Are healthcare workers more stressed out during the COVID-19 pandemic?

Burnout continues to be a burden among healthcare workers (HCWs) during the COVID-19 pandemic despite the lack of quality research with pre-COVID-19 data, according to a Singapore study.

“Only one cohort study evaluated the impact of COVID-19 on the burnout of HCWs,” the researchers said. “Comparable outcomes were observed among specific professions, such as doctors and nurses.”

Reane Tang from the Singapore General Hospital and colleagues performed a systematic search on PubMed database for articles published between 1 December 2019 and 30 June 2021. Their search strategy combined terms for HCWs, COVID-19, burnout, and Maslach Burnout Inventory (MBI).

Burnout was the primary outcome, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalization (DP), and low personal accomplishment (PA).

The review included four cohort studies, 90 cross-sectional studies, and one randomized controlled trial. Of these, only one cohort study did a comparison of burnout data among HCWs before and during the COVID-19 pandemic. [Proc Singap Healthc 2022;doi:10.1177/20101058221117390]

In the said study, a statistically significant increase was noted in mean EE (from 21.9 to 24.9; p=0.001) and PA scores (from 42.7 to 48.7; p=0.001). The rest of the studies only analysed burnout data during the pandemic and presented no data before COVID-19 for comparison.

The overall mean prevalence of burnout among HCWs was 39.95 percent across studies, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Overall, burnout outcomes were similar across specific healthcare professions such as doctors and nurses.

“[M]ost studies were not designed to compare burnout before and during COVID-19 among HCWs, except for [the cohort study by Leskovic and colleagues],” the researchers said. “That study reported a significant increase in EE and PA among HCWs, suggesting a worsening of burnout based on EE but a slight improvement in burnout based on PA.” [Ann Agric Environ Med 2020;27:664-671]

However, the researchers could still not assess the impact of COVID-19 on the burnout of HCWs based on this single study only.

“More studies adopting the appropriate methodology of having historical comparators would be required to address this research question,” they said. “However, if historical data of pre-COVID-19 period is absent, it is likely that this research question may stay unresolved.”

Some limitations were present in this systematic review. First, some articles may have not been included due to the different terms used to describe burnout. Second, many studies were prone to bias due to nonrandomized methods when recruiting participants and the presence of confounders. Finally, there were not enough studies with prepandemic data to assess the impact of COVID-19 on HCW burnout.

“Future studies examining burnout among HCWs measured with MBI incorporating comparisons between this period and post-COVID-19 are needed to help us better understand the impact of COVID-19 on burnout of HCWs,” the researchers said.