Prevalence of Burnout among Healthcare Workers during the COVID-19 Pandemic: A Systematic Literature Review

Prevalence of Burnout among Healthcare Workers during the COVID-19 Pandemic: A Systematic Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence of Burnout among Healthcare Workers during the COVID-19 Pandemic: A Systematic Literature Review Beebee Zeba Mahetaab Mubarak Jan, Bibi Sumera Keenoo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4499162/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Burnout among healthcare workers has been a significant issue exacerbated by the COVID-19 pandemic. This review aims to synthesise the existing literature on the prevalence, signs, symptoms, and risk factors of burnout among healthcare workers during the pandemic. Methods This systematic review follows the PRISMA guidelines. We searched the Web of Science and Scopus for relevant studies published between January 2020 and December 2022. Inclusion criteria were studies reporting burnout prevalence among healthcare workers during the COVID-19 pandemic. All healthcare workers were above 18years old and consent was obtained. Data were extracted and analysed using a structured framework. Results The review included 50 studies, with a total sample size of 30,000 healthcare workers. Prevalence of burnout varied significantly across regions, with the highest rates reported in Saudi Arabia (75%) and Kuwait (76.9%). Common symptoms included emotional exhaustion, depersonalisation, and reduced personal accomplishment. Key risk factors identified were high work demands, lack of personal protective equipment (PPE), and prolonged working hours. Conclusion The COVID-19 pandemic has significantly impacted the mental health of healthcare workers, leading to high burnout rates. Tailored interventions are needed to address this issue and support healthcare workers during global health emergencies Biological sciences/Psychology/Human behaviour Health sciences/Health care/Occupational health Health sciences/Health care/Public health Health sciences/Health care/Quality of life Figures Figure 1 Introduction Rationale Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. It is characterised by three key dimensions: emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment​​. Freudenberger introduced the concept of burnout in the 1970s, and has since been extensively studied in various professional settings, particularly among healthcare workers​​​​. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has posed unprecedented challenges to healthcare systems globally. Healthcare workers (HCWs) have been at the forefront of the pandemic response, facing increased workloads, extended hours, and high-risk environment​​. These conditions have exacerbated the prevalence of burnout among HCWs, making it a critical issue that demands immediate attention and action. Burnout among HCWs affects the well-being of the individuals. It impacts the quality of patient care, leading to decreased patient satisfaction, increased medical errors, and higher turnover rates among staff​​​​. Therefore, understanding the prevalence, symptoms, and risk factors associated with burnout during the COVID-19 pandemic is essential for developing effective interventions and supporting the healthcare workforce during such crises. Objectives This systematic review aims to: Assess the prevalence of burnout among healthcare workers during the COVID-19 pandemic. Identify common signs and symptoms of burnout experienced by healthcare workers. Examine the risk factors contributing to burnout in this population. Recommend interventions to mitigate burnout among healthcare workers during global health emergencies. Prevalence of Burnout Several studies have reported varying prevalence rates of burnout among healthcare workers during the COVID-19 pandemic. For instance, a study conducted in Saudi Arabia found that 75% of healthcare workers experienced burnout, particularly among younger and early-career professionals​​. Similarly, in Kuwait, the prevalence of burnout was reported as high as 76.9%​​. In contrast, a cross-national meta-analysis highlighted that China had the lowest prevalence of anxiety and depression among healthcare workers during the pandemic despite initial high levels of burnout due to the outbreak's epicentre in Wuhan​​. Signs and Symptoms The signs and symptoms of burnout among healthcare workers can be categorised into physical, psychological, and behavioural domains. Physical symptoms include fatigue, sleep disturbances, headaches, gastrointestinal problems, and increased heart rate​​. Psychological symptoms encompass emotional exhaustion, frustration, depression, and a decreased sense of self-worth​​. Behavioural symptoms often involve depersonalisation, reduced professional efficacy, and victimisation of patients​​. Risk Factors Multiple risk factors have been identified that contribute to burnout among healthcare workers during the COVID-19 pandemic. These include high workload, lack of personal protective equipment (PPE), extended working hours, and the psychological stress associated with the risk of infection and transmission to family members​​​​. Additionally, organisational factors such as inadequate support from management, limited career advancement opportunities, and negative workplace environments further exacerbate burnout​​​​. Impact on Healthcare Systems The impact of burnout extends beyond individual healthcare workers to affect the overall healthcare system. High levels of burnout can lead to increased absenteeism, higher turnover rates, and reduced quality of patient care​​​​. Therefore, addressing burnout is crucial for maintaining a resilient and effective healthcare workforce, particularly during global health emergencies like the COVID-19 pandemic. The COVID-19 pandemic has significantly increased the prevalence of burnout among healthcare workers, highlighting the urgent need for targeted interventions to support their mental health and well-being. This systematic review aims to synthesise the literature on this critical issue, providing insights into the prevalence, symptoms, risk factors, and potential interventions to mitigate burnout among healthcare workers. Methods Eligibility Criteria To ensure a comprehensive and relevant review, studies were included based on the following criteria: Population: Studies must involve healthcare workers, including doctors, nurses, and allied health professionals. Exposure: The studies must report on burnout during the COVID-19 pandemic. Outcomes: Studies must measure the prevalence of burnout, symptoms, or risk factors associated with burnout. Study Design: Both quantitative (cross-sectional, cohort, case-control) and qualitative studies were included. Language: Only studies published in English were included. Publication Status: Only peer-reviewed journal articles were included. Information Sources A comprehensive literature search was conducted using two primary databases: Web of Science and Scopus. These databases were selected for their extensive coverage of high-quality peer-reviewed journals across various disciplines. As this study involved the synthesis of existing literature, no primary data collection was conducted, and ethical approval was not required. However, all included studies were peer-reviewed and adhered to ethical standards in their respective jurisdictions. Search Strategy The search strategy was developed with the assistance of a research librarian, who used controlled vocabulary and free-text terms. The following search terms and Boolean operators were used to identify relevant studies: "burnout" AND "healthcare workers" AND "COVID-19" "burnout syndrome" AND "healthcare providers" AND "coronavirus" "emotional exhaustion" AND "HCWs" AND "pandemic" The search was limited to studies published between January 2020 and December 2023 to capture the impact of the COVID-19 pandemic. Study Selection The study selection process was conducted in two stages: Title and Abstract Screening: Two independent reviewers screened the titles and abstracts of all identified records to exclude studies that did not meet the inclusion criteria. Discrepancies were resolved through discussion or by a third reviewer. Full-Text Review: The full texts of potentially eligible studies were retrieved and assessed independently by the same two reviewers. Studies that met the inclusion criteria were included in the final review. Any disagreements were resolved through consensus or consultation with a third reviewer. Data Extraction A standardised data extraction form was used to collect relevant information from each included study. The following data were extracted: Study Characteristics: Author(s), year of publication, country, study design. Population Characteristics: Sample size demographic details of participants (age, gender, profession). Burnout Measurement: Tools and scales used to measure burnout (e.g., Maslach Burnout Inventory). Prevalence of Burnout: Reported prevalence rates of burnout among healthcare workers. Symptoms and Risk Factors: Detailed description of reported symptoms and identified risk factors associated with burnout. Two reviewers independently extracted data from the included studies. Any discrepancies were discussed and resolved by consensus or consultation with a third reviewer. Risk of Bias Assessment The quality of the included studies was assessed using a standardised risk of bias tool appropriate for each study design: Cross-Sectional Studies: The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Cohort Studies: The Newcastle-Ottawa Scale (NOS). Qualitative Studies: The Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Each study was evaluated for potential sources of bias, including selection bias, measurement bias, and confounding. Based on the assessment tool criteria, studies were classified as having low, moderate, or high risk of bias. The table below (Table 1 ) shows the risk of bias assessment gathered from various study design by different authors. Table 1 Risk of Bias Assessment Table Study Design First Author Year Tool Used Selection Bias Measurement Bias Confounding Overall Risk of Bias Cross-Sectional Dana Lo 2018 JBI Checklist Low Moderate Low Low Cross-Sectional AlJhani et al. 2021 JBI Checklist Moderate High High High Cohort Xin Zhang 2021 Newcastle-Ottawa Scale Low Low Moderate Moderate Cohort Meredith Bradley 2020 Newcastle-Ottawa Scale High Moderate High High Qualitative Nicholas W.S. Chew 2020 CASP Checklist Moderate Low Moderate Moderate Qualitative Helen L. Richards 2022 CASP Checklist Low Moderate Low Low Data Synthesis Approach to Data Synthesis Given the heterogeneity of the included studies in terms of study design, population characteristics, measurement tools, and outcomes, a narrative synthesis approach was adopted. This method allows for integrating and interpreting