ABSTRACT
Introduction: Burnout has become a major concern in health care systems and has also been a critical issue during the COVID-19 pandemic. As many as 76% of medical professionals report burnout symptoms that may lead to medical errors, substance abuse, and even suicide [1,2]. Meanwhile, previous studies report on the importance of peoples’ sense of coherence (SOC) or control over work for dealing with burnout experience which implicates a stress-coping capacity involving comprehensibility, manageability, and meaningfulness. However, little is known on how SOC cognitively modulates burnout experiences, as neural substrates for SOC and burnout are insufficiently explored [2,3]. Aim: We aimed to investigate neurocognitive mechanisms of SOC and burnout in medical professionals. Methods: We recruited early-career registered nurses and forty-one were enrolled in this study. This study was approved by the institutional review board of Kyoto University and was conducted in accordance with the Code of Ethics of the World Medical Association. Participants were recruited by advertisements in the hospitals. Participants’ SOC and burnout levels were investigated using the sense of coherence scale and Maslach Burnout Inventory (MBI) [3]. Higher scores of SOC and MBI represented a greater sense of coherence and more burnout experience, respectively. We used functional magnetic resonance imaging and measured resting-state brain activity. We identified brain regions associated with SOC and burnout levels by correlating these trait scores to the regional fractional amplitude of low frequency fluctuations (fALFF). Subsequently, we investigated whether participants’ levels of SOC impacted their fALFF-burnout association by mediation analysis. Results: SOC and the depersonalization dimension of burnout were negatively correlated. The fALFF in the mid dorsolateral prefrontal cortex (DLPFC) correlated positively with SOC scores, and negatively with the depersonalization dimension of burnout. Based on the above correlations, we conducted a mediation analysis and observed that SOC mediates the negative relationship between DLPFC activity and burnout severity (p < 0.05). That is, the participants’ depersonalization level was better explained by their SOC level, together with their resting-state brain activity (fALFF of the DLPFC), rather than the brain activity level alone. Conclusions: The results suggest that our participants’ burnout severity associates with decreased SOC and prefrontal activity those of which may support cognitive control. It is possible that they may facilitate flexible shifting of perspective and optimistic reappraisal of work-stress. In effect, workplace stressors may be acknowledged as being more meaningful than distressing. Meanwhile, without sufficient SOC, frequent exposures to stressors can lead to maladaptive coping to exhibit emotional numbing or depersonalization. The results also suggest that the sense of coherence/control and burnout effect can be generalized and carried over into no-task, spontaneous brain activity to a certain extent. The further approach in this line may pave the ways to illuminate which intervention and training effectively impact the subjective experience of burnout in medical education. No conflict of interest
ABSTRACT
Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019 (COVID-19) exhibit anxiety, depression, and altered brain microstructure, their long-term physical problems, neuropsychiatric sequelae, and changes in brain function remain unknown. This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19 (8 males and 11 females, aged 54.2 ± 8.7 years). Fatigue and myalgia were persistent symptoms at the 1-year follow-up. The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls (7 males and 18 females, aged 50.5 ± 11.6 years), COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation (ALFF) values in the left precentral gyrus, middle frontal gyrus, inferior frontal gyrus of operculum, inferior frontal gyrus of triangle, insula, hippocampus, parahippocampal gyrus, fusiform gyrus, postcentral gyrus, inferior parietal angular gyrus, supramarginal gyrus, angular gyrus, thalamus, middle temporal gyrus, inferior temporal gyrus, caudate, and putamen. ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores, and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization. The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors. This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae. This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (approval No. 2020S004) on March 19, 2020.