The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.

A cross-sectional study.

Sweden, using data from the Swedish National Environmental Health Survey 2019.

The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.

Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.

About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.

Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.

Interest in workplace bullying (WPB) has been steadily growing with a focus on understanding its consequences as well as prevalence rates in different occupations and across different countries with varying cultural contexts. Research in the Middle East remains limited, especially in Lebanon. The scarcity of data from the Lebanese healthcare sector underscores the need to better understand WPB in this unique sociocultural and organisational environment.

The primary aim of this study is to investigate the prevalence of WPB among healthcare providers and hospital staff in Greater Beirut. The secondary aim is to investigate the relationship between WPB, psychological well-being, burnout and sick leaves in the Lebanese cultural context.

A cross-sectional study design was conducted.

Seven hospitals in Greater Beirut took part in the study, including six private hospitals and one public hospital.

A total of 958 participants aged 18–64 were recruited using stratified proportionate non-random sampling. Stratification by hospital size and department aimed to ensure broad representation of nursing and support staff across institutions. The participants included nursing and supporting staff, of which 26.3% were males and 73.7% were females. Those employed for less than 6 months were excluded.

The Arabic versions of each of the Negative Acts Questionnaire-Revised (NAQ-R), the General Health Questionnaire (GHQ-12) and the Copenhagen Burnout Inventory (CBI) were administered. These instruments were selected for their established reliability and widespread use in cross-cultural occupational health research. Surveys were administered via paper-and-pencil (six hospitals) and online (one hospital). Prevalence of bullying using the NAQ-R cut-off scores was first calculated and then their respective thresholds identified using receiver operating characteristic analysis. Pearson’s correlation coefficient was used to evaluate the relationship between the NAQ-R and the GHQ-12, CBI and number of sick leaves.

Using the lower threshold as a cut-off on the NAQ-R, 35.1% of participants were classified as bullied. When applying the higher threshold as a cut-off, the percentage was slightly lower but remained comparable at 32.4%. Results showed that across the two outcomes, those who were bullied both when using a lower threshold and upper threshold were significantly more distressed and burnt out (pt(df) = –8.43, p±1.96; Upper threshold: ² (4, N=902)=9.963, p=0.019, Standardised residual for 6–10 days=2.2>±1.96).

Findings yielded lower prevalence rates of WPB among nurses and the entire sample as compared with research carried out in the Arab region. Our study further supports the impact of culture on the perpetuation of WPB and the uniqueness of Lebanon’s culture on influencing this prevalence. Results indicated that participants who were bullied were significantly more distressed, more burnt out and reported taking up more sick leaves. These findings highlight the need to consider local workplace culture when addressing bullying and reinforce the significant psychological and occupational toll bullying takes on affected individuals. Healthcare institutions are encouraged to implement and reinforce clear antibullying policies, WPB prevention strategies and confidential reporting mechanisms. Future research should explore longitudinal patterns of bullying, obtain a more nationally representative sample and examine the effectiveness of targeted interventions to create safer, more supportive work environments.

To systematically review the evidence on the association between non-standard working time arrangements (such as night work or shift work) and the occurrence of safety incidents.

Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a structured narrative approach and the Synthesis Without Meta-analysis framework to evaluate and summarise findings.

MEDLINE, Embase, PsycINFO, Web of Science and ProQuest Health and Safety Science Abstracts were searched through February 2024.

We included peer-reviewed English-language studies of paid workers (18–70 years) that examined the association between non-standard working time arrangements and safety incidents (accidents, near-accidents, safety incidents or injuries), excluding cross-sectional designs and studies on unpaid workers, athletes or military personnel.

Two reviewers independently extracted data and assessed risk of bias using standardised forms, extracting study characteristics (author, year, country, sector and population), working time arrangements and exposure assessment, outcomes and their assessment, and reported risk estimates. We conducted a narrative synthesis, classifying studies into three exposure contrasts (shift worker versus non-shift worker, time-of-day and shift intensity), and summarised risk estimates using forest plots without calculating pooled effects.