findings from diverse studies, highlighting patterns and drawing conclusions based on the overall body of evidence. The synthesis is structured around key themes identified in the research questions: prevalence of burnout, signs and symptoms, risk factors, and interventions. Prevalence of Burnout The prevalence of burnout among healthcare workers during the COVID-19 pandemic varied widely across different regions and study populations. Key findings include: Asia: In China, initial studies from Wuhan reported a prevalence of burnout at 48.6% among healthcare workers directly involved in COVID-19 patient care​​. However, a subsequent meta-analysis indicated that China had one of the lowest prevalence rates of anxiety and depression among healthcare workers globally during the pandemic​​. In India, personal burnout was reported at 44.6%, with higher rates among younger healthcare workers (21–30 years old)​​. Middle East: Saudi Arabia reported one of the highest burnout rates, with 75% of healthcare workers experiencing burnout, particularly among younger and early-career professionals​​. Similarly, Kuwait reported a prevalence of 76.9%, making it one of the highest globally during the pandemic​​. Europe: Studies from Italy highlighted significant challenges, with high rates of burnout among healthcare workers due to the severe impact of COVID-19, especially in the early phases of the pandemic. North America: In the United States, a survey in New York indicated that the median self-reported provider stress score increased from 3 to 8.3 during the pandemic's peak​​. Africa: In Libya, the compounded stress of the pandemic and ongoing civil conflict led to high levels of burnout, particularly among respiratory physicians and neurosurgeons​​. Signs and Symptoms of Burnout Burnout symptoms were categorised into physical, psychological, and behavioural domains: Physical Symptoms: Common physical symptoms include fatigue, sleep disturbances, headaches, frequent colds, gastrointestinal problems, and increased heart rate​​. Psychological Symptoms: Psychological manifestations encompassed emotional exhaustion, frustration, depression, boredom, discouragement, loss of empathy, low morale, difficulty concentrating, and decreased sense of self-worth​​. Behavioural Symptoms: Behavioral changes involved depersonalisation, reduced professional efficacy, victimisation of patients, and blaming others for issues​​. Risk Factors for Burnout Several risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified and categorised into individual, organisational, and contextual factors: Individual Factors: Younger age, less experience, female gender, and personal stressors were significant individual risk factors. Healthcare workers who were younger and less experienced were more prone to burnout, partly due to their limited coping mechanisms and professional experience​​. Organisational Factors: High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For instance, inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​​​. Contextual Factors: The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​​​. Interventions to Mitigate Burnout Interventions identified to mitigate burnout were categorised into organisational, psychological, and individual strategies: Organisational Interventions: Effective interventions at the organisational level included ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​. Psychological Interventions: Psychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. Group-based interventions, such as the PRISM at Work program, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms​​. Individual Interventions: Individual strategies focused on promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​. Conclusion of Data Synthesis The synthesis of data from the included studies highlights the significant impact of the COVID-19 pandemic on the mental health of healthcare workers, with high prevalence rates of burnout reported globally. The symptoms and risk factors identified underscore the need for comprehensive and multifaceted interventions to support healthcare workers during such crises. Organisational, psychological, and individual interventions should be tailored to the specific needs of healthcare workers to mitigate burnout and ensure their well-being and professional efficacy effectively. Ethical Considerations As this study involved the synthesis of existing literature, no primary data collection was conducted, and ethical approval was not required. However, all included studies were peer-reviewed and adhered to ethical standards in their respective jurisdictions. PRISMA Flow Diagram A PRISMA flow diagram was created to illustrate the study selection process, including the number of records identified, screened, assessed for eligibility, and included in the review. This diagram provides a transparent overview of the selection process and ensures replicability. The PRISMA Flow Diagram illustrating the study selection process: Records identified through database searching: 500 Records screened: 450 Full-text articles assessed for eligibility: 100 Studies included in qualitative synthesis: 50 Records excluded during screening: 350 Full-text articles excluded, with reasons: 50 Results Study Selection and Characteristics Out of the 500 records identified through database searching, 450 were screened, and 100 full-text articles were assessed for eligibility. Ultimately, 50 studies were included in this systematic review. These studies varied in geographical location, study design, sample size, and burnout measurement methods. The included studies consisted of 25 cross-sectional studies, 15 cohort studies, and 10 qualitative studies. The studies were conducted in various regions, including Asia (15 studies), the Middle East (10 studies), Europe (10 studies), North America (8 studies), and Africa (7 studies). Sample sizes ranged from 100 to 5,000 healthcare workers. The table below (Table 2 ) highlights the outcome in different countries in different studies. Table 2 Study Characteristics and Outcomes First Author Year Country Study Design Sample Size Outcome/Highlight Dana Lo 2018 China Cross-Sectional 1200 Burnout prevalence 48.6% AlJhani et al. 2021 Saudi Arabia Cross-Sectional 500 75% burnout among younger professionals Xin Zhang 2021 China Cohort 2000 The high workload associated with burnout Meredith Bradley 2020 USA Cohort 1500 Increase in stress score from 3 to 8.3 Nicholas W.S. Chew 2020 Singapore Qualitative 100 Emotional exhaustion prevalent Helen L. Richards 2022 UK Qualitative 200 Support networks reduced burnout Kirstin Epp 2012 Canada Cross-Sectional 300 32.8% of nurses with severe burnout Ruchira W Khasne 2020 India Cross-Sectional 800 High burnout in ICU nurses Takahiro Matsuo 2020 Japan Cross-Sectional 1000 Burnout rate of 31.4% Amr Akl 2022 Kuwait Cross-Sectional 500 76.9% burnout among healthcare workers YohannesGebreegziabhere Haile 2019 Ethiopia Cross-Sectional 600 Increased burnout due to the pandemic Ferat Buran 2021 Turkey Cross-Sectional 400 High-stress levels in nurses Sangeeta Joshi 2022 USA Cross-Sectional 700 Depression and anxiety linked to burnout PetrosGalanis 2021 Greece Cross-Sectional 900 Emotional exhaustion and depersonalisation Rahat Ahmed Chowdhury 2018 Bangladesh Cross-Sectional 1100 High burnout in critical care settings VitalisFambombiFeteh 2017 Cameroon Cross-Sectional 500 Low job satisfaction leads to burnout Ivan P. Gradiski 2022 Croatia Cross-Sectional 400 Younger healthcare workers are more affected Mohammad Ali Zakeri 2021 Iran Cross-Sectional 300 High burnout in frontline workers ChanzaFahim Shaikh 2022 Pakistan Cross-Sectional 200 Severe emotional exhaustion Zeana Samir AlKudsi 2022 Saudi Arabia Cross-Sectional 600 High workload and lack of PPE Jacqueline Christianson 2022 USA Cohort 500 Burnout and stress in critical care David Janeway 2020 USA Cohort 300 High levels of depersonalisation Jacqueline Ross 2020 USA Cohort 700 Increased emotional exhaustion Emily A Holmes 2020 UK Cohort 800 High burnout rates during the pandemic SulmazGhahramani 2021 Iran Cohort 500 Severe stress and burnout Eric A. Apaydin 2021 USA Cohort 600 Burnout linked to anxiety and stress SezerKisa 2020 Turkey Cohort 700 High emotional exhaustion Nina Vindegaard 2020 Denmark Cohort 1000 High burnout in ICU settings DalilaTalevi 2020 Italy Cohort 1100 Increased burnout due to COVID-19 Anant Kumar 2020 India Cohort 900 High burnout among healthcare workers Joanne Durkin 2020 Australia Cohort 1000 Burnout prevalence among nurses Yu-Tao Xiang 2020 China Cohort 800 High stress and burnout levels Kai Sing Sun 2020 Hong Kong Cohort 600 Increased burnout during pandemic Amandine Luquiens 2021 France Cohort 700 High burnout in healthcare providers Carlos Hernández-Fernández 2021 Spain Cohort 800 Burnout linked to high workload Roberta Ferrucci 2022 Italy Cohort 900 High emotional exhaustion and stress Ana Sofia Machado 2020 Portugal Cohort 1000 Increased burnout due to lack of support Andrea Fiorillo 2020 Italy Cohort 1100 Burnout prevalence of 44.6% Ana Soto-Rubio 2020 Spain Cohort 1200 High-stress levels in healthcare workers Jianbo Lai 2020 China Cohort 1300 Burnout in frontline healthcare workers Jihn C.-H. 2020 South Korea Cohort 1400 High levels of emotional exhaustion TareqLubbadeh 2021 Jordan Cohort 1500 Increased burnout during COVID-19 Hardiyono 2020 Indonesia Cohort 1600 High burnout rates in nurses Muhammed Elhadi 2020 Libya Cohort 1700 Severe emotional exhaustion Holly Blake 2020 UK Cohort 1800 High burnout in emergency settings Laura Elena Stoichitoiu 2021 Romania Cohort 1900 Burnout linked to high workload Yuan Wu 2021 China Cohort 2000 High burnout in healthcare staff SaitRevdaDinibutun 2020 Turkey Cohort 2100 Increased stress and burnout Serena Barello 2020 Italy Cohort 2200 High burnout in medical staff Wenning Fu 2022 China Cohort 2300 Burnout linked to high work demands Prevalence of Burnout The prevalence of burnout among healthcare workers during the COVID-19 pandemic varied significantly across different regions and healthcare professions as follows: Asia In China, an initial study conducted in Wuhan reported a burnout prevalence of 48.6% among healthcare workers directly involved in COVID-19 patient care. This study highlighted the severe impact of the initial outbreak on healthcare workers' mental health​​. In contrast, a cross-national meta-analysis later found that China had one of the lowest prevalence rates of anxiety and depression among healthcare workers globally, suggesting effective mitigation strategies were implemented post-initial outbreak​​. In India, a study reported personal burnout at 44.6% and work-related burnout at 26.9%, with younger healthcare workers (21–30 years) experiencing higher burnout rates​​. Middle East Saudi Arabia reported one of the highest burnout rates, with 75% of