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Nichada Khanngern, M.Sc.*, Woraphat Ratta-apha, M.D., Ph.D.**, Kamonporn Wannarit, M.D., M.Sc.**
*Songkhla Rajanagarindra Psychiatric Hospital, Mueang Songkhla, Songkhla 90000, ailand.
**Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, ailand.
Burnout among Mental Health Professionals in
a Tertiary University Hospital
ABSTRACT
Objective: To examine the level of burnout syndrome, and to investigate the relationship between burnout,
personality traits, coping strategies, and other related personal factors among mental health professionals working
in a tertiary hospital.
Materials and Methods: Online questionnaires were sent to 160 mental health professionals at Siriraj Hospital.
e questionnaire comprised questions collecting demographic data, the Copenhagen Burnout Inventory (ai
version), the Big Five Inventory, and the Coping Scale. e data were analyzed through descriptive statistics, analysis
of variance, Pearson correlation, and stepwise multiple regression.
Results: A total of 121 (75.6%) responses were collected. Of the 121 participants, 41.3% reported high total burnout
levels. However, no dierence in total burnout was found between the dierent mental health professions. e
group aged between 20-29 years demonstrated higher burnout than the others. Individuals with bachelor’s and
master’s degrees showed greater burnout than those with lower than undergraduate degrees. Moreover, individuals
who worked for less than ve years had higher burnout than those in other groups. Furthermore, neuroticism and
avoidance signicantly predicted the burnout syndrome.
Conclusion: In contrast to previous studies in ailand, the results highlighted the risk factors for burnout syndrome
in terms of personal, work-related, and client-related burnout. ese results can strengthen awareness surrounding
mental health conditions, for the eective provision of psychoeducation and psychological interventions.
Keywords: Burnout; coping strategies; health care professionals; personality traits (Siriraj Med J 2022; 74: 185-192)
Corresponding author: Kamonporn Wannarit
E-mail: kamonporn.wan@mahidol.edu
Received 18 January 2022 Revised 7 February 2022 Accepted 7 February 2022
ORCID ID: https://orcid.org/0000-0002-5395-7848
http://dx.doi.org/10.33192/Smj.2022.23
All material is licensed under terms of
the Creative Commons Attribution 4.0
International (CC-BY-NC-ND 4.0)
license unless otherwise stated.
INTRODUCTION
Burnout syndrome is a mental health condition
commonly found in present-day society among working
populations, with an annually ascending number. Rising
concern about the adverse impacts of burnout syndrome
has led the World Health Organization (WHO) to include
burnout syndrome in ICD-11, which will be in eect 2022
onwards. Burnout is not dened as a medical disorder,
but rather as an abnormality caused by occupational
phenomena, specically in the workplace environment.
1
Burnout syndrome may arise from chronic stress that
aects an individual’s daily functioning, thus contributing
to mental and physical health problems among those who
fail to cope with stress and consequently seek treatment.
Burnout is a state when work-related chronic stress has
not been handled appropriately, thus, causing physical,
emotional, and mental consequences.
2
Physical symptoms
of burnout are fatigue, lethargy, headache, and insomnia
while mental symptoms include apathy, despair, and
frustration. Some consequences of burnout in healthcare
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186
workers included an impaired work ability and high
turnover intention.
3,4
Borritz, Rugulies, Bjorner, Villadsen,
Mikkelsen, and Kristensen described burnout with an
emphasis on exhaustion with both physical and mental
eects, in which burnout consists of three components:
personal, work-related, and client-related burnout.
5
Burnout can occur due to external factors such as
workplace environment, stressful job, high workload,
and jobs related to interpersonal interactions.
6
However,
researchers have noticed that not everyone in the same
workplace environment would experience similar burnout;
thus, there may be personal factors besides job specic
factors that aect how individuals perceive, respond, and
cope with stress. Past research revealed that the number of
patients a physician attends to per day directly contributes
to their burnout.
7
Further, individuals who employ harm
avoidant strategies to cope with stress experience the
most burnout. Moreover, self-control plays an important
role in burnout prevention, where stress, neuroticism,
negative aectivity, and disengagement coping has a
positive relationship with burnout.
8
Furthermore, in
the same study, negative relationships have been found
between burnout and certain personality traits, including
extraversion, agreeableness, conscientiousness, positive
aectivity, and engagement coping. Additionally, young
married females with a bachelor’s degree tend to have
higher stress.
9
Neuroticism is considered a risk factor
that increases stress levels, while extraversion and active
coping styles are the best at stress prevention. Previous
studies in ailand demonstrated many signicant factors
that were associated with burnout such as work hours
per week, perception of sleeping/rest quality, perception
of having stress from work and family relationships.