A total of 13 569 records were screened, and 24 studies met the inclusion criteria. The results indicated that shift workers generally had an elevated safety incident risk compared with non-shift workers (risk estimates ranged from 1.11 to 5.33). Most of the included studies found an increased risk of safety incidents during or after night shifts. Accumulated exposure to evening or night shifts increased the risk of safety incidents during the following 7 days. However, bias and heterogeneity across studies in design, populations and outcome measures resulted in an overall low to very low certainty of the evidence.

Non-standard working time arrangements, including night and evening shifts, appear to increase the risk of occupational safety incidents. Despite the low certainty of evidence, the findings highlight a potential area for preventive measures in work scheduling. Future longitudinal studies using individual data on daily working hours are needed.

Among the emergency services, firefighters have the highest percentage of mortality (45%) due to sudden cardiac death, with the majority related to underlying cardiovascular disease. This necessitates that firefighters stay in good physical condition and maintain adequate cardiovascular fitness to cope with these stressors and perform their duties with minimal health risks. Therefore, this study aims to determine the association between metabolic syndrome and physical fitness in firefighters.

The authors will search the following electronic databases: PubMed/Medline, SCOPUS and Web of Science, with no limitations to publication year. For data extraction, the two principal reviewers will use a general data extraction form to retrieve the key characteristics of each study. The Rayyan intelligent systematic review tool will be used to screen and select studies for inclusion. Thereafter, information from the included studies will be captured on the researcher-generated data extraction form. The Joanna Briggs Institute (JBI) Critical Appraisal Tools for quantitative studies will be used to conduct the methodological assessment of each study included. Data will be analysed using Review Manager 5.3 to determine the exposure effects and MedCalc statistical software Ltd and will be used to determine the pooled correlation effects. The results will be presented using figures, graphs and tables.

Details for this systematic review protocol can be accessed on PROSPERO (CRD42024535088). The authors will disseminate this protocol and the findings of the systematic review and meta-analysis in peer-reviewed journals and in national and international conferences. In addition, this review will add significantly to the body of knowledge in the scientific community worldwide and assist academics in exploring research gaps on this topic.

CRD42024535088.

There is a wealth of reviews investigating the relations between healthcare worker (HCW) variables and quality of care (QoC) outcomes. Individually, these reviews predominantly focus on one aspect relevant to HCWs’ functioning at work, unintentionally contributing to a scattered body of evidence. This umbrella review uses the concept of sustainable employability (SE)—a multidimensional construct that captures an individual’s long-term ability to function adequately at work and in the labour market—to integrate existing reviews on the topic, and to examine if and how HCWs’ SE is related to QoC.

An umbrella review of systematic reviews was conducted.

Systematically conducted reviews or meta-analyses of empirical primary studies (quantitative, qualitative or mixed methods) were included.

Reviews were eligible for inclusion if they included studies that focused on HCWs providing direct patient care; explored a relation between SE indicators and QoC outcomes; were peer-reviewed and published in an academic journal in either English or Dutch and were appraised as high-quality reviews.

We followed the Joanna Briggs Institute manual for Evidence synthesis when conducting this review. Nine verified indicators of SE, pertaining to health, well-being and competence domains of SE, were used to identify published reviews in Embase, Medline, PsycINFO and CINAHL up until 10 May 2024. Quality of reviews was critically appraised with the Joanna Briggs Institute Critical Appraisal Instrument. Data were extracted by one reviewer in a standardised form with a second reviewer verifying outcome data that directly informed our evidence statements.

55 high-quality reviews were included, and 6 SE indicators linked to 19 QoC outcome categories were identified, distinguishing a total of 50 unique relations—whether positive, negative, partial, absent or mixed. Although extensive, evidence is disproportionally represented, with reviews on ‘burn-out’ and ‘lack of knowledge/skills’ being over-represented and well-established. Only four reviews covered multiple SE domains simultaneously.

When theoretically integrated, there is an impressive array of evidence showing the crucial role of HCWs’ SE for QoC. Researchers are advised to adopt more multidimensional perspectives and concepts to empirically validate the interrelatedness of individual HCW variables for QoC. Practitioners may use this overview to consider interventions that target multiple indicators of HCWs’ SE.

