Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study

(2022) 22:809 Cyr et al. BMC Psychiatry https://doi.org/10.1186/s12888-022-04457-2 Open Access RESEARCH Evolution of burnout and psychological distress in healthcare workers during the COVID‑19 pandemic: a 1‑year observational study Samuel Cyr1,2†, Marie‑Joelle Marcil1,3†, Cylia Houchi1,3, Marie‑France Marin3,4,5, Camille Rosa6, Jean‑Claude Tardif1,7, Stéphane Guay3,8, Marie‑Claude Guertin6, Christine Genest8,9, Jacques Forest10, Patrick Lavoie1,9, Mélanie Labrosse7,11, Alain Vadeboncoeur1,7, Shaun Selcer1,7, Simon Ducharme12,13 and Judith Brouillette1,3* Abstract Background: Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psy‑ chiatry; 2021) remained associated when assessed several months later. Methods: We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multi‑ variable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equiva‑ lent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. Results: Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. Conclusions: Healthcare workers’ occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and † Samuel Cyr and Marie-Joelle Marcil contributed equally to this work. *Correspondence: 3 Department of Psychiatry and Addiction, Université de Montréal, RogerGaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec H3C 3J7, Canada Full list of author information is available at the end of the article © The Author(s) 2022. 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The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Cyr et al. BMC Psychiatry (2022) 22:809 Page 2 of 13 perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important fac‑ tors over time. Keywords: Burnout, Anxiety, Depression, Posttraumatic stress disorder, COVID-19, Health personnel Background The COVID-19 pandemic is unprecedented in recent history, both in duration and number of cases and deaths. Having started nearly three years ago (in early 2020 [1]), the pandemic has become an ongoing reality for healthcare workers who have been on the frontline ever since. In our previously published study [2], as well as in systematic reviews/meta-analyses [3–16], it was found that the pandemic exposed healthcare workers to higher burnout (≈50%) as well as posttraumatic stress disorder (PTSD; ≈25%), anxiety (≈25%), and depression (≈15%). However, psychological distress among healthcare workers was already present before the pandemic started [17– 19]. In our multivariable model [2] using data measured three months after the pandemic onset, resilience and perceived organizational support were two protective factors significantly associated with lower odds of burnout and lower scores of psychopathological symptoms. Other related factors have also been documented at the beginning of the pandemic, such as higher exposure to the COVID virus, social support, and personal protective equipment (PPE) availability [20–22]. The pandemic can no longer be recognized as an acute stressor but rather as a chronic stressor, with associated issues such as a higher prevalence of psychopathology potentially emerging [23]. More than 1000 studies have been conducted on the psychological health of healthcare workers since the beginning of this pandemic. However, most were conducted in the first six months of the pandemic. As it is still ongoing, there is a need to continue monitoring the long-term evolution of this population’s mental health. This is particularly relevant considering that previous pandemics (including the 2003 SARS outbreak), although less important in terms of cases/ deaths and duration than the COVID-19 pandemic, had a long-term impact on the psychological health of healthcare workers [24]. Higher perceived stress still present one year after the onset of the SARS pandemic in highrisk health care workers was a particular example of a long-term effect on psychological health [25]. To our knowledge, few research teams have attempted to verify whether the factors associated with burnout and psychopathological symptoms found at the beginning of the COVID-19 pandemic remained associated with the same outcomes when assessed several months later. The objectives of this study were to measure the evolution of burnout and PTSD, anxiety and depressive symptoms in healthcare workers at 3 and 12 months after the COVID-19 pandemic onset, and to determine if individual, occupational, social, and organizational factors previously associated, or not, three months after the onset of the pandemic [2] remained associated, or not, with the outcomes 12 months after it began. Methods Setting, patients and study design We conducted this o (...truncated)