Burnout Syndrome in Primary Health Care Professionals

The study examines burnout syndrome as a response to chronic occupational stress characterized by three dimensions: emotional exhaustion, depersonalization, and reduced professional accomplishment/professional inefficacy. It emphasizes that external organizational factors such as workload, recognition, resources, autonomy, and organizational structure strongly influence burnout. Primary Health Care (PHC) professionals are at particular risk due to continuous, direct patient contact, complex care demands, and reliance on infrastructure and resources that may be insufficient, leading to psychosocial stress, frustration, and dissatisfaction. Given the implications for worker health, productivity, absenteeism, turnover, and occupational accidents, the research aims to determine the prevalence of burnout symptoms among PHC professionals in Toledo, Paraná, Brazil, to inform prevention policies.

The introduction references foundational work on burnout (Maslach, Schaufeli, Leiter) defining its three dimensions and highlighting the role of organizational factors. It notes higher prevalence among professions with direct human contact (healthcare, education, safety). Prior studies suggest PHC professionals experience particularly high burnout due to continuous patient interaction and complex demands. Brazilian studies in various regions have reported burnout prevalence among PHC workers in the range of roughly 7–11%. Organizational issues such as poor infrastructure, teamwork difficulties, resource shortages, and lack of recognition are frequently linked to reduced professional accomplishment, while high work demands and exposure to violence are associated with emotional exhaustion and depersonalization.

Design: Quantitative, descriptive, cross-sectional study assessing the occurrence of burnout symptoms among PHC professionals in Toledo, Paraná, Brazil, and correlating these with sociodemographic variables. Setting: Eleven Basic Health Units (BHUs) in Toledo, PR. Participants: Physicians, nurses, nursing technicians, and nursing assistants working at BHUs for more than 6 months, with weekly working hours of at least 20 hours, and who completed at least 75% of the MBI-HSS. Exclusion: Workers absent for health reasons or on intentional leave during data collection, and those refusing participation. Instruments: (1) Sociodemographic questionnaire (sex, age, occupation, weekly working hours, number of employment relationships, monthly income, use of psychiatric medication); (2) Maslach Burnout Inventory – Human Services Survey (MBI-HSS), Portuguese version validated by Lautert, with 22 items: 9 for emotional exhaustion (EE), 5 for depersonalization (DP), and 8 for reduced professional accomplishment (RPA). Response format: 5-point Likert frequency (1 = never; 2 = a few times per year; 3 = a few times per month; 4 = a few times per week; 5 = everyday). Scoring and classification: Symptom level cutoffs were: EE high ≥ 27; medium 17–26; low ≤ 15. DP high ≥ 13; medium 7–12; low ≤ 6. RPA high symptoms ≤ 30; medium 31–38; low symptoms ≥ 39 (note that lower RPA scores indicate higher level of symptoms). Risk for burnout was categorized jointly across dimensions: high risk if high levels in all three dimensions (high EE, high DP, low RPA); moderate risk if high levels in two dimensions; low risk if high in at most one or none. Statistical analysis: Associations between burnout scores and working hours, age, number of jobs, and monthly income were examined using Spearman’s rho; use of psychiatric medication was analyzed with chi-square test. Analyses were conducted in SPSS v25. Ethics: Conducted under Resolution 466/12 of Brazil’s National Health Council; approved by the Research Ethics Committee of Universidade Federal do Paraná (process 3683180/2019).

Sample: 109 workers participated; 94 valid questionnaires (86.23%) were analyzed. Demographics: 76.14% female; 71% younger than 40 years (with 59% aged 30–39). Professional categories: nursing technicians 42.05%, nurses 31.82%. Working hours: 62.07% worked 40–60 hours/week; 80.23% had a single employment contract. Income: 44.58% earned less than three minimum wages. Use of psychiatric medication: 17.05% reported use. Overall burnout risk: High risk in 10 participants (10.6%); moderate in 17 (18.1%); low in 67 (71.3%). Dimension-specific high symptom levels: Emotional exhaustion 29.8% (28/94); reduced professional accomplishment 52.1% (49/94); depersonalization 22.3% (21/94). Medium levels predominated for EE (54.3%) and DP (53.2%); only 6.4% showed low symptoms on RPA (i.e., high professional accomplishment). Gender: High EE and high RPA symptoms were similar between men and women (~28–29%); high DP symptoms were more prevalent among men (38.09%) than women (17.90%). Age: Seven of the ten high-risk cases were under 40, but dimension-specific high symptom prevalence was similar across age groups; notably, 50.84% of younger participants had high RPA symptoms versus a predominance of medium RPA symptoms (58.30%) among older participants. Professional category: High risk prevalence was 11.7% among physicians and 9.23% among nursing staff; 1 of 6 oral health workers was high risk. Over 90% of physicians and nursing professionals had medium-to-high RPA symptoms. Working hours and number of jobs: No significant differences; the three professionals working >60 hours/week were all low risk; those working 40–60 hours/week showed slightly higher EE (31.4%) versus <40 hours (27.5%). Association with psychiatric medication: Significant association with burnout risk (p = 0.001); half of the high-risk participants were using psychiatric medication.

The study demonstrates a 10.6% prevalence of high risk for burnout among PHC professionals in Toledo, aligning with prior Brazilian PHC studies reporting similar ranges. While most were low risk overall, medium symptom levels predominated for emotional exhaustion and depersonalization, and more than half exhibited high symptoms of reduced professional accomplishment. The low proportion indicating high professional accomplishment (6.4%) underscores the salience of organizational contributors—such as limited autonomy, scarce resources, poor infrastructure, teamwork difficulties, and insufficient recognition—in PHC settings. Consistent with literature, direct and sustained contact with complex patient demands likely contributes to elevated emotional exhaustion and depersonalization. Physicians showed slightly higher high-risk prevalence than nursing professionals, reflecting pressures for productivity and the emotional burden of complex clinical scenarios. A significant association between prior use of psychiatric medication and burnout risk suggests potential overlap with mental health conditions (e.g., depression) that share symptomatology but differ etiologically, reinforcing the need for careful differential assessment. Younger professionals tended to present higher symptoms of reduced professional accomplishment, consistent with unmet career expectations observed in other studies. Gender patterns showed higher depersonalization among men, mirroring reports that men may manifest greater emotional distancing in occupational contexts. Overall, findings substantiate burnout as a meaningful occupational health issue in PHC, with implications for workforce well-being and service quality, and they corroborate the recognition of burnout in ICD-11.

Among PHC professionals in Toledo, Paraná, 10.6% were at high risk for burnout, with high symptom prevalence particularly in reduced professional accomplishment, and substantial proportions showing medium to high emotional exhaustion and depersonalization. The study provides region-specific evidence consistent with national findings and highlights organizational and psychosocial stressors in PHC that may drive burnout. The authors consider the study to have internal validity and applicable insights for similar PHC contexts, supporting the development of preventive public health policies and managerial strategies aimed at improving working conditions, recognition, autonomy, and resources.