To investigate whether seafarers in Norway who were declared unfit for service at sea or received a time-limited health certificate had a higher risk of acute somatic hospital admissions compared with those who received a full health certificate.

Registry-based cohort study.

Seafarers in Norway who presented to a seafarer’s doctor to obtain a health certificate between 2018 and 2019, as required for work aboard Norwegian vessels. The study was conducted within Norway’s publicly funded healthcare system.

Norwegian seafarers aged 18–70 years who underwent medical examinations (n=43 758), including n=5452 females (12.5%).

Acute somatic hospital admission within 2 years of medical examination. HRs were estimated using Cox regression models in two separate time periods (0–3 months and 3–24 months), with adjustment for possible confounding from age, gender, level of education and centrality of residence (proximity to healthcare services).

The crude risk of acute somatic hospital admissions was higher for individuals who received a declaration of unfitness, as compared with those who received a full health certificate, in both follow-up periods: 0–3 months (HR=5.13, 95% CI: 3.27 to 8.04) and 3–24 months (HR=2.63, 95% CI: 2.07 to 3.34). Similarly, those with time-limited health certificates had a higher risk in both periods: 0–3 months (HR=2.02, 95% CI: 1.39 to 2.93) and 3–24 months (HR=2.45, 95% CI: 2.15 to 2.79). Adjustment of the analyses for socio-demographic factors did not change the effect estimates substantially.

These findings highlight the importance of comprehensive and continuous health assessments to help prevent adverse health outcomes and ensure safety at sea, particularly among vulnerable subgroups of seafarers.

Presenteeism, defined as reduced work efficiency due to health issues despite attending work, accounts for a substantial proportion of labour productivity loss. Although pain significantly impacts presenteeism, the relationship between pain and presenteeism remains poorly understood due to the multifaceted nature of pain, encompassing psychosocial factors and daily functioning. This study aimed to identify which of these factors are significantly associated with presenteeism among employees.

Cross-sectional study using self-administered questionnaires and generalised additive model analysis.

Multiple workplaces (including a university and hospitals) in Japan.

Employed individuals (n=212, age range: 20–65 years; 59 males and 153 females) participated. They were recruited through workplace bulletin boards, email announcements and direct invitations. Participants with and without chronic pain were included.

Participants completed self-report measures, including the Health and Work Performance Questionnaire (HPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Pain Catastrophising Scale (PCS), Beck Depression Inventory-second edition (BDI-II), State-Trait Anxiety Inventory (STAI) and WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).

The results indicated that absolute HPQ was significantly associated with BDI-II scores (F=4.51, p=0.035). On the other hand, relative HPQ was influenced by SF-MPQ (F=3.76, p=0.005), PCS (F=4.16, p=0.014), STAI (F=5.62, p=0.019) and limited daily activities (F=13.25, p=0.00035).

These findings suggest that presenteeism is multifactorial, with pain, psychosocial factors and daily functioning playing critical roles. Moreover, the impact of depression on presenteeism differs from that of pain and anxiety. Therefore, tailored intervention approaches may be required for each factor, ultimately improving workplace productivity.

This study was preregistered at UMIN-CTR (UMIN000054797).

This systematic review and meta-analysis aimed to determine the pooled prevalence of and factors associated with work-related musculoskeletal disorders (WMSDs) among low- and middle-income countries.

Databases such as PubMed/MEDLINE, CINAHL, LIVIVO, African Journals Online, African Index Medicus (AIM), HINARI, Science Direct, Web of Science, Cochrane Library, Google Scholar, Semantic Scholar and Google were used to retrieve all the relevant articles. The search was carried out from 22 April 2024 to 26 June 2024. Data were analysed via STATA 17 software. With a 95% CI, this meta-analysis with a random-effects model was carried out to determine the pooled prevalence.

The study was conducted in low- and middle-income countries.

Weavers of low- and middle-income countries.

The primary outcome of this study was the prevalence of WMSD.

