Is There a Burnout Epidemic among Medical Students? Results from a Systematic Review.

Background and Objectives: Medical students represent the ideal target group for promoting mental health and mental wellbeing, being exposed to specific risk factors, such as the content of medical training, the exposure to sickness and death, and a stressful academic routine. Medical students report high levels of cynicism and emotional exhaustion, which represent two of the essential features of burnout syndrome. In this systematic review, studies assessing the levels of burnout among medical students through validated tools worldwide were analyzed. Materials and Methods: A systematic review has been performed in order to identify studies: (1) focusing on samples of medical students; (2) evaluating burnout syndrome using validated tools; (3) providing prevalence data on burnout; and (4) written in English. Results: Out of the 5547 papers initially obtained, 64 were finally included in the analysis. The sample sizes ranged from 51 to 2682 participants. Almost all studies had a cross-sectional design; the Maslach Burnout Inventory and its related versions were the most frequently used assessment tools. The prevalence of burnout, which was stratified based on gender and academic stage, ranged from 5.6 to 88%. Burnout was mostly predicted by thoughts of stopping medical education, negative life events, lack of support, dissatisfaction, and poor motivation. Conclusions: The prevalence of burnout syndrome in medical students is quite heterogeneous, reaching a peak of 88% in some countries. However, several predictors have been identified, including negative life events or poor motivation. These findings highlight the need to develop preventive interventions targeting the future generation of medical doctors, in order to improve their coping strategies and resilience styles.

Mental fatigue in individuals with psychiatric disorders: a scoping review.

OBJECTIVE: The aim of this study was to complete a scoping review of the published literature describing the relationship between mental fatigue and various psychiatric disorders, to better understand its frequency and clinical impact, and to provide recommendations for future clinical research. METHODS: A scoping review using PubMed/MEDLINE, Cochrane and PsychArticles databases was conducted using the keywords 'mental fatigue', 'mental tiredness' or 'mental exhaustion', and completed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews 2018 checklist. RESULTS: We extracted 10 studies fulfilling our inclusion criteria from a total of 2937 publications. Mental fatigue was studied within mood disorders, anxiety disorders, obsessive compulsive disorder and obsessive-compulsive personality disorder. A commonly used tool to measure mental fatigue in these samples was the Multidimensional Fatigue Inventory-20. Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender and diagnosis. CONCLUSION: Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation.Key pointsA commonly used tool to measure mental fatigue was the Multidimensional Fatigue Inventory-20. However, more research into the validity and reliability for illness specific instruments to measure mental fatigue in psychiatric population is required.Reduction of mental fatigue was associated with improvement on quality of life.Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender.Reviewed articles indicated that mental fatigue presence was associated with lower odds of OCD. In addition, the results suggested that mental fatigue symptoms were more common in individuals with OCPD rather than OCD.Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation to prevent potential misattribution as mental fatigue symptoms overlap between different psychiatric disorders.

Healthcare Workers Who Work With COVID-19 Patients Are More Physically Exhausted and Have More Sleep Problems.

In this survey study of 7,208 Dutch healthcare workers, we investigate whether healthcare workers dealing with COVID-19 patients experience lower general health, more physical and mental exhaustion and more sleep problems than other healthcare workers. Additionally, we study whether there are differences in well-being within the group of healthcare workers working with COVID-19 patients, based on personal and work characteristics. We find healthcare workers who are in direct contact with COVID-19 patients report more sleep problems and are more physically exhausted than those who are not in direct contact with COVID-19 patients. Mental exhaustion and general health do not significantly differ between healthcare workers who are in direct contact with COVID-19 patients and those who are not. Among healthcare workers in direct contact with COVID-19 patients, lower well-being on one or more indicators is reported by those who are female, living alone, without leadership role, or without sufficient protective equipment. Regarding age, physical exhaustion is more prevalent under healthcare workers older than 55 years, whereas mental exhaustion is more prevalent under healthcare workers younger than 36 years. These results stress the need of mental and physical support of healthcare workers during a pandemic, catered to the needs of healthcare workers themselves.

