ISSN: 2320-5407 Int. J. Adv. Res.

12(07), 01-07

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/19015
DOI URL: http://dx.doi.org/10.21474/IJAR01/19015

RESEARCH ARTICLE
BURNOUT SYNDROME AMONG HEALTHCARE PROFESSIONALS IN THE SOUSS REGION:
CROSS-SECTIONAL STUDY

Youssef Benachour, Adil Elmekkaoui, Otmane Benlenda, Laila Lahlou and Hicham Nassik
Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Hassan II Regional Hospital, Agadir. Morocco.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History In the context of the COVID-19 pandemic, the population has been put
Received: 05 May 2024 under a major psychological constraint. high incidence of psychological
Final Accepted: 09 June 2024 and professional burden on health care providers have been recorded.
Published: July 2024 These observations are related to the considerable stress, additional
pressure, accompanied by very significant awareness and media
coverage which have all focused on the role of health professionals.
Through this work, we aim to determine the prevalence of burnout
syndrome among medical and nursing staff in the intensive care units
of Hassan II Hospital in Agadir (Morocco) at the time of the
Coronavirus and to look for the associated factors.

Copy Right, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Since January 2020, the global economy and the professional world have been disrupted in proportions that have
been never seen before. On March 11, the World Health Organization (WHO) defined the novel coronavirus as a
pandemic. This virus, which initially appeared in China, quickly spread across the globe, forcing governments to
prepare for the first wave of health emergencies by adopting drastic measures, paralyzing daily life in many
countries around the world [1, 2].

Indeed, as of August 23, 2020, more than 23 million cases of COVID-19 have been recorded and the virus has killed
more than 802,693 people [3]. In Morocco, the cumulative number of confirmations at the national level stood at
25,537 cases as of August 03, 2020 and the number of deaths at 382 people. The highest values of deaths were noted
in the provinces of Tangier-Assilah and Marrakech with 8.6 and 5.0 deaths per 100,000 respectively [2].

In addition, the province of Souss-Massa recorded 295 positive cases and 6 deaths as of October 23, 2020 and 0
deaths in the city of Agadir-Ida -Ou-Tanane [2].

In the context of this health crisis, the population has been put under a major psychological constraint. Preliminary
reports from affected countries at the start of the pandemic highlight the high incidence of psychological and
professional burden on health care providers outside of intensive care. Indeed, the latter have seen their working
hours doubled, the days off adjourned and their number of hours of sleep reduced [1].

Throughout the world and not only in Morocco, the pandemic has triggered considerable stress, additional pressure,
accompanied by very significant awareness and media coverage which have all focused on the role of health
professionals, thus, to their psychological health which has become disturbing and worrying [1].

Corresponding Author:-Youssef Benachour 1

Address:-Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Hassan II
Regional Hospital, Agadir. Morocco.
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

The objective of this study was to determine the prevalence of burnout syndrome among nursing staff in the
intensive care units of Hassan II Hospital in Agadir (Morocco) at the time of the Coronavirus and to look for the
associated factors.

Methods:-
Type and duration of the study
This is a cross-sectional, descriptive and analytical study carried out over the period of March-July 2021.

Study location
Our study sites are the departments dedicated to the resuscitation of patients suspected or declared positive by PCR
or COVID serologies and presenting respiratory distress or patients suffering from other vital distresses with a
positive serological status or Covid PCR within the Agadir regional hospital.

The work of health professionals in these departments consists of taking care of patients in serious condition by
providing them with adequate oxygen therapy by various means, by administering treatments, taking samples for the
necessary assessments, ensuring their transport to perform imaging by monitoring them continuously.

Study population
The studied population was made up of health professionals (doctors, nurses and nursing assistants) working in the
COVID-19 resuscitation department at the Hassan II Regional Hospital in Agadir. The study focused on a sample of
100 of these professionals. This number is justified by the number of teams of professionals received from the
various hospitals in the Souss-Massa region. We included in this study health professionals who operated during the
period of March-July 2021 at the Covid-19 resuscitation departments and who agreed to participate in the survey of
our study.

