Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Sripada, Grau, Porath, Burgess, Van, Kim, Zivin); Department of Psychiatry, Michigan Medicine (Sripada, Grau, Zivin), and Consulting for Statistics, Computing and Analytics Research (Kim), University of Michigan, Ann Arbor; Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden).
Psychiatr Serv. 2024 Mar 1;75(3):206-213. doi: 10.1176/appi.ps.20230086. Epub 2023 Oct 26.
Burnout is widespread among psychotherapists and leads to negative mental and other health outcomes, absenteeism, and turnover. Job resources, including institutional support for evidence-based practices, can buffer against burnout and may improve satisfaction among therapists. The Veterans Health Administration (VHA) is the nation's largest integrated health system and employs 23,000 therapists, including psychologists, social workers, and counselors. The authors assessed associations between perceived institutional support for evidence-based treatment and satisfaction and burnout among VHA therapists.
This analysis used data from the VHA's national 2018 Mental Health Provider Survey. Responding therapists (N=5,341) answered questions about the quality of mental health care and job satisfaction. Multilevel logistic regression models were used to predict burnout and satisfaction. The authors tested availability of evidence-based treatment and measurement-based care (MBC) as predictors; analyses were adjusted for therapist workload, demographic characteristics, and potential clustering by facility.
VHA therapists had less burnout and more job satisfaction when they perceived receiving institutional support for evidence-based psychotherapy (EBP) and MBC, irrespective of whether the analyses were adjusted for workload. Less difficulty in scheduling EBP was significantly associated with decreased likelihood of burnout (OR=0.83, p<0.001) and increased satisfaction (OR=1.09, p=0.008). Less difficulty ending psychotherapy was significantly associated with decreased likelihood of burnout (OR=0.89, p=0.002) and increased satisfaction (OR=1.12, p=0.004).
Support for evidence-based practices, including EBP and MBC, was closely linked to VHA therapists' satisfaction and burnout. Expanding support for therapists to provide evidence-based treatment may benefit therapists, patients, and the health care system.
倦怠在心理治疗师中普遍存在，并导致负面的心理和其他健康结果、旷工和离职。工作资源，包括对循证实践的机构支持，可以缓冲倦怠的影响，并可能提高治疗师的满意度。退伍军人健康管理局（VHA）是美国最大的综合性医疗系统，雇用了 23000 名治疗师，包括心理学家、社会工作者和顾问。作者评估了 VHA 治疗师感知的循证治疗和满意度与倦怠之间的关联。
本分析使用了 VHA 2018 年全国心理健康提供者调查的数据。回答问题的治疗师（N=5341）回答了关于心理健康护理质量和工作满意度的问题。使用多水平逻辑回归模型预测倦怠和满意度。作者测试了循证治疗和基于测量的护理（MBC）的可用性作为预测因素；分析调整了治疗师工作量、人口统计学特征和设施的潜在聚类。
VHA 治疗师在感知到机构对循证心理治疗（EBP）和 MBC 的支持时，倦怠程度较低，工作满意度较高，无论是否对工作量进行调整。安排 EBP 时的困难程度与倦怠的可能性降低显著相关（OR=0.83，p<0.001），满意度增加（OR=1.09，p=0.008）。结束心理治疗时的困难程度与倦怠的可能性降低显著相关（OR=0.89，p=0.002），满意度增加（OR=1.12，p=0.004）。
对循证实践的支持，包括 EBP 和 MBC，与 VHA 治疗师的满意度和倦怠密切相关。扩大对治疗师提供循证治疗的支持可能使治疗师、患者和医疗保健系统受益。
