This study aims to assess the prevalence of burnout, depression, and their correlation during the COVID-19 pandemic among psychiatry residents in Saud Arabia. Our study revealed that about 27.3% of the participants were suffering from burnout. This finding seems to be lower than the results of the study by Jovanović and colleagues, who reported the prevalence of burnout among psychiatric trainees in 22 countries to be 36.7% (9). However, our finding is within the range of burnout rates reported by residents from different medical specialties (13–80%) (18). The lower prevalence in our study could be attributed to the reduction in all hospital activity and resident duties in the early days of the pandemic. However, psychiatry residents are among the entire health-care system that is thought to be affected during the pandemic. Multiple sources are thought to increase burnout among the study population during the pandemic. Some of these sources are the new policies and rules, stress among staff, and the fact that infected individuals could be encountered in the workplace at any time (19). Factors not related directly to the pandemic could also contribute to burnout among the study population, such as dealing with suicidal and homicidal patients, difficulty separating one’s personal life from professional life, and dealing with sensitive and emotional patients (20). Also, psychiatrists’ personality traits may make them more vulnerable to burnout as they tend to internalize their stressful experiences (21).
Burnout is not the only type of reaction a psychiatry resident can expect to have when exposed to a pandemic. Exposure to a pandemic is reported to be associated with depression, which was found to be the case in our study. It showed that 27.3% of the participants were suffering from depression. This result is in line with the result of a rapid systematic review conducted by Ricci-Cabello and colleagues. They reported that the pool prevalence of depression among health care workers during a viral epidemic outbreak was 38% (8). Our study also aimed to analyze the complex associations between depression and burnout among the study population. We found a strong relationship between burnout and depression (p < 0.001). It is still debatable whether burnout syndrome and depressive symptoms arise from the same situation, or are two different conditions (22). There was a statistically significant positive correlation between all three burnout subscales (EE, DP, and PA) and depression. This strong correlation highlights the importance of early recognition of burnout symptoms, where it is significantly predictive of depression.
Burnout among psychiatry residents was associated with several sociodemographic factors that have an impact on whether the participants experienced burnout or not. In this study, the sociodemographic data, including age, sex, marital status, and raising children, had no statistically significant impact on the prevalence of burnout. Similar findings were reported in a systematic review by Chan MK et al. (23). They concluded that the data regarding the age and gender of participants were inconsistent in the rates of burnout.
However, in this study, we found that being alone (single, divorced) and in junior years of training (residence years one and two) were associated with experiencing burnout more than counterparts. This finding is consistent with many studies conducted among psychiatry residents included in a systematic review by Chan MK (23). For example, Kealy and colleagues (24) reported that burnout rates in program year (PGY)-2 and PGY-3 residents ranged from 27–31% compared with 16–18% in PGY-4 and PGY-5 residents. Moreover, a study conducted among medical residents during the H1N1 outbreak in Mexico reported that younger age was a risk factor for burnout (25). In our study, increased reporting of burnout during the first two years of training can be attributed to many factors, which could be related to the pressure of fast skill attainment in assessing, diagnosing, and managing patients while experiencing the circumstances surrounding dealing with psychiatric patients with COVID-19 in emergency, inpatient, and outpatient units.
Also, respondents currently raising children were less likely to have burnout, as was observed in a previous studies (26)(9). This finding is also in agreement with a study conducted among emergency department nurses during the Middle East respiratory syndrome coronavirus in Korea (27).
Relationships between sociodemographic factors and depression were mostly consistent with the results of previous studies (28). Similar to the result shown in our study, females were reported to have more depression than males among psychiatry residents and the general population (28, 29). In addition, a recent study in China during the COVID-19 pandemic showed a similar result, of more females with depression than males among health care workers (30). Moreover, residents in their first and second years of training had an increased chance of having depression compared to other years, and this finding is consistent with findings from another study (31).
Respondents who had received mental health help in the preceding two years before the study were 6.59 times significantly more likely to experience burnout and depression than those who had not (p < 0.05). An explanation for this finding is that respondents who received mental health help, whether due to having a mental illness or facing difficulty with stressors, are at higher risk of developing burnout. This emphasizes the importance of intrinsic factors related to personality traits that make them prone to internalize their stressful experience as well as deficient in coping skills to deal with the current pandemic (32).
Much attention has been paid to the frontline health care workers although that all health care providers are affected by COVID-19, especially those in training. As highlighted by the World Health Organization on May 14, 2020, there is a need to urgently increase investment in mental health services or risk a massive increase in mental health conditions in the coming months (33). Under these circumstances, mental health workers will be under more pressure and could be more prone to burnout in these coming months. Hence, the need to construct a plan to reduce this risk is more important than ever by conducting future studies and developing preventative strategies and effective treatment programs to prevent burnout and promote wellness.
The limitation of the present study is that the focus of the research was limited to a subgroup population in one country; therefore, it is important to expand the scope of participants to compare it with different cases in different countries. Moreover, at the time of data collection, the pandemic was at its early stages in Saudi Arabia, which might not represent the current burnout and depressive symptoms. In addition, factors such as weekly working hours and the type of care provided by residents, being in contact with COVID-19 patients, personality traits, coping plans, and job attitude could be examined as other factors influencing burnout and depression. Last, follow-up studies are needed to assess progression or even a potential rebound effect of psychological manifestations once the imminent threat of COVID-19 subsides.