Article Figures & Data
Figures
- Figure 1 Burnout Profiles and Regional Distribution in Europe
(A) Three-dimensional scatter plot illustrating z-score distributions for each MBI subscale (emotional exhaustion, cynicism, efficacy), each dot represents a survey responder while burnout profiles are indicated with different color hues (burnout, overextended, disengaged, ineffective, engaged). (B) Heat map illustrating z-scores for each MBI subscale for each burnout profile. (C) Country response rate is depicted by absolute number of response (dot size) and proportion of responses (color scale). (D) Correlation plot of RRFS members and responders per country; each dot represents a country, dot size indicates the absolute number of responses while dot color illustrates the response rate, and axes are expressed in log10 scale. MBI = Maslach Burnout Inventory; RRFS = Resident and Research Fellow Section.
- Figure 2 Burnout Profiles Based on Level of Education, Subspecialty, and COVID-19 Pandemic
(A, B) Distribution of burnout profiles according to level of education achieved (A) and subspecialty of interest (B). (C) Impact of COVID-19 on burnout profile distribution expressed as proportion of profiles. 3D-WFI = Three‐Dimensional Work Fatigue Inventory; COVID-19 = coronavirus disease 2019; PHQ-9 = Patient Health Questionnaire-9.
- Figure 3 Multidimensional Profiling of Factors Associated With Burnout Profiles
(A) Job Satisfaction Survey (JSS) score of distinct burnout profiles. Score lower than 108 express dissatisfaction, while scores higher than 144 identify satisfied responses. (B) Multidimensional Scale of Perceived Social Support (MSPSS) score of distinct burnout profiles. A mean scale score lower than 3 is considered as low support while a score of higher than 5 is considered as high support. (C) Patient Health Questionnaire 9 (PHQ-9) as depression scale for distinct burnout profiles. A score <4 indicates absence of depression, a score of 5–9 indicates mild depression, a score of 10–14 indicates moderate depression, a score of 15–19 indicates moderately severe depression, and a score 20 indicates severe depression. (D) Three-Dimensional Work Fatigue Inventory (3D-WFI) for distinct burnout profiles. A total score 40 indicates severe fatigue, a score between 20 and 40 indicates moderate fatigue, while a score <20 indicates low fatigue. Horizontal lines within the violin plots (A–D) indicate median (thick) and quartiles (thin), ****p < 0.0001, ***p < 0.001, **p < 0.01, *p < 0.05; ns, not significant by one-way analysis of variance with the Dunnett test (A–F) and the Tukey test (G–I) for multiple comparisons.
Tables
Responders Nonresponders p Value Age, y n = 314 n = 589 0.061 Mean 30.9 31.3 Median 30.0 31.0 SD 3.5 3.3 Sex, % n = 314 n = 589 0.880 Female 61.5 61.0 Region, % n = 314 n = 589 0.244 Northern Europe 4.8 6.3 Southern Europe 40.5 40.8 Eastern Europe 23.3 21.9 Western Europe 23.3 26.2 Other 8.3 4.9 Career stage, % n = 314 n = 508 0.395 Neurology resident 48.7 39.2 Neurologist 31.9 31.9 Research fellow/PhD student 19.8 17.8 Comparisons tested using Mann-Whitney for continuous variables (age) and χ2 for categorical variables (sex, region, career stage). Geographic region was assigned according to the United Nations Geoscheme.
