We read the article ‘Psychological distress, burnout and personality traits in Dutch anaesthesiologists’ by Van der Wal et al.1 that was recently published in the European Journal of Anaesthesiology and we must congratulate the authors on their work and efforts to raise awareness of burnout in anaesthetists. We would like to come forward with some contributions, as it is in line with the current work we are developing.
Although burnout as an overall research topic has been present in anaesthesia journals for more than a decade, it continues to be a problem without an effective solution. A recent publication by Shanafelt2 seems to confirm this, showing that burnout is increasing toward epidemic levels with potential implications for society in general, and anaesthesia is no exception.
Interestingly enough, the article by Van der Wal et al. presents a prevalence of burnout in Dutch anaesthetists lower than published results from other countries.2,3 This raises the question whether Dutch anaesthetists are more resilient or whether their organisations are more adequate, thus preventing them from developing higher levels of burnout? It would be worthwhile to perform a multicentre study in different countries to explore which are the characteristics of the countries with the lowest percentage of burnout. This research may in turn reveal important factors for burnout management, which depends not only on organisational factors but also on individual factors. The multiple organisational measures that have been widely recommended appear not to be effective in overcoming this problem. Moreover, anaesthesiology has inherent and unique characteristics that make it stressful. Studies including specific stressor evaluation in anaesthesia could be promising for a better understanding of true inducers of stress in the daily life of anaesthetists.
Many factors contribute to the vast array of ways in which each individual experiences, reacts and regulates stress. One of these factors is personality traits. Consistent with studies in other areas4 Van der Wal et al. found that burnout in anaesthetists is related to neuroticism; and drew attention to the fact that personality traits are usually considered stable over time and are hard to change.
However, there is now increasing consensus that personality traits also continue to develop throughout adult life,5 and personality theory also shifts in that direction. Van der Wal et al. suggest personality testing in the selection of anaesthesia residents to reduce burnout in future anaesthesiologists. As personality traits are not static and can be dynamically influenced by work life, assessing personality traits may be useful in detecting individuals at risk of developing burnout but should not exclude them. Physicians can evolve naturally or use psychological strategies to regulate stress and become good professionals.
Neuroticism is a rather general, nonspecific trait that has been associated with multiple psychopathologies, thus it is not at all surprising to find an association with burnout. To better understand the processes underlying burnout, research should focus on recent, more refined constructs, such as self-compassion and mindfulness. These constructs have been also described as personality traits and are emerging as interesting topics for research. Emotional regulation mechanisms are complex and these traits should not be considered independently, but their relative impact should be explored. In fact, emotional regulation skills appear to be centrally important in understanding how individuals respond to workplace stressors. These traits, as well as the interventions designed to promote them, seem to enhance better emotional regulation profiles, improving stress outcomes and promoting well-being.6 Standardised programmes such as Mindfulness-based Stress Reduction have also proved to benefit personality traits of neuroticism.7
Determining the differentiated influence of these psychological traits and processes in explaining anaesthetists’ stress outcomes is a key step in the development of interventions to improve stress and burnout management. Therefore, in future studies of burnout in anaesthetists, mindfulness and self-compassion traits should be evaluated. Mindfulness and self-compassion based stress reduction programmes for anaesthetists need to be evaluated and their impact, not only upon professional well-being but also in clinical care outcomes.
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1. van der Wal RA, Bucx MJ, Hendriks JC, et al. Psychological distress, burnout and personality traits in Dutch anaesthesiologists: a survey. Eur J Anaesthesiol
2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc
3. Morais A, Maia P, Azevedo A, et al. Stress and burnout among Portuguese anaesthesiologists. Eur J Anaesthesiol
4. Armon G, Shirom A, Melamed S. The big five personality factors as predictors of changes across time in burnout and its facets. J Pers
5. Roberts BW, Walton KE, Viechtbauer W. Patterns of mean-level change in personality traits across the life course: a meta-analysis of longitudinal studies. Psychol Bull
6. Raab K. Mindfulness, self-compassion, and empathy among healthcare professionals: a review of the literature. J Health Care Chaplain
7. de Vibe M, Solhaug I, Tyssen R, et al. Does personality moderate the effects of mindfulness training for medical and psychology students? Mindfulness (N Y)