Risk of burnout syndrome in paediatricians in Bogotá, Colombia: a cross-sectional survey

Abstract

Background

Burnout syndrome is a significant issue among healthcare professionals, significantly affecting their mental well-being. Its prevalence has increased since the onset of the COVID-19 pandemic. In Colombia, data on burnout prevalence are limited, and no specific studies have been conducted in paediatrics. Therefore, this study aims to assess the risk of mental disorders and burnout syndrome among paediatricians working in various healthcare settings in Bogotá during 2023.

Methods

A cross-sectional survey was conducted among paediatricians in Bogotá, Colombia. The sample size was calculated at 179 participants based on the city’s paediatrician population and previous studies on burnout prevalence in paediatric emergency services. The survey included the Maslach Burnout Inventory (MBI) for medical personnel, the Self-Report Questionnaire, the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2.

Results

A total of 186 surveys were collected, revealing that 95% of paediatricians were at risk of burnout syndrome. This was indicated by impairments in at least one of the three MBI domains: depersonalisation, emotional exhaustion and reduced personal accomplishment. Furthermore, a relationship was identified between unfavourable working conditions and the risk of mental illness, highlighting the urgent need for intervention by health authorities and medical organisations.

Conclusion

There is a clear association between working conditions and mental health, highlighting the urgent need for action from health authorities and medical organisations.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Burnout syndrome affects healthcare professionals and is associated with various personal, social and workload-related factors.

WHAT THIS STUDY ADDS

• This study establishes possible associations between different workload conditions and the risk of developing burnout syndrome and mental health disorders, while also defining specific cut-off points to help mitigate this risk.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Identifying concrete thresholds—such as the number of workplaces, weekly working hours, number of patients seen per day and time allocated per consultation—may facilitate the development of monitoring systems for risk prevention, as well as guide the design of labour policies that support the mental health of healthcare professionals.

Introduction

The WHO defines mental health as ‘a state of mental well-being that enables people to cope with the stresses of life, develop their abilities, learn and work well and contribute to their community’.¹ While this definition applies to the general population, it holds relevance for healthcare professionals due to the social impact of their work and the high demand for their services.

Several factors can compromise the mental health of this group, particularly those related to the work environment and workload. Among them are high job demands, low control over activities and an imbalance between effort and reward,² conditions that have worsened since the COVID-19 pandemic.³ Additionally, individual factors like sociodemographic characteristics (such as ethnicity, upbringing and exposure to violence),^{4 5} lifestyle habits (including smoking and physical activity)⁶ and a history of mental illness (eg, depression)² play a significant role. These elements not only affect healthcare professionals’ job performance⁷ but also increase their risk of developing mental disorders and associated complications.^{8 9}

One of the primary mental health risks among healthcare professionals is burnout syndrome, a condition