Asian Journal of Psychiatry 58 (2021) 102619

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Asian Journal of Psychiatry

journal homepage: www.elsevier.com/locate/ajp

Burnout and job satisfaction among psychiatrists in the Mental Health

Service, Hamad Medical Corporation, Qatar
Nisha Kader a, Bushra Elhusein b, *, Nahid M. Elhassan b, Majid Alabdulla a, d,
Samer Hammoudeh c, Nur-Run Hussein a
a
Consultant Psychiatrist, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
b
Clinical Fellow, Consultation-Liaison Psychiatry, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
c
Medical Research Center, Research Affairs, Hamad Medical Corporation, Doha, Qatar
d
Clinical Assistant Professor-College of Medicine, Qatar University, Qatar

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Job satisfaction is a critical concern among medical staff and directly affects patient safety and
Burnout quality of health care services. Burnout has been reported to be correlated with job satisfaction.
Depersonalization Aims: This study aimed to determine the prevalence of burnout and level of job satisfaction among psychiatrists
Emotional exhaustion
working in the Mental Health Service, Hamad Medical Corporation, Qatar, and examine correlations among
Job satisfaction
Psychiatrists
socio-demographic variables, burnout, and job satisfaction.
Method: A cross-sectional survey was conducted using a socio-demographic questionnaire, the Maslach Burnout
Inventory (MBI), and the Job Descriptive Index (JDI).
Results: One-third of psychiatrists reported high levels of emotional exhaustion, with a similar proportion
describing low levels of personal accomplishment. Less than 20 % demonstrated high levels of depersonalization.
Trainees were more burned out than senior psychiatrists. Opportunities for promotion was the only factor with
which the majority of psychiatrists were not satisfied.
Conclusions: The prevalence of high burnout in psychiatrists remains lower in Qatar than in other countries.
Lower levels of satisfaction with co-workers, work, supervision, opportunities for promotion, and the job in
general increased emotional exhaustion and depersonalization. Interestingly, satisfaction with salary did not
have a significant effect on burnout.

1. Introduction psychiatric morbidity among hospital consultants (gastroenterologists,

surgeons, radiologists, and oncologists) was approximately 27 %.
1.1. Burnout Burnout and psychiatric morbidity were associated with feeling over­
loaded, feeling poorly managed, having inadequate resources, and being
Burnout became increasingly recognized in the 1970s to describe a exposed to patient suffering. Burnout was also associated with low
state of emotional, physical, and mental exhaustion caused by excessive satisfaction in three distinct areas: relationships with patients, relatives,
and chronic stress. According to Lee and Ashforth (1996), burnout is a and staff; professional status/esteem; and intellectual stimulation.
syndrome of emotional exhaustion (tiredness; fewer emotional re­ Mental illness, burnout, and suicidal thoughts pose a higher risk for
sources), depersonalization (development of negative, cynical attitudes; psychiatrists than other health professionals (Snibbe et al., 1989).,
impersonal treatment of clients), and feelings of a lack of personal perhaps due to the nature of their work and the populations they serve
accomplishment (thoughts of incompetence and inadequacy). Burnout is (Kumar et al., 2007). Interacting with patients who may be traumatized,
highly prevalent among health care providers (Morse et al., 2012); up to suicidal, homicidal, hostile, or unappreciative can lead to psychiatrists
67 % of mental health care providers are estimated to experience high experiencing helplessness and mental exhaustion.
levels of burnout. Several studies showed that burnout rates were rising. One U.S. study
A study by Ramirez et al. (1996) reported that the prevalence of reported that 54.4 % of physicians and other workers reported at least

* Corresponding author at: Consultation-Liaison Psychiatry, Mental Health Service, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar.
E-mail address: drbushra1@hotmail.com (B. Elhusein).

https://doi.org/10.1016/j.ajp.2021.102619
Received 14 January 2021; Received in revised form 4 February 2021; Accepted 18 February 2021
Available online 25 February 2021
1876-2018/© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
N. Kader et al. Asian Journal of Psychiatry 58 (2021) 102619