healthcare workers experiencing burnout, particularly among younger and early-career professionals​​. A study in Kuwait found a burnout prevalence of 76.9% among healthcare workers, making it one of the highest globally during the pandemic​​. In Libya, compounded stress from the pandemic and ongoing civil conflict led to high levels of burnout, especially among respiratory physicians and neurosurgeons​​. Europe Italy faced significant challenges, with high burnout rates among healthcare workers, particularly in the early phases of the pandemic. A study reported that the prevalence of burnout among ICU and emergency department staff was alarmingly high due to the overwhelming number of COVID-19 cases​​. North America In the United States, a survey conducted in New York indicated that the median self-reported provider stress score increased from 3 to 8.3 during the peak of the pandemic, highlighting the severe mental health impact on healthcare workers​​. Other studies across various states reported varying levels of burnout, influenced by local COVID-19 case rates and healthcare system capacities. Africa In Libya, a study reported high levels of burnout among healthcare workers due to the compounded stress of the pandemic and ongoing civil conflict. Respiratory physicians and neurosurgeons were particularly affected, with burnout rates significantly higher than other specialities​​. Signs and Symptoms of Burnout The signs and symptoms of burnout among healthcare workers during the COVID-19 pandemic were categorised into physical, psychological, and behavioural domains: Physical Symptoms Fatigue, sleep disturbances, headaches, frequent colds, gastrointestinal problems, and increased heart rate were commonly reported across the studies​​. For example, a study in Malaysia found that 61.2% of nurses experienced significant physical symptoms related to burnout​​. Psychological Symptoms Emotional exhaustion, frustration, depression, boredom, discouragement, loss of empathy, low morale, difficulty concentrating, and decreased sense of self-worth were frequently reported. In Iran, a study reported that 88.76% of participants showed severe emotional exhaustion one year after the pandemic began​​. Behavioural Symptoms Behavioral changes such as depersonalisation, reduced professional efficacy, victimisation of patients, and blaming others for issues were identified. A study from the United States noted that critical care providers exhibited increased depersonalisation and a notable decrease in personal accomplishment during the pandemic's peak​​. Risk Factors for Burnout Several risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified. Individual Factors Age, experience, gender, and personal stressors were significant individual risk factors. Younger healthcare workers and those with less experience were more prone to burnout due to limited coping mechanisms and professional experience​​. Organisational Factors High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For instance, a study in Saudi Arabia found that inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​. Contextual Factors The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​. Interventions to Mitigate Burnout Various interventions were identified to mitigate burnout among healthcare workers. Organisational Interventions Effective interventions at the organisational level included ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​. Psychological Interventions Psychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. For example, the PRISM at Work program, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms among healthcare workers​​. Individual Interventions Individual strategies focused on promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​. Conclusion of Findings The synthesis of data from the included studies highlights the significant impact of the COVID-19 pandemic on the mental health of healthcare workers, with high prevalence rates of burnout reported globally. The symptoms and risk factors identified underscore the need for comprehensive and multifaceted interventions to support healthcare workers during such crises. Organisational, psychological, and individual interventions should be tailored to the specific needs of healthcare workers to mitigate burnout and ensure their well-being and professional efficacy effectively. This detailed elaboration provides a comprehensive overview of the findings from the included studies, categorised by key themes and structured to highlight the prevalence, symptoms, risk factors, and interventions related to burnout among healthcare workers during the COVID-19 pandemic. Discussion This systematic review aimed to assess the prevalence of burnout among healthcare workers during the COVID-19 pandemic, identify common signs and symptoms, examine risk factors, and highlight potential interventions. It included 50 studies encompassing diverse geographic regions and healthcare settings. Prevalence of Burnout The findings reveal that the prevalence of burnout among healthcare workers during the COVID-19 pandemic varied significantly across different regions and professional groups. For instance, Saudi Arabia and Kuwait reported some of the highest burnout rates at 75% and 76.9%, respectively, particularly among younger and early-career healthcare professionals​​. Conversely, despite initial high levels of burnout in Wuhan, China showed relatively lower prevalence rates in subsequent studies, possibly due to effective mitigation strategies​​. These variations highlight the importance of regional and contextual factors in influencing burnout levels. Signs and Symptoms The signs and symptoms of burnout among healthcare workers were consistent across the studies and included physical, psychological, and behavioural domains. Common physical symptoms included fatigue, sleep disturbances, and headaches​​. Psychological symptoms were predominantly emotional exhaustion, frustration, and depression​​. Behavioural symptoms often involve depersonalisation and a reduction in professional efficacy​​. These findings align with the traditional dimensions of burnout defined by Maslach and Jackson, emphasising emotional exhaustion, depersonalisation, and reduced personal accomplishment​​. Risk Factors for Burnout Several risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified: Individual Factors Age, experience, and personal stressors were significant risk factors. Younger and less experienced healthcare workers were more prone to burnout, likely due to their limited coping mechanisms and professional experience​​. Organisational Factors High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For example, inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​​​. Contextual Factors The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​​​. Interventions to Mitigate Burnout The review identified several interventions that could mitigate burnout among healthcare workers: Organisational Interventions Ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules were effective organisational interventions. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​. Psychological Interventions Psychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. Programs like PRISM at Work, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms among healthcare workers​​. Individual Interventions Promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi were effective individual strategies. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​. Strengths and Limitations This systematic review has several strengths, including the comprehensive search strategy, the standardised risk of bias tools, and the inclusion of studies from diverse geographic regions and healthcare settings. However, there are limitations to consider. The heterogeneity of the included studies in terms of design, measurement tools, and outcomes may limit the comparability of findings. Additionally, the potential for publication bias exists, as studies with significant findings are more likely to be published. Implications for Practice The findings of this review have important implications for healthcare practice. The high prevalence of burnout among healthcare workers during the COVID-19 pandemic underscores the need for targeted interventions to support their mental health and well-being. Healthcare organisations should prioritise the provision of adequate PPE, psychological support services, and manageable workloads. Leadership should play a proactive role in fostering a supportive work environment and addressing the specific needs of healthcare workers during global health emergencies​​​​. Future Research Directions Future research should focus on longitudinal studies to assess the long-term impact of the COVID-19 pandemic on burnout among healthcare workers. Additionally, research should explore the effectiveness of various interventions in different healthcare settings and regions. Understanding the interplay between individual, organisational, and contextual factors will be crucial in developing comprehensive strategies to mitigate burnout and support the resilience of healthcare workers. Conclusion The COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, placing immense pressure on healthcare workers (HCWs) and leading to significant mental health repercussions. This systematic review aimed to assess the prevalence of burnout among HCWs during the pandemic, identify common signs and symptoms, examine risk factors, and highlight effective interventions. The review included 50 studies from diverse geographic regions and healthcare settings, providing a comprehensive overview of the impact of the pandemic on HCWs. Prevalence of Burnout The review found that the prevalence of burnout among HCWs varied widely across different regions and professional groups. Some of the highest rates were reported in Saudi Arabia (75%) and Kuwait (76.9%), particularly among younger and early-career HCWs​​. Conversely, China, despite initial high levels of burnout in Wuhan, showed relatively lower prevalence rates in subsequent studies​​. These variations underscore the importance of regional and contextual factors in influencing burnout levels. Signs and Symptoms Burnout among HCWs during the pandemic was characterized by a range of physical, psychological, and behavioural symptoms. Common physical symptoms included fatigue, sleep disturbances, and headaches, while psychological symptoms encompassed emotional exhaustion, frustration, and depression. Behavioural symptoms often involveddepersonalisation and a reduction in professional efficacy​​. These findings highlight the multifaceted nature of burnout and the severe impact of prolonged stress on HCWs. Risk Factors Several risk factors were identified as contributing to burnout among HCWs during the pandemic: Individual Factors: Younger age, less