title: Mindfulness, Resilience, and Burnout Subtypes in Primary Care Physicians: The Possible Mediating Role of Positive and Negative Affect.
abstract: OBJECTIVE
  Primary care health professionals suffer from high levels of burnout. The aim of the present study was to evaluate the associations of mindfulness and resilience with the features of the burnout types (overload, lack of development, neglect) in primary care physicians, taking into account the potential mediating role of negative and positive affect.
  
  
  METHODS
  A cross-sectional design was used. Six hundred and twenty-two Spanish primary care physicians were recruited from an online survey. The Mindful Attention Awareness Scale (MAAS), Connor-Davidson Resilience Scale (CD-RISC), Positive and Negative Affect Schedule (PANAS), and Burnout Clinical Subtype Questionnaire (BCSQ-12) questionnaires were administered. Polychoric correlation matrices were calculated. The unweighted least squares (ULS) method was used for developing structural equation modeling.
  
  
  RESULTS
  Mindfulness and resilience presented moderately high associations (φ = 0.46). Links were found between mindfulness and overload (γ = -0.25); resilience and neglect (γ = -0.44); mindfulness and resilience, and negative affect (γ = -0.30 and γ = -0.35, respectively); resilience and positive affect (γ = 0.70); negative affect and overload (β = 0.36); positive affect and lack of development (β = -0.16). The links between the burnout types reached high and positive values between overload and lack of development (β = 0.64), and lack of development and neglect (β = 0.52). The model was a very good fit to the data (GFI = 0.96; AGFI = 0.96; RMSR = 0.06; NFI = 0.95; RFI = 0.95; PRATIO = 0.96).
  
  
  CONCLUSIONS
  Interventions addressing both mindfulness and resilience can influence burnout subtypes, but their impact may occur in different ways, potentially mediated by positive and negative affect. Both sorts of trainings could constitute possible tools against burnout; however, while mindfulness seems a suitable intervention for preventing its initial stages, resilience may be more effective for treating its advanced stages.
authors.affiliation: Faculty of Health and Sport Sciences, University of ZaragozaHuesca, Spain; Miguel Servet University Hospital, University of ZaragozaZaragoza, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Montero-Marin
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam Amsterdam, Netherlands.
authors.forename: Mattie
authors.initials: M
authors.lastname: Tops
authors.affiliation: Primary Care and Mental Health London, UK.
authors.forename: Rick
authors.initials: R
authors.lastname: Manzanera
authors.affiliation: Department of Preventive Medicine, Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo Sao Paulo, Brazil.
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Piva Demarzo
authors.affiliation: Department of Internal Medicine, University of Alcalá Madrid, Spain.
authors.forename: Melchor
authors.initials: M
authors.lastname: Álvarez de Mon
authors.affiliation: Miguel Servet University Hospital, University of ZaragozaZaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP)Zaragoza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Campayo
keywords: affect; burnout subtypes; mindfulness; primary care; resilience; structural equation modeling