one symptom of burnout in 2014 compared with 45.5 % in 2011 (Sha­ to participants. None of the questionnaires contained any personally
nafelt et al., 2015). Another study in Thailand reported that burnout identifiable data, every possible measure was undertaken to ensure
among psychiatrists increased dramatically from 17.1 % in 2011 to 49.3 confidentiality and privacy, and all participants provided written
% in 2019 (Nimmawitt et al., 2020). informed consent.
Leaving burnout unaddressed in psychiatrists can lead to serious
consequences. Psychiatrists are vulnerable to mental suffering, psychi­ 2.2. Measures
atric co-morbidities (depression, anxiety, and substance abuse), and
medical errors; these factors can potentially lead to diminished profes­ The MBI assessed burnout. It is a 22-item self-reported questionnaire
sionalism and disruption of personal and family life (Shanafelt, 2009). that is internationally recognized, validated, and widely used to measure
Further, when psychiatrists experience burnout with other risk factors, burnout in relation to occupational stress (Bakker et al., 2002). It has
they become more susceptible to suicidal thoughts and suicide (Spickard three subscales used to measure emotional exhaustion (EE), deperson­
et al., 2002). Ultimately, burnout among psychiatrists can have a alization (DP), and feelings of a lack of personal accomplishment (PA).
negative impact on the quality of care provided to patients. The JDI was used to measure job satisfaction and comprises five
facets: satisfaction with co-workers, the work itself, pay, promotion
1.2. Job satisfaction opportunities, and supervision. It also includes job in general (JIG),
which is considered a global measure of job satisfaction.
Job satisfaction is defined as the positive feelings or emotions that A socio-demographic questionnaire recorded age, gender, marital
connect workers with their role. An employee experiences job satisfac­ status, number of children, whether they were living with family, cur­
tion through job stability, career development and growth, and a rent job title, and years spent in their current job. Job designation was
comfortable work-life balance. Job stress leads to burnout by dimin­ categorized into two groups: trainees (residents and fellows) and senior/
ishing people’s capacity to fulfill work demands. In comparison, a experienced psychiatrists (specialists, consultants, and senior
manageable workload provides opportunities to improve existing skills consultants).
as well as become successful in new areas of activity (Maslach and
Leiter, 2016). 2.3. Statistical analysis
Job satisfaction is a protective factor against burnout and negative
consequences of stress at work (Kumar, 2008). Among doctors, job Statistical analysis was conducted using the SPSS, version 22. De­
satisfaction is a vital concern, as it directly affects patient safety and mographic variables were analyzed using descriptive statistics and
quality of health care services (Wallace et al., 2009). Burnout is nega­ presented as frequencies and valid percentages if categorical or as means
tively correlated with job satisfaction, staff support, and involvement in ± standard deviations (SDs) if continuous with normal distribution;
one’s organization (Melchior et al., 1997). However, according to otherwise, variables were presented as medians and ranges. Variables
Kumar et al. (2007), despite experiencing moderate or high levels of related to burnout and job satisfaction were presented as means ± SDs.
burnout, most psychiatrists continued to experience high levels of job T-tests or one-way analyses of variance were used to compare these
satisfaction. factors against demographic variables. Chi-square tests were used to
determine relationships between categorical variables. Correlation an­
1.3. The present study alyses and linear regression were used to examine associations between
burnout variables and job satisfaction variables. Finally, a logistic
Abdulla et al. (2011) explored the prevalence of burnout in primary regression model was constructed using demographic variables to
health care physicians in Qatar and reported that 16 % of general explore their relationship with burnout and job satisfaction variables.
practitioners had burnout syndrome. In a recent systematic review
(Chemali et al., 2019), 54 articles examined burnout among physicians 3. Results
in Middle Eastern countries and revealed that high burnout levels were
reported. 3.1. Socio-demographic data
However, this study is the first on burnout and job satisfaction
among psychiatrists in Qatar. Further, an extensive search through Of the 99 participants selected, 73 responded, giving a response rate
PubMed, Web of Science, and PsycINFO using search terms reflecting of 73.7 %. The majority of participants were men (n = 43; 58.9 %),
burnout and job satisfaction in Middle Eastern countries did not yield between the ages of 25–34 years (n = 41; 57.7 %), married (n = 55; 76.4
any studies comparing burnout and job satisfaction among trainees and %), and living with their families (n = 59; 81.9 %). One-third of the
senior psychiatrists using the Maslach Burnout Inventory (MBI) and the participants did not have children (n = 24; 33.3 %). A total of 63.0 % (n
Job Descriptive Index (JDI). = 46) of the respondents were trainees. (Table 1).