In this meta-analysis, a total of 21 articles with 7322 study participants were included. The pooled prevalence of WMSDs was 72.20%. Working more than 8 hours per day, working in a chair with no back support, working in an uncomfortable posture, not performing regular physical exercise, lacking knowledge of the causes of WMSD and lacking job satisfaction were factors significantly associated with WMSDs.

A high prevalence of WMSDs among weavers in low- and middle-income countries was recorded. This indicates the need to take effective intervention measures. Rigorous ergonomic training, providing lengthy breaks and building centres for physical exercise, improving workplace ergonomic design and increasing job satisfaction are recommended.

CRD42024561064.

Healthcare settings are experiencing profound changes that make them increasingly complex and demanding environments, particularly for nurses. Against this backdrop are the numerous phenomena of violence in healthcare settings, which are a worrying reflection of the growing problem of aggression in society. Institutions maintain a constant focus on the phenomenon while trying to counter it; however, workplace aggression is still on the rise.

Workplace violence (WPV) potentially leads to lower quality of care and increased costs; it also exposes nurses to burnout, turnover and intention to leave the profession.

The purpose of this scoping review is to explore the physical and psychological consequences on nurses who are victims of WPV and to identify possible correlations with burnout, turnover and intention to leave the workforce.

This scoping review will follow the methodology proposed by Arksey and O’Malley, also incorporating recommendations from the Joanna Briggs Institute Handbook for Scoping Review. A literature search will be conducted in PubMed, CINAHL, PsycInfo, Web of Science and Scopus. Grey literature sources including Google Scholar and ProQuest Dissertations & Theses will also be consulted. Data will be summarised in descriptive form and categorised according to the identified outcome variables, following an inductive approach. The results will be presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

The review will include studies published from January 2020 to March 2025.

This scoping review represents the preliminary phase of a larger project aimed at developing support strategies for nurses who are victims of violence.

This scoping review protocol has been registered in the Open Science Framework (https://osf.io/785qd/?view_only=21952c15efd14b34a9931f07121bf935). No ethical opinion is required, as the review does not involve direct involvement of human subjects.

The findings will be disseminated through peer-reviewed publications and presentations at national and international conferences and workshops dedicated to workplace safety and nursing. In addition, the results will be shared with healthcare managers and stakeholders to inform context-specific strategies and support interventions within care settings.

To assess the prevalence of occupational exposure to hepatitis B and C, examine exposure reporting patterns and identify associated factors among healthcare workers (HCWs) in a military hospital in Ghana.

Analytical cross-sectional study.

A 500-bed tertiary military healthcare facility in Accra, Ghana.

A total of 369 HCWs were selected using stratified random sampling and completed a structured questionnaire. Data were collected through a structured questionnaire administered to 369 respondents. Bivariate and multivariate analyses were conducted using STATA V.17. Proportions, ORs and corresponding 95% CIs were calculated, with a significance level set at 0.05.

Primary outcomes were the prevalence of occupational exposure to bloodborne pathogens (hepatitis B virus (HBV) and hepatitis C virus (HCV)) and the rate of reporting these exposures.

In the 12 months prior to the study, 20.1% of HCWs reported exposure to HBV or HCV. Exposures were more common during weekdays (60.8%) and afternoon shifts (47.3%). Only 37.8% of exposure incidents were reported. Male HCWs were more likely to report exposures than females (OR 82.5, 95% CI 2.5 to 273). Diploma holders were less likely to report compared with degree holders (OR 0, 95% CI 0 to 0.3).

The study demonstrates that HCWs in the military health facility face a significant risk of exposure to bloodborne pathogens, yet under-reporting remains high. Strengthened training, clear reporting systems and supportive workplace policies are urgently needed to address these gaps and safeguard both staff and patient safety.

Maintaining a healthy workforce is crucial for safe, high-quality care. To enhance well-being and engagement in Dutch university medical centres (UMCs), an overview of staff well-being and job perceptions is needed first. Surveys are widely used to improve working conditions, but varying questionnaires hinder a comprehensive view. This study aimed to evaluate the content of employee surveys currently used in UMCs in the Netherlands from a well-being perspective and to analyse the survey results at a national level.

