Burnout and coping strategies among future healthcare professionals: a structural equation modelling approach

Sonja V. Ivančević; Milica M. Maričić; Tatjana R. Ivanović; Vesna J. Tepšić Ostojić; Sanja S. Stošić

doi:10.2298/VSP211006094I

Sonja V. Ivančević University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
Milica M. Maričić University of Belgrade, Department of Operations Research and Statistics, Belgrade, Serbia
Tatjana R. Ivanović University of Belgrade, Department of Human Resource Management, Belgrade, Serbia
Vesna J. Tepšić Ostojić Military Medical Academy, Psychiatric Clinic, Belgrade, Serbia
Sanja S. Stošić Megatrend University, Faculty of Business Studies, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP211006094I

Keywords: adaptation, psychological;, burnout, psychological;, health personnel;, models, psychological;, schools;, stress, psychological;, students, medical;, risk factors.

Abstract

Background/Aim. To reduce the risk of burnout development in medical professionals, it is important to identify the contributing factors as early as in their schooling years. The aim of this study was to propose a model for determining the relationship between the coping strategies used by medical high school and medical faculty students and burnout. Methods. The cross-sectional study included 164 students of Medical High School (80.5% female and 19.5% male) and 344 students of the Faculty of Medicine University of Belgrade, Serbia (76.9% female and 23.1% male). The model exploring the relationship between coping strategies (measured by the Brief COPE scale) and burnout [measured by the Copenhagen Burnout Inventory-student version (CBI-S) scale] was tested using structural equation modelling (SEM) analysis. Results. When copied with stress, Medical High School students used Acceptance, Venting, Behavioural Disengagement, and Planning, which increased their burnout, but they did not use any strategies to help them reduce burnout. When copied with stress, Faculty of Medicine students used Planning, Acceptance, Humour, Venting, Behavioural Disengagement, Self-Blame, and Substance Use, which increased their burnout, and Positive Reframing, which helped them reduce burnout. Conclusion. The results of this research showed an evident lack of using adaptive coping strategies with both groups of respondents. Proper education could help them replace these dysfunctional coping strategies with constructive ones.

References

1. Guruprakash KV, Mehta SG, Atul B, Prakash J, Divinakumar KJ, Khan SA, et al. A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students. Ind Psychiatry J 2018; 27(1): 141‒6.

2. da Costa BRC, Pinto ICJF. Stress, Burnout and Coping in Health Professionals: A Literature Review. J Psychol Brain Stud 2017, 1: 4.

3. Howlett M, Doody K, Murray J, LeBlanc-Duchin D, Fraser J, Atkinson PR. Burnout in emergency department healthcare professionals is associated with coping style: a cross-sectional survey. Emerg Med J 2015; 32(9): 722‒7.

4. Shin H, Park YM, Ying JY, Kim B, Noh H, Lee SM. Relationships between coping strategies and burnout symptoms: A meta-analytic approach. Prof Psychol Res Pract 2014; 45(1): 44‒56.

5. Mealer M. Burnout Syndrome in the Intensive Care Unit. Future Directions for Research. Ann Am Thorac Soc 2016; 13(7): 997‒8.

6. Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud 2015; 52(2): 649‒61.

7. Popa-Velea O, Diaconescu L, Mihăilescu A, Jidveian Popescu M, Macarie G. Burnout and Its Relationships with Alexithymia, Stress, and Social Support among Romanian Medical Students: A Cross-Sectional Study. Int J Environ Res Public Health 2017; 14(6): 560.

8. Rudman A, Gustavsson JP. Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study. Int J Nurs Stud 2012; 49(8): 988‒1001.

9. Erschens R, Keifenheim KE, Herrmann-Werner A, Loda T, Schwille-Kiuntke J, Bugaj TJ, et al. Professional burnout among medical students: Systematic literature review and meta-analysis. Med Teach 2019; 41(2): 172‒83.

10. Zarobkiewicz MK, Sławiński MA, Woźniakowski MM, Wawryk-Gawda E, Kulak-Janczy E, Korzeniowska S, et al. Burnout among students of medical universities in Poland. Polish J Public Health 2018; 128(1): 26‒9.

11. da Silva RM, Goulart CT, Lopes LFD, Serrano PM, Costa ALS, de Azevedo Guido L. Hardy personality and burnout syndrome among nursing students in three Brazilian universities-an analytic study. BMC Nurs 2014; 13(1): 9.

12. Lopes AR, Nihei OK. Burnout among nursing students: predictors and association with empathy and self-efficacy. Rev Bras Enferm 2020; 73(1): e20180280. (English, Portuguese)

13. Ivancevic S, Ivanovic T, Maricic M, Cudanov M. Student Heavy Work Investment, Burnout, and Their Antecedents: The Case of Serbia. Amfiteatru Economic 2020; 22(14): 1182‒205.

14. Yusoff MS. Stress, stressors and coping strategies among secondary school students in a Malaysian government secondary school: Initial findings. ASEAN J Psychiatry 2010; 11(2): 143‒57.

15. Ching SSY, Cheung K, Hegney D, Rees CS. Stressors and coping of nursing students in clinical placement: A qualitative study contextualizing their resilience and burnout. Nurse Educ Pract 2020; 42: 102690.