2. Methods 3.2. Burnout

2.1. Participants The categorization of subscale scores as high, medium, or low was
based on the MBI scoring guidelines. On the EE subscale, 32 (43.8 %)
A cross-sectional survey was conducted among psychiatrists of all respondents scored low (score range 0–16), 20 (27.4 %) scored moder­
grades in the Mental Health Service, Hamad Medical Corporation ate (17–26), and 21 (28.8 %) scored high (≥27). On the DP subscale, 49
(HMC), which is the primary provider of specialized mental health (67.1 %) scored low (0–6), 11 (15.1 %) scored moderate (7–12), and 13
service and treatment in Qatar. The Service provides a range of acute (17.8 %) scored high (≥13). On the PA subscale, 22 (30.1 %) scored low
and community-based services, including outpatient clinics, inpatient (0–31), 29 (39.7 %) scored moderate (32–38), and 22 (30.1 %) scored
care, consultation-liaison, and emergency services across the country. high (≥39).
The potential participants were the total number of psychiatrists The mean (SD) MBI subscale scores are provided in Table 2. The
working in the mental health service at HMC at the time of conducting socio-demographic variables included were age, gender, marital status,
this study (N = 99), including residents, fellows, specialists, consultants, number of children, whether they were living with family, job desig­
and senior consultants. Approval for the study was obtained from the nation, and the number of years working in the hospital. Linear
Medical Research Centre (approval number: MRC-01-18-463). regression analyses were conducted to ascertain whether there was any
The MBI, JDI, and socio-demographic questionnaire were distributed correlation between socio-demographic variables and the three

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N. Kader et al. Asian Journal of Psychiatry 58 (2021) 102619

Table 1 3.2.2. Depersonalization

Descriptive statistics of the study population. Only 13 (17.8 %) respondents had high DP scores. Variables that had
Socio-demographic variables Frequency (%) a statistically significant association with DP were the number of chil­
dren (p = 0.010), living with family (p = 0.035), and job designation (p
Age (years)
< 25 0 = 0.002).
25–34 41 (57.7 %) The majority (n = 11; 84.6 %) of respondents who scored high on DP
35–44 16 (22.5 %) were aged 25–34. The majority (n = 9; 69.2 %) of respondents with high
45–60 8 (11.3 %) DP scores did not have children. A total of 28.3 % (n = 13) of trainees
> 60 6 (8.5 %)
Gender
had high DP scores. All respondents who scored high on DP were
Male 43 (58.9 %) trainees and had no children (n = 9; 69.2 %) or ≤2 children (n = 4; 30.8
Female 30 (41.1 %) %). Only 13.6 % (n = 8) of those who lived with family had high DP
Marital status 16 (22.2 %) scores, compared to 38.5 % (n = 5) of those who did not live with family.
Single
Married 55 (76.4 %)
Divorced 1 (1.4 %) 3.2.3. Personal accomplishment
Number of children Most of the respondents had either moderate or high PA scores
None 24 (33.3 %) (overall n = 51; 69.9 %), while 22 (30.1 %) had low PA scores. The only
≤2 24 (33.3 %) factor that had a statistically significant association with PA was job
3–4 20 (27.8 %)
>4 4 (5.6 %)
designation (p = 0.008). However, this was not a significant predictor of
Living with family low PA (p = 0.097). A total of 37 % (n = 17) of the trainees had low PA,
Yes 59 (81.9 %) compared to 18.5 % (n = 5) of senior psychiatrists (Fig. 1).
No 13 (18.1 %)
Job designation
3.3. Job satisfaction
Trainee 46 (63 %)
Senior psychiatrist 27 (37 %)
Years working at HMC JDI facet scores and a JIG score were calculated by summing the
0–3 33 (45.2 %) values of the items in each JDI facet and JIG. Overall scores for the work,
4–6 21 (28.8 %) supervision, and co-worker facets of the JDI and JIG were compiled by
7–10 11 (15.1 %)
> 10 8 (11 %)
summing the values of the 18 items. Two of the JDI facets, pay, and
promotion, have only nine items. For these two facets, the final scores
