Burnout in Italian hospital physicians during the COVID-19 pandemic: the roles of alexithymia and defense mechanisms

Michela Di Trani, Anna Chiara Pippo, Alessia Renzi

Abstract


Background: COVID-19 pandemic placed unusual additional burden upon international healthcare systems. This study aims to explore the associations between burnout, alexithymia and defense mechanisms in a group of Italian hospital physicians during the COVID-19 pandemic.


Methods: 96 hospital physicians completed self-reported questionnaires through Google Forms platform, including Maslach Burnout Inventory (MBI), Defense Style Questionnaire-40 (DSQ-40), and 20-item Toronto Alexithymia Scale (TAS-20).


Results: Emotional Exhaustion (EE) and Depersonalization (DP) burnout dimensions were positively correlated with alexithymia and with immature and neurotic defenses, while negative associations were correlated with a mature defensive style. MBI Personal Accomplishment (PA) was negatively correlated with alexithymia levels but positively correlated with mature defenses. According to regression models, EE levels were predicted by female gender (beta = −0.20; p < .04) and DSQ mature defenses (beta= -.24; p< .02); DP levels were predicted by alexithymia total score (beta= 0.26; p < .04) and DSQ mature defenses (beta= -.20; p< .05); and PA levels were predicted by alexithymia total score (beta = -0.29; p < .02) and DSQ mature defense (beta= .45; p< .001).


 Conclusions: Consistent with the broader literature, an association between burnout and both alexithymia and defense mechanisms emerged. These findings highlight the importance of reducing occupational-related burden on healthcare workers and of promoting protecting strategies to deal with emergency situations.

Keywords


COVID-19; Burnout; Hospital physician; Alexithymia; Defense mechanisms; Clinical psychology.

Full Text:

PDF

References


Almeida, M., & DeCavalcante, G. (2021). Burnout and the mental health impact of COVID-19 in anesthesiologists: A call to action. Journal of Clinical Anesthesia, 68, 110084. https://doi.org/10.1016/j.jclinane.2020.110084

Andrews, G., Singh, M., & Bond, M. (1993). The defense style questionnaire. Journal of Nervous and Mental Disease, 181, 246–256. https://doi.org/10.1097/00005053-199304000-00006

Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32. https://doi.org/10.1016/0022-3999(94)90005-1.

Barello, S., Palamenghi, L., & Graffigna, G. (2020). Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID‐19 pandemic. Psychiatry Research, 290, 113129. https://doi.org/10.1016/j.psychres.2020.113129

Blekas, A., Voitsidis, P., Athanasiadou, M., Parlapani, E., Chatzigeorgiou, A. F., Skoupra, M., et al. (2020). COVID-19: PTSD symptoms in Greek health care professionals. Psychological Trauma: Theory, Research, Practice, and Policy, 12(7), 812-819. http://dx.doi.org/10.1037/tra0000914

Bond, M., & Perry, J.C. (2004). Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. The American Journal of Psychiatry, 161(9), 1665-1671. https://doi.org/10.1176/appi.ajp.161.9.1665

Bratis, D., Tselebis, A., Sikaras, C., Moulou, A., Giotakis, K., Zoumakis, E., & Ilias, I. (2009). Alexithymia and its association with burnout, depression and family support among Greek nursing staff. Human Resources for Health, 7, 72. https://doi.org/10.1186/1478-4491-7-72

Bressi, C., Manenti, S., Porcellana, M., Cevales, D., Farina, L., Felicioni, I., Meloni, G., Milone, G., Miccolis, I. R., Pavanetto, M., Pescador, L., Poddigue, M., Scotti, L., Zambon, A., Corrao, G., Lambertenghi-Deliliers, G., & Invernizzi, G. (2008). Haemato-oncology and burnout: an Italian survey. British Journal of Cancer, 98(6), 1046–1052. https://doi.org/10.1038/sj.bjc.6604270.

Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, I., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of Psychosomatic Research, 41(6), 551–559. https://doi.org/10.1016/s0022-3999(96)00228-0.

Bria, M., Baban, A., & Dumitrascu, D. L. (2012). Systematic review of burnout risk factors among European healthcare professionals. Cognition, Brain, Behavior, 16, 423–452.

Brubaker L. (2020). Women physicians and the COVID-19 pandemic. Journal of American Medical Association, 324, 835–6. 10.1001/jama.2020.14797

Chen, Q., Liang, M., Li, Y., Guo, J., Fei, D., Wang, L., He, L., Sheng, C., Cai, Y., Li, X., Wang, J., & Zhang, Z. (2020). Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet. Psychiatry, 7(4), e15–e16. https://doi.org/10.1016/S2215-0366(20)30078-X

Cohen, J.A. (2003). Managed care and the evolving role of the clinical social worker in mental health. Social work, 48(1), 34–43. https://doi.org/10.1093/sw/48.1.34.