Cognitive Fatigability Interventions in Neurological Conditions: A Systematic Review.

INTRODUCTION: Although fatigue is a well-studied concept in neurological disease, cognitive fatigability (CF) is less understood. While most studies measure fatigue using subjective self-report, fewer have measured CF objectively. Given the negative impact of CF on quality-of-life, there is a need for targeted interventions. The objective of this review was to determine which procedural, behavioural and pharmacological treatments for objectively measured CF are available to people living with neurological conditions. METHODS: In accordance with the PRISMA guidelines, systematic searches for randomized control trials (RCTs), case-controlled studies and case reports/series were conducted across the Ovid Medline, PsycInfo, EMBASE and Cochrane Library databases. English-language articles published between 1980 and February 2019 were considered for eligibility. Included were those that objectively measured CF in individuals with neurological disease/disorder/dysfunction between the ages of 18 and 65 years. Studies were reviewed using a modified Cochrane Data Extraction Template. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review process was facilitated using Covidence software (www.covidence.org). Two authors reviewed articles independently, with a third resolving conflicts regarding article inclusion. RESULTS: The search identified 450 records. After duplicates were removed and remaining titles/abstracts were screened for eligibility, 28 full-text articles were assessed, and two studies were included in the qualitative synthesis. Studies were a priori divided into those with pharmacological, procedural or behavioural interventions. Two studies met eligibility criteria; both of these included participants with multiple sclerosis. One study utilized a procedural intervention (i.e. transcranial direct current stimulation), while the other utilized a pharmacological intervention (i.e. fampridine-SR). Studies were evaluated for risk of bias, and evidence from both eligible studies was discussed. CONCLUSION: Despite the positive results of the procedural intervention, the paucity of eligible studies and the nascent nature of the field suggests that more studies are required before firm conclusions can be drawn regarding the amenability of CF to treatment. TRIAL REGISTRATION: The review was registered with PROSPERO (CRD42019118706).

As novas relações de trabalho, o desgaste mental do trabalhador e os transtornos mentais no trabalho precarizado / New labor relations, workers mental exhaustion, and mental disorders in precarious work

A perda da razão social do trabalho tem como ressonância a perda do sentido do trabalho para aqueles que o realizam. O objetivo principal deste ensaio é analisar de que forma a saúde mental é prejudicada pelas atuais contradições entre modernização e expansão da precarização social e do trabalho. Na primeira parte, procura-se entender a questão através de uma visão sócio-histórica, expondo-se a seguir indicadores internacionais e brasileiros que demonstram essa precarização. Na sequência, as autoras apresentam uma análise crítica do modo pelo qual, a partir da busca de maximização da competitividade, surgiu um modelo social que, em nome de uma excelência cujo significado conjuga perfeição e superioridade, propicia discriminação ou exclusão para todos os quede alguma forma desvelam seus limites humanos. Os paradigmas deste modelo, atualmente dominante, são examinados para identificar os impactos psíquicos, destacando os adoecimentos relacionados à violência laboral. As autoras assinalam ainda o aumento de vulnerabilidade psíquica nos contextos de pobreza.A seguir, é apresentada uma reflexão sobre o despertencimento social e o desenraizamento humano e, na parte final, são discutidas perspectivas de reverter a degradação social, do trabalho e da natureza.

Loosing the social purpose of work leads individuals to perform senselesswork. This paper aims at analyzing the effect of current contradictions between modernization and expansion of labor and social precariousness on mental health. It begins by investigating this issue through a social and historical viewpoint, followed by showing international and Brazilian indicators that illustrate the above mentioned precariousness. Further on, the authors analyze critically the social model generated by targeting maximum competitiveness, which on behalf of an excellence that conjugates perfection and superiority fosters discrimination or exclusion of all those who in anyway unveil their human limits. The authors examine the current dominating paradigms of this model to identify its psychological impacts, highlighting illnesses related to occupational violence. They further stress the increase of psychic vulnerability in contexts of poverty and discuss social non-belonging and human ungrounding processes. They conclude by commenting on possibilities of reverting labor, nature, and social degradation.