were calculated by summing the values in each facet and doubling the
sum to produce final scores. This doubling equalized the lengths of all
Table 2
JDI and JIG scales. Hence, the range of scores on each scale was 0–54.
Burnout and job satisfaction scores.
Higher scores indicated higher job satisfaction.
Variables Mean ± standard deviation; median (range) The mean (SD) JIG score was 43.23 (10.958). The mean (SD) JDI
Burnout variables scores for the co-worker facet was 34.92 (14.853), work facet was 37.04
Emotional exhaustion 20.16 ± 11.799; 19 (2–47) (14.727), pay facet was 41.14 (15.577), supervision facet was 36.38
Depersonalization 5.78 ± 6.458; 4 (0–26)
(14.064), and opportunities for promotion facet was 16.58 (16.085).
Personal accomplishment 35.22 ± 6.715; 36 (19–48)
Job satisfaction variables The majority of respondents were satisfied with JIG, work on the present
Job in general 43.23 ± 10.958; 47 (9–54) job, co-workers, pay, and supervision. However, respondents were less
People on present job 34.92 ± 14.853; 39 (0–54) satisfied with opportunities for promotion.
Work on present job 37.04 ± 14.727; 42 (0–45)
Linear regression analyses were performed to examine correlations
Pay 41.14 ± 15.577; 48 (0–54)
Opportunities for promotion 16.58 ± 16.085; 12 (0–54)
between socio-demographic variables, JIG, and JDI facets. There were
Supervision 36.38 ± 14.064; 42 (0–54) no statistically significant correlations between socio-demographic
variables and JIG. There was no statistically significant correlation be­
tween socio-demographic variables and the work and supervision facets
subscales of the MBI. of the JDI.
High scores on the EE and DP subscales and a low score on the PA The number of years working at HMC (p = 0.001) was the only
subscale indicate a high degree of burnout. For the comparative anal­ variable with a statistically significant association with the co-worker
ysis, those with low and moderate EE and DP scores were combined into facet. Those who had worked at HMC for 0–3 years and >10 years
one group, and those with high scores were considered the second were more satisfied with their co-workers. The only variable with a
group. Those with moderate and high scores were combined into one significant association with the pay facet was living with family (p =
group for the PA subscale, while those with low scores were considered 0.057). Those who lived with family were more satisfied with the pay
the second group. Logistic regression analyses were performed to received in their current job. The only variable with a statistically sig­
determine significant risk factors for high EE and DP and low PA. nificant association with the opportunities for promotion facet of the JDI
was the number of years working at HMC (p = 0.007). Those who had
3.2.1. Emotional exhaustion worked at HMC for 0–3 years were more satisfied with promotion op­
Approximately one-third (n = 21; 28.8 %) of the respondents had portunities (Fig. 2).
high EE scores, and the majority (n = 16; 76.2 %) were in the 25–34 age
group. Marital status (p = 0.001) and the number of children (p = 0.005) 3.4. Burnout and job satisfaction
were statistically significant predictors for EE. A total of 62.5 % (n = 10)
of respondents who were single had high EE scores, compared to only 20 The association between the three burnout subscales and six job
% (n = 11) of married respondents. The majority (n = 13; 61.9 %) of satisfaction variables was analyzed using Pearson’s correlation.
respondents with high EE scores did not have children.
Job designation (p = 0.044) was also associated with high EE scores. 3.4.1. Emotional exhaustion vs. Job satisfaction
The majority (n = 17; 81 %) of respondents who had high EE scores were EE had an inverse association with JIG (r = − 0.490; p < 0.001), co-
trainees; 37 % (n = 17) of trainees had high EE scores, compared to 14.8 workers (r = − 0.504; p = 0.000), work (r = − 0.409; p < 0.001), op­
% (n = 4) of experienced psychiatrists. portunities for promotion (r = − 0.295; p = 0.011), and supervision (r =