All (n = 314) Neurology resident (n = 122) Neurology resident doing a PhD (n = 30) Neurologist (n = 55) Neurologist doing a PhD (n = 45) PhD in neurology research (n = 35) Post-doc in neurology research (n = 27) Female/male ratio Ratio 1.6 1.7 1.7 2.1 0.9 1.7 1.7 Hours per week Mean 49.5 50.6 51.4 47.2 48.6 47.3 50.9 Median 50.0 50.0 50.0 40.0 50.0 45.0 50.0 SD 13.5 13.3 11.6 14.2 11.7 15.5 15.0 Time devoted to clinical practice, % Mean 60.6 71.6 54.6 72.7 51.2 34.2 47.4 Median 65.0 75.5 55.0 80.0 50.0 27.5 50.0 SD 26.9 21.2 24.4 21.4 24.5 27.9 23.1 Time devoted to research, % Mean 21.2 9.7 21.5 16.6 31.0 58.8 27.8 Median 10.0 5.0 10.0 10.0 25.0 55.0 20.0 SD 24.0 10.7 23.0 16.4 22.9 29.6 20.6 Time devoted to teaching, % Mean 5.9 4.5 7.9 6.7 7.8 7.6 11.1 Median 0.0 0.0 5.0 5.0 5.0 5.0 10.0 SD 11.1 10.4 10.9 9.7 12.0 9.7 17.8 Time devoted to administrative work, % Mean 10.6 13.2 13.8 13.4 6.9 8.4 11.3 Median 5.0 5.0 10.0 10.0 5.0 10.0 10.0 SD 13.7 16.8 14.1 11.8 8.8 8.1 11.5 Time devoted to other activities work, % Mean 1.5 1.4 1.5 2.7 2.9 3.4 2.1 Median 0.0 0.0 0.0 0.0 0.0 0.0 0.0 SD 4.3 3.6 3.5 4.1 7.3 6.2 4.7 Nights on call per month Mean 2.9 3.3 3.3 2.8 2.2 1.1 2.0 Median 3.0 3.0 3.0 3.0 2.0 0.0 2.0 SD 3.3 2.3 2.7 3.1 1.9 2.1 2.0 Weekend on call per month Mean 1.6 1.8 1.5 1.4 1.4 1.0 1.3 Median 2.0 2.0 2.0 1.0 1.0 0.0 1.0 SD 1.2 1.1 1.0 1.3 1.3 1.3 0.9 Working in university hospital, % Proportion 80.3 79.5 96.7 61.8 88.9 88.6 77.8 Affected by the COVID-19 pandemic with increase in workload, % Proportion 43.6 37.7 50.0 52.7 51.1 28.6 48.2 Duration of neurology residency or PhD program, y Mean NA 4.7 4.9 NA 3.7 3.4 NA Median NA 5.0 5.0 NA 3.0 3.0 NA SD NA 0.7 1.1 NA 1.0 0.6 NA NRP year, % NRP1 Proportion NA 11.5 10.0 NA NA NA NA NRP2 Proportion NA 13.9 20.0 NA NA NA NA NRP3 Proportion NA 29.5 16.7 NA NA NA NA NRP4 Proportion NA 34.4 23.3 NA NA NA NA NRP5 or more Proportion NA 10.7 26.7 NA NA NA NA Time after neurology certification, y Mean NA NA NA 1.8 2.2 NA NA Median NA NA NA 1.0 2.0 NA NA SD NA NA NA 1.4 1.8 NA NA Workplace/residency abroad, % Proportion 11.5 9.0 10.0 14.3 8.9 25.7 11.1 Annual income, % of responders <15,000 € 36.6 36.1 33.3 41.8 37.8 28.6 40.7 15,000–30,000 € 39.2 47.5 36.7 25.5 40.0 40.0 29.6 30,000–45,000 € 13.7 6.6 13.3 23.6 17.8 25.7 3.7 45,000–60,000 € 5.1 4.1 10.0 3.6 4.4 5.7 7.4 60,000–75,000 € 1.6 3.3 0.0 0.0 0.0 0.0 3.7 75,000–90,000 € 2.2 0.8 6.7 0.0 0.0 0.0 14.8 >90,000 € 1.6 1.6 0.0 5.5 0.0 0.0 0.0 Abbreviations: COVID-19 = coronavirus disease 2019; NA = not applicable; NRP = neurology residency programme.