10
In
addition, the prevalence of burnout syndrome among
residents in medical school training was 95.4%, with the
highest score revealed to be emotional exhaustion.
11
e
associated factors of sleep quality were environmental
problems in the bedroom while being on duty and
emotional exhaustion.
Burnout syndrome can occur to anyone in any
profession, but it is common in the medical eld.
3,4,12
As medical professionals engage with activities related
to safety, specialistic skills must be properly delivered
so that clients recover eectively, particularly in mental
health services. Previous studies on burnout syndrome
showed that 67% (2 out of 3) mental health professionals
experienced burnout as their profession is a health-
related service that entails dealing with clients’ emotional
problems, mood swings, and expectations of illness
improvement.
13
Despite the increasing number of patients
with mental health problems, the number of mental
health professionals is still limited, making them prone
to experience negative emotions, thus causing chronic
work stress and, eventually, burnout. Overall, burnout
syndrome may aect people at all levels, including service
providers, clients, and organizations as a whole.
14
erefore, this study aimed to examine the inuence
of personal factors on burnout syndrome among mental
health professionals in Siriraj Hospital. e ndings may
aid in the assistance and prevention of burnout syndrome
in both, mental health professionals and patients.
MATERIALS AND METHODS
Participants
In June 2020, the online questionnaires were sent to
all 160 mental health professionals who were working
as a multidisciplinary team to deliver integrated care
for patients with mental health problems and were
employed in three departments at that time, including
the Department of Psychiatry, Division of Child and
Adolescent Psychiatry of the Department of Pediatrics,
and Medical Nursing Department, at Siriraj Hospital,
a tertiary referral university hospital in ailand. e
sample included psychiatrists, psychiatric residents,
registered nurses providing psychiatric nursing, practical
nurses providing psychiatric nursing, psychologists,
social workers, occupational therapists, special educators
(evaluate children’s educational needs and make those
specic needs more accessible to each person with learning
disability), and speech therapists (help children who
have diculties in speaking and communication such as
patients with delayed speech development, intellectual
disability and autistic disorder).
e sample size was calculated by using G power
program version 3.1.9.4. e appropriate sample size
for this research was 109; however, the sample size
was increased by 10% to compensate for incomplete
questionnaires and random responses. Hence, the total
sample size was 121.
MATERIALS AND METHODS
e demographic questionnaire contained six
items recording gender, age, education, marital status,
years of work experience, and number of work hours
per week.
e ai version of the Copenhagen Burnout
Inventory (T-CBT) consists of 19 items separated into
three components: personal burnout, work-related burnout,
and client-related burnout. e overall internal coecient
was .96.
15
T-CBT was measured on a 5 point Likert scale
from 1 (Never/Almost Never) to 5 (Always).
The Big Five Inventory (BFI) consists of 12
Khanngern et al.
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items categorized into ve components: neuroticism,
extraversion, openness to experience, agreeableness, and
conscientiousness. e overall internal consistency was
.80 for 60 items.
16-17
e Coping Scale comprises 39 items that measure
coping strategies in three aspects: problem-focused
coping, social support coping, and avoidance coping,
with scores ranging from 1 (not at all) to 5 (always).
18
e
score tabulation is represented by each coping strategy
according to the scale.
Data collection
is study was approved by the Siriraj Institutional
Review Board (SIRB) of the Faculty of Medicine Siriraj
Hospital (Si 433/2020). Participants who matched the
inclusion criteria were invited to participate using an
online survey (Google form) which could be accessed
through an online link or QR code. Participants were
informed via an online platform with a description of the
study and types of questions that they would be asked.
ey were also allowed to withdraw from the study if
they found it distressful. We ensured them that the
questionnaires did not ask about the information that
could identify their identity.
Statistical analysis
Data were analyzed using SPSS version 18. Descriptive
statistics were used to analyze demographic data and
the main variables (frequency, percentage, mean, and
standard deviation). Independent t-tests and analysis
of variance (ANOVA) were conducted to compare the
means between personal characteristics and burnout
syndrome. Pearson’s correlation coecient was used to
determine the relationship between burnout syndrome,
personality traits, and coping strategies. e predictive
value of personality traits and coping strategies regarding
burnout syndrome of mental health professionals in
Siriraj Hospital were examines using stepwise multiple
regression analysis.
RESULTS
Demographic data of participants
ere were totally 160 mental health professionals,
and the response rate was 75.6% (n=121). e most
participants were nurses (54.5%) followed by psychiatrists
(25.6%) and others (29.8%). eir personal characteristics
are summarized in Table 1. e majority of participants
were female (86%) and the mean age was 34.36 ± 10.6.
