Work/Life Balance or the Actual Workplace? Factors Associated with Depression and Burnout Among Healthcare Employees

Background and Purpose: Burnout is a crisis among healthcare professionals and trainees. While contributing to staff shortages, burnout also contributes to high rates of depression. The majority of interventions aimed at reducing burnout and depression among healthcare professionals focus on individually focused wellness changes, rather than considering the impact of work itself. With healthcare professionals, this study examined, 1) how burnout is associated with cognitive and somatic depression dimensions; and 2) how work-related stressors and work-life balance are associated with burnout. We hypothesized burnout was more strongly associated with work-related issues, as compared to work/life issues.

Methods: This study used secondary data from four healthcare systems offering the American Foundation for Suicide Prevention’s Interactive Screening Program (ISP). ISP offers employees anonymous online screening and dialogue with trained counselors who provide support and referrals. One thousand twenty-two healthcare professionals and trainees completed the voluntary screening between 2018-2019. Respondents were primarily female (97%), White (55%), and average age of 37 years old. The ISP includes the Patient Health Questionnaire-9, a 3-item burnout questionnaire based on the Maslach Burnout Inventory, and open-ended space for respondents to describe their presenting problem(s). The research team coded all open-ended responses (n=694) into 11 categories and this study focused on work-related issues (e.g. relationship with co-worker or manager, harassment) and work-life balance issues (e.g. childcare, education, financial). Confirmatory factor analysis (CFA) was used to examine the measurement model of depression and burnout. Structural equation modeling was used to examine the association between burnout and two dimensions of depression, and examine factors associated with burnout. All analyses were conducted using Mplus 8.3.

Results: Half of the respondents reported burnout symptoms and almost half of those who responded open-ended question reported work-related problems (45%) and/or work-life balance problems (34%). CFA results showed good model fit and confirmed two depression dimensions. Burnout was associated with depression (b=0.617, p<0.001) and explained 40% of the variance. Burnout was associated with both somatic and cognitive depression symptoms, but was more predictive of somatic symptoms. We found that having work-related issues was associated with burnout after controlling for demographics and all other presenting issues. Work-life balance issues were not associated with burnout when work-related issues were also present.

Conclusion and implications: This study supports that burnout is associated with both somatic symptoms (e.g problems sleeping, eating, concentrating) and cognitive symptoms (e.g. low self-esteem, anhedonia, and depressed mood). Further, work-related issues, rather than work-life balance problems, are a more salient contributing factor of burnout. These results support the need for workplaces to consider the negative impact of work-related problems and revise policies, procedures and programs to focus more on changing systemic workplace stressors such as harassment and discrimination, in addition to improving work relationships with co-workers and managers. The continued focus on individual supports to reduce burnout, such as medication, mindfulness and general wellness, can only go so far in improving workplace culture – a more upstream approach is needed to create a work environment in which healthcare professionals can thrive.