Thus, professionals who did not work in COVID-19 intensive care units during this period and those who refused to
participate in the study were excluded from this study.

Data collection
The data was collected using a survey providing information on five factors: socio-demographic and professional
factors (gender, age, seniority, marital status and professional category); perceived burnout data; data on the health
status of the study population and the Maslach Burn-out Inventory instrument [Maslach and Jackson, 1981, 1986]

The survey was based on the French version of the adapted MBI with 22 items whose responses are rated by a Likert
scale from 0 (never) to 6 (every day).

The Maslach Burn-out Inventory subscales are emotional exhaustion (9 items), depersonalization (5 items), and
personal accomplishment (8 items). The calculation of the scores for each of these dimensions is obtained by the
sum of the responses to the items.

The three levels (low, moderate and high) of burnout are defined by specific thresholds: EE (low BO: score < 18,
moderate BO: 18 to 29, high BO: > 29); DP (low BO: < 6, moderate BO: 6 to 11, high BO: > 11); PA (high BO: <
34, moderate BO: 34 to 39, low BO: > 39) [9,10]. Thus, stages of different severity of Burn-out are distinguished
according to the number of dimensions reached. Burnout is low when only one dimension is affected, medium when
2/3 of the dimensions are affected and severe when the 3 dimensions are pathological [7]. Associations between
dependent and independent variables were established with the chi-2 test. The analysis was performed using SPSS
13.0 software.

Ethical Considerations:
Participants were assured of the anonymity of their answers in the survey as well as the confidentiality of the
information.

Results:-
In our series, the majority of participants (93%) were over 40 years old. There is a male predominance with a
percentage of 60% against 40% of women who responded to the survey.

2
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

Single participants outnumbered those who are married (66% vs. 34%).

The most represented professional categories in our study were doctors with a percentage of 39% and disabilities
with a percentage of 40%, against only 21% for nursing auxiliaries.

Concerning the seniority of exercise in the field of health, the majority (85%) of the participants had a seniority of
10 years or more against 15% of the participants had a seniority of less than 10 years.

During the period of our study, 60% of the participants worked for more than 40 hours during the last two months of
the total duration of our study.the majority (63%) of the staff worked on weekends once every two weeks. 21% work
weekends every week and 14% never work weekends. A feeling of exhaustion was felt during the Covid crisis by 74
of the participants (74%). This exhaustion was further amplified by the fear of transmitting the infection to family
members (85%) as well as the fear of becoming infected (59%).

The results of our study show that the factors that were statistically significant for the three dimensions of burnout
were: (Table 2)
1. The gender of the participants (p=0.012)
2. Professional category (p<0.001)
3. The seniority of exercise (p=0.037)
4. The fear of being infected with covid-19 (P=0.002)

Discussion:-
Our study was carried out with medical or paramedical personnel who had worked during the Covid-19 pandemic.
The results show the significant psychological impact on the individuals who participated in the study.

Concerning the three Burn-out dimensions, 85% presented an emotional exhaustion, 88% a depersonalization and
84% an alteration of personal accomplishment.

The first dimension of Burn-out is represented by emotional exhaustion. This represents the affective side of Burn-
out and is linked to physical and/or mental exhaustion.

Among the direct causes of emotional exhaustion is the excessive workload as would be the case for health
professionals facing patients suffering during the Covid-19 pandemic. [3].