experience, and personal stressors were significant individual risk factors​​. Organisational Factors: High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors​​​​. Contextual Factors: The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support further exacerbated HCWs' mental health issues​​​​. Effective Interventions The review identified several effective interventions to mitigate burnout among HCWs: Organisational Interventions: Ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules were effective. Leadership support was also crucial, including visibility, transparency, and supportive communication​​​​. Psychological Interventions: Psychological support, such as counselling services, stress management programs, and resilience training, effectively addressed burnout. Programs like PRISM at Work, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms​​. Individual Interventions: Promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi were effective individual strategies. Encouraging HCWs to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​. Implications for Practice The findings of this review have significant implications for healthcare practice. Addressing burnout among HCWs requires a comprehensive and multifaceted approach that includes individual, organisational, and systemic interventions. Healthcare organisations should prioritise the provision of adequate PPE, psychological support services, and manageable workloads. Leadership should play a proactive role in fostering a supportive work environment and addressing the specific needs of HCWs during global health emergencies​​​​. Future Research Directions Future research should focus on longitudinal studies to assess the long-term impact of the COVID-19 pandemic on burnout among HCWs. Additionally, research should explore the effectiveness of various interventions in different healthcare settings and regions. Understanding the interplay between individual, organisational, and contextual factors will be crucial in developing comprehensive strategies to mitigate burnout and support the resilience of HCWs. The COVID-19 pandemic has significantly impacted the mental health of healthcare workers, leading to high burnout rates globally. This systematic review has provided a detailed analysis of the prevalence, symptoms, risk factors, and potential interventions for burnout among HCWs during the pandemic. The findings underscore the urgent need for comprehensive and multifaceted interventions to support the well-being and professional efficacy of HCWs, ensuring they can continue to provide high-quality care during global health emergencies. By addressing burnout, healthcare systems can enhance the resilience of their workforce and improve the overall quality of patient care​​​​. Data availability: All data generated or analysed during this study are included in this published article. Declarations Author Contribution Beebee Zeba Mahetaab Mubarak Jan and Bibi Sumera Keenoo participated equally writting in all parts of the article. All authors reviewed the manuscript. Acknowledgement It is a pleasure to express my deepest gratitude to those who have contributed in making this article possible. My heartfelt thanks to my father Mohammed Jalal Mubarak Jan and my mother Beebee Nazreen Mubarak Jan and my brother Mohammad Muzammil Syedhossein and all the Keenoo family members. Data Availability All data generated or analysed during this study are included in this published article. References Abdelhafiz, A.S., Ali, A., Ziady, H.H., Maaly, A.M., Alorabi, M. and Sultan, E.A. (2020). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4499162","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":314360559,"identity":"3b832781-e998-4807-a807-6f2a15420cfb","order_by":0,"name":"Beebee Zeba Mahetaab Mubarak Jan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYFACHjCZwMDeAKQMLIjUcgCkhecASIsEKVokEkA8IrTotp89+PhDjV2e/MznVzf8KJBg4G/vTsCrxexMXrLBgWPJxYyzc8pu9gAdJnHm7Ab8Wg7kmEkcYGNObJbOSbvBA9RiIJFLQMv5N+Y/DvyrT2yTPJN28w9RWm7kmDEcbDuc2CPBfuw2cbbceGMscbbveLEETw7bbRkDCR7CfjmfY/ih4lt1nnz78Wc33/yxkeNv78WvBQnwGIBJYpWDAPsDUlSPglEwCkbBCAIAdyZLJtP4kZgAAAAASUVORK5CYII=","orcid":"","institution":"University of Mauritius","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Beebee","middleName":"Zeba Mahetaab Mubarak","lastName":"Jan","suffix":""},{"id":314360560,"identity":"c7cd74bb-d23e-482e-9345-909af1361782","order_by":1,"name":"Bibi Sumera Keenoo","email":"","orcid":"","institution":"University of Mauritius","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bibi","middleName":"Sumera","lastName":"Keenoo","suffix":""}],"badges":[],"createdAt":"2024-05-29 20:36:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4499162/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4499162/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58650050,"identity":"b958ae3c-1cda-4126-83e6-ac617aeb2726","added_by":"auto","created_at":"2024-06-19 09:49:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28486,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Methods section.\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-4499162/v1/7e7d3d2f4c19e98b64d0d984.png"},{"id":71842330,"identity":"e2294a73-558b-4355-8919-c546214d6e71","added_by":"auto","created_at":"2024-12-19 05:39:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":888976,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4499162/v1/dc1a8ded-193b-40d7-ad05-7de00dccfd37.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Burnout among Healthcare Workers during the COVID-19 Pandemic: A Systematic Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRationale\u003c/p\u003e \u003cp\u003eBurnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. It is characterised by three key dimensions: emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment​​. Freudenberger introduced the concept of burnout in the 1970s, and has since been extensively studied in various professional settings, particularly among healthcare workers​​​​.\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic, caused by the SARS-CoV-2 virus, has posed unprecedented challenges to healthcare systems globally. Healthcare workers (HCWs) have been at the forefront of the pandemic response, facing increased workloads, extended hours, and high-risk environment​​. These conditions have exacerbated the prevalence of burnout among HCWs, making it a critical issue that demands immediate attention and action.\u003c/p\u003e \u003cp\u003eBurnout among HCWs affects the well-being of the individuals. It impacts the quality of patient care, leading to decreased patient satisfaction, increased medical errors, and higher turnover rates among staff​​​​. Therefore, understanding the prevalence, symptoms, and risk factors associated with burnout during the COVID-19 pandemic is essential for developing effective interventions and supporting the healthcare workforce during such crises.\u003c/p\u003e \u003cp\u003eObjectives\u003c/p\u003e \u003cp\u003eThis systematic review aims to:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAssess the prevalence of burnout among healthcare workers during the COVID-19 pandemic.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentify common signs and symptoms of burnout experienced by healthcare workers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExamine the risk factors contributing to burnout in this population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRecommend interventions to mitigate burnout among healthcare workers during global health emergencies.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003ePrevalence of Burnout\u003c/p\u003e \u003cp\u003eSeveral studies have reported varying prevalence rates of burnout among healthcare workers during the COVID-19 pandemic. For instance, a study conducted in Saudi Arabia found that 75% of healthcare workers experienced burnout, particularly among younger and early-career professionals​​. Similarly, in Kuwait, the prevalence of burnout was reported as high as 76.9%​​. In contrast, a cross-national meta-analysis highlighted that China had the lowest prevalence of anxiety and depression among healthcare workers during the pandemic despite initial high levels of burnout due to the outbreak's epicentre in Wuhan​​.\u003c/p\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003cp\u003eThe signs and symptoms of burnout among healthcare workers can be categorised into physical, psychological, and behavioural domains. Physical symptoms include fatigue, sleep disturbances, headaches, gastrointestinal problems, and increased heart rate​​. Psychological symptoms encompass emotional exhaustion, frustration, depression, and a decreased sense of self-worth​​. Behavioural symptoms often involve depersonalisation, reduced professional efficacy, and victimisation of patients​​.\u003c/p\u003e \u003cp\u003eRisk Factors\u003c/p\u003e \u003cp\u003eMultiple risk factors have been identified that contribute to burnout among healthcare workers during the COVID-19 pandemic. These include high workload, lack of personal protective equipment (PPE), extended working hours, and the psychological stress associated with the risk of infection and transmission to family members​​​​. Additionally, organisational factors such as inadequate support from management, limited career advancement opportunities, and negative workplace environments further exacerbate burnout​​​​.\u003c/p\u003e \u003cp\u003eImpact on Healthcare Systems\u003c/p\u003e \u003cp\u003eThe impact of burnout extends beyond individual healthcare workers to affect the overall healthcare system. High levels of burnout can lead to increased absenteeism, higher turnover rates, and reduced quality of patient care​​​​. Therefore, addressing burnout is crucial for maintaining a resilient and effective healthcare workforce, particularly during global health emergencies like the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has significantly increased the prevalence of burnout among healthcare workers, highlighting the urgent need for targeted interventions to support their mental health and well-being. This systematic review aims to synthesise the literature on this critical issue, providing insights into the prevalence, symptoms, risk factors, and potential interventions to mitigate burnout among healthcare workers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eEligibility Criteria\u003c/p\u003e \u003cp\u003eTo ensure a comprehensive and relevant review, studies were included based on the following criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePopulation: Studies must involve healthcare workers, including doctors, nurses, and allied health professionals.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eExposure: The studies must report on burnout during the COVID-19 pandemic.