Dahlke, A. R., Johnson, J. K., Greenberg, C. C., Love, R., Kreutzer, L., Hewitt, D. B., Quinn, C. M., Engelhardt, K. E., & Bilimoria, K. Y. (2018). Gender differences in utilization of duty-hour regulations, aspects of burnout, and psychological well-being among general surgery residents in the United States. Annals of Surgery, 268(2), 204-211. https://doi.org/10.1097/SLA.0000000000002700

Di Giuseppe, M., Nepa, G., Prout, T.A., Albertini, F., Marcelli, S., Orrù, G., & Conversano, C. (2021). Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms. International Journal of Environmental Research and Public Health, 18, 5258.

https://doi.org/10.3390/ijerph18105258

Di Giuseppe, M. & Perry, J.C. (2021). The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning with the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology, 12, 718440.

https://doi.org/10.3389/fpsyg.2021.718440.

Di Monte, C., Monaco, S., Mariani, R., & Di Trani, M. (2020). From resilience to burnout: psychological features of italian general practitioners during COVID-19 emergency. Frontiers in Psychology, 11, 567201. https://doi.org/10.3389/fpsyg.2020.567201

Di Tella, M., Romeo, A., Benfante, A., & Castelli, L. (2020). Mental health of healthcare workers during the COVID-19 pandemic in Italy. Journal of Evaluation in Clinical Practice, 26(6), 1583–1587.

https://doi.org/10.1111/jep.13444.

Di Trani, M., Mariani, R., Ferri, R., De Berardinis, D., & Frigo, M.G. (2021). From resilience to burnout in healthcare workers during the covid-19 emergency: the role of the ability to tolerate uncertainty. Frontiers in Psychology, 12, 646435. https://doi.org/10.3389/fpsyg.2021.646435

Farma, T., & Cortinovis, I. (2000). Misurare i meccanismi di difesa attraverso il Defense Style Questionnaire a 40 item. Attendibilità dello strumento e suo utilizzo nel contesto italiano. Ricerche di Psicologia, 24, 127–144. http://digital.casalini.it/10.3280/RIP2000-003007

Fitzgerald-Yau, N., & Egan, J. (2018). Defense Styles Mediate the Association Between Empathy and Burnout Among Nurses. The Journal of nervous and mental disease, 206(7), 555–561.

https://doi.org/10.1097/NMD.0000000000000837

Franco, P., Tesio, V., Bertholet, J., Gasnier, A., Gonzalez Del Portillo, E., Spalek, M., Bibault, J. E., Borst, G., Van Elmpt, W., Thorwarth, D., Mullaney, L., Røe Redalen, K., Dubois, L., Chargari, C., Perryck, S., Heukelom, J., Petit, S., Lybeer, M., & Castelli, L. (2020). Professional quality of life and burnout amongst radiation oncologists: The impact of alexithymia and empathy. Radiotherapy and Oncology, 147, 162–168. https://doi.org/10.1016/j.radonc.2020.05.017.

Frawley, W. & Smith, R. N. (2001). A processing theory of alexithymia. Journal of Cognitive Systems Research, 2: 189–206. Doi: 10.1016/S1389-0417(01)00029-8

Giusti, E. M., Pedroli, E., D’Aniello, G. E., Stramba Badiale, C., Pietrabissa, G., Manna, C., Stramba Badiale, M., Riva, G., Castelnuovo, G. & Molinari, E. (2020). The psychological impact of the COVID‐19 outbreak on health professionals: a cross‐sectional study. Frontiers in Psychology, 11:1684. https://doi.org/10.3389/fpsyg.2020.01684.

Gómez-Urquiza, J.L., Vargas, C., De la Fuente, E.I., Fernández-Castillo, R., Cañadas-De la Fuente, G.A. (2017). Age as a risk factor for burnout syndrome in nursing professionals: a meta-analytic study. Research in Nursing & Health, 40(2), 99-110. https://doi.org/10.1002/nur.21774

Gourounti, K., Anagnostopoulos, F., Griva, F., & Vaslamatzis, G. (2016). Alexithymia and fertility-related stress. Women & Health, 56, 312-325. http://dx.doi.org/10.1080/03630242.2015.1088119

Gualano, M.R., Sinigaglia, T., Lo Moro, G., Rousset, S., Cremona, A., Bert, F., & Siliquini, R. (2020). The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review. International Journal of Environmental Research and Public Health, 18, 8172. https://doi.org/10.3390/ijerph18158172

Helmes, E., McNeill, P.D., Holden, R.R., & Jackson, C. (2008). The construct of alexithymia: associations with defense mechanisms. Journal of Clinical Psychology, 64,318–331. https://doi.org/10.1002/jclp.20461

Lasalvia A, Amaddeo F, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, & Bonetto C. (2021). Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open, 11(1), e045127. http://dx.doi.org/10.1136/bmjopen-2020-045127.