All seven UMCs were approached to participate in the study and share employee survey data. The primary outcome of interest is work experience; a secondary analysis was conducted. Items were categorised following the Job Demands-Resources model. Descriptive statistics were presented as percentages, means and medians with IQRs.

Two UMCs participated and 31 862 completed surveys were included. Variation in survey items (eg, 15–18 subcategories, 21–33 question items), response options (eg, 1–5, 1–10), frequency (1–3 times per year) and timing were found. Scores on the following outcomes are presented: work overload, coworker support, job control, organisational justice, participation in decision-making, performance feedback, possibilities for learning and development, recognition, task variety, team atmosphere, team effectiveness, trust in leadership, other job resources, connecting/inspiring leadership, self-efficacy, goal-directiveness, boredom, burnout, job satisfaction, work engagement, other employee well-being, commitment organisation/team and work ability. Results should be interpreted with caution, and solely found for hospital A, for certain job control items, median scores of 2 or 3 were observed, whereas the majority of other question items revealed a median score of 4.

There is a significant lack of cohesion across employee surveys. As it stands, employee surveys in Dutch UMCs are not effective tools for monitoring the work experience or well-being of the healthcare workforce. While these surveys may support management decisions, this support is not reflected in interventions related to work and the work environment.

To assess the relation of exposure to cement dust and heavy metal (aluminium, cadmium and lead) exposures to pulmonary function among male cement plant workers. The study also aimed to evaluate dose–response relationships and prevalence and severity of respiratory symptoms among exposure categories compared with a control group.

Cross-sectional study.

Secondary-level occupational health clinic in Ankara, Türkiye.

461 male non-smoking cement plant employees were included in total. Participants were categorised into packaging (n=101), milling (n=162) and office unexposed workers (n=198). Inclusion criteria were more than 70% work history in the cement industry and exclusion of pre-existing respiratory disease and missing data from the participants.

Not applicable.

Pulmonary function tests (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC and peak expiratory flow (PEF)) and urinary, cadmium and blood lead concentrations were measured. Lung function impairment was the primary outcome measure; secondary outcomes included metal exposure—pulmonary measure correlations.

Significant negative correlations existed between FEV1 and urine aluminium (r=–0.622, p

Occupational cement dust and heavy metal exposure is closely linked to impaired pulmonary function in cement plant employees, particularly those who work in higher exposure jobs. The implications are robust endorsement of targeted monitoring and preventive interventions. Long-term longitudinal research is necessary to identify long-term outcome and efficacy of exposure reduction approaches.

The medical profession is facing an unprecedented crisis. Reasons for this are complex and multifactorial; however, rising rates of burnout will undoubtedly contribute to problems with recruitment and retention. Chronic workplace stress, whereby there are insufficient resources available to meet the demands doctors face, is a contributor to burnout. There are a wide variety of available self-report measures for stress, with heart rate variability (HRV) shown to be a biomarker of stress and recovery in doctors. We aim to triangulate continuous HRV measurements with validated self-report measures and qualitative data to better understand the patterns of stress and recovery.

This study has a sequential explanatory mixed-methods design. Participants will be recruited from multiple sites within National Health Service (NHS) Grampian. Initially, participants will complete a suite of validated scales, including the Maslach Burnout Inventory for Medical Personnel, the Resilience Scale for Adults and the Interpersonal, Community, Occupational, Physical, Psychological (ICOPPE) well-being scale. Following this, participants will undertake seven consecutive days of ecological momentary assessment of real-time demands, resources and fatigue, alongside 7 days of continuous ambulatory assessment of HRV via Firstbeat Bodyguard 3 chest-worn monitors. Participants will be provided with a summary report following their study period. If 40 participants are recruited within the recruitment timeframe, multilevel modelling will be used to analyse data; otherwise, N-of-1 statistical techniques will be used. Following initial analysis of the quantitative data, participants of interest will be invited to take part in semistructured interviews, which will be thematically analysed and presented alongside the quantitative data.

