ZĞǀŝĞǁƌƟĐůĞ

Prevalence and Factors Associated with Burnout

among Healthcare Professionals in India:
A Systematic Review and Meta-Analysis

Vartika Kesarwani, Zeeshan Gulam Husaain1, Jaiben George1

ABSTRACT
Background: With increasing workload and dismal working conditions, healthcare professionals (HCPs) in India often
suffer from burnout. Understanding the extent of these problems and the contributing factors is necessary to build a
healthy workforce capable of serving the society. The purpose of this study was to systematically review and analyze:
1) the prevalence of burnout among HCPs in India and 2) the factors associated with burnout in this population.
Methods: A systematic search of MEDLINE and EMBASE, from the inception of these databases to October 2019, was
conducted using keywords. The search results were screened to identify studies evaluating burnout among HCPs in India
using a standard burnout tool. Using a random effect model, the pooled prevalence of burnout was estimated using
Maslach Burnout Inventory (MBI) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal
accomplishment (PA). Risk factors for burnout were assessed qualitatively. Results: A total of 15 studies assessing
burnout in 3845 Indian HCPs were identified. The pooled prevalence of burnout was 24% in the EE domain, 27% in the
DP domain, and 23% in the PA domain. Younger age, female gender, unmarried status, and difficult working conditions
were associated with increased risk of burnout. Conclusion: Burnout is highly prevalent among Indian HCPs, with close to
one-fourth of them suffering from burnout. A number of personal and professional factors are associated with burnout,
and these should be considered while developing solutions to tackle burnout.

Key words: Burnout, doctors, healthcare, India, meta-analysis

Key messages:$VDFRQVLGHUDEOHSURSRUWLRQRI,QGLDQ+&3VVX௺HUIURPEXUQRXWDSSUHFLDWLRQRIEXUQRXWDVDPDMRU
health-care-related problem is necessary to ensure timely interventions to tackle burnout.

Burnout is common in many professions and refers to

a clinical syndrome characterized by excessive stress,
lack of satisfaction, and a feeling of being overworked.[1] This is an open access journal, and articles are distributed under the
terms of the Creative Commons Attribution-NonCommercial-ShareAlike
Access this article online 4.0 License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms.
Quick Response Code

Website:
www.ijpm.info For reprints contact: [email protected]

How to cite this article: Kesarwani V, Husaain ZG, George J.

DOI: Prevalence and factors associated with burnout among healthcare
10.4103/IJPSYM.IJPSYM_387_19 professionals in India: A systematic review and meta-analysis. Indian J
Psychol Med 2020;42:108-15.

Academic Section, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 1Academic Section, All India Institute of Medical
Sciences, New Delhi, India
Address for correspondence: Dr. Jaiben George
Academic Section All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail: [email protected]
Submitted: 13-Sep-2019, Submitted: 08-Oct-2019, Accepted: 26-Dec-2019, Published: 09-Mar-2020

108 © 2020 Indian Psychiatric Society - South Zonal Branch | Published by Wolters Kluwer - Medknow
 Kesarwani, et al.: Burnout among Indian healthcare professionals