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N. Kader et al. Asian Journal of Psychiatry 58 (2021) 102619

Fig. 1. EE, DP, and PA among trainees and senior psychiatrists.

Fig. 2. Job satisfaction in relation to EE, DP, and PA.

− 0.386; p = 0.001). Those who were less satisfied with JIG, co-workers, PA.
work, opportunities for promotion, and supervision had higher EE.
4. Discussion
3.4.2. Depersonalization vs. Job satisfaction
DP had an inverse association with JIG (r = − 0.362; p = 0.002), co- Growing scientific evidence indicates that the level of burnout is
workers (r = − 0.350; p = 0.002), work (r = − 0.304; p = 0.009), op­ more prevalent among psychiatrists than among doctors in other spe­
portunities for promotion (r = − 0.256; p = 0.029), and supervision (r = cialties (Moore and Cooper, 1996). This study showed that burnout was
− 0.418; p < 0.001). Those who had high depersonalization were less generally lower among psychiatrists working in the Mental Health Ser­
satisfied with JIG, co-workers, work, opportunities for promotion, and vices in HMC, Qatar, than doctors in similar international studies
supervision. (Kumar et al., 2007).
There is a strong relation between psychiatrists’ working hours per
3.4.3. Personal accomplishment vs. Job satisfaction week and the DP sub-scale, this was found in a recent study from Egypt,
PA had a positive association with JIG (r = 0.230; p = 0.050), co- it also indicated that the burnout rate among psychiatrists of Al-Abbassia
workers (r = 0.250; p = 0.033), and work (r = 0.326; p = 0.005). Hospital was higher than in western countries, marriage and sleeping in
Those who had high PA were better satisfied with JIG, co-workers, and the home have protective effects. Furthermore, there was a significant
work. association between the high number of working hours per week and the
quality of the relationship with seniors and burnout. (Abu zied et al.,
2020).
3.5. Regression analysis of job satisfaction variables and burnout The effect of work-hour limitations on residents has been widely
subscales researched as an important environmental consideration in the devel­
opment of burnout (IsHak et al., 2009; Martini et al., 2006).
A multiple regression analysis was conducted to investigate whether Marital status and number of children were found to be statistically
job satisfaction variables significantly predicted burnout scores. The significant factors for EE. A total of 62.5 % of respondents who were
results indicated that the model explained 37.5 % of the variance and single had high EE scores, compared to only 20 % of married re­
was a significant predictor of EE (F(6,66) = 6.594; p < 0.001). JIG (B = spondents. The majority of respondents with high EE scores did not have
− 0.310, p = 0.012) and co-workers (B = − 0.250, p = 0.057) signifi­ children. Past studies have examined marriage and parenting in relation
cantly contributed to EE. to burnout. (Martini et al., 2004) showed that 65.2 % of single, divorced,
For DP, the model explained 25.2 % of the variance and was a sig­ or unmarried residents met the criteria for burnout, compared with only
nificant predictor (F(6,66) = 3.711; p = 0.003). Supervision (B = 40.0 % of married individuals. Other studies reported no correlation
− 0.284, p = 0.039) was the only factor that significantly contributed to between marriage and burnout (Shanafelt et al., 2002). Although it
DP. might be presumed that having the added responsibility of caring for
For PA, the model explained 19 % of the variance and was a signif­ children would add to one’s potential for burnout, research has shown
icant predictor (F(6,66) = 2.587; P = 0.026). Work on the present job (B that parenting can act as a protective factor against burnout (Maslach
= 0.314, p = 0.028) was the only factor that significantly contributed to

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N. Kader et al. Asian Journal of Psychiatry 58 (2021) 102619

and Leiter, 2016), which was reflected in this study as well. Data sharing statement
Trainees experience higher work-related stresses and burnout
compared to consultants. A study in the United Kingdom found that even The data that support the findings of this study are available from the
when consultants and trainees have similar job satisfaction levels, principal investigator (NK) upon reasonable request.
trainees had more symptoms of burnout (West et al., 2018). In the
present study, we found that the highest DP rate was found in trainees Declaration of Competing Interest
and those without children, despite being the most satisfied by the su­
pervision they were receiving. The authors have no competing interests to declare.
Supportive colleagues and collegiality have been cited as important
factors in increasing satisfaction among psychiatrists (Guthrie et al., Acknowledgments
1999; Lepnurm et al., 2006). This was reinforced in the present study,
where high levels of satisfaction in working with others were correlated We want to thank all mental health service doctors who participated
to all components of the MBI. Perceived support from peers or family can in this project.We want to extend our deep appreciation to the Medical
be necessary for reducing work-related stresses. Research Centre for their continuous and unlimited support.Open Ac­
Overall, high job satisfaction is strongly associated with interest in cess funding provided by the Qatar National Library (Abdulla et al.,
work, career growth and advancement opportunities, the ability to work 2011; Abu zied et al., 2020; Bakker et al., 2002; Chemali et al., 2019;
at one’s own discretion, and the ability to communicate effectively and Fleury et al., 2017; Guthrie et al., 1999; IsHak et al., 2009; Jiang et al.,
comfortably with supervisors and coworkers (Koreki et al., 2015). 2018; Koreki et al., 2015; Kumar, 2008; Kumar et al., 2007; Lee and
In conclusion, recognizing the burnout process and associated risk Ashforth, 1996; Lepnurm et al., 2006; Martini et al., 2004, 2006; Mas­
factors early is the first critical step in organizing sufficient internal and lach and Leiter, 2016; Melchior et al., 1997; Moore and Cooper, 1996;
external support needed to address the problem. Positive motivational Morse et al., 2012; Nimmawitt et al., 2020; Ramirez et al., 1996; Sha­
factors, such as work well-done recognition, promotions, and wage nafelt, 2009; Shanafelt et al., 2002, 2015; Snibbe et al., 1989; Spickard
improvement, can also go a long way to protecting against burnout. et al., 2002; Wallace et al., 2009; West et al., 2018).
Educational services aimed at educating physicians on burnout and of­
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