Working hours per week ranged between 0 and 72 hours,
with an average of 40.2 hours ± 14.1.
TABLE 1. Demographic data of the sample in this study
(n=121).
Demographics N %
Gender Male 17 14
Female 104 86
Age 20 – 29 56 46.3
30 – 39 36 29.7
40 – 49 11 9.1
50 – 59 18 14.9
Mean ± SD 34.36 ± 10.6
Education Undergraduate Degree 25 20.7
Bachelor’s Degree 55 45.5
Master’s Degree 31 25.6
Doctoral Degree 10 8.3
Marital Status Single 86 71.1
Married 32 26.4
Widow/Divorced 3 2.5
Occupational
Psychiatrists Psychiatrist 11 9.1
Psychiatry Resident 20 16.5
Nurses Registered Nurse 39 32.2
Practical Nurse 27 22.3
Demographics n %
Others Psychologist 13 10.7
Social Worker 5 4.1
Occupational Therapist 2 1.7
Special Educator 3 2.5
Speech Therapist 1 0.8
Year in present < 5 years 50 42.1
working 5 – 10 years 28 23.5
11 – 15 years 11 9.2
16 – 20 years 5 4.2
> 20 years 25 21
Mean ± SD 10.34 ± 10.3
Working hours Less than 40 hours 23 20.2
per week 40 – 50 hours 73 64
More than 50 hours 18 15.8
Mean ± SD 40.2 ± 14.1
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Burnout syndrome among mental professionals
e study found that 41.3% of the participants scored
a high level of total burnout; specically, in subscales,
personal burnout was 46.3%, work-related burnout was
43.8%, and client-related burnout was 27.3%. When
considered by occupation, 51.6% of psychiatrists had a
high mean burnout score (Table 2).
Personal characteristics and burnout syndrome
e 20-29 years-old group showed higher average
and work-related burnout scores than the 40-49 years-
old group and 50-59 years-old group. Additionally, the
average personal burnout score was lower in the 40-49
year-old group than in the 20-29 and 30-39 year-old
groups. e average burnout score, personal-related
burnout, and work-related burnout were greater in
participants with master’s and bachelor’s degrees as
opposed to undergraduate degree holders. Moreover,
participants with less than ve years of work experience
had signicantly higher average scores, work-related
burnout, and client-related burnout than those with
5-10 years and more than 20 years of work experience.
However, no signicant dierence was detected between
total burnout and demographic factors, including gender,
marital status, occupation, and weekly work hours.
Relationship between burnout syndrome, personality
traits and coping strategies
A moderate positive correlation between burnout
syndrome, avoidance, and neuroticism was detected,
while low negative correlations were found between
burnout syndrome and conscientiousness, agreeableness,
and extraversion. Additionally, burnout was negatively
correlated with openness and problem-focused coping
at a negligible level (Table 3).
TABLE 2. Burnout syndrome among mental professionals (n=121).
Occupational
Level
M SD
low high
Psychiatrists Total Burnout 15 (48.4%) 16 (51.6%) 2.52 0.63
(n=31) Personal Burnout 15 (48.4%) 16 (51.6%) 2.52 0.55
Work-related Burnout 15 (48.4%) 16 (51.6%) 2.58 0.77
Client-related Burnout 20 (64.5%) 11 (35.5%) 2.46 0.67
Nurses Total Burnout 41 (62.1%) 25 (37.9%) 2.40 0.69
(n=66) Personal Burnout 37 (56.1%) 29 (43.9%) 2.50 0.68
Work-related Burnout 37 (56.1%) 29 (43.9%) 2.49 0.87
Client-related Burnout 49 (74.2%) 17 (25.8%) 2.21 0.70
Others Total Burnout 15 (62.5%) 9 (37.5%) 2.27 0.71
(n=24) Personal Burnout 13 (54.2%) 11 (45.8%) 2.56 0.85
Work-related Burnout 16 (66.7%) 8 (33.3%) 2.26 0.79
Client-related Burnout 19 (79.2%) 5 (20.8%) 2.01 0.68
Total Total Burnout 71 (58.7%) 50 (41.3%) 2.41 0.68
Personal Burnout 65 (53.7%) 56 (46.3%) 2.52 0.68
Work-related Burnout 68 (56.2%) 53 (43.8%) 2.47 0.83
Client-related Burnout 88 (72.7%) 33 (27.3%) 2.24 0.70
Note: Psychiatrists = psychiatrists and psychiatric residents; nurses = registered nurses and practical nurses; Others = psychologists, social
workers, occupational therapists, special educational needs, and speech therapists. e level of burnout syndrome was classied using a
cut-o point equal to 2.5.
