Abstract

Objective: To examine the associations with symptoms of a) burnout and b) work-related post-traumatic stress, in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies. Design: Point prevalence cross-sectional study Setting: Three adult and four pediatric ICUs Subjects: Three hundred and seventy seven ICU staff Interventions: None Measures: Brief Resilience Scale (BRS); abbreviated Maslach Burnout Inventory (aMBI); Trauma Screening Questionnaire (TSQ) and Hospital Anxiety and Depression Scale (HADS). Main Results: Prevalence of burnout (defined as high emotional exhaustion or high depersonalization) was 37%. Prevalence of clinically significant post-traumatic stress symptoms was 13%. There was a degree of overlap between burnout and other measures of distress, most notably for anxiety (OR=10.56, 95% CI:4.12,27.02, p<0.001). Hierarchical logistic regression demonstrated that self-reported resilience was strongly associated with decreased likelihood of meeting criteria for both forms of work-related distress (burnout: OR=0.52, 95% CI:0.36,0.74, p<0.001; post-traumatic stress: OR=0.28, 95% CI:0.16,0.46, p<0.001) and that physicians were twice as likely as nurses to be at risk of reporting burnout (OR=2.11, CI:1.18,3.78, p=0.012). After controlling for resilience, profession and setting, the following coping strategies were independently associated with outcomes: attending debriefing reduced risk of burnout (OR=0.45, 95% CI:0.21,0.95, p=0.036), while the odds of post-traumatic stress were less if staff used talking to seniors (OR=0.43, 95% CI:0.20,0.92, p=0.029) or hobbies (OR=0.46, 95% CI:0.23,0.93, p=0.030) to cope with stress at work. Venting emotion (OR=1.92, 95% CI:1.12,3.31, p=0.018) and using alcohol (OR=2.30, 95% CI:1.26,4.20, p=0.006) were associated with a doubling in risk of reporting burnout. Conclusions: The use of particular coping strategies was systematically associated with symptoms of burnout and work-related post-traumatic stress in this group of intensive care staff, even after controlling for resilience and other factors. More research on how best to promote adaptive coping is needed in these challenging settings.