Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 28, 2022; 10(4): 206-219
Published online Aug 28, 2022. doi: 10.13105/wjma.v10.i4.206
No increase in burnout in health care workers during the initial COVID-19 outbreak: Systematic review and meta-analysis
Vincent Kimpe, Michel Sabe, Othman Sentissi
Vincent Kimpe, Faculty of Medicine, Geneva University, Geneva 1208, Geneva, Switzerland
Michel Sabe, Othman Sentissi, Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva 1205, Geneva, Switzerland
Author contributions: Kimpe V helped to develop the research question, performed the review, and wrote the main part of the manuscript; Sabe M participated in the development of the research question, helped with the meta-analysis strategy and contributed to the writing of the manuscript; Sentissi O developed the research question, oversaw the progress of the review, and contributed to the writing of the manuscript. The authors approved the manuscript.
Conflict-of-interest statement: Othman Sentissi has received advisory board honouraria from Otsuka, Lilly, Lundbeck, Sandoz, and Janssen in an institutional account for research and teaching. Other authors have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Othman Sentissi, MD, PhD, Chief Doctor, Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, CAPPI Jonction: 35, rue des Bains, Geneva 1205, Switzerland. o.sentissi@hcuge.ch
Received: March 27, 2022
Peer-review started: March 27, 2022
First decision: June 11, 2022
Revised: July 27, 2022
Article in press: July 27, 2022
Published online: August 28, 2022
Processing time: 143 Days and 5.5 Hours
ARTICLE HIGHLIGHTS
Research background

For decades and before the coronavirus disease 2019 (COVID-19) pandemic, for health care workers, (HCWs) burnout can be experienced as an upsetting confrontation with their self and the result of a complex a multifactorial process interacting with environmental and personal features.

Research motivation

During these century previous outbreak, some HCWs isolated themselves out of fear of infecting their friends and families, and lack of training, protection and hospital support was associated with higher burnout.

Research objectives

The objective of this literature review and meta-analysis was to obtain a comprehensive understanding of burnout and work-related stress in health care workers around the world during the first outbreak of the COVID-19 pandemic.

Research methods

We analysed burnout risk factors and protective factors in included studies published from June 1, 2020 to October 10, 2020, studying an HCW population during the first COVID-19 wave. The typical profile of an HCW with high levels of burnout was a young, single, female nurse or resident physician in an institution perceived as poorly prepared for the COVID-19 pandemic. This HCW experienced anxiety related to infection with COVID-19 or infecting her friends and family and possibly had a history of prior psychiatric conditions and low levels of resilience. Nevertheless, COVID-19 exposure was not a leading factor in burnout, as burnout levels were not notably higher than those before the COVID-19 pandemic. We included original studies published in peer-reviewed journals as of January 2020, studying an HCW population during the first COVID-19 wave without any geographic restrictions

Research results

Through screening, 39 cross-sectional, one longitudinal and one prospective cohort study were retained. Of the 41 studies, all from 2020, 12 were included in the meta-analysis. Table 2 details the main features of the studies. Of the 27907 health care professionals who participated in the reviewed studies, 70.4% were women, and two-thirds were either married or living together. The most represented age category was 31-45 years, at 41.5%. Approximately half of the sample comprised nurses (47.6%), and 44.4% were working in COVID-19 wards (intensive care unit, emergency room and dedicated internal medicine wards). The meta-analytic estimate of burnout prevalence in HCWs was 30.05% (95%CI: 23.91%–36.5%), with a sample size of 6784.

Research conclusions

During the COVID-19 pandemic, HCWs have been under high levels of stress and have suffered considerable burnout, putting quality of care at risk. We reviewed 41 studies and highlighted personal and sociodemographic features strongly associated with higher perceived stress and burnout. Female sex, younger age, low resilience, nurse occupational role and lack of preparedness were associated with higher burnout, but actual COVID-19 exposure was not a leading factor. Prevalence pre-COVID-19 was either lower or in the same ballpark as during COVID-19; our meta-analytic estimate based on 12 studies and approximately 6800 respondents returned a burnout prevalence of 30%, with important geographical variation

Research perspectives

In a pandemic context such as COVID-19, specific interventions could probably yield immediate results, benefiting HCWs and patients in very direct ways. We have highlighted how institutional preparedness has a clear correlation with stress and burnout. PPE, up-to-date protocols and regular communication from hospital management are low hanging fruit, as they would both reduce actual infection rates amongst staff and alleviate fear of infection and transmission. Workload and stress about childcare are recurring subjects, and if the former is a challenge during a pandemic, it should be feasible for institutions to help organize childcare for single workers who are more at risk for burnout. Where prevention fails, institutions must deal with existing stress and burnout resulting from both ordinary and extraordinary circumstances. Some institutions implemented telephone helplines for HCWs with difficulties coping with grief, death, high workloads, and burnout, the use of which was perceived as useful and appropriate. A culture promoting acknowledgement, communication and peer support programs, employee assistance programs and structured health response programs are many other exploration options.