The characteristics of personnel in the cohort at T1 are described in Table 1.
Table 1. Characteristics of participants
|
|
N (%)
|
Role type*
|
Nursing
|
134 (24.9)
|
|
Other clinical professionals
|
156 (29.0)
|
|
Other clinical personnel
|
90 (16.7)
|
|
Non-clinical personnel
|
158 (29.4)
|
Gender
|
Female
|
422 (78.6)
|
(Missing 1)
|
Male
|
85 (15.8)
|
|
Other/Prefer not to say
|
30 (5.6)
|
Highest education
|
High school
|
13 (2.4)
|
|
College diploma
|
79 (14.7)
|
|
Undergraduate degree
|
176 (32.7)
|
|
Professional/Graduate degree
|
270 (50.2)
|
Ethnic group
|
African/Black
|
30 (5.6)
|
(Missing 1)
|
Asian
|
148 (27.6)
|
|
South Asian
|
35 (6.5)
|
|
European/White
|
278 (51.8)
|
|
Hispanic
|
15 (2.8)
|
|
Other/Mixed/Multiple
|
31 (5.8)
|
Marital status
|
Single
|
211 (39.2)
|
|
Married/Common-law
|
306 (56.9)
|
|
Divorced/Separated/Widowed
|
21 (3.9)
|
*Specific job types, in descending order of number of participants. Groups with two or fewer members not listed. Some roles appear in both clinical and non-clinical lists as determined by patient contact as described by participant.
Other clinical professionals: Physician, resident, dietician, occupational therapist, social worker, physiotherapist, manager of clinical area, speech language pathologist, pharmacist, respiratory therapist, spiritual care practitioner.
Other clinical positions: Administrative assistant, medical imaging technologist, assistant to physician/occupational therapist/physiotherapist, retail employee, porter, clinical research staff, volunteer.
Non-clinical positions: Research scientist, research staff, laboratory technician, corporate and administrative staff, administrative assistant, volunteer, manager of non-clinical area, building services staff, clerk, laboratory technologist, housekeeper.
Emotional exhaustion
Mean levels of emotional exhaustion for each occupational group at each time point are reported in Table 2. Mean levels peak at the winter 2021 or spring 2021 measurement point in each group and are lower by the summer 2021 measurement. Repeated measures ANOVA of emotional exhaustion for participants for whom there were no missing data over four time-points (82 nurses, 102 other healthcare professionals, 60 other clinical staff, and 118 non-clinical staff) demonstrated significant within-subjects changes in emotional exhaustion over time (F = 4.6, p = .004) and significant between-subject effects of occupational role (F = 11.4, p < .001) and age (F = 12.3, p < .001). The interaction of occupational role X time was not significant (F = 1.4, p = .24), indicating a similar pattern of change over time in all groups.
Table 2. Emotional exhaustion and psychological distress at four time-points in occupational groups.
|
|
Emotional exhaustion
|
Psychological distress
|
Occupational Role
|
Time of survey
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Nurse
|
Fall 2020
|
28.8
|
12.4
|
7.4
|
4.2
|
Winter 2021
|
32.4
|
12.6
|
8.5
|
4.2
|
Spring 2021
|
31.3
|
13.7
|
8.7
|
4.5
|
Summer 2021
|
30.6
|
13.4
|
7.1
|
4.7
|
Other healthcare professional
|
Fall 2020
|
24.4
|
12
|
5.3
|
3.6
|
Winter 2021
|
28.3
|
11.9
|
6
|
4
|
Spring 2021
|
29.8
|
11.5
|
6.7
|
3.9
|
Summer 2021
|
25.3
|
11.9
|
5.3
|
3.8
|
Non-professional with patient contact
|
Fall 2020
|
24.9
|
13.2
|
6.8
|
5.3
|
Winter 2021
|
25
|
12.7
|
6.8
|
5.1
|
Spring 2021
|
27.3
|
13.1
|
8
|
6
|
Summer 2021
|
22.2
|
12.5
|
6.2
|
5
|
Non-professional without patient contact
|
Fall 2020
|
22.4
|
11.6
|
6.7
|
4.3
|
Winter 2021
|
24
|
12.2
|
7
|
4.3
|
Spring 2021
|
24.4
|
12.6
|
6.9
|
4.5
|
Summer 2021
|
20.9
|
12.2
|
5.9
|
4.4
|
Post hoc testing revealed that the relationship between age and emotional exhaustion was inverse (higher emotional exhaustion with younger age) and grew in strength over time (T1 R = -.06, p = .14, T2 R = -.09, p = .05, T3 R = -.19, p < .001, T4 R = -.21, p < .001). Regarding the direction and magnitude of differences in emotional exhaustion between staff with different occupational roles, the proportion of participants with high emotional exhaustion at each time point, by occupational role, is illustrated in Figure 1 (with the epidemiological curve of case rates in Toronto included for context). The rate of high burnout was highest in nurses, followed by other healthcare professionals, other clinical staff, and lowest in non-clinical staff.
Other burnout dimensions
Mean levels of depersonalization and personal achievement at each time point are provided in Table 3, as well as the proportion of participants whose depersonalization scores were high or personal achievement scores were low. Participants with high depersonalization scores were rising over time, while the numbers with low personal achievement scores were falling. The number of subjects randomly selected to complete these extra measures (the 50% of subjects assigned to the Enriched survey), who completed measures of depersonalization and personal achievement at all four time-points included too few participants in one particular occupation category (non-professional staff without patient contact, N=8) to compare all occupational role groups. However, given the differences found for emotional exhaustion, we compared nurses (N= 41) to other healthcare professionals (N=55). With respect to depersonalization there were significant differences between these groups, with nurses reporting greater depersonalization (F=7.4, p = .008), with no significant effect of age. With respect to personal achievement there were also significant differences between nurses and other healthcare professionals (F=9.6, p = .003), with nurses reporting lower personal achievement, with no significant effect of age.
Table 3. Depersonalization and Personal Achievement dimensions of burnout at four time-points.
|
Depersonalization
|
Personal Achievement
|
|
N
|
mean
|
SD
|
High (%)
|
N
|
mean
|
SD
|
High (%)
|
Fall 2020
|
277
|
4.80
|
5.59
|
18.1
|
270
|
34.42
|
10.99
|
37.0
|
Winter 2021
|
245
|
5.32
|
6.28
|
18.4
|
238
|
34.47
|
10.2
|
36.6
|
Spring 2021
|
154
|
6.42
|
6.86
|
23.4
|
148
|
37.85
|
7.05
|
20.3
|
Summer 2021
|
153
|
6.67
|
7.12
|
26.8
|
147
|
37.06
|
8.90
|
29.9
|
Psychological distress
Mean levels of psychological distress for each occupational group at each time point are reported in Table 2. Similarly to the results for emotional exhaustion, mean levels peak at the winter 2021 or spring 2021 measurement point in each group and are lower by the summer 2021 measurement. Repeated measures ANOVA of psychological distress for participants for whom there were no missing data over four time-points (77 nurses, 103 other healthcare professionals, 60 other clinical staff, and 110 non-clinical staff) demonstrated significant within-subjects changes in psychological distress over time (F = 3.2, p = .024) and significant between-subject effects of occupational role (F = 3.6, p = .01) and age (F = 32.3, p < .001). The interaction of occupation role X time was not significant (F = 0.6, p = .83), indicating a similar pattern of change over time in all groups.
Post hoc testing revealed that the relationship between age and psychological distress was inverse (higher psychological distress with younger age) and significant at each time point (T1 R = -.24, T2 R = -.29, T3 R = -.24, T4 R = -.29, p < .001 at each time point). The proportion of participants with high psychological distress at each time point, by occupational role, is illustrated in Figure 2. The severity of psychological distress was highest in nurses.