Lenzo, V., Barberis, N., Cannavò, M., Filastro, A., Verrastro, V., Quattropani, M.C. (2020). The relationship between alexithymia, defense mechanisms, eating disorders, anxiety and depression. Rivista di Psichiatria, 55(1), 24-30. 10.1708/3301.32715

Mannocci, A., Sestili, C., Carnevale, F., Minotti, C., De Giusti, M. G., Villari, P., Foà, R., Cartoni, C., & La Torre, G. (2019). Assessment of burnout in health care personnel in hematological unit of a teaching hospital. Giornale Italiano di Medicina del Lavoro ed Ergononimia, 41, 45–51.

Mariani, R., Renzi, A., Di Trani, M., Trabucchi, G., Danskin, K., & Tambelli, R. (2020). The Impact of Coping Strategies and Perceived Family Support on Depressive and Anxious Symptomatology during the Coronavirus Pandemic (COVID‐19) Lockdown. Frontiers in Psychiatry, 11:1195. https://doi.org/10.3389/fpsyt.2020.587724

Marton, G., Vergani, L., Mazzocco, K., Garassino, MC & Pravettoni, G. (2020). 2020s heroes are not fearless: the impact of the covid-19 pandemic on wellbeing and emotions of italian health care workers during Italy phase 1. Frontiers in Psychology, 11, 588762. https://doi.org/10.3389/fpsyg.2020.588762

Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach burnout inventory manual. Palo Alto: Consulting Psychologists Press.

Mattila, A. K., Poutanen, O., Koivisto, A. M., Salokangas, R. K., & Joukamaa, M. (2007). Alexithymia and life satisfaction in primary healthcare patients. Psychosomatics, 48(6), 523–529. https://doi.org/10.1176/appi.psy.48.6.523.

Nil, R., Jacobshagen, N., Schächinger, H., Baumann, P., Höck, P., Hättenschwiler, J., Ramseier, F., Selfritz, E., Holsboer-Trachsler, E. (2010) Burnout –eine Standordbestimmung. Schweizer Archiv fur Neurologie und Psychiatrie, 161:72–77.

Nikmanesh, Z., Darvish Molla, M., & Mehranfard, M. (2021). The Mediating Role of Alexithymia in the Relationship between Defense Mechanisms and Tendency to High-risk Behaviors among Adolescents. Journal of Health Research, 11(1):29-36. http://dx.doi.org/10.32598/JRH.11.1.363.6

Ng, Q.X., De Deyn, M., Lim, D.Y., Chan, H.W., & Yeo, W.S. (2020). The wounded healer: a narrative review of the mental health effects of the COVID-19 pandemic on healthcare workers. Asian Journal of Psychiatry, 54:102258. 10.1016/j.ajp.2020.102258

Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology,8, 161–187. https://doi.org/10.1146/annurev-clinpsy-032511-143109

Perry, J. C. (2014). Anomalies and specific functions in the clinical identification of defense mechansims. Journal of Clinical Psychology, 70, 406–418. https://doi.org/10.1002/jclp.22085

Pompili, M., Rinaldi, G., Lester, D., Girardi, P., Ruberto, A., & Tatarelli, R. (2006). Hopelessness and suicide risk emerge in psychiatric nurses suffering from burnout and using specific defense mechanisms. Archives of Psychiatric Nursing, 20(3), 135–143. https://doi.org/10.1016/j.apnu.2005.12.002

Popa-Velea, O., Diaconescu, L., Mihăilescu, A., Jidveian Popescu, M., & Macarie, G. (2017). Burnout and its relationships with alexithymia, stress, and social support among romanian medical students: a cross-sectional study. International Journal of Environmental Research and Public Health, 14(6), 560. https://doi.org/10.3390/ijerph14060560.