Healthcare professionals (HCPs) are at an increased approval was required as this systematic review was
risk of developing burnout due to chronic exposure to based on published data that did not contain any
high work stress.[2] HCPs comprise of doctors, trainees, protected health information.
nurses, etc., who work collectively to take care of the
different health-related needs of the society. Increased Eligibility criteria
patient load, long and unsociable working hours, lack of All studies that were published in English from
a supportive work environment, daily confrontation with inception of these databases to October 2019, sampled
death, and lack of appreciation are some of the factors a population of HCPs from India and used standardized
that have contributed to the development of burnout tools to identify and estimate the prevalence of burnout
in HCPs.[3] Burnout is increasingly getting recognition were included in the review.
as it has severe consequences on the physicians’ sense
of wellness, institutions’ performance, and patient Literature search
outcomes.[4] Burnout among HCPs can result in medical Two large electronic databases (MEDLINE and
errors, hostile attitude toward patients, and a difficult EMBASE) were systematically searched for relevant
working environment. Those suffering from burnout are publications from their inception to 15th October 2019
also more prone to depression, anxiety, sleep disturbance, using a combination of relevant search terms. The
substance abuse, problems with marriage, early following Boolean phrase was used:(“professional
retirement, and even suicide.[5-7] Due to the tremendous burnout” OR “burnout” OR “occupational stress”)
consequences of burnout in HCPs, it is very important AND (“health personnel” OR “healthcare professionals”
to understand and tackle this emerging problem. OR “nurses” OR “residents” OR “physicians” OR
“doctors”) AND (“India” OR “Indian”). The reference
Although burnout and work-related stress have been list of each full-text article was reviewed along with a
studied widely in the western/developed countries, search of related articles in Google Scholar to identify
there has been a paucity of literature about burnout in additional articles to be included in this review.
India.[6,8-11] A number of factors such as long working
hours, lack of infrastructure, lack of leisure/recreational Study selection and data collection
time, etc., can lead to burnout among HCPs.[12,13] The After removal of duplicates, titles and abstracts of
growing incidence of violence on HCPs, especially the identified studies were initially reviewed by two
doctors, may also contribute to stress in the healthcare authors (VK, JG) independently. Studies considered
profession.[13,14] Previous studies have evaluated the eligible for full-text screening were retrieved for a full
extent of burnout among various HCPs from different review. The following information was extracted from
parts of India. However, most of these studies each paper satisfying the eligibility criteria: publication
included only a few specialties and were restricted to details, the region of the study, study population, sample
one or a few institutions. Although it would not be size, and tool used to assess burnout. When necessary
surprising to find a high prevalence of burnout among and feasible, the authors of the included studies were
HCPs in India due to weaker health infrastructure, contacted to obtain additional information. Several scales
scarcity of resources, overburdened health system, and and questionnaires are available to measure burnout;
shortage of healthcare providers, a systematic review these include the Maslach Burnout Inventory (MBI),
has not been conducted yet about the prevalence of the Copenhagen Burnout Inventor y (CBI), the
burnout and its associated factors.[7,15] Such a review Burnout Clinical Subtype Questionnaire (BCSQ), the
will provide a much broader understanding of burnout Shirom-Melamed Burnout Measure (SMBM), and
and will help administrators and policymakers to ensure the Oldenburg Burnout Inventory. Among these, MBI
the wellbeing of HCPs in India. is the most widely used tool in the medical literature
for identifying and measuring burnout. MBI consists
Therefore, the purpose of this study was to systematically of 22 items that measure burnout in three different
review and analyze: 1) the prevalence of burnout among domains (emotional exhaustion, EE; depersonalization,
HCPs in India and 2) the factors associated with DP; personal accomplishment, PA), with nine items
burnout in this population. in the EE subscale, five in the DP subscale and eight
in the PA subscale.[16] Scoring is based on the Likert
METHODS scale, with each question assessed on a scale of 0 (not
at all) to 5 (yes, absolutely). The prevalence of burnout
Study design is reported separately for all the three domains using
A systematic review was conducted on studies of SUHVSHFLILHGWKUHVKROGV •LQ((•LQ'3”
burnout prevalence among HCPs in India according in PA), and was recorded for the present study. The
to Preferred Reporting Items for Systematic Reviews prevalence of burnout reported using other tools was
and Meta-analysis (PRISMA) guidelines. No ethical also recorded as appropriate.

Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 109

 Kesarwani, et al.: Burnout among Indian healthcare professionals

Risk of bias in individual studies the pooled prevalence of burnout was computed only using
Modified five-point Nottingham–Ottawa scale the studies using MBI and reporting burnout in the three
was used to assess the risk of bias in individual domains. Forest plots were developed to assess the pooled
studies.[17] The risk of bias was assessed on five separate prevalence of burnout. Due to the expected heterogeneity
domains: representativeness of the sample (low risk among the studies, a random-effects model was used to
– multiple institutions/specialties; high risk – single estimate the pooled prevalence. The I-squared (I2) test
institution/specialty), sample size (high risk – less was used to assess heterogeneity. The factors associated
than 200; low risk – more than or equal to 200), response with burnout were assessed qualitatively. Ninety five
UDWH ORZULVN•UHVSRQVHUDWHKLJKULVN percent confidence intervals (CI) were computed, and
response rate), assessment of burnout (low risk – use a P value of less than 0.5 was taken as the threshold for
of MBI for assessment of burnout; high risk – use statistical significance. Analyses were performed using
of a standard tool other than MBI), and quality of R software (version 3.1.3, Vienna, Austria).[18]
reporting (low risk – burnout defined using predefined
thresholds published in literature; high risk – lack of RESULTS
reporting of burnout prevalence or burnout defined using
authors’ own thresholds). Each criterion was given a score Study characteristics
of either 1 (low risk of bias) or 0 (high risk of bias), with The PRISMA flowchart summarizing the data collection
the maximum obtainable score being 5 (higher scores process is presented in Figure 1. A total of 212 studies
indicate higher quality of study). The total numerical were initially identified. A systematic stepwise process
score was calculated for individual studies and a score was used to exclude studies that did not fulfill the
RI ” FRUUHVSRQGV WR D KLJK ULVN RI ELDV ORZTXDOLW\ eligibility criteria. A total of 15 studies that met the
study). Two of the authors (VK, ZGH) independently inclusion criteria were finally included in this review.
assessed the risk of bias for each eligible study, and Data extracted from each study have been summarized
disagreements were resolved by the third author (JG). in a tabular form and presented in Table 1.

Statistical analysis All the 15 papers included for review were cross-sectional
The primary outcome of interest was the pooled prevalence studies. The final sample size of the included studies
of burnout. As different studies used different burnout tools, varied from 56 to 576. Gandhi et al.[19] reported the highest

Figure 1:6JGƀQYFKCITCOUJQYKPIVJGKPENWUKQPQHUVWFKGUDCUGFQP2TGHGTTGF4GRQTVKPI+VGOUHQT5[UVGOCVKE4GXKGYUCPF/GVCCPCN[UKU 24+5/# 

guidelines

110 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020

 Kesarwani, et al.: Burnout among Indian healthcare professionals
Table 1: Characteristics of included studies
Study Number of respondents Department/specialty Participants Location Scale/s used to
(response rate, %) asses burnout
.KDQQDet al>@   $OOPHGLFDOVSHFLDOWLHV 'RFWRUVQXUVHVSK\VLRWKHUDSLVWV 5DMDVWKDQ MBI
6ZDPLet al>@   0HGLFDODQGVXUJLFDOVSHFLDOWLHV 5HVLGHQWGRFWRUV 5DMDVWKDQ SMBM
5HGG\et al  XQFOHDU 'HQWLVWU\ )DFXOWLHVDQGVWXGHQWV $QGKUD3UDGHVK MBI
6KHWW\et al>@   'HQWLVWU\ 3RVWJUDGXDWHGHQWDOVWXGHQWV .DUQDWDND MBI
-XJDOHet al>@   'HQWLVWU\ 'HQWLVWV .DUQDWDND LWHP0%,
.XONDUQLet al>@   'HQWLVWU\ 1HZO\JUDGXDWHGHQWLVWV 8GDLSXU CBI
/DQJDGHet al>@   $OOPHGLFDOVSHFLDOWLHV 5HJLVWHUHGPHGLFDOSUDFWLWLRQHUV $FURVV,QGLD $EEUHYLDWHG0%,
DQG%&46
5DWQDNDUDQet al>@   $OOPHGLFDOVSHFLDOWLHV ,QWHUQVDQGUHVLGHQWV .HUDOD CBI
6KHWW\et al>@   2UWKRSHGLFVXUJHU\ 3K\VLFLDQV $FURVV,QGLD MBI
:LOVRQet al>@  XQFOHDU (PHUJHQF\GHSDUWPHQW 1XUVHVUHVLGHQWVDQGGRFWRUV 6RXWK,QGLD MBI
*DQGKLet al>@   $QHVWKHVLDDQGVXUJLFDOEUDQFKHV 5HVLGHQWV &KDQGLJDUK %&64
*URYHUet al>@   $OOVSHFLDOLWLHV H[FHSWSV\FKLDWU\ 5HVLGHQWVDQGIDFXOW\ &KDQGLJDUK MBI
6UHHODWKDet al>@   $OOVSHFLDOLWLHV 5HVLGHQWV $QGKUD3UDGHVK MBI
&KLFKUDet al>@   $OOVSHFLDOLWLHV )DFXOW\ 7DPLO1DGX MBI
%DUXDKet al>@  XQFOHDU (PHUJHQF\GHSDUWPHQW 'RFWRUVQXUVHVSDUDPHGLFV $VVDP MBI
MBI - Maslach Burnout Inventory; CBI - Copenhagen Burnout Inventory; BCSQ - Burnout Clinical Subtype Questionnaire; SMBM - Shirom-Melamed
Burnout Measure

