An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic.

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic's first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

Factors Associated with Burnout among Resident Physicians Responding to the COVID-19 Pandemic: A 2-Month Longitudinal Observation Study.

BACKGROUND: Burnout during residency may be a function of intense professional demands and poor work/life balance. With the onset of the COVID-19 pandemic, NYC hospital systems were quickly overwhelmed, and trainees were required to perform beyond the usual clinical duties with less supervision and limited education. OBJECTIVE: The present longitudinal study examined the effects of COVID-19 caseload over time on burnout experienced by resident physicians and explored the effects of demographic characteristics and organizational and personal factors as predictors of burnout severity. METHODS: This study employed a prospective design with repeated measurements from April 2020 to June 2020. Participants were surveyed about their well-being every 5 days. Predictors included caseload, sociodemographic variables, self-efficacy, hospital support, perceived professional development, meaning in work, and postgraduate training level. RESULTS: In total, 54 resident physicians were recruited, of whom 50% reported burnout on initial assessment. Periods of higher caseload were associated with higher burnout. PGY-3 residents reported more burnout initially but appeared to recover faster compared to PGY-1 residents. Examined individually, higher self-efficacy, professional development, meaningful work, and hospital support were associated with lower burnout. When all four predictors were entered simultaneously, only self-efficacy was associated with burnout. However, professional development, meaningful work, and hospital support were associated with self-efficacy. CONCLUSION: Burnout among residency is prevalent and may have implications for burnout during later stages of a physician's career. Self-efficacy is associated with lower burnout and interventions to increase self-efficacy and the interpersonal factors that promote self-efficacy may improve physician physical and emotional well-being.

Pathways from exposure to racial/ethnic discrimination to depression: Testing a social-cognitive model.

RATIONALE AND OBJECTIVE: Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition. METHODS: The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N = 136; Mage = 38, SD = 13.0) and a private university (N = 120; Mage = 19.4, SD = 1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas. RESULTS: Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI = 0.96, RMSEA = 0.06, SRMR = 0.04). A significant mediational effect was found only for concerns about rejection and invalidation. CONCLUSION: The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health.

Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence.

Parents of adolescents and young adults (AYAs) with cancer experience distress comparable to other caregiver populations, but remain understudied. This study tested the social cognitive processing model of emotional adjustment to cancer. We hypothesized that social constraints on emotional disclosure would inhibit cognitive processing and be related to greater fear of cancer recurrence (FCR), potentially negatively influencing psychological adjustment. Data were collected through an online cross-sectional survey study of 66 parents of AYAs with cancer (aged 15-39) and analyzed using bootstrapping techniques for ordinary least squares regression. One-third of the parents reported moderate to severe depressive symptoms. Serial mediation analyses indicated that greater social constraints were related to poorer cognitive processing and higher FCR, and, ultimately, greater depressive symptoms. Alternative models were tested and were not significant. Future psychosocial interventions for parents of AYAs with cancer should include improving cancer-related communication between parents and their social network.