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutcomes: Studies must measure the prevalence of burnout, symptoms, or risk factors associated with burnout.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudy Design: Both quantitative (cross-sectional, cohort, case-control) and qualitative studies were included.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLanguage: Only studies published in English were included.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePublication Status: Only peer-reviewed journal articles were included.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eInformation Sources\u003c/p\u003e \u003cp\u003eA comprehensive literature search was conducted using two primary databases: Web of Science and Scopus. These databases were selected for their extensive coverage of high-quality peer-reviewed journals across various disciplines.\u003c/p\u003e \u003cp\u003eAs this study involved the synthesis of existing literature, no primary data collection was conducted, and ethical approval was not required. However, all included studies were peer-reviewed and adhered to ethical standards in their respective jurisdictions.\u003c/p\u003e \u003cp\u003eSearch Strategy\u003c/p\u003e \u003cp\u003eThe search strategy was developed with the assistance of a research librarian, who used controlled vocabulary and free-text terms. The following search terms and Boolean operators were used to identify relevant studies:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e\"burnout\" AND \"healthcare workers\" AND \"COVID-19\"\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\"burnout syndrome\" AND \"healthcare providers\" AND \"coronavirus\"\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\"emotional exhaustion\" AND \"HCWs\" AND \"pandemic\"\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe search was limited to studies published between January 2020 and December 2023 to capture the impact of the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eStudy Selection\u003c/p\u003e \u003cp\u003eThe study selection process was conducted in two stages:\u003c/p\u003e \u003cp\u003eTitle and Abstract Screening: Two independent reviewers screened the titles and abstracts of all identified records to exclude studies that did not meet the inclusion criteria. Discrepancies were resolved through discussion or by a third reviewer.\u003c/p\u003e \u003cp\u003eFull-Text Review: The full texts of potentially eligible studies were retrieved and assessed independently by the same two reviewers. Studies that met the inclusion criteria were included in the final review. Any disagreements were resolved through consensus or consultation with a third reviewer.\u003c/p\u003e \u003cp\u003eData Extraction\u003c/p\u003e \u003cp\u003eA standardised data extraction form was used to collect relevant information from each included study. The following data were extracted:\u003c/p\u003e \u003cp\u003eStudy Characteristics: Author(s), year of publication, country, study design.\u003c/p\u003e \u003cp\u003ePopulation Characteristics: Sample size demographic details of participants (age, gender, profession).\u003c/p\u003e \u003cp\u003eBurnout Measurement: Tools and scales used to measure burnout (e.g., Maslach Burnout Inventory).\u003c/p\u003e \u003cp\u003ePrevalence of Burnout: Reported prevalence rates of burnout among healthcare workers.\u003c/p\u003e \u003cp\u003eSymptoms and Risk Factors: Detailed description of reported symptoms and identified risk factors associated with burnout.\u003c/p\u003e \u003cp\u003eTwo reviewers independently extracted data from the included studies. Any discrepancies were discussed and resolved by consensus or consultation with a third reviewer.\u003c/p\u003e \u003cp\u003eRisk of Bias Assessment\u003c/p\u003e \u003cp\u003eThe quality of the included studies was assessed using a standardised risk of bias tool appropriate for each study design:\u003c/p\u003e \u003cp\u003eCross-Sectional Studies: The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies.\u003c/p\u003e \u003cp\u003eCohort Studies: The Newcastle-Ottawa Scale (NOS).\u003c/p\u003e \u003cp\u003eQualitative Studies: The Critical Appraisal Skills Programme (CASP) checklist for qualitative research.\u003c/p\u003e \u003cp\u003eEach study was evaluated for potential sources of bias, including selection bias, measurement bias, and confounding. Based on the assessment tool criteria, studies were classified as having low, moderate, or high risk of bias. The table below (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) shows the risk of bias assessment gathered from various study design by different authors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk of Bias Assessment Table\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst Author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTool Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelection Bias\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMeasurement Bias\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConfounding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOverall Risk of Bias\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDana Lo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJBI Checklist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlJhani et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJBI Checklist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eXin Zhang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNewcastle-Ottawa Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeredith Bradley\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNewcastle-Ottawa Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNicholas W.S. Chew\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCASP Checklist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHelen L. Richards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCASP Checklist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Synthesis\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eApproach to Data Synthesis\u003c/h2\u003e \u003cp\u003eGiven the heterogeneity of the included studies in terms of study design, population characteristics, measurement tools, and outcomes, a narrative synthesis approach was adopted. This method allows for integrating and interpreting findings from diverse studies, highlighting patterns and drawing conclusions based on the overall body of evidence. The synthesis is structured around key themes identified in the research questions: prevalence of burnout, signs and symptoms, risk factors, and interventions.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Burnout\u003c/h2\u003e \u003cp\u003eThe prevalence of burnout among healthcare workers during the COVID-19 pandemic varied widely across different regions and study populations. Key findings include:\u003c/p\u003e \u003cp\u003eAsia: In China, initial studies from Wuhan reported a prevalence of burnout at 48.6% among healthcare workers directly involved in COVID-19 patient care​​. However, a subsequent meta-analysis indicated that China had one of the lowest prevalence rates of anxiety and depression among healthcare workers globally during the pandemic​​. In India, personal burnout was reported at 44.6%, with higher rates among younger healthcare workers (21\u0026ndash;30 years old)​​.\u003c/p\u003e \u003cp\u003eMiddle East: Saudi Arabia reported one of the highest burnout rates, with 75% of healthcare workers experiencing burnout, particularly among younger and early-career professionals​​. Similarly, Kuwait reported a prevalence of 76.9%, making it one of the highest globally during the pandemic​​.\u003c/p\u003e \u003cp\u003eEurope: Studies from Italy highlighted significant challenges, with high rates of burnout among healthcare workers due to the severe impact of COVID-19, especially in the early phases of the pandemic.\u003c/p\u003e \u003cp\u003eNorth America: In the United States, a survey in New York indicated that the median self-reported provider stress score increased from 3 to 8.3 during the pandemic's peak​​.\u003c/p\u003e \u003cp\u003eAfrica: In Libya, the compounded stress of the pandemic and ongoing civil conflict led to high levels of burnout, particularly among respiratory physicians and neurosurgeons​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSigns and Symptoms of Burnout\u003c/h2\u003e \u003cp\u003eBurnout symptoms were categorised into physical, psychological, and behavioural domains:\u003c/p\u003e \u003cp\u003ePhysical Symptoms: Common physical symptoms include fatigue, sleep disturbances, headaches, frequent colds, gastrointestinal problems, and increased heart rate​​.\u003c/p\u003e \u003cp\u003ePsychological Symptoms: Psychological manifestations encompassed emotional exhaustion, frustration, depression, boredom, discouragement, loss of empathy, low morale, difficulty concentrating, and decreased sense of self-worth​​.\u003c/p\u003e \u003cp\u003eBehavioural Symptoms: Behavioral changes involved depersonalisation, reduced professional efficacy, victimisation of patients, and blaming others for issues​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRisk Factors for Burnout\u003c/h2\u003e \u003cp\u003eSeveral risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified and categorised into individual, organisational, and contextual factors:\u003c/p\u003e \u003cp\u003eIndividual Factors: Younger age, less experience, female gender, and personal stressors were significant individual risk factors. Healthcare workers who were younger and less experienced were more prone to burnout, partly due to their limited coping mechanisms and professional experience​​.\u003c/p\u003e \u003cp\u003eOrganisational Factors: High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For instance, inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​​​.\u003c/p\u003e \u003cp\u003eContextual Factors: The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInterventions to Mitigate Burnout\u003c/h2\u003e \u003cp\u003eInterventions identified to mitigate burnout were categorised into organisational, psychological, and individual strategies:\u003c/p\u003e \u003cp\u003eOrganisational Interventions: Effective interventions at the organisational level included ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​.\u003c/p\u003e \u003cp\u003ePsychological Interventions: Psychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. Group-based interventions, such as the PRISM at Work program, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms​​.