title: Burnout syndrome among psychiatric trainees in 22 countries: Risk increased by long working hours, lack of supervision, and psychiatry not being first career choice.
abstract: BACKGROUND
  Postgraduate medical trainees experience high rates of burnout, but evidence regarding psychiatric trainees is missing. We aim to determine burnout rates among psychiatric trainees, and identify individual, educational and work-related factors associated with severe burnout.
  
  
  METHODS
  In an online survey psychiatric trainees from 22 countries were asked to complete the Maslach Burnout Inventory (MBI-GS) and provide information on individual, educational and work-related parameters. Linear mixed models were used to predict the MBI-GS scores, and a generalized linear mixed model to predict severe burnout.
  
  
  RESULTS
  This is the largest study on burnout and training conditions among psychiatric trainees to date. Complete data were obtained from 1980 out of 7625 approached trainees (26%; range 17.8-65.6%). Participants were 31.9 (SD 5.3) years old with 2.8 (SD 1.9) years of training. Severe burnout was found in 726 (36.7%) trainees. The risk was higher for trainees who were younger (P<0.001), without children (P=0.010), and had not opted for psychiatry as a first career choice (P=0.043). After adjustment for socio-demographic characteristics, years in training and country differences in burnout, severe burnout remained associated with long working hours (P<0.001), lack of supervision (P<0.001), and not having regular time to rest (P=0.001). Main findings were replicated in a sensitivity analysis with countries with response rate above 50%.
  
  
  CONCLUSIONS
  Besides previously described risk factors such as working hours and younger age, this is the first evidence of negative influence of lack of supervision and not opting for psychiatry as a first career choice on trainees' burnout.
authors.affiliation: Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E13 8SP, UK. Electronic address: n.jovanovic@qmul.ac.uk.
authors.forename: N
authors.initials: N
authors.lastname: Jovanović
authors.affiliation: Department of Psychology, University of Ljubljana, Aškerčeva 2, 1000 Ljubljana, Slovenia.
authors.forename: A
authors.initials: A
authors.lastname: Podlesek
authors.affiliation: Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Volpe
authors.affiliation: Department of Liaison Child and Adolescent Psychiatry, Our Lady's Hospital Crumlin, Dublin, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Barrett
authors.affiliation: Department of Diagnostic-Clinical Medicine and Public Health University of Modena & Reggio Emilia, Modena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12, 10 000 Zagreb, Croatia.
authors.forename: M
authors.initials: M
authors.lastname: Rojnic Kuzman
authors.affiliation: Private psychiatric practice, 140, avenue Victor-Hugo, 75116 Paris, France; UPC KU Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Wuyts
authors.affiliation: Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
authors.forename: S
authors.initials: S
authors.lastname: Papp
authors.affiliation: Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Institute of Neuropsychiatric Care (INEP), Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Nawka
authors.affiliation: Clinical Hospital of Psychiatry 2, Tirgu Mures, Romania; Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vaida
authors.affiliation: Department of Child and Adolescent Psychiatry, Hospital de D. Estefânia, Lisbon, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Moscoso
authors.affiliation: Laboratoire de Neurosciences de Besançon, Université de France-Comté, 25000 Besançon, France; Newham centre for mental health, East London NHS Foundation Trust, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Andlauer
authors.affiliation: Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tateno
authors.affiliation: HSSD Guernsey, UK; UCL, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lydall
authors.affiliation: Private psychiatric practice, 122A, New Henry House, 10, Ice House Street, Central, Hong Kong.
authors.forename: V
authors.initials: V
authors.lastname: Wong
authors.affiliation: Department of child psychiatry, University Children's Hospital, Bohoričeva 20, 1525 Ljubljana, Slovenia.
authors.forename: J
authors.initials: J
authors.lastname: Rujevic
authors.affiliation: Department for Affective Disorders, Aarhus University Hospital, DK-8000 Aarhus, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Platz Clausen
authors.affiliation: Private Psychiatric Practice, Athens, Greece.
authors.forename: R
authors.initials: R
authors.lastname: Psaras
authors.affiliation: Department for Psychiatry, University Clinical Center Tuzla, Bosnia and Herzegovina.
authors.forename: A
authors.initials: A
authors.lastname: Delic
authors.affiliation: University of Latvia, 19 Raina Blvd., Riga LV 1586, Latvia.
authors.forename: M A
authors.initials: MA
authors.lastname: Losevich
authors.affiliation: Private psychiatric practice, Cape Town, South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Flegar
authors.affiliation: Union Sanitaire et Sociale Aude Pyrénées, Clinique Via Domitia, 11100 Narbonne, France; Psychiatry Clinic of University of Tartu, 50417, Estonia.
authors.forename: P
authors.initials: P
authors.lastname: Crépin
authors.affiliation: Siberian State Medical University, Moskovsky tract 2, Tomsk 634050, Russia.
authors.forename: E
authors.initials: E
authors.lastname: Shmunk
authors.affiliation: Republican Research and Practice Centre of Mental Health, Minsk, Belarus.
authors.forename: I
authors.initials: I
authors.lastname: Kuvshinov
authors.affiliation: Landesklinikum Baden-Mödling, Standort Baden, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Loibl-Weiß
authors.affiliation: Norfolk and Suffolk NHS Foundation Trust, Norwich, UK; University of East Anglia, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Beezhold
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002321:Career Choice; D003710:Demography; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D010555:Personality Inventory; D011570:Psychiatry / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance / Q000523:psychology*
keywords: Burnout; Psychiatry; Risk factors; Supervision; Training