Engaged Ineffective Disengaged Overextended Burnout p Value JSS score (n = 292) Mean 137.2 128.1 124.5 111.5 106.0 <0.001 Median 140.0 127.0 123.0 113.0 105.0 SD 23.5 17.1 11.5 18.7 20.0 MSPSS score (n = 269) Mean 6.0 5.6 5.3 5.5 5.2 0.002 Median 6.2 5.8 5.6 5.7 5.5 SD 1.0 0.9 1.0 1.2 1.2 PHQ-9 score (n = 269) Mean 4.6 5.5 6.8 9.8 11.3 <0.001 Median 4.0 4.0 6.0 8.0 11.0 SD 3.8 4.5 4.6 5.4 5.2 3D-WFI score (n = 269) Mean 30.1 29.2 37.5 46.9 53.9 <0.001 Median 30.0 31.0 42.0 49.0 54.0 SD 15.2 17.3 14.9 15.1 14.0 WSAS score (n = 269) Mean 10.2 12.1 15.0 19.3 22.5 <0.001 Median 8.0 12.0 16.0 19.0 23.0 SD 7.7 8.4 10.2 9.3 8.7 LCI score (n = 258) Mean 235.4 276.4 195.6 257.6 256.5 0.611 Median 188.5 199.0 205.0 233.0 207.5 SD 167.5 238.2 109.7 170.3 167.9 Hours per week (n = 314) Mean 48.0 44.3 44.8 51.7 54.2 <0.001 Median 48.0 45.0 48.0 50.0 55.0 SD 14.4 13.3 13.6 11.8 12.6 Nights on call per month (n = 314) Mean 2.6 2.3 3.7 2.3 3.5 0.013 Median 2.5 2.0 4.0 2.0 3.5 SD 2.3 2.3 2.0 2.5 2.8 Weekend on call per month (n = 314) Mean 1.4 1.6 1.6 1.6 1.8 0.524 Median 1.0 2.0 2.0 2.0 2.0 SD 1.2 1.3 1.0 1.2 1.3 Abbreviations: 3D-WFI = Three‐Dimensional Work Fatigue Inventory; JSS = Job Satisfaction Survey; LCI = Life Change Index Scale; MSPSS = Multidimensional Scale of Perceived Social Support; NA = not applicable; PHQ-9 = Patient Health Questionnaire-9; WSAS = Work and Social Adjustment Scale.
Model Variable Estimate OR 95% CI p Value p Value summary Burnout profile Night 0.218 1.244 1.084–1.436 0.002 ** JSS score −0.023 0.978 0.959–0.996 0.017 * 3D-WFI score 0.052 1.054 1.024–1.088 <0.001 *** Engaged profile Certified neurologist 1.022 2.779 1.210–6.444 0.016 * JSS score 0.036 1.037 1.020–1.056 <0.001 *** MSPSS 0.439 1.552 1.089–2.290 0.020 * PHQ-9 −0.097 0.907 0.823–0.994 0.043 * Abbreviations: 3D-WFI = Three‐Dimensional Work Fatigue Inventory; JSS = Job Satisfaction Survey; MSPSS = Multidimensional Scale of Perceived Social Support; OR = odds ratio; PHQ-9 = Patient Health Questionnaire-9.
Variables in the multivariate logistic model for burnout profile as outcome: burnout profile, JSS, MSPSS, night shift per month, 3D-WFI, PHQ-9, being a certified neurologist; variables in the multivariate logistic model for engaged profile as outcome: engaged profile, JSS, MSPSS, night shift per month, 3D-WFI, PHQ-9, being a certified neurologist.
Asterisks denote statistical significance significance: *p < 0.05; **p < 0.01; ***p < 0.001.
Name Location Contribution Giovanni Di Liberto, MD, PhD Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data Giuseppina Baldizzi, MSc Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data; additional contributions: co-first author Vanessa Carvalho, MD Department of Neurosciences and Mental Health (Neurology), and Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Luca Cuffaro, MD Department of Health Sciences, Clinical Neurology Unit, ASST Santi Paolo & Carlo, Milan, Italy Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Anna Sauerbier, MD Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Lisa Klingelhoefer, MD Department of Neurology, Technical University Dresden, Germany Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Nina Vashchenko, MD University Hospital of Neurological Disorders, Sechenov First Moscow State Medical University, Russia Drafting/revision of the manuscript for content, including medical writing for content Lucia Pavlakova European Academy of Neurology, Head Office, Vienna, Austria Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data Anja Sander European Academy of Neurology, Head Office, Vienna, Austria Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data Marianne de Visser, MD, PhD Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands Drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data Paul A.J.M. Boon, MD, PhD Department of Neurology, Ghent University Hospital, Belgium Drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data Elena Moro, MD, PhD Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes University, France Drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data Claudio Bassetti, MD Department of Neurology, Inselspital, University of Bern, Switzerland Drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
