Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak

Elie Azoulay  1 , Jan De Waele  2 , Ricard Ferrer  3   4 , Thomas Staudinger  5 , Marta Borkowska  2 , Pedro Povoa  6   7 , Katerina Iliopoulou  8 , Antonio Artigas  9 , Stefan J Schaller  10 , Manu Shankar Hari  11   12 , Mariangela Pellegrini  13 , Michael Darmon  14 , Jozef Kesecioglu  15 , Maurizio Cecconi  16 ; ESICM
Affiliations

Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak

Elie Azoulay et al. Ann Intensive Care. .

Abstract

Background: The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak.

Methods: Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model.

Results: Response rate was 20% (1001 completed questionnaires were returned, 45 years [39-53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33-2.55]), working in a university-affiliated hospital (HR 0.58 [0.42-0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01-1.94]), and clinician's rating of the ethical climate (HR 0.83 [0.77-0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15-2.31]) and clinician's rating of the ethical climate (HR 0.84 [0.78-0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97-0.99]) and clinician's rating of the ethical climate (HR 0.76 [0.69-0.82]).

Conclusions: The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel.

Keywords: Acute respiratory distress syndrome; Coronavirus; Depersonalization; Exhaustion; Pneumonia; Well-being.

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Conflict of interest statement

Authors declare no conflict of interest in relation with this survey.

Figures

Fig. 1
Fig. 1
Maslach and Burnout Inventory in 846 ICU specialists. The three domains of the instrument, namely emotional exhaustion, depersonalization, and personal accomplishment, are displayed separately. Symptoms of emotional exhaustion are mild or severe in 29.9% and 23.0% of the respondents. Symptoms of depersonalization are mild or severe in 34.3% and 23.0% of the respondents. Symptoms of personal accomplishment are mild or severe in 35.2% and 31.4% of the respondents. Overall, prevalence of severe burnout was reported in 51.8% (439/846) of the respondents
Fig. 2
Fig. 2
Physician’s ranking (from 0 [very poor relationship] to 10 [excellent relationship]) of their relationship with other ICU specialists, nurses, administrators, or with referring physicians. They have also ranked the quality of the decision-making and the ethical climate in their ICU. Results are presented according to the presence of symptoms of anxiety (a), the presence of symptoms of depression (b), or the presence of symptoms of severe burnout (c). This figure displays the results in the 848 ICU specialists returning complete HADS. *** indicates P value < 0.0001
Fig. 3
Fig. 3
Physician’s ranking (from 0 [less challenging than non-COVID patients] to 100 [more challenging than non-COVID patients]) of how the pandemic has been a professional and emotional challenge, and whether it was a source of intra-team or intra-family conflict. Results are presented according to the presence of symptoms of anxiety (a), the presence of symptoms of depression (b), or the presence of symptoms of severe burnout (c)
Fig. 4
Fig. 4
Prevalence and adjusted prevalence of anxiety, depression and severe burnout in the 12 participating regions
Fig. 5
Fig. 5
World map displaying the prevalence (graphs in the left) and the adjusted odds ratio (OR, graphs in the right) of symptom of anxiety, depression and severe burnout across regions
See this image and copyright information in PMC

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