Khanngern et al.
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TABLE 3. Pearson’s correlation coecients between burnout syndrome, personality traits, and coping strategies.
TABLE 4. Stepwise multiple regression analysis for the predictive variable of burnout syndrome.
N E O A C PFC SSS AVO
Total Burnout .648** -.422** -.194* -.428** -.451** -.190* .019 .680**
Personal .562** -.331** -.152 -.351** -.357** .143 .053 .640**
Work-related .631** -.417** -.223* -.409** -.455** -.188* -.001 650**
Client-related .573** -.401** -.141 -.408** -.411** -.184* .008 572**
Abbreviations: N = neuroticism, E = extraversion, O = openness to experience, A = agreeableness, and C = conscientiousness. PFC =
problem-focused coping; SSS = Seek social support; AVO = avoidance
*p < .05; **p < .01
The personal burnout subscale was positively
correlated with avoidance and neuroticism at a moderate
level, but negatively associated with conscientiousness,
agreeableness, and extraversion at a low level.
For the work-related burnout subscale, positive
correlations were found for avoidance and neuroticism, while
low negative correlations were detected for conscientiousness,
extraversion, and agreeableness. Moreover, work-related
burnout was negatively correlated with openness and
problem-focused coping at a negligible level.
Client-related burnout was positively correlated
with neuroticism and avoidance at a moderate level, but
negatively correlated with conscientiousness, agreeableness,
and extraversion at a low level. e relationship with
problem-focused coping was correlated at a negligible
level.
e eect of personality traits and coping strategies
on burnout
Multiple regression analysis was conducted using the
stepwise method. Avoidance and neuroticism (predictive
variables) could explain burnout (dependent variable)
at a signicant level (F=63.82, P <.001). Aer adjusting
the value, avoidance and neuroticism could predict
burnout by 51.1% (adjusted R
2
=.511). When considering
multiple regression at a standardized value, the highest
value fell to avoidance (β= .444), followed by neuroticism
(β =.336) (Table 4).
Model Predictors R R
2
R
2
change
Coefcients
t p
b SE β
1 AVO .680 .462 .462 .783 .077 .680 10.113 <0.001
2 AVO .721 .520 .057 .512 .103 .444 4.959 <0.001
N .373 .099 .336 .3756 <0.001
Adjusted R
2
=.511 F = 63.820 P <0.001
Constant = .145 SE = .207
Abbreviations: N = neuroticism, AVO = avoidance
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DISCUSSION
is research illustrated that the overall burnout
syndrome among mental health professionals in Siriraj
Hospital was low. However, 41.3% of mental health
professionals in Siriraj Hospital reported having high
burnout, which corresponds with past research.
9,19,20
In
line with Ogresta and Rusac, no signicant associations
between professions in the mental health eld were
detected. Close investigation of a group with a high
burnout rate showed that 51.6% were psychiatrists, 37.9%
were nurses, and 37.5% belonged to other professions.
20
is is consistent with previous research suggesting
that high burnout was detected among psychiatrists in
ailand, with greater emotional exhaustion (49.3%).
21
When examining burnout components, the results
showed that personal burnout was the highest among
mental health professionals in Siriraj Hospital. is is
congruent with a previous study examining burnout
patterns in Australian midwives.
22
However, our results
contradict research on physicians where work-related
burnout (46.7%) was highest, followed by personal burnout
(44.8%) and client-related burnout (35.1%); while all
sub-scale scores indicated high burnout.
23
Consistently,
although no signicant dierence in burnout level was
detected between dierent mental health professions,
psychiatrists still had the highest risk of burnout compared
to other professions.
24,25
One possible explanation is that
psychiatrists are more involved with work associated
with complex emotional problems alongside high patient
expectations; thus, they are more likely to experience
stress, pressure, and burnout.
Consistent with previous studies, our results showed
no signicant dierence between genders and burnout.
7,26,27
is may be due to the low number of male samples
(14%) in this study. Therefore, samples may not be
representative of gender and burnout score dierences
among mental health professionals. Moreover, there is
a very limited number of studies that have examined
gender and burnout among mental health professionals
using the Copenhagen Burnout Inventory (CBI). e
current ndings are supported by Erik Erikson’s theory
on psychosocial development, where the age between 21
and 40 years is a period when individuals hold greater
responsibilities, and thus are more prone to stress and
burnout. Additionally, previous research reported
similar results where older sta had lower scores for
all burnout components than younger stas.
24
Older
ages seemed to signify lower burnout, particularly in
personal and work-related burnout.
