Therapist burnout lowers patients’ odds for clinically meaningful improvement in PTSD

Key takeaways:

• Fewer patients seeing a therapist with burnout achieved clinically meaningful improvement (28.3% vs. 36.8%).
• Therapists in the South had significantly higher odds of burnout than therapists in the Northeast.

Therapist burnout was associated with lower odds of clinically meaningful improvement among patients being treated for PTSD, according to a study published in JAMA Network Open.

“Clinicians experiencing burnout self-report lower quality of care, poorer communication with patients and more medical errors,” Nina A. Sayer, PhD, a clinical psychologist at the Center for Care Delivery and Outcomes Research of the U.S. Department of Veterans Affairs, and colleagues wrote. “However, burnout is not consistently associated with evidence of poorer quality of care or worse outcomes. Health systems need information about whether reducing burnout may be important for treatment effectiveness.”

The prospective cohort study included 165 therapists (53.9% women) at health centers in the U.S. Veterans Affairs Health Care System and 1,268 patients (75.8% men) undergoing trauma-focused psychotherapy for PTSD symptoms.

The therapists responded to an online survey between May 2, 2019, and Oct. 8, 2019, and completed a single-item, 5-point burnout measure from the Physician Worklife Study, for which a score of 3 or more indicated burnout.

Fifty-eight therapists (35.2%) reported burnout. The odds of having burnout appeared higher among therapists in the South compared with the Northeast (OR = 5.39; 95% CI, 1.82-20.02). Patients in the South were also more likely to have a therapist with burnout than patients in the Northeast (OR = 4.95; 95% CI, 3.15-8.13).

Researchers also evaluated patient outcomes through Dec. 31, 2020, with the PTSD checklist for the DSM-5 (PCL-5), for which they defined a clinically meaningful as a 15 point or higher score reduction.

One-third of patients (34%) experienced clinically meaningful improvement in PTSD symptoms. Nearly half of patients (46.3%) dropped out of treatment, which significantly lowered the odds for clinically meaningful improvement (OR = 0.15; 95% CI, 0.11-0.19).

Session spacing — defined as the therapist’s mean days between treatment sessions across their patients — also affected outcomes, with a 20% lower chance of improvement for every 3 extra days between sessions (OR = 0.8; 95% CI, 0.7-0.92).

Among patients seen by therapists with burnout, 28.3% experienced meaningful improvement vs. 36.8% of patients who saw therapists without burnout. The odds of clinically meaningful improvement were lower among patients seeing a therapist with burnout (OR = 0.63; 95% CI, 0.48-0.85). This finding persisted after adjusting for patient dropout (adjusted OR = 0.56; 95% CI, 0.39-0.79) and session spacing (aOR = 0.65; 95% CI, 0.49-0.86).

“Low-certainty evidence indicates that interventions to increase compassion, gratitude or mindfulness may improve resilience of health care professionals,” Sayer and colleagues wrote. “Yet management interventions that support workplace control and improve staffing may be preferred over and more effective than those directed toward personal well-being. This is consistent with a view that while burnout manifests in individuals, it is rooted in systems and that system-level interventions to address the causes of occupational burnout are needed.”