In a recent 2022 study, about 451 health personnel working in the context of the Covid-19 pandemic, the risk factors
for emotional exhaustion would be: female gender, nurse or medical professional category, work in a university
establishment, work in an environment with a high risk of contamination by Covid-19, fear of infection by Covid-
19, work with low wages, heavy workload, lack of time for oneself and for the family and guilt following the risk of
Covid-19 contamination of loved ones. [4]

In contrast to these factors and as results of this same study, the factors which protect against the emotional
exhaustion would be the satisfaction with the place of exercise, the exercise with a title of professor as well as the
exercise in a private structure. [4]

This study has highlighted the negative effect of the association of a work overload and a lack of salary increase on
the mental health of health personnel. [4]

In our series, and contrary to the results of the study carried out with 135 health professionals during the same covid-
19 pandemic in 2021 [10-11], young doctors, nurses and caregivers are more interested in Burn-out compared to
older staff. Similar to this result and always in opposition to the results of this same study, the group aged over 40 in
our series have a lower incidence of burnout compared to the young population (under 40 years old). [1]

As demonstrated by the results of our study as well as for the majority of studies, the relatively low incidence of
burnout in the elderly population is explained by the experience accumulated in the latter during the years of
exercise. [5]

3
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

The more one practices in the medical field, the more one will develop capacities such as the management of the
stress imposed by the nature and the workload. [5]

Our study is an analytical study that assesses the factors that were most associated with the occurrence of burnout
among the members of our series. The results of our study show that the factors that were statistically significant for
the three burnout parameters were:
1. The female gender of the participants (p=0.012)
2. The professional category, doctors being the most affected compared to nurses and caregivers (p<0.001)
3. An exercise period exceeding 10 years. (p=0.037)
4. The fear of being infected with covid-19. (p=0.002)

The results of our study are in harmony with those of several studies [6]. The studies carried out trying to explain the
relationship between the workload and the occurrence of burn-out have accused several mechanisms, among others
[6]:
1. Mental fatigue
2. Anxiety which further complicates the heavy workload
3. Exaggerated sense of responsibility among staff.

It seems that gender plays a decisive role as shown by the results of our study (p=0.012) with men showing more
impairment in personal accomplishment than women. Regarding emotional exhaustion, another factor that is
significant according to gender (p=0.013), it is reversed for men and women because they are altered more in
women than in men. These results correspond to those observed in several other studies [7].

In a recent study from 2022, high scores for personal accomplishment, reflecting an alteration of this factor would
be secondary in the context of the Covid-19 pandemic in certain circumstances, in particular: being a resident,
having a history of Covid-19 infection, the lack of time allotted for oneself or for the family. On the other hand,
having children would play a protective role against the alteration of personal accomplishment. [4]

Our study demonstrates the significant relationship between the occurrence of Burn-out and the fear of being
infected with Covid-19. This is confirmed by several studies in the literature. [1] It seems that the fear of
contamination is more prevalent among women, especially those with children. [8]

The same study of 2022 was able to demonstrate that depersonalization, one of the dimensions of Burn-out, would
be linked to the possession of children, the status of doctor, the status of resident, work in a university establishment,
being at risk of contamination by Covid-19, a low salary, the lack of time for oneself and for the family, the feeling
of guilt for the risk of Covid-19 infection for relatives and the consumption of alcohol. [4]

Conversely to these factors, those that protect health personnel against depersonalization would be a large number of
children, exercise with a professor's title, work in a private establishment and satisfaction with the exercise
environment. [4]

These results, whether from our study or other studies in the literature, should alert us to the importance of
preventing burnout, especially for the personnel most at risk, especially those on the front line.

Psychological and psychiatric support, as well as recognition of their efforts, must be the rule.

One of the great protective elements against Burn-out would be social support. Receiving social support serves to
reduce the harmful effect of stress. [9]

Family support, being part of social support, is alone capable of fighting against the 3 dimensions of Burn-out as
well as against the loss of hope.[9]

Conclusion:-
During the COVID-19 pandemic, psychological and professional burden on health care providers have been related
in many studies to the considerable stress, additional pressure, accompanied by very significant awareness and
media coverage which have all focused on the role of health professionals. In our work, we would like to emphasize

4
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

the role of Psychological and psychiatric support, as well as recognition of efforts provided by the medical and nurse
staff.