response rate with 100% (200/200) of the contacted

HCPs responding to the survey, whereas Langade et al.[20]
reported the lowest response rate of 5% (482/9,691).
The total number of HCPs from the 15 studies was
3845, out of which 2202 (57%) were males and
1034 (27%) were females. Gender characteristics were
not defined for 609 (16%) participants. The majority
of the HCPs were doctors (n = 3650, 95%), of which
1168 (32%) were residents from different specialties.
Nurses from different specialties ranked second, with
n = 131, followed by paramedical staff (n = 36) and
physiotherapists (n = 28). Eight studies included HCPs
from multiple specialties, four from dentistry, two from
the emergency department, and one from orthopedics. To Figure 2: Bar chart showing the distribution of risks of bias among
estimate burnout, nine studies used 22 item MBI scale, various domains for all the included studies (n = 15)
two used the CBI scale, one used abbreviated MBI along
with BCSQ-12, one used BCSQ-12, one used 6-item high scores in the EE domain, 27% (95% CI: 15–44%) were
MBI scale, and one used SMBM. found to have high scores in DP domain, and 23% (95%
CI: 11– 42%) had a low score in the PA domain [Figure 3].
The mean total score for bias was 2.7 ± 1.1 (range, 0–4). There was significant heterogeneity among the studies
(OHYHQ VWXGLHV KDG D KLJK ULVN RI ELDV VFRUH ”  for all the three domains (EE: I2 = 97%, P  
whereas the remaining four had a low risk of bias. DP: I2 = 98%, P 3$,2 = 98%, P  $OWKRXJK
Sample size (7 out of 15 studies had a high risk of bias) Reddy et al.,[21] used MBI, information on prevalence could
and response rate (13 out of 15 studies had a high risk not be obtained from published or unpublished data, and
of bias) were the two most common domains where a hence, that study was not included in quantitative analysis.
high risk of bias was present [Figure 2]. Using the CBI, Ratnakaran et al.[22] found that 55% of the
respondents had personal burnout, 35% had work-related
Prevalence of burnout burnout, and 35% had patient-related burnout. Studies
Out of the 15 included studies, ten were used to estimate by Swami et al.[23] and Kulkarni et al.[24] assessed only the
the pooled prevalence of burnout using MBI in three factors associated with burnout and did not report the
domains (EE, DP and PA). Prevalence was obtained from the prevalence of burnout.
published data for eight studies and the unpublished data,
for the remaining two studies (Jugale et al. 2016,[1] Grover Factors associated with burnout
et al. 2018[13]) [Figure 3]. Using random-effects model, Age was assessed by nine studies,[1,20,24-30] of which three
24% (95% CI: 16 – 36%) of the HCPs were found to have found that younger age was associated with a higher risk

Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 111

 Kesarwani, et al.: Burnout among Indian healthcare professionals

c
Figure 3: (a) The forest plot showing the pooled prevalence of burnout among the Emotional Exhaustion domain of Maslach Burnout Inventory.
(b) The forest plot showing the pooled prevalence of burnout among the Depersonalization domain of Maslach Burnout Inventory. (c) The forest
plot showing the pooled prevalence of burnout among the Low Personal Accomplishment domain of Maslach Burnout Inventory

of burnout,[1,25,29] whereas the remaining six studies failed age and burnout.[20,24,26-28,30] Gender was evaluated
to show a statistically significant association between by 11 studies,[1,13,19,20,22,24-29] of which three found that

112 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020

 Kesarwani, et al.: Burnout among Indian healthcare professionals

females were more likely to suffer from burnout.[13,25,26] the prevalence of burnout among oncology nurses was
Langade et al.[20] too reported an association between found to be 30%, 15%, and 35% in EE, DP, and PA
females and burnout, though statistical analysis domains, respectively.[39] This suggests that burnout
was not performed. The other seven studies did not is a universal problem across specialties and different
find any significant association between burnout sets of HCPs, with miniscule difference between the
and gender.[1,19,22,24,27-29] Jugale et al.,[1] Shetty et al.,[27] developed and developing world.
and Sreelatha et al.[28] evaluated the association between
marital status and burnout and found that unmarried Multiple factors such as younger age, female gender,
respondents were more likely to have burnout. A number unmarried status, and difficult working conditions
of other closely related factors, such as longer working were found to be associated with burnout in some
hours,[20,26] professional dissatisfaction,[25,26] perceived studies included in this review. However, many
stress,[23] low remuneration,[20] lack of time for leisure studies failed to show an association between burnout
activities,[26] disturbed sleep-wake cycle,[16] and lack of and age/gender, suggesting that there is inconclusive
respect at work[20,22] were also mentioned as risk factors evidence to consider them as risk factors for burnout.
for burnout. The heterogeneity in the results of the studies could
be related to unadjusted confounding factors. Although
DISCUSSION younger HCPs can be expected to have increased
workloads, low remuneration, and less respect, the
Burnout among HCPs has been associated with incidence of burnout might also be affected by the
depression, anxiety, drug and alcohol abuse, deterioration specialty and the hospital. The higher rate of burnout
in health,[31] and suboptimal patient care.[32] Burnout found in females highlights the need for gender equality
and work-related stress have been studied widely in and family-friendly work environments, especially in a
developed countries, but there is a paucity of literature patriarchal society like India.[40-42] The higher burnout
about the same in the Indian context. This study observed in unmarried HCPs could be related to the
was designed to systematically review and analyze lack of family support, which is a known risk factor for
prevalence and risk factors of burnout among Indian depression and suicide.[43,44] Similar to our findings,
HCPs. After a systematic search of online databases, Amoafo et al.,[45] in a review of 47 studies, found that
15 studies that assessed burnout among 3845 Indian younger age, female sex, and unmarried status are
HCPs were included. Our study found that burnout predictors of burnout. In a meta-analysis of 65 studies,
is widely prevalent among Indian HCPs, and many Lee et al.[11] reported that burnout was negatively
personal and professional factors are associated with associated with autonomy, positive work attitudes, and
increased risk of burnout. quality and safety culture, whereas it was positively
associated with workload, constraining organizational
In the present study, the pooled prevalence of burnout structure, conflicts, low standards, negative work
ranged from 23% to 27% depending on the domain attitudes, and work-life conflict. Therefore, maintaining
in which burnout was assessed. Most studies from a friendly and stress-free working environment is of
different parts of the world have reported a similar paramount importance in reducing burnout among
prevalence of burnout.[9,33-35] Trufelli et al.[35] conducted HCPs.
a systematic review on the prevalence of burnout among
2,375 oncologists across the world. They reported a Even though our study is the first of its kind among
burnout prevalence of 36% in the EE domain, 34% in Indian HCPs, it has many limitations. Only a handful
the DP domain, and 25% in the PA domain. Rodrigues of studies could be included in this review. Even among
et al.[36] conducted a meta-analysis and found the these studies, there was heterogeneity with respect to
overall prevalence of burnout among residents from all the tool used to assess burnout, making it difficult to
specialties to be 35%. In a systematic review, of more perform a comparison between the studies. As a result,
than 100 studies, by Rotenstein et al.,[37] the assessment only ten studies could be used to evaluate the pooled
and prevalence of burnout showed substantial variation prevalence of burnout. Many studies had small sample
between studies, with the prevalence in some studies sizes, and the response rates were very low in most of
being more than 80%, while in some others it was them. This in itself is a limitation compared to the fact
less than 10%. In another systematic review among that there are about 12–15 million registered HCPs in
4,108 Arab HCPs, the burnout prevalence for the India[46] belonging to different geographical, ethnic,
three domains ranged from 20 to 81% for EE, 9 to and subspecialty classes. The working environment is
80% for DP, and 13 to 86% for low PA3. Similarly, the also markedly different across the various health care
overall prevalence of burnout among Iranian nurses systems in India and was not accounted for in this
was estimated to be 36% based on 21 studies including study. Finally, the present study was also unable to
4,180 participants.[38] In yet another meta-analysis, perform quantitative analysis with respect to risk factors

Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 113

 Kesarwani, et al.: Burnout among Indian healthcare professionals

associated with burnout, due to the heterogeneity in the anaesthesia: A real world problem? Curr Opin Anaesthesiol
assessment of risk factors among the included studies. 2015;28:151-8.
10. Roberts DL, Cannon KJ, Wellik KE, Wu Q, Budavari AI.
Burnout in inpatient-based versus outpatient-based
CONCLUSION physicians: A systematic review and meta-analysis. J Hosp
Med 2013;8:653-64.
In summary, our analysis found that, based on the pooled 11. Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L.
results, approximately one-fourth of Indian HCPs suffer Correlates of physician burnout across regions and
specialties: A meta-analysis. Hum Resour Health
from burnout. There was substantial variation in the
2013;11:1-24.
reported prevalence of burnout among the studies. 12. Murthy S, Rao K, Ramani S, Chokshi M, Khandpur N, Hazarika I.
Appreciation of burnout as a major health -related What do doctors want? Incentives to increase rural recruitment
problem will help in its early detection and will ensure and retention in India. BMC Proc 2012;6(Suppl 1):5.
timely interventions to tackle this problem effectively. 13. Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological
Some of the possible strategies to prevent burnout problems and burnout among medical professionals of a
tertiary care hospital of North India: A cross-sectional study.
include a reduction in working hours, scheduled Indian J Psychiatry 2018;60:175-88.
staff meetings, encouraging cooperation/discussion 14. Ambesh P. Violence against doctors in the Indian
between professionals, workshops to improve coping subcontinent: A rising bane. Indian Heart J 2016;68:749-50.
skills, etc.[47,48] As the Indian healthcare system is 15. Purohit B, Vasava P. Role stress among auxiliary nurses
constantly changing, with significant differences in midwives in Gujarat, India. BMC Health Ser v Res
2017;17:1-8.
physician-patient relations and working environment
16. Wilson W, Raj JP, Narayan G, Ghiya M, Murty S, Joseph B.
compared to other healthcare systems, it is important Quantif ying burnout among emergency medicine
to implement strategies specifically addressing professionals. J Emerg Trauma Shock 2017;10:199-204.
burnout in the Indian system. Therefore, further studies 17. Mata DA, Ramos MA, Bansal N, Khan R, Guille C,
are required to assess the effectiveness of these various Di Angelantonio E, et al. Prevalence of depression and
interventions in reducing burnout among Indian HCPs. depressive symptoms among resident physicians. JAMA
2015;314:2373-83.
18. R Core Team. R: A Language and Environment for Statistical
Financial support and sponsorship Computing. 2015. Available from: http://www.r-project.
Nil. org/. [Last accessed on 2017 Jan 07].
19. Gandhi K, Sahni N, Padhy SK, Mathew PJ. Comparison of
&RQÁLFWVRILQWHUHVW stress and burnout among anesthesia and surgical residents
