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. 2025 Jul 30;13(15):1859.
doi: 10.3390/healthcare13151859.

Prolonged Overtime Predicts Worsening Burnout Among Healthcare Workers: A 4-Year Longitudinal Study in Taiwan

Yong-Hsin Chen  1   2 , Gwo-Ping Jong  3   4 , Ching-Wen Yang  2 , Chiu-Hsiang Lee  5   6
Affiliations

Prolonged Overtime Predicts Worsening Burnout Among Healthcare Workers: A 4-Year Longitudinal Study in Taiwan

Yong-Hsin Chen et al. Healthcare (Basel). .

Abstract

Background: Overtime adversely affects physical and mental health, contributing to irritability, anxiety, reduced sleep, and even cardiovascular issues, ultimately lowering care quality and increasing turnover intentions. This study aimed to investigate whether prolonged overtime increases the risk of occupational burnout over time among healthcare workers. Methods: We conducted a four-year longitudinal observational study using secondary data from annual surveys (2021-2024) of healthcare workers at a medical university hospital in Taichung, Taiwan. Burnout was assessed using the personal burnout (PB) scale from the Copenhagen Burnout Inventory (CBI), with high PB levels (HPBL) defined as scores in the upper quartile of the 2021 baseline. Survival analysis utilizing the Kaplan-Meier method and Cox regression investigated burnout progression and the effects of overtime. Results: HPBL was defined as PB scores ≥45.83 (upper quartile in 2021). The proportions of HPBL were 30.28% (2021), 33.29% (2022), 36.75% (2023), and 32.51% (2024). Survival analysis confirmed that the risk of burnout increased over time, with the survival time estimated at 2.50 ± 0.03 years and lower survival probabilities observed among participants working overtime (Log-rank test, p < 0.0001). Multivariate logistics revealed overtime work, female gender, being a physician/nurse, and reduced sleep as independent risk factors for HPBL (OR = 3.14 for overtime, p < 0.001). These findings support the hypotheses on burnout progression and the impact of overtime. Conclusions: Overtime significantly heightens the risk of burnout, which worsens over time. Female sex, healthcare roles, obesity, and insufficient sleep are additional risk factors. Limiting overtime and proactive interventions are crucial to preventing burnout in healthcare workers.

Keywords: burnout; healthcare workers; longitudinal study; overtime; survival analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The results of the follow-up from 2021 to 2024. N, individuals; d, duration between the starting and ending follow-up.
Figure 2
Figure 2
Survival analysis of HPBL. a, mean ± standard error for survival probability.
Figure 3
Figure 3
Stratified analysis for the survival analysis of HPBL. a, mean ± standard error for survival probability.
See this image and copyright information in PMC

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