EXAMINING THE BURNOUT EPIDEMIC: PREVALENCE AND CONTRIBUTING FACTORS AMONG HEALTH-CARE PROFESSIONALS IN BALOCHISTAN: A CROSS-SECTIONAL STUDY.
DOI:
https://doi.org/10.55519/JAMC-01-14261Keywords:
Burnout; Healthcare; BalochistanAbstract
Background: Burnout is a well-recognised occupational phenomenon characterised by a prolonged state of physical and emotional exhaustion, depersonalisation, and reduced sense of personal accomplishment. Healthcare professionals are disproportionately vulnerable owing to the inherently demanding, high-stakes nature of clinical practice. This study investigated the prevalence of burnout and its contributing factors among healthcare workers (HCWs) in Balochistan, the largest but most under-resourced province of Pakistan. Methods: A cross-sectional study was conducted at six major public-sector hospitals across three divisions of Balochistan (Quetta Division, Khuzdar Division, and Makran Division) from January to June 2023. A quota sampling technique was employed, with participant quotas allocated proportionally across the six hospitals based on their estimated eligible workforce sizes. Within each hospital, healthcare professionals were recruited by convenience — those present on duty and willing to participate during scheduled data-collection visits were enrolled consecutively until the hospital quota was met. A total of 307 healthcare professionals — including physicians, nurses, pharmacists, and allied health staff — were enrolled. Burnout was assessed using the American Public Welfare Association (APWA) 28-item standardised questionnaire, which classifies respondents into five burnout grades (Grade I–V). The minimum required sample size was calculated using the formula n = Z²P(1−P)/d² with an estimated burnout prevalence of 32%, a 95% confidence level, and a 5% margin of error, yielding a minimum of 334. Results: Of the 307 participants, 30% (n=92) reported no stress or professional burnout, 37% (n=112) experienced stress without burnout, 16% (n=48) demonstrated a fair likelihood of burnout, 10.77% (n=32) were in early burnout, and 4.3% (n=13) showed advanced burnout. The predominant self-reported causes of burnout were work overload (40%), a suboptimal work environment (25%), long working hours (18%), low wages (15%), and miscellaneous factors (2%). Conclusion: Burnout affects a substantial proportion of healthcare professionals in Balochistan, with approximately one-third showing clinically significant burnout indicators. Work overload, inadequate staffing, and financial constraints are the principal drivers. Targeted institutional interventions, including workload redistribution, competitive remuneration, and formal resilience-building programmes, are urgently needed to safeguard workforce wellbeing and sustain the quality of healthcare delivery in the province.
References
1. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry 2016;15(2):103–11.
2. Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA 2012;305(19):2009–10.
3. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283(6):516–29.
4. Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med 2007;175(7):686–92.
5. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288(16):1987–93.
6. Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-graham, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med 2017;177(2):195–205.
7. Afzal A, Khan MA, Saeed H, Anjum S. Burnout and its associated factors among health professionals in Pakistan: a cross-sectional survey. J Ayub Med Coll Abbottabad 2020;32(2):179–83.
8. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PK, Lewin D, Chiang VW, et al. Rates of medication errors among depressed and burnt-out residents: prospective cohort study. BMJ 2008;336(7642):488–91.
9. Halbesleben JR, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manag Rev 2008;33(1):29–39.
10. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996;347(9003):724–8.
11. Dewa CS, Loong D, Bonato S, Trojanowski L, Rea M. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open 2017;7(6):e015141.
12. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum 2017;60(6):567–76.
13. Mealer M, Conrad D, Evans J, Jooste K, Solyntijes J, Rothbaum B, et al. Feasibility and acceptability of a resilience training program for intensive care unit nurses. Am J Crit Care 2014;23(6):e97–105.
14. Williams ES, Konrad TR, Linzer M, et al. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife study. Health Serv Res 2002;37(1):121–43.
15. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: a systematic review. JAMA 2018;320(11):1131–50.
16. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One 2017;12(10):e0185781.
17. Toker S, Biron M, Spector PE. Relationships between job stressors and job performance: a meta-analytic review. J Appl Psychol 2012;97(3):619–32.
18. Dubale BW, Friedman LE, Chemali Z, Denninger JW, Mehta DH, Alem A, et al. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health 2019;19(1):1247.
19. Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel) 2016;4(3):37.
20. Chirico F, Magnavita N. The COVID-19 pandemic and the burnout syndrome among healthcare workers in Italy. J Health Soc Sci 2020;5(2):169–75.
21. Poghosyan L, Clarke SP, Finlayson M, Aiken LH. Nurse burnout and quality of care: cross-national investigation in six countries. Res Nurs Health 2010;33(4):288–98.
22. Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud 2015;52(2):649–61.
23. Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach 2013;10(4):242–5.
24. Bano S, Ullah H, Khan A, Javed I. Prevalence and factors associated with burnout among physicians in public sector hospitals of Quetta, Balochistan. Pak J Public Health 2021;11(2):88–92.
25. Ahmed Z, Shaikh BT. Medical education and research in Pakistan: challenges and the way forward. J Coll Physicians Surg Pak 2008;18(5):317–9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Abdul Samad Gichki, Nawab Shah, Mir Mubarak Baloch, Bakhtiyar Ali
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