There are no conflicts of interest. in a tertiary care teaching hospital in North India. J Postgrad
Med 2018;64:145-9.
20. Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS,
REFERENCES Wankhade K, et al. Burnout syndrome among medical
practitioners across India: A questionnaire-based survey.
1. Jugale PV, Mallaiah P, Krishnamurthy A, Sangha R. Burnout Cureus 2016;8:e771. Available from: https://doi.org/10.7759/
and work engagement among dental practitioners in cureus. 771. [Last accessed on 2019 Oct 12].
Bangalore city: A cross-sectional study. J Clin Diagn Res 21. Reddy RS, Lavanya R, Ramesh T, Vijayalaxmi N, Swapna LA,
2016;10:ZC63-7. Singh TR. Burnout among dental faculty and students in a
2. Romani M, Ashkar K. Burnout among physicians. Libyan J dental college. Indian J Public Heal Res Dev 2014;5:64-8.
Med 2014;9:23556. 22. Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence
3. Elbarazi I, Loney T, Yousef S, Elias A. Prevalence of and of burnout and its correlates among residents in a tertiary
factors associated with burnout among health care medical center in Kerala, India: A cross-sectional study.
professionals in Arab countries: A systematic review. BMC J Postgrad Med 2016;62:157-61.
Health Serv Res 2017;17:1-14. 23. Swami MK, Mathur DM, Pushp BK. Emotional intelligence,
4. Morse G, Salyers MP, Rollins AL, Monroe-DeVita M, perceived stress and burnout among resident doctors:
Pfahler C. Burnout in mental health services: A review of the An assessment of the relationship. Natl Med J India
problem and its remediation. Adm Policy Ment Heal Ment 2013;26:210-3.
Heal Serv Res 2012;39:341-52. 24. Kulkarni S, Dagli N, Duraiswamy P, Desai H, Vyas H,
5. Feteh VF, Njim T, Nji MA, Ayeah CM, Sama CB, Tianyi FL. Baroudi K. Stress and professional burnout among newly
Prevalence and determinants of burnout syndrome among graduated dentists. J Int Soc Prev Community Dent
physicians in Cameroon: A research proposal. BMC Res 2016;6:535-41.
Notes 2017;10:1-7. 25. Khanna R, Khanna R. Is medicine turning into unhappy
6. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How profession? Indian J Occup Environ Med 2013;17:2-6.
does burnout affect physician productivity? A systematic 26. Shetty A, Shetty A, Hegde MN, Narasimhan D, Shetty S.
literature review. BMC Health Serv Res 2014;14:1-12. Stress and burnout assessment among post graduate. Nitte
7. Al-Mendalawi M. Prevalence of burnout and its correlates Univ J Health Sci 2015;5:31-6.
among residents in a tertiary medical center in Kerala, India: 27. Shetty SH, Assem Y, Khedekar RG, Asha S, Arora M. Indian
A cross-sectional study. J Postgrad Med 2016;62:271-2. orthopaedic surgeons are less burned out than their Western
8. Epp K. Burnout in critical care nurses: A literature review. colleagues. J Arthrosc Jt Surg 2017;4:1-7.
Dynamics 2012;23:25-31. 28. Sreelatha P, Premlal L, Ryali VS. Burnout and coping
9. Rama-Maceiras P, Jokinen J, Kranke P. Stress and burnout in strategies among residents of a private medical college