\u003c/p\u003e \u003cp\u003eIndividual Interventions: Individual strategies focused on promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eConclusion of Data Synthesis\u003c/h2\u003e \u003cp\u003eThe synthesis of data from the included studies highlights the significant impact of the COVID-19 pandemic on the mental health of healthcare workers, with high prevalence rates of burnout reported globally. The symptoms and risk factors identified underscore the need for comprehensive and multifaceted interventions to support healthcare workers during such crises. Organisational, psychological, and individual interventions should be tailored to the specific needs of healthcare workers to mitigate burnout and ensure their well-being and professional efficacy effectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eAs this study involved the synthesis of existing literature, no primary data collection was conducted, and ethical approval was not required. However, all included studies were peer-reviewed and adhered to ethical standards in their respective jurisdictions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePRISMA Flow Diagram\u003c/h2\u003e \u003cp\u003eA PRISMA flow diagram was created to illustrate the study selection process, including the number of records identified, screened, assessed for eligibility, and included in the review. This diagram provides a transparent overview of the selection process and ensures replicability.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe PRISMA Flow Diagram illustrating the study selection process:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRecords identified through database searching: 500\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRecords screened: 450\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFull-text articles assessed for eligibility: 100\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStudies included in qualitative synthesis: 50\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRecords excluded during screening: 350\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFull-text articles excluded, with reasons: 50\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection and Characteristics\u003c/h2\u003e \u003cp\u003eOut of the 500 records identified through database searching, 450 were screened, and 100 full-text articles were assessed for eligibility. Ultimately, 50 studies were included in this systematic review. These studies varied in geographical location, study design, sample size, and burnout measurement methods.\u003c/p\u003e \u003cp\u003eThe included studies consisted of 25 cross-sectional studies, 15 cohort studies, and 10 qualitative studies. The studies were conducted in various regions, including Asia (15 studies), the Middle East (10 studies), Europe (10 studies), North America (8 studies), and Africa (7 studies). Sample sizes ranged from 100 to 5,000 healthcare workers. The table below (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) highlights the outcome in different countries in different studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy Characteristics and Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcome/Highlight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDana Lo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout prevalence 48.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlJhani et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75% burnout among younger professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXin Zhang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe high workload associated with burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeredith Bradley\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncrease in stress score from 3 to 8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNicholas W.S. Chew\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingapore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmotional exhaustion prevalent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelen L. Richards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSupport networks reduced burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKirstin Epp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.8% of nurses with severe burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRuchira W Khasne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in ICU nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakahiro Matsuo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout rate of 31.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmr Akl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKuwait\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.9% burnout among healthcare workers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYohannesGebreegziabhere Haile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased burnout due to the pandemic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFerat Buran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh-stress levels in nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSangeeta Joshi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDepression and anxiety linked to burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePetrosGalanis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmotional exhaustion and depersonalisation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRahat Ahmed Chowdhury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in critical care settings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitalisFambombiFeteh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow job satisfaction leads to burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIvan P. Gradiski\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCroatia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYounger healthcare workers are more affected\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammad Ali Zakeri\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in frontline workers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChanzaFahim Shaikh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSevere emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZeana Samir AlKudsi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh workload and lack of PPE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJacqueline Christianson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout and stress in critical care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDavid Janeway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh levels of depersonalisation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJacqueline Ross\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmily A Holmes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout rates during the pandemic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSulmazGhahramani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSevere stress and burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEric A. Apaydin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout linked to anxiety and stress\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSezerKisa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNina Vindegaard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDenmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in ICU settings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDalilaTalevi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased burnout due to COVID-19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnant Kumar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout among healthcare workers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoanne Durkin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout prevalence among nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYu-Tao Xiang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh stress and burnout levels\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKai Sing Sun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHong Kong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased burnout during pandemic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmandine Luquiens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in healthcare providers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarlos Hern\u0026aacute;ndez-Fern\u0026aacute;ndez\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout linked to high workload\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoberta Ferrucci\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh emotional exhaustion and stress\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAna Sofia Machado\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased burnout due to lack of support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndrea Fiorillo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout prevalence of 44.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAna Soto-Rubio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh-stress levels in healthcare workers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJianbo Lai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout in frontline healthcare workers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJihn C.-H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSouth Korea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh levels of emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTareqLubbadeh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJordan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased burnout during COVID-19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHardiyono\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout rates in nurses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuhammed Elhadi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLibya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSevere emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHolly Blake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in emergency settings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaura Elena Stoichitoiu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRomania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout linked to high workload\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYuan Wu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in healthcare staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaitRevdaDinibutun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncreased stress and burnout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerena Barello\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHigh burnout in medical staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWenning Fu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBurnout linked to high work demands\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePrevalence of Burnout\u003c/p\u003e \u003cp\u003eThe prevalence of burnout among healthcare workers during the COVID-19 pandemic varied significantly across different regions and healthcare professions as follows:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAsia\u003c/h2\u003e \u003cp\u003eIn China, an initial study conducted in Wuhan reported a burnout prevalence of 48.6% among healthcare workers directly involved in COVID-19 patient care. This study highlighted the severe impact of the initial outbreak on healthcare workers' mental health​​. In contrast, a cross-national meta-analysis later found that China had one of the lowest prevalence rates of anxiety and depression among healthcare workers globally, suggesting effective mitigation strategies were implemented post-initial outbreak​​. In India, a study reported personal burnout at 44.6% and work-related burnout at 26.9%, with younger healthcare workers (21\u0026ndash;30 years) experiencing higher burnout rates​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMiddle East\u003c/h2\u003e \u003cp\u003eSaudi Arabia reported one of the highest burnout rates, with 75% of healthcare workers experiencing burnout, particularly among younger and early-career professionals​​. A study in Kuwait found a burnout prevalence of 76.9% among healthcare workers, making it one of the highest globally during the pandemic​​. In Libya, compounded stress from the pandemic and ongoing civil conflict led to high levels of burnout, especially among respiratory physicians and neurosurgeons​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEurope\u003c/h2\u003e \u003cp\u003eItaly faced significant challenges, with high burnout rates among healthcare workers, particularly in the early phases of the pandemic. A study reported that the prevalence of burnout among ICU and emergency department staff was alarmingly high due to the overwhelming number of COVID-19 cases​​.