This study was approved by the University of Aberdeen, School of Medicine, Medical Sciences and Nutrition ethics review board (ref. 3389193) and the NHS Grampian research and development team. Results will be disseminated in international peer-reviewed journals.

NCT06721312.

This study aims to determine key workforce variables (demographic, health and occupational) that predicted National Health Service (NHS) staff’s absence due to illness and expressed intention to leave their current profession.

Staff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately 12 months later.

Logistic and linear regression were used to explore relationships between baseline exposures and four 12-month outcomes: absence due to COVID-19, absence due to non-COVID-19 illness, actively seeking employment outside current profession and regularly thinking about leaving current profession.

22 555 participants (out of a possible 152 286 employees; 15%) completed the baseline questionnaire. 10 831 participants completed the short follow-up questionnaire at 12 months and 5868 also completed the long questionnaire; these participants were included in the analyses of sickness absence and intention to leave, respectively. 20% of participants took 5+ days of work absence for non-COVID-19 sickness in the 12 months between baseline and 12-month questionnaire; 14% took 5+ days of COVID-19-related sickness absence. At 12 months, 20% agreed or strongly agreed they were actively seeking employment outside their current profession; 24% thought about leaving their profession at least several times per week. Sickness absence (COVID-19 and non-COVID-19 related) and intention to leave the profession (actively seeking another role and thinking about leaving) were all more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers.

Several factors affected both workforce retention and sickness absence. Of particular interest are the impact of colleague and manager support because they are modifiable. The NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. Further, staff should be given sufficient opportunities to form and foster social connections. Selection bias may have affected the presented results.

High-speed boat operations expose personnel to slamming-induced impacts, which can lead to musculoskeletal injuries and cognitive impairments. Despite existing safety measures, regulations and protocols, the risk of injuries remains significant. The MultiAgency, prospective, exploratory, non-intervention, cohort Study on Human Impact Exposure oNboard high-speed boats study aims to investigate the nature and magnitude of these impacts, their acute and long-term health effects, and potential injury prevention strategies to improve operational safety and performance.

This is an ongoing multicentre, prospective, non-intervention, observational cohort study. The first participant was enrolled on 23 August 2024. High-speed boat operators log self-reported pain data via a smartphone app, using a Visual Analogue Scale and pain drawings. Triaxial accelerometers are installed on boat hulls and worn by participants to measure impact exposure. Data analysis assesses correlations between exposure and reported pain, enabling the identification of risk factors and the development of safety guidelines for high-speed boat operations.

The study has received ethical approval from the relevant ethics committees, including the Swedish Ethics Review Authority (no. 2022-04931-01). All participants will provide informed consent before enrolment. The findings will be disseminated through technical reports, articles in peer-reviewed journals, conference presentations and direct engagement with military and maritime stakeholders to enhance training protocols and safety measures.

NCT05299736.

This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden.

A 1 year follow-up panel cohort observational study—the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February–May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March–May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey.

Swedish primary and specialist healthcare.

At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up.

ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment Tool (BAT-23) was used to measure burnout, including a burnout total score and scores for the four symptom dimensions of exhaustion, mental distance, emotional impairment and cognitive impairment. Depressive symptoms were assessed using the Symptom Checklist-core depression (SCL-CD6). Associations between baseline burnout and depressive symptoms and subsequent ACMCSA were estimated with logistic regression analyses.

ACMCSA was found in 9% of the participating physicians. In the sample, 4.7% had severe burnout complaints, and 3.7% had depressive symptoms. Burnout (OR=2.57; 95% CI=1.27 to 5.23) and the burnout symptom dimensions emotional impairment (OR=1.80; 95% CI=1.03 to 3.15) and cognitive impairment (OR=2.52; 95% CI=1.12 to 5.50) were associated with a higher likelihood of subsequent ACMCSA. Depressive symptoms were not associated with ACMCSA when adjusted for severe burnout complaints and other covariates.

This study demonstrates the distinction between burnout and depressive symptoms, particularly in predicting future ACMCSA. Early intervention targeting exhaustion and burnout may mitigate symptom development and reduce the risk of ACMCSA.