114 Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020

 Kesarwani, et al.: Burnout among Indian healthcare professionals
in South India: A cross-sectional study. Ind Psychiatry J Prevalence of burnout among nurses in Iran: A systematic
2018;27:213-8. review and meta-analysis. Int Nurs Rev 2018;65:361-9.
29. Chichra A, Abhijnhan A, Tharyan P. Job stress and 39. C a ñ a d a s - D e l a Fu e n t e GA , G ó m e z - U rq u i z a J L ,
satisfaction in faculty of a teaching hospital in south India: Ortega-Campos EM, Cañadas GR, Albendín-García L,
A cross-sectional survey. J Postgrad Med 2019;65:201-6. De la Fuente-Solana EI. Prevalence of burnout syndrome in
30. Baruah A, Das S, Dutta A, Das B, Sharma T, Hazarika M. oncology nursing: A meta-analytic study. Psychooncology
Degree and factors of burnout among emergency healthcare 2018;27:1426-33.
workers in India. Int J Sci Res (Ahmedabad, India) 40. von Hippel C, Kalokerinos EK, Zacher H. Stereotype threat
2019;8:41-5. and perceptions of family-friendly policies among female
31. Pr i n s J T, G a z e n d a m - D o n o f r i o S M , Tu b b e n B J , employees. Front Psychol 2017;7:2043.
v a n d e r H e i j d e n F M M A , v a n d e Wi e l H B M , 41. Tsai SY. Impact of a breastfeeding-friendly workplace on an
Hoekstra-Weebers JEHM. Burnout in medical residents: employed mother’s intention to continue breastfeeding after
A review. Med Educ 2007;41:788-800. returning to work. Breastfeed Med 2013;8:210-6.
32. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and 42. Lantz PM. Gender and leadership in healthcare
self-reported patient care in an internal medicine residency administration: 21st century progress and challenges.
program. Ann Intern Med 2002;136:358-67. J Healthc Manag 2009;53:291-301; discussion 302-3.
33. Dyrbye LN, Thomas MR, Massie FS, Power D V, Eacker A, 43. Roy A. Risk factors for suicide in psychiatric patients. Arch
Harper W, et al. Burnout and suicidal ideation among U.S. Gen Psychiatry 1982;39:1089-95.
medical students. Ann Intern Med 2008;149:334-41. 44. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological
34. de Oliveira GS, Chang R, Fitzgerald PC, Almeida MD, autopsy studies of suicide: A systematic review. Psychol
Castro-Alves LS, Ahmad S, et al. The prevalence of Med 2003;33:395-405.
burnout and depression and their association with 45. Amoafo E, Hanbali N, Patel A, Singh P. What are the
adherence to safety and practice standards: A survey significant factors associated with burnout in doctors?
of United States anesthesiology trainees. Anesth Analg Occup Med (Chic Ill) 2015;65:117-21.
2013;117:182-93. 46. Ministry of Statistics and Programme Implementation.
35. Trufelli DC, Bensi CG, Garcia JB, Narahara JL, Abrão MN, Statistical Year Book India. New Delhi Gov. India. 2017;
Diniz RW, et al. Burnout in cancer professionals: A systematic Section-30.8.
review and meta-analysis. Eur J Cancer Care (Engl) 47. Spinetta JJ, Jankovic M, Ben Arush MW, Eden T, Epelman C,
2008;17:524-31. Greenberg ML, et al. Guidelines for the recognition,
36. Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, prevention, and remediation of burnout in health care
Gurgel K, et al. Burnout syndrome among medical residents: professionals participating in the care of children with
A systematic review and meta-analysis. PLoS One cancer: Report of the SIOP Working Committee on
2018;13:e0206840. Psychosocial Issues in Pediatric Oncology. Med Pediatr
37. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Oncol 2000;35:122-5.
Sen S, et al. Prevalence of burnout among physicians a 48. Nelis D, Quoidbach J, Mikolajczak M, Hansenne M.
systematic review. JAMA 2018;320:1131-50. Increasing emotional intelligence: (How) is it possible? Pers
38. Rezaei S, Karami Matin B, Hajizadeh M, Soroush A, Nouri B. Individ Dif 2009;47:36-41.

Indian Journal of Psychological Medicine | Volume 42 | Issue 2 | March-April 2020 115