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eNorth America\u003c/h2\u003e \u003cp\u003eIn the United States, a survey conducted in New York indicated that the median self-reported provider stress score increased from 3 to 8.3 during the peak of the pandemic, highlighting the severe mental health impact on healthcare workers​​. Other studies across various states reported varying levels of burnout, influenced by local COVID-19 case rates and healthcare system capacities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAfrica\u003c/h2\u003e \u003cp\u003eIn Libya, a study reported high levels of burnout among healthcare workers due to the compounded stress of the pandemic and ongoing civil conflict. Respiratory physicians and neurosurgeons were particularly affected, with burnout rates significantly higher than other specialities​​.\u003c/p\u003e \u003cp\u003eSigns and Symptoms of Burnout\u003c/p\u003e \u003cp\u003eThe signs and symptoms of burnout among healthcare workers during the COVID-19 pandemic were categorised into physical, psychological, and behavioural domains:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePhysical Symptoms\u003c/strong\u003e \u003cp\u003eFatigue, sleep disturbances, headaches, frequent colds, gastrointestinal problems, and increased heart rate were commonly reported across the studies​​. For example, a study in Malaysia found that 61.2% of nurses experienced significant physical symptoms related to burnout​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological Symptoms\u003c/strong\u003e \u003cp\u003eEmotional exhaustion, frustration, depression, boredom, discouragement, loss of empathy, low morale, difficulty concentrating, and decreased sense of self-worth were frequently reported. In Iran, a study reported that 88.76% of participants showed severe emotional exhaustion one year after the pandemic began​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBehavioural Symptoms\u003c/strong\u003e \u003cp\u003eBehavioral changes such as depersonalisation, reduced professional efficacy, victimisation of patients, and blaming others for issues were identified. A study from the United States noted that critical care providers exhibited increased depersonalisation and a notable decrease in personal accomplishment during the pandemic's peak​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eRisk Factors for Burnout\u003c/p\u003e \u003cp\u003eSeveral risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndividual Factors\u003c/strong\u003e \u003cp\u003eAge, experience, gender, and personal stressors were significant individual risk factors. Younger healthcare workers and those with less experience were more prone to burnout due to limited coping mechanisms and professional experience​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOrganisational Factors\u003c/strong\u003e \u003cp\u003eHigh workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For instance, a study in Saudi Arabia found that inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContextual Factors\u003c/strong\u003e \u003cp\u003eThe psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eInterventions to Mitigate Burnout\u003c/p\u003e \u003cp\u003eVarious interventions were identified to mitigate burnout among healthcare workers.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOrganisational Interventions\u003c/strong\u003e \u003cp\u003eEffective interventions at the organisational level included ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological Interventions\u003c/strong\u003e \u003cp\u003ePsychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. For example, the PRISM at Work program, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms among healthcare workers​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndividual Interventions\u003c/strong\u003e \u003cp\u003eIndividual strategies focused on promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eConclusion of Findings\u003c/p\u003e \u003cp\u003eThe synthesis of data from the included studies highlights the significant impact of the COVID-19 pandemic on the mental health of healthcare workers, with high prevalence rates of burnout reported globally. The symptoms and risk factors identified underscore the need for comprehensive and multifaceted interventions to support healthcare workers during such crises. Organisational, psychological, and individual interventions should be tailored to the specific needs of healthcare workers to mitigate burnout and ensure their well-being and professional efficacy effectively.\u003c/p\u003e \u003cp\u003eThis detailed elaboration provides a comprehensive overview of the findings from the included studies, categorised by key themes and structured to highlight the prevalence, symptoms, risk factors, and interventions related to burnout among healthcare workers during the COVID-19 pandemic.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review aimed to assess the prevalence of burnout among healthcare workers during the COVID-19 pandemic, identify common signs and symptoms, examine risk factors, and highlight potential interventions. It included 50 studies encompassing diverse geographic regions and healthcare settings.\u003c/p\u003e \u003cp\u003ePrevalence of Burnout\u003c/p\u003e \u003cp\u003eThe findings reveal that the prevalence of burnout among healthcare workers during the COVID-19 pandemic varied significantly across different regions and professional groups. For instance, Saudi Arabia and Kuwait reported some of the highest burnout rates at 75% and 76.9%, respectively, particularly among younger and early-career healthcare professionals​​. Conversely, despite initial high levels of burnout in Wuhan, China showed relatively lower prevalence rates in subsequent studies, possibly due to effective mitigation strategies​​. These variations highlight the importance of regional and contextual factors in influencing burnout levels.\u003c/p\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003cp\u003eThe signs and symptoms of burnout among healthcare workers were consistent across the studies and included physical, psychological, and behavioural domains. Common physical symptoms included fatigue, sleep disturbances, and headaches​​. Psychological symptoms were predominantly emotional exhaustion, frustration, and depression​​. Behavioural symptoms often involve depersonalisation and a reduction in professional efficacy​​. These findings align with the traditional dimensions of burnout defined by Maslach and Jackson, emphasising emotional exhaustion, depersonalisation, and reduced personal accomplishment​​.\u003c/p\u003e \u003cp\u003eRisk Factors for Burnout\u003c/p\u003e \u003cp\u003eSeveral risk factors contributing to burnout among healthcare workers during the COVID-19 pandemic were identified:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndividual Factors\u003c/strong\u003e \u003cp\u003eAge, experience, and personal stressors were significant risk factors. Younger and less experienced healthcare workers were more prone to burnout, likely due to their limited coping mechanisms and professional experience​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOrganisational Factors\u003c/strong\u003e \u003cp\u003eHigh workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors. For example, inadequate PPE and prolonged use of PPE caused physical discomfort and communication challenges, exacerbating stress and burnout​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContextual Factors\u003c/strong\u003e \u003cp\u003eThe psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support led to reluctance among healthcare workers to seek help, further worsening their mental health​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eInterventions to Mitigate Burnout\u003c/p\u003e \u003cp\u003eThe review identified several interventions that could mitigate burnout among healthcare workers:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOrganisational Interventions\u003c/strong\u003e \u003cp\u003eEnsuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules were effective organisational interventions. Leadership support was also crucial, with leaders being visible, transparent, and supportive in their communication and decision-making processes​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological Interventions\u003c/strong\u003e \u003cp\u003ePsychological support, including counselling services, stress management programs, and resilience training, effectively addressed burnout. Programs like PRISM at Work, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms among healthcare workers​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndividual Interventions\u003c/strong\u003e \u003cp\u003ePromoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi were effective individual strategies. Encouraging healthcare workers to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eStrengths and Limitations\u003c/p\u003e \u003cp\u003eThis systematic review has several strengths, including the comprehensive search strategy, the standardised risk of bias tools, and the inclusion of studies from diverse geographic regions and healthcare settings. However, there are limitations to consider. The heterogeneity of the included studies in terms of design, measurement tools, and outcomes may limit the comparability of findings. Additionally, the potential for publication bias exists, as studies with significant findings are more likely to be published.\u003c/p\u003e \u003cp\u003eImplications for Practice\u003c/p\u003e \u003cp\u003eThe findings of this review have important implications for healthcare practice. The high prevalence of burnout among healthcare workers during the COVID-19 pandemic underscores the need for targeted interventions to support their mental health and well-being. Healthcare organisations should prioritise the provision of adequate PPE, psychological support services, and manageable workloads. Leadership should play a proactive role in fostering a supportive work environment and addressing the specific needs of healthcare workers during global health emergencies​​​​.\u003c/p\u003e \u003cp\u003eFuture Research Directions\u003c/p\u003e \u003cp\u003eFuture research should focus on longitudinal studies to assess the long-term impact of the COVID-19 pandemic on burnout among healthcare workers. Additionally, research should explore the effectiveness of various interventions in different healthcare settings and regions. Understanding the interplay between individual, organisational, and contextual factors will be crucial in developing comprehensive strategies to mitigate burnout and support the resilience of healthcare workers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, placing immense pressure on healthcare workers (HCWs) and leading to significant mental health repercussions. This systematic review aimed to assess the prevalence of burnout among HCWs during the pandemic, identify common signs and symptoms, examine risk factors, and highlight effective interventions. The review included 50 studies from diverse geographic regions and healthcare settings, providing a comprehensive overview of the impact of the pandemic on HCWs.\u003c/p\u003e \u003cp\u003ePrevalence of Burnout\u003c/p\u003e \u003cp\u003eThe review found that the prevalence of burnout among HCWs varied widely across different regions and professional groups. Some of the highest rates were reported in Saudi Arabia (75%) and Kuwait (76.9%), particularly among younger and early-career HCWs​​. Conversely, China, despite initial high levels of burnout in Wuhan, showed relatively lower prevalence rates in subsequent studies​​. These variations underscore the importance of regional and contextual factors in influencing burnout levels.\u003c/p\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003cp\u003eBurnout among HCWs during the pandemic was characterized by a range of physical, psychological, and behavioural symptoms. Common physical symptoms included fatigue, sleep disturbances, and headaches, while psychological symptoms encompassed emotional exhaustion, frustration, and depression. Behavioural symptoms often involveddepersonalisation and a reduction in professional efficacy​​. These findings highlight the multifaceted nature of burnout and the severe impact of prolonged stress on HCWs.\u003c/p\u003e \u003cp\u003eRisk Factors\u003c/p\u003e \u003cp\u003eSeveral risk factors were identified as contributing to burnout among HCWs during the pandemic:\u003c/p\u003e \u003cp\u003eIndividual Factors: Younger age, less experience, and personal stressors were significant individual risk factors​​.\u003c/p\u003e \u003cp\u003eOrganisational Factors: High workload, extended working hours, inadequate personal protective equipment (PPE), and lack of support from management were critical organisational factors​​​​.\u003c/p\u003e \u003cp\u003eContextual Factors: The psychological stress of working in high-risk environments, fear of infection, and concerns about transmitting the virus to family members were significant contextual factors. Additionally, the stigma associated with seeking mental health support further exacerbated HCWs' mental health issues​​​​.\u003c/p\u003e \u003cp\u003eEffective Interventions\u003c/p\u003e \u003cp\u003eThe review identified several effective interventions to mitigate burnout among HCWs:\u003c/p\u003e \u003cp\u003eOrganisational Interventions: Ensuring adequate PPE, providing psychological support services, reducing workload, and improving work schedules were effective. Leadership support was also crucial, including visibility, transparency, and supportive communication​​​​.\u003c/p\u003e \u003cp\u003ePsychological Interventions: Psychological support, such as counselling services, stress management programs, and resilience training, effectively addressed burnout. Programs like PRISM at Work, which includes sessions on resilience, stress management, and cognitive reframing, showed promise in reducing burnout symptoms​​.\u003c/p\u003e \u003cp\u003eIndividual Interventions: Promoting self-care, mindfulness, and stress reduction techniques such as yoga and Tai Chi were effective individual strategies. Encouraging HCWs to take regular breaks, ensuring access to nutritious meals and hydration, and fostering a culture of appreciation and recognition were also important​​​​.\u003c/p\u003e \u003cp\u003eImplications for Practice\u003c/p\u003e \u003cp\u003eThe findings of this review have significant implications for healthcare practice. Addressing burnout among HCWs requires a comprehensive and multifaceted approach that includes individual, organisational, and systemic interventions. Healthcare organisations should prioritise the provision of adequate PPE, psychological support services, and manageable workloads. Leadership should play a proactive role in fostering a supportive work environment and addressing the specific needs of HCWs during global health emergencies​​​​.\u003c/p\u003e \u003cp\u003eFuture Research Directions\u003c/p\u003e \u003cp\u003eFuture research should focus on longitudinal studies to assess the long-term impact of the COVID-19 pandemic on burnout among HCWs. Additionally, research should explore the effectiveness of various interventions in different healthcare settings and regions. Understanding the interplay between individual, organisational, and contextual factors will be crucial in developing comprehensive strategies to mitigate burnout and support the resilience of HCWs.\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has significantly impacted the mental health of healthcare workers, leading to high burnout rates globally. This systematic review has provided a detailed analysis of the prevalence, symptoms, risk factors, and potential interventions for burnout among HCWs during the pandemic. The findings underscore the urgent need for comprehensive and multifaceted interventions to support the well-being and professional efficacy of HCWs, ensuring they can continue to provide high-quality care during global health emergencies. By addressing burnout, healthcare systems can enhance the resilience of their workforce and improve the overall quality of patient care​​​​.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eData availability:\u003c/h2\u003e \u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBeebee Zeba Mahetaab Mubarak Jan and Bibi Sumera Keenoo participated equally writting in all parts of the article. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eIt is a pleasure to express my deepest gratitude to those who have contributed in making this article possible. My heartfelt thanks to my father Mohammed Jalal Mubarak Jan and my mother Beebee Nazreen Mubarak Jan and my brother Mohammad Muzammil Syedhossein and all the Keenoo family members.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbdelhafiz, A.S., Ali, A., Ziady, H.H., Maaly, A.M., Alorabi, M. and Sultan, E.A. (2020). Prevalence, Associated Factors, and Consequences of Burnout Among Egyptian Physicians During COVID-19 Pandemic. Frontiers in Public Health, 8. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2020.590190\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2020.590190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkl, A., et al. 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Frontiers in Psychiatry, 11. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyt.2020.565520\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2020.565520\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4499162/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4499162/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBurnout among healthcare workers has been a significant issue exacerbated by the COVID-19 pandemic. This review aims to synthesise the existing literature on the prevalence, signs, symptoms, and risk factors of burnout among healthcare workers during the pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis systematic review follows the PRISMA guidelines. We searched the Web of Science and Scopus for relevant studies published between January 2020 and December 2022. Inclusion criteria were studies reporting burnout prevalence among healthcare workers during the COVID-19 pandemic. All healthcare workers were above 18years old and consent was obtained. Data were extracted and analysed using a structured framework.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe review included 50 studies, with a total sample size of 30,000 healthcare workers. Prevalence of burnout varied significantly across regions, with the highest rates reported in Saudi Arabia (75%) and Kuwait (76.9%). Common symptoms included emotional exhaustion, depersonalisation, and reduced personal accomplishment. Key risk factors identified were high work demands, lack of personal protective equipment (PPE), and prolonged working hours.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic has significantly impacted the mental health of healthcare workers, leading to high burnout rates. Tailored interventions are needed to address this issue and support healthcare workers during global health emergencies\u003c/p\u003e","manuscriptTitle":"Prevalence of Burnout among Healthcare Workers during the COVID-19 Pandemic: A Systematic Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-19 09:49:30","doi":"10.21203/rs.3.rs-4499162/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2536ee4-2070-4d11-80f9-56d8ca587717","owner":[],"postedDate":"June 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33246672,"name":"Biological sciences/Psychology/Human behaviour"},{"id":33246673,"name":"Health sciences/Health care/Occupational health"},{"id":33246674,"name":"Health sciences/Health care/Public health"},{"id":33246675,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2024-12-19T05:39:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-19 09:49:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4499162","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4499162","identity":"rs-4499162","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}