16. Backović DV, Zivojinović JI, Maksimović J, Maksimović M. Gender differences in academic stress and burnout among medical students in final years of education. Psychiatr Danub 2012; 24(2): 175‒81.

17. de la Fuente J, Lahortiga-Ramos F, Laspra-Solís C, Maestro-Martín C, Alustiza I, Aubá E, et al. A structural equation model of achievement emotions, coping strategies and engagement-burnout in undergraduate students: a possible underlying mechanism in facets of perfectionism. Int J Environ Res Public Health 2020; 17(6): 2106.

18. Vizoso C, Arias-Gundín O, Rodríguez C. Exploring coping and optimism as predictors of academic burnout and performance among university students. Educ Psychol 2019; 39(6): 768‒83.

19. Carver CS. You want to measure coping but your protocol’s too long: Consider the brief cope. Int J Behav Med 1997; 4(1): 92‒100.

20. Campos JADB, Carlotto MS, Marôco J. Copenhagen Burnout Inventory-student version: adaptation and transcultural validation for Portugal and Brazil. Psicol Reflex Crít 2013; 26(1): 87-97.

21. Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav 1980; 21(3): 219‒39.

22. Palupi R, Findyartini A. The relationship between gender and coping mechanisms with burnout events in first-year medical students. Korean J Med Educ 2019; 31(4): 331‒42.

23. Guo YF, Cross W, Plummer V, Lam L, Luo YH, Zhang JP. Exploring resilience in Chinese nurses: a cross-sectional study. J Nurs Manag 2017; 25(3): 223‒30.

24. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16(3): 297–334.

25. Milenković M, Glavić D, Maričić M. Determining factors affecting congestion pricing acceptability. Transport Policy 2019; 82(C): 58–74.

26. Statistical Office of the Republic of Serbia. Secondary education bulletin - Beginning of the school year 2019/20; 2020 [cited 2021 Aug 12]. Available from: https://publikacije.stat.g
/>ov.rs/G2020/Pdf/G20205659.pdf (Serbian)

27. University of Belgrade. Izveštaj univerzitetske komisije za upis studenata u prvu godinu studijskih programa. Belgrade; 2020 [cited 2021 Aug 15]. Available from: http://www.bg.ac.rs/files
/>/sr/studije/Analiza_upisa_OAS_IAS_OSS_2019-2020.pdf (Serbian)

28. Singh S, Prakash J, Das RC, Srivastava K. A cross-sectional assessment of stress, coping, and burnout in the final-year medical undergraduate students. Ind Psychiatry J 2016; 25(2): 179‒83.

29. Lazarus RS. From psychological stress to the emotions: a history of changing outlooks. Annu Rev Psychol 1993; 44: 1‒21.

30. Kupcewicz E, Jóźwik M. Positive Orientation and Strategies for Coping with Stress as Predictors of Professional Burnout among Polish Nurses. Int J Environ Res Public Health 2019; 16(21): 4264.

31. Spataro BM, Tilstra SA, Rubio DM, McNeil MA. The toxicity of self-blame: sex differences in burnout and coping in internal medicine trainees. J Women's Health (Larchmt) 2016; 25(11): 1147‒52.

32. Alosaimi FD, Almufleh A, Kazim S, Aladwani B. Stress-coping strategies among medical residents in Saudi Arabia: A cross-sectional national study. Pak J Med Sci 2015, 31(3): 504‒9.

33. Chao RCL. Managing perceived stress among college students: The roles of social support and dysfunctional coping. J College Counseling 2012; 15(1): 5‒21.

34. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol 1989; 56(2): 267‒83.

35. Abouammoh N, Irfan F, AlFaris E. Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study. BMC Med Educ 2020; 20(1): 124.

36. Talbot LA. Burnout and humor usage among community college nursing faculty members. Community Coll J Res Pract 2000; 24(5): 359‒73.

37. Wallace SL, Lee J, Lee SM. Job stress, coping strategies, and burnout among abuse-specific counselors. J Employ Couns 2010; 47(3): 111–22.

38. Ho SK. The relationship between teacher stress and burnout in Hong Kong: positive humour and gender as moderators. Educ Psychol 2017; 37(3): 272‒86.

39. Malinowski AJ. Characteristics of job burnout and humor among psychotherapists. Int J Humor Res 2013; 26(1): 117‒33.

40. Doolittle BR, Windish DM, Seelig CB. Burnout, coping, and spirituality among internal medicine resident physicians. J Grad Med Educ 2013; 5(2): 257–61.

41. Isaksson Ro KE, Tyssen R, Hoffart A, Sexton H, Aasland OG, Gude T. A three-year cohort study of the relationships between coping, job stress and burnout after a counselling intervention for help-seeking physicians. BMC Public Health 2010; 10: 213.

42. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer Pub Co; 1984.

43. van der Merwe LJ, Botha A, Joubert G. Resilience and coping strategies of undergraduate medical students at the University of the Free State. S Afr J Psychiatr 2020; 26: 1471.

44. Talih F, Warakian R, Ajaltouni J, Shehab AA, Tamim H. Correlates of Depression and Burnout Among Residents in a Lebanese Academic Medical Center: a Cross-Sectional Study. Acad Psychiatry 2016; 40(1): 38‒45.