23,28
Similarly, younger
age was found to be correlated with high emotional
exhaustion.
19
Moreover, there were dierences in the burnout
average scores and burnout component scores across
dierent education levels. Samples with education of
lower than undergraduate degrees had lower personal
and work-related burnout than those with bachelor’s and
master’s degrees. is is in line with a Taiwanese research
demonstrating that a graduate school group had higher
average burnout than college group.
24
Furthermore,
a research also showed that master’s-level education
corresponded with greater burnout scores.
6
Taking the
above research into consideration, this suggested that
bachelor’s and master’s degrees require a more specied
level of training, expertise, and work experiences in mental
health services, and thus, are more prone to experiencing
burnout. Strikingly, the dierences in burnout scores
were not signicant in those with a doctorate level of
education. is may be due to the collected experiences
related to work that had already been adjusted and
managed.
Concerning marital status, no signicant dierence
between being single, married, or divorced and experiencing
burnout was detected, which is consistent with other
studies.
7,28
e uneven number of single samples (71.1%)
and married samples (26.4%) might explain the above
nding. erefore, future research conducted with mental
health professionals should further investigate whether
there are dierences in burnout scores based on marital
status.
Moreover, our study showed that individuals who
had worked for less than ve years had signicantly
higher average scores. Although research on years of
employment using CBI is very limited, one study found
an association between longer working hours and lower
personal and work-related burnout.
23
Furthermore, a study
revealed that greater emotional exhaustion correlated
with fewer years of work experience among mental
health providers.
29
Furthermore, we found that only neuroticism and
avoidance could predict higher burnout, similar to past
research showing that neuroticism was a risk factor for
workplace stress.
9
Similarly, openness, extraversion,
agreeableness, conscientiousness, and active coping styles
could be protective factors against stress.
9
Correspondingly,
neuroticism was one of the main factors that could
predict burnout, whereas social support and self-blame
aected personal and work-related burnout.
30
Additionally,
behavioral disengagement inuenced work-related and
client-related burnout.
30
Furthermore, factors such as
gender, job stress, weekly work hours, positive aectivity,
negative aectivity, extraversion, conscientiousness, and
problem-focused disengagement could predict burnout.
8
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Study limitations and suggestions for future research
is research was a cross-sectional design which
explained factors related to work exhaustion in mental
health professionals in a certain period. erefore, future
research may include a continual burnout monitoring and
evaluating with interventions such as a group therapy,
workplace health promotion programs or stress management
training to assess whether there are changes in burnout
scores aer participating in the interventions or not.
Moreover, our research employed a self-report in the
data collection method, a sort of an online questionnaire,
in which straightforward responses from participants
might not be provided, and the evaluation was merely
based on their point of views; subsequently, the result
accuracy was diverse. In addition, e online survey may
not be able to reach participants who do not use the social
network platforms or those who nd this type of survey
bothersome. ere might also be a potential confounding
factor like the COVID-19 pandemic situation which
could have emotional impacts on health care workers;
however, this issue was not included in our questionnaires
since we would like to investigate participants’ overall
perceptions on themselves, work and clients in the rst
place so further studies to explore the COVID-19-related
burnout should be done. Furthermore, for the reason
that burnout is merely a syndrome without specic
diagnosis criteria while an assessment tool is simply a
questionnaire, further research may include responses
from participant’s associate people, for example, superiors,
colleagues and intimate friends or, on the contrary,
an additional interview with the participant. Lastly, it
is feasible to establish more precise diagnosis criteria
for burnout as the syndrome threatens mental health
of working age people. Another limitation is that our
samples only comprised mental health professionals,
and thus the ndings cannot be generalized to other
populations. erefore, it might be useful for future
studies to examine the eect of other positive factors
and dierent workplace settings (such as general and
psychiatric hospitals) on burnout among mental health
professionals. In addition, future studies should examine
other positive factors (such as sleep factors, exercise,
and job description) that may be useful in preventing or
reducing work-related exhaustion among mental health
professionals.
CONCLUSION
e present research is one of the rst studies in
ailand that examined factors related to burnout in
mental health professionals. Our results highlighted
personal, work-related and client-related factors that
could predict a high level of burnout. ese results could
be used to inform future research and aid prevention
schemes for more specic work-related exhaustion among
the ai population.
ACKNOWLEDGMENTS
is research was funded by the Siriraj Graduate
Scholarship under the Faculty of Medicine Siriraj Hospital,
Mahidol University. e authors would like to express
their gratitude to the participants from the Department
of Psychiatry, the Department of Pediatrics (Division
of Child and Adolescent Psychiatry), and medical and
psychiatric nursing.
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