College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Hum Resour Health. 2019 Jul 18;17(1):58. doi: 10.1186/s12960-019-0383-3.
The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district.
We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors.
A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally.
In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout.
中低收入国家医护人员的短期倦怠状况已经过有限评估。本研究旨在评估在非洲农村地区实施新心理健康计划的背景下，倦怠症状的短期结局。
我们随访了在埃塞俄比亚南部 66 个农村初级保健（PHC）设施中工作的 145 名初级保健工作者（HCW），那里正在实施新的综合心理健康服务。在引入新服务时（即基线）和 6 个月后评估倦怠情况。通过自我管理问卷收集数据，包括 Maslach 倦怠量表（MBI）和衡量职业满意度和心理社会因素的工具。使用广义估计方程（GEE）评估倦怠核心维度（情绪衰竭）变化与相关工作相关和心理社会因素之间的关联。
共有 136 名（93.8%）HCW 在 6 个月时完成并返回了他们的问卷。两个时间点之间的倦怠水平没有显著降低。在 GEE 回归模型中，高抑郁症状评分（调整平均差异（aMD）0.56，95%CI 0.29，0.83，p<0.01）、经历两个或更多压力性生活事件（aMD 1.37，95%CI 0.06，2.14，p<0.01）、作为社区卫生推广工作者与设施基础 HCW（aMD 5.80，95%CI 3.21，8.38，p<0.01）、感知工作不安全（aMD 0.73，95%CI 0.08，1.38，p=0.03）和年龄较大（aMD 0.36，95%CI 0.09，0.63，p=0.01）与情绪衰竭呈显著纵向相关。
在添加精神保健服务到 HCW 工作量的背景下，短期内倦怠水平没有显著变化。然而，需要进行更长期和更大规模的研究来证实这一点。这一证据可以作为干预措施发展的基线信息，以增强幸福感并减少倦怠。