Purvanova, R. K., & Muros, J. P. (2010). Gender differences in burnout: A meta-analysis. Journal of Vocational Behavior, 77(2), 168–185. https://doi.org/10.1016/j.jvb.2010.04.006

Renzi A., Verrusio W., Messina M., Gaj F. (2020a). Psychological intervention with elderly people during the COVID-19 Pandemic: the experience of a Nursing Home in Italy. Psychogeriatrics. https://doi.org/10.1111/psyg.12594

Renzi A., Di Trani M., Solano L., Minutolo E., & Tambelli R. (2020b). Alexithymia, infertility-related stress and quality of life in women undergoing an Assisted Reproductive Treatment. Stress & Health, 1-9. https://doi.org/10.1002/smi.2967

Raggio, B., & Malacarne, P. (2007). Burnout in intensive care unit. Minerva Anestesiology, 73, 195-200.

Raggio, B. & Ercolani, A.P. (2009). Burnout in healthcare workers. Giornale Italiano di Psicopatologia, 15, 390-394.

Riethof, N., Bob, P., Laker, M., Zmolikova, J., Jiraskova, T., Raboch, J. (2020). Alexithymia, traumatic stress symptoms and burnout in female healthcare professionals. Journal of International Medical Research, 48(4) 1–9.

https://doi.org/10.1177/0300060519887633

Rodríguez‐Rey, R., Garrido‐Hernansaiz, H., & Collado, S. (2020). Psychological Impact and Associated Factors During the Initial Stage of the Coronavirus (COVID-19) Pandemic Among the General Population in Spain. Frontiers in Psychology, 11: 1540. https://doi.org/10.3389/fpsyg.2020.01540

Sanchez, F.M., Garcia, M.A., Soria, B.O. (2003). Alexithymia - State or Trait?. The Spanish Journal of Psychology, 6, 51-59. 10.1017/s1138741600005205.

Sanfilippo, F., Noto, A., Palumbo, G. J., Ippolito, M., Gagliardone, M., Scarlata, M., Bignami, E., Sangalli, F., Cattaneo, S., Blangetti, I., Scolletta, S., Locatelli, A., Tritapepe, L., Lorini, F.L., & Arcadipane, A. (2018). Burnout in cardiac anesthesiologists: results from a national survey in Italy. Journal of Cardiothoracic and Vascular Anesthesia, 32, 2459–2466. https://doi.org/10.1053/j.jvca.2018.06.010.

Sani, G., Janiri, D., Di Nicola, M., Janiri, L., Ferretti, S., & Chieffo, D. (2020). Mental health during and after the COVID-19 emergency in Italy. Psychiatry and Clinical Neurosciences, 74(6), 372. https://doi.org/10.1111/pcn.13004.

Seidler, A., Thinschmidt, M., Deckert, S., Then, F., Hegewald, J., Nieuwenhuijsen, K., & Riedel-Heller, S. G. (2014). The role of psychosocial working conditions on burnout and its core component emotional exhaustion - a systematic review. Journal of Occupational Medicine and Toxicology, 9(1), 10. https://doi.org/10.1186/1745-6673-9-10

Sirigatti, S., & Stefanile, C. (1993). Adattamento e taratura per l’Italia. In C. Maslach and S. Jackson (Eds), MBI Maslach burnout inventory. Firenze: Organizzazioni Speciali, 33–42.

Taycan, O., Taycan, S.E., & Celik, C. (2014). Relationship of burnout with personality, alexithymia, and coping behaviors among physicians in a semiurban and rural area in Turkey. Archives of Environmental and Occupational Health, 69(3):159-66. https://doi.org/10.1080/19338244.2013.763758

Taylor, G. J., & Bagby, R. M. (2013). Psychoanalysis and empirical research: the example of alexithymia. Journal of the American Psychoanalytic Association, 61(1), 99-133. https://doi.org/10.1177/0003065112474066

Templeton K, Bernstein CA, Sukhera J, et al. (2019). Gender-Based differences in burnout: issues faced by women physicians. NAM Perspectives. https://doi.org/10.31478/201905a

Vaillant, G. E. (1977). Adaptation to Life. Boston, MA: Little, Brown.

Vaillant, G. E. (1992). Ego Mechanisms of Defense: A Guide for Clinicians and Researchers. Washington, DC: American Psychiatric Press.

Vargas, M., Spinelli, G., Buonanno, P., Iacovazzo, C., Servillo, G., & De Simone, S. (2020). Burnout among anesthesiologists and intensive care physicians: results from an Italian national survey. Inquiry, 57:46958020919263. https://doi.org/10.1177/0046958020919263.

West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529. https://doi.org/10.1111/joim.12752.

Zhang, S. X., Wang, Y., Rauch, A., & Wei, F. (2020). Unprecedented disruption of lives and work: health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak. Psychiatry Research, 288, 112958. https://doi.org/10.1016/j.psychres.2020.112958




DOI: https://doi.org/10.13129/2282-1619/mjcp-3250

Refbacks

  • There are currently no refbacks.