Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic

Guangtian Liu; Yan Tong; Jinghong Li; Xiaoya Sun; Linlin Chen; Xiwei Zheng; Xinhui Zhang; Jufen Lv; Jinyan Wang; Bingfen Wei; Jianhua Wei; Ruixia Cheng; Zhizhong Wang

doi:10.1177/00912174231219041

Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic

Int J Psychiatry Med. 2023 Dec 4:912174231219041. doi: 10.1177/00912174231219041. Online ahead of print.

Authors

Guangtian Liu¹, Yan Tong², Jinghong Li², Xiaoya Sun³, Linlin Chen⁴, Xiwei Zheng⁵, Xinhui Zhang¹, Jufen Lv⁴, Jinyan Wang⁶, Bingfen Wei⁶, Jianhua Wei¹, Ruixia Cheng¹, Zhizhong Wang^{4

7}

Affiliations

¹ Department of Infectious Disease, The No.4 Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
² Department of Social Medicine, School of Public Health, Shanxi Medical University, Taiyuan, China.
³ Department of Clinical Psychology, Futian Center for Chronic Disease Control, Shenzhen, China.
⁴ Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, China.
⁵ Department of Respiratory and Critical Care, General Hospital of Ningxia Medical University, Yinchuan, China.
⁶ Department of Rehabilitation and Nursing, Ningxia Vocational and Technical College for Minorities, Wuzhong, China.
⁷ Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China.

PMID: 38047438
DOI: 10.1177/00912174231219041

Abstract

Objective: This survey aimed to explore the relationships between burnout, moral injury, and suicidal/self-harm ideation among Chinese health professionals to provide a reference for protecting their mental health.

Method: Health professionals were surveyed online using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, Patient Health Questionnaire-9, and the Moral Injury Symptoms Scale-Health Professional.

Results: In the analysis, 6146 eligible respondents were included in the study. The average participant age was 34.9 ± 8.5 years, and suicidal/self-harm ideation was detected in 2338 participants (38.0%). The prevalence of suicidal/self-harm ideation among those with severe burnout in the dimensions of emotional exhaustion, depersonalisation, and decreased personal accomplishment was significantly higher than those with mild burnout. The prevalence of suicidal/self-harm ideation among those with significant moral injury symptoms was higher than those without moral injury. Unconditional logistic regression analysis showed that those with moderate or severe emotional exhaustion, moderate or severe reduced sense of professional accomplishment and moderate or severe depersonalisation had increased risks of suicidal/self-harm ideation.

Conclusions: Structural equation modelling demonstrated that burnout significantly mediated the relationship between moral injury and suicidal/self-harm ideation. The proportion of mediation (PM) by burnout was 43.0%. Burnout and moral injury were potential predictors of suicidal/self-harm ideation among health professionals. Both moral injury and burnout had positive and direct effects on suicidal/self-harm ideation, and burnout was a mediator in this relationship among Chinese health professionals. Therefore, to alleviate the moral injury and subsequent burnout of healthcare workers and enhance their mental qualities, active interventions should be developed in the future.

Keywords: burnout; cross-sectional study; health professional; moral injury; suicidal/self-harm ideation.