In this study the response rate was 52.47%, similar to other Burnout studies, as for Castro et al., 2020, in which the response rate was 63.4%, 38% for Khan et al. (2021), 23.28% for Civantos et al. (2020) and 44% for Singh et al. 2022 [5, 7–9].
Regarding the prevalence of Burnout Syndrome among physicians in this study, 77.54% of professionals had BS, the prevalence of BS due to depersonalization was 48.55% (67/138) and 72.46% (100/138) from emotional exhaustion. The result was similar to that found by Khan et al. (2021), in which 68% of the sample had BS, with a depersonalization prevalence of 39% (99/251) and emotional exhaustion of 63% (157/250). In the study by SINGH et al. (2022), the prevalence of BS was 73%. Both used MBI in their methodology, the first to estimate the prevalence among doctors (in general) during the pandemic and the second for oncologists only. In the study by Baptista et al. (2021), which used the Copenhagen Burnout Inventory (CBI) to assess the prevalence among primary care physicians during the pandemic, high levels of BS were found for the 3 domains: 65.9% with personal burnout, 68.7% for Work-related burnout and 54.7% for patient-related burnout. In the study by Civantos et al. (2020), who used the Mini-Z for head and neck surgeons, the prevalence was 14.7% [5, 8–10].
In this research, the mean age was 30 years (95%CI: 28.32–31.67), and, there was a statistically significant p-value indicating younger age as a risk factor for BS. In general, those professionals up to 30 years of age were more likely to have Burnout syndrome (p = 0.000000165), with the prevalence decreasing with increasing age. Similarly, in the study by Khan et al. (2021), the prevalence of BS was higher among those aged 36–50 years (74%), decreasing with increasing age: 68% for those aged 51–65 years and 32% for those over 66 years. The same happened to Ma et al. (2020), with levels of occupational burnout decreasing according to age, moreover, emotional exhaustion and low personal accomplishment were substantially lower in those over 45 years of age. Being younger was also identified as a risk factor for Baptista et al. (2021), and Ferry et al. (2021). Singh et al. (2022), stated that those aged 56 years or older had a lower probability of burnout (OR = 0.16; 95% CI, 0.1–0.4; P < .001). Civantos et al. (2020), observed higher scores on the GAD − 7 scale for anxiety among those younger, between 25 and 44 years old, so those over 45 years old were less likely to experience anxiety symptoms (p = 0.011) [5, 8–12].
Concerning the characteristics of the population evaluated, in the present study, 63% of the participants were female. According to the latest medical demography performed by the Federal Council of Medicine in 2018, the prevalence of male physicians in Porto Velho (RO) is 57, 1%, and female physicians 42.9%. The highest proportion of female doctors was also observed in other studies, such as in Sosa and Jeampiere (2021), carried out in a province in Peru, where 52.6% were women, as well as in Liu et al. (2020), a Chinese study, which obtained a percentage of 68.2% of women composing the sample, an even higher prevalence for Baptista et al., 2021, whose percentage reached 80.8% of women. Whereas Khan et al. (2021), and Civantos et al. (2020), obtained a predominantly male sample, with only 49% women and 74.2% men, respectively [5, 6, 8, 10, 13, 14].
In this study, being female was identified as a possible risk factor for the development of BS, as demonstrated by Civantos et al. (2020), in which women were more likely to have a positive screening for Burnout, with p = 0.036, with higher mean scores (p = 0.002). Furthermore, Baptista et al. (2021), showed that being a woman was significantly associated with higher rates of patient-related burnout (OR = 2.57;95%; CI=(1.17–5.65); p = 0.019). In the results of the study by Khan et al. (2021), women were more likely to experience emotional exhaustion (p = 0.03) [5, 8, 10].
Regarding the marital status of the participants, being married was identified in the present study as a possible protective factor for developing BS (prevalence ratio of 0.7224 (95%CI: 0.5929–0.8803); p = 0.0005213). Similar results were found by Zheng et al. (2022), in which single physicians were more likely to have depersonalization than married ones, and by Ma et al. (2020), in which singles experienced occupational burnout more severely compared to married people, especially concerning depersonalization and low personal accomplishment [11, 15].
In this study, having children proved to be a possible protective factor for BS, especially among women. For C. Buehrsch, et al., 2012, who also used MBI, men and women with children had lower levels of depersonalization, while lower levels of emotional exhaustion were observed only in men. However, in the study by Khan et al. (2021), in which 76.9% of physicians without BS had children and 68.9% among those with Burnout, no statistically significant association was found between children and BS (p = 0.52). As for Baptista et al. (2021), in which having children aged 12 years or younger was also not significantly associated with Burnout [5, 10, 16].
Furthermore, still within the scope of personal and family life, in this study moving away from family during the pandemic (p = 0.02663) and not living with family (p = 0.02265) were statistically significant as possible risk factors for BS. In the study of Ma et al. (2020), receiving family support had a negative impact on the prevalence of depersonalization and low personal accomplishment [11].
Of the total sample (n = 138), even though 77,54% (107/138) had Burnout, only 27.53% (n = 38) were seeking a psychologist or psychiatrist help, between these 92.1% (n = 35) had BS. Likewise, a systematic review [17] showed that a significant proportion of doctors reported that they would not seek help for depression, between the many barriers described, were concerns about confidentiality and impact on career, patients, and colleagues. Moreover, as doctors are culturally expected to be infallible and there is a stigma that mental illness is a sign of weakness, they may find it difficult to identify symptoms and vulnerabilities in themselves. Hence, this may lead to self-diagnosis and self-medication, with substance abuse problems, especially with prescription drugs, going unrecognized [17].
Regarding the association between religiosity and BS, in the current study, there was no statistical significance for it to be defined as a protective factor for the development of Burnout (p = 0.2925), as shown in an Italian and a Brazilian study, respectively Giusti, et al. (2020) and Castro, et al. (2020), but it is worth noting that in both, a heterogeneous population was used, composed of other health professionals. On the other hand, the study by Silveira and Borges (2021) concluded that religiosity acts as a protective factor since it acted in reducing the rates of professional effectiveness and cynicism [7, 18, 19].
In this study, it was observed that there is no statistical significance between specialty and Burnout Syndrome. The same was observed by Khan et al. (2021), with a p of 0.54 [5]. Zheng et al. (2022) found an association between specialty and occupational burnout, so surgeons were more likely to suffer from emotional exhaustion and low personal accomplishment than pediatricians and psychiatrists. However, the authors state that the results for specialties should be considered with caution due to the limited sample and bias in studies involving analysis by specialties [15].
Moreover, there was no statistically significant difference between the average worked hours by physicians with or without BS. Likewise, there was no relationship between hours worked and the occurrence of the outcome, nor between years of experience (less than or greater than 5 years) and hours worked. In a divergent way, Khan et al. (2021) found a significant relationship between the greater number of hours worked and the probability of BS [5]. Furthermore, Lin et al. (2021), studied the prevalence of BS in health professionals, in general, using the Copenhagen Burnout Inventory scale, showing that the average weekly workload was associated with Burnout in a non-linear and dose-dependent manner. However, for physicians, the occurrence of Burnout was less susceptible to both an increase and a decrease in the weekly workload compared to other health professionals, with a weekly average of approximately 64 hours [20].
In terms of working (currently or in the past) on the frontline, it represented almost twice the risk of developing BS when compared to doctors who did not work on the frontline at any time (risk of 80.95% in those exposed and 41.67% in those not exposed). Among physicians who worked at some point on the frontline, professionals who stopped working in this sector presented a lower risk when compared to those who remained active. Cahill et al., 2022, attested in their report that the number of hours in contact with aerosol-generating procedures in patients with COVID-19 was positively related to Burnout, in addition to anxiety and depression [21]. Greene et al., 2021 demonstrated that frontline workers who did not have reliable access to personal protective equipment, who had caught COVID-19, who felt stigmatized due to their job, who were concerned about infecting others, and who could not tell their managers if they were not coping, were more likely to have depression, anxiety, or post-traumatic stress disorder [22].
This study had some limitations. Although the MBI is considered the most used method in the medical research literature for the identification of BS, there is no consensus on the appropriate clinical features to be considered in the clinical assessment of BS; the minimum duration and frequency of these symptoms; the reflected effects of these symptoms to be expected in the patient's life or workplace; or differential diagnosis procedures [23–25]. So, some authors suggest replacing the notion of burnout with job-induced depression [24, 25]. Moreover, as it is a self-administered questionnaire and modified from the original, there is the possibility that some participants had their results minimized or exaggerated, or even felt insecure despite the guarantee of anonymity. In addition, as it is a cross-sectional study, it is only possible to estimate the prevalence ratio, which can be close to the relative risk (RR), but calculating RR is only possible in incidence studies, such as a cohort and randomized clinical trial. It is also noteworthy that this study has a limited sample size, with an error margin of 8%, in addition to having a low response rate to the questionnaire. Furthermore, it would be important to perform a multivariate analysis to assess the impact of possible risk factors observed.
