Symptom-based approach may reduce health care workers’ pandemic-linked burnout

Frontline health care workers responding to the COVID-19 pandemic may benefit from a transdiagnostic, symptom-based approach regarding links between their acute psychopathology and burnout and functional difficulties.

Researchers supported the recommendation of this approach based on results of a symptomics analysis published in Journal of Clinical Psychiatry.

“Characterization of specific psychiatric symptoms that are most strongly associated with burnout and aspects of functioning, particularly in the early emergence of the COVID-19 pandemic, can help inform the development of more targeted, transdiagnostic and symptom-focused approaches to minimize the potential of developing long-term burnout and functional difficulties following trauma exposure in [frontline health care workers],” Lorig K. Kachadourian, PhD, of the department of psychiatry at Yale School of Medicine in Connecticut, and colleagues wrote. “In the current study, we examined the cross-sectional association between individual symptoms of COVID-19–related PTSD, [major depressive disorder] and generalized anxiety disorder (GAD) and burnout and [two] aspects of functioning (ie, work difficulties and relationship difficulties) in a large sample of 2,579 [frontline health care workers] working in NYC during the COVID-19 pandemic surge.”

The researchers assessed symptoms of COVID-19-related PTSD via the four-item PTSD-Checklist 5, MDD via the Patient Health Questionnaire-8, GAD via the Generalized Anxiety Disorder-7, burnout via the Single-Item Mini-Z Burnout Assessment and functional difficulties via the Brief Inventory of Psychosocial Functioning. They conducted relative importance analyses to pinpoint symptoms of PTSD, MDD and GAD linked to burnout and functional difficulties.

Results showed the strongest associations with burnout for feeling tired/having little energy, being easily annoyed or irritable and feeling nervous, anxious or on edge. Kachadourian and colleagues noted the greatest amount of explained variance, which was greater than 15%, for feeling tired/having little energy. They also observed the strongest associations between work difficulties and trouble concentrating, feeling easily annoyed or irritable and negative expectations of oneself or the world, the latter of which accounted for the greatest among of explained variance at greater than 9%. Further, relationship difficulties had the strongest associations with negative expectations about oneself or the world, feeling bad about oneself and feeling easily annoyed or irritable, the latter of which accounted for the greatest amount of explained variance at greater than 10%.

“The current study adds to the emerging ‘psychiatric symptomics’ literature by examining how individual symptoms of PTSD, MDD and GAD may be linked to clinical outcomes of high relevance to health care workers on the frontlines of the COVID-19 pandemic,” Kachadourian and colleagues wrote. “This approach provides insight into how the more nuanced clinical manifestation of these disorders may shape risk for burnout as well as work and relationship difficulties during the acute phase of a large-scale traumatic event. Further research using network analysis may be useful in further elucidating key psychiatric symptoms that drive the manifestation and maintenance of stress-related psychopathology in [frontline health care workers] and other populations affected by the COVID-19 pandemic.”