Tables
Table 1:-Socio-demographic and professional characteristics.
Variables n(%)
Age
< 40 years old 93 (93)
≥ 40 years old 7 (7)
Gender
Male 60 (60)
Female 40 (40)
Marital status
Married 34 (34)
Single 66 (66)
Professional category
Doctor 39 (39)
Nurse 40 (40)
Caregivers 21 (21)
Seniority
≤ 10 years 85 (85)
> 10 years 15 (15)
Average hours worked per week over the past two months
< 10 hours 1 (1)
10 à 20 hours 10 (10)
21 à 40 hours 27 (27)
41 à 60 hours 36 (36)
61 à 80 hours 16 (16)
> 80 hours 10 (10)
Number of times worked on weekends in the last two months
Never 14 (14)
Every 2 weeks 63 (63)
Every week 21 (21)
Feeling exhausted more now than before the covid-19 crisis
Disagree 17 (17)
Agree 74 (74)
Neither agree nor disagree 14 (14)
Missing data 1 (1)
Fear of infection
Disagree 26 (26)
Agree 59 (59)
Neither agree nor disagree 14 (14)
Missing data 1(1)
Fear that the family is infected
Disagree 12(12)
Agree 85 (85)
Neither agree nor disagree 2 (2)
Missing data 1(1)

Table 2:-Burn-out severity and different related factors in the studies population.
Factor emotional exhaustion (EE) Depersonalization (DP) Personal accomplishment (PA)
n=100 n=100 n=100
Low Mediu Sever p Low Mediu Sever p Low Mediu Sever p
EE m EE e EE DP m DP e DP PA m PA e PA

5
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

General 24 16 45 26 19 43 17 19 48
(28,2 (18,8 (52,9 (29,5%) (21,6 (48,9 (20,2 (22,6 (57,1
%) %) %) %) %) %) %) %)
Age
<40 23 16 41 0,24 24(28,9 18 41 0,94 15 18 46 0.27
years old (28,8 (20%) (51,2 0 %) (21,7 (49,4 5 (19%) (22,8 (58,2 8
%) %) %) %) %) %)
≥40 1 0 4 2 (40%) 1 2 2 1 2
years old (20%) (0%) (80%) (20%) (40%) (40%) (20%) (40%)
Gender
Male 19 13 22 0.01 18 10 26 0,53 6 12 36 0.01
(35,2 (24,1 (40,7 3 (33,3%) (18,5 (48,2 0 (11,1 (22,2 (66,7 2
%) %) %) %) %) %) %) %)
Female 5 3 23 8 9 17 11 7 12
(16,1 (9,7% (74,2 (23,5%) (26,5 (50%) (36,7 (23,3 (40%)
%) ) %) %) %) %)
Professio
nal
category
Doctor 3 10 21 <0.0 3 6 26 <0.0 9 7 16 0.06
(8,8% (29,4 (61,8 01 (8,6%) (17,1 (71,3 01 (28,1 (21,9 (50%) 7
) %) %) %) %) %) %)
Nurse 18 1 13 21 6 6 2(6,1 7 24
(56,3 (3,1% (40,6 (63,6%) (18,2 (18,2 %) (21,2 (72,7
%) ) %) %) %) %) %)
Caregive 3 5 11 2 (10%) 7 11 6 5 8
r (13,8 (26,3 (57,9 (35%) (55%) (31,5 (26,3 (42,1
%) %) %) %) %) %)
Marital
status
Married 6 4 16 0.59 8 4 16 0.43 8 6 13 0.33
(23,1 (15,4 (61,5 9 (28,6%) (14,3 (57,1 7 (29,6 (22,2 (48,2 1
%) %) %) %) %) %) %) %)
Single 18 12 29 18 15 27 9 13 35
(30,5 (20,3 (49,2 (30%) (25%) (45%) (15,8 (22,8 (61,4
%) %) %) %) %) %)
Seniority
≤10 23 16 37 0,03 24 18 36 0.52 14 15 46
years (30,3 (21%) (48,7 9 (30,8%) (23,1 (46,1 3 (18,7 (20%) (61,3 0.03
%) %) %) %) %) %) 7
> 10 1 0 8 2 (20%) 1 7 3 4 2
years (11,1 (0%) (88,9 (10%) (70%) (33,3 (44,4 (22,3
%) %) %) %) %)
Exhausti
on more
during
the
COVID-
19 period
Yes 19 8 35 0.15 22 12 30 0.16 12 14 38 0.59
(30,6 (12,9 (56,5 6 (34,2%) (18,8 (47%) 9 (18,8 (21,9 (59,3 7
%) %) %) %) %) %) %)
No 3 7 7 4 7 13 5 5 10
(17,6 (41,2 (41,2 (16,7%) (29,2 (54,1 (25%) (25%) (50%)
%) %) %) %) %)

6
ISSN: 2320-5407 Int. J. Adv. Res. 12(07), 01-07

Fear of
being
infected
with
COVID-
19
Worried 20 4 25 0,00 22 8 20 0.00 8 10 32 0.42
(40,8 (8,2% (51%) 2 (44%) (16%) (40%) 4 (16%) (20%) (64%) 1
%) )
Not 4 10 11 4 11 23 9 9 16
worried (16%) (40%) (44%) (10,5%) (28,9 (60,6 (26,5 (26,5 (47%)
%) %) %) %)
The fear
that a
family
member
is
infected
with
COVID-
19
Worried 22 11 39 0.23 25 14 35 0.14 15 15 44 0.37
(30,6 (15,3 (54,1 4 (33.8%) (18,9 (47,3 8 (20,3 (20,3 (59,4 9
%) %) %) %) %) %) %) %)
Not 2 4 5 1 5 8 2 4 4
worried (18,2 (36,4 (45,4 (7,1%) (35,7 (57,2 (20%) (40%) (40%)
%) %) %) %) %)

Competing interests
The authors declare no competing interest.

Authors’ contributions
All the mentioned authors have equallycontributed in data collection, data analysis, literature review and in
manuscript redaction.

Acknowledgements:-
Not Applicable.

References:-
[1] Kapasa, R. L., Hannoun, A., Rachidi, S., Ilunga, M. K., Toirambe, S. E., Tady, C., ... &Khalis, M. (2021).
Évaluation du burn-out chez les professionnels de santé des unités de veille sanitaire COVID-19 au Maroc. Archives
des Maladies Professionnelles et de l'Environnement, 82(5), 524-534.
[2] Ministère de la santé-Maroc. (2020). Bulletin Epidémiologique COVID-19 N°9 du 06/08/2020. 10.
[3] Gernet I. Approche clinique et psychopathologique du burn-out : discussion à partir de la psychodynamique
du travail. EvoluPsychiatr 2021 ;86(1) :119—30.
[4] Karagöl, A., & Kaya, Z. T. (2022). Healthcare Workers’ Burn-out, Hopelessness, Fear of COVID-19 and
Perceived Social Support Levels. The European Journal of Psychiatry.
[5] V Duqueroy. Burn-out des médecins franc¸ais: enquête 2020. Medascape; 200; 33000229:20-11.
[6] Lacaze C. Évaluation des gardes par les internes de premier semestre de médecine générale nic¸ois depuis
la réforme du troisième cycle. HAL 2019 ;02394455 :796—801.
[7] Maslach, C., & Leiter, M. P. (1997). The truth about burnout Sanfrancisco. CA: Josey-Bass.
[8] Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustain: Sci
Pract Policy. 2020;16(1): 67−73.
[9] Cohen S, Wills TA. Stress, social support and the buffering hypothesis. Psychol Bull. 1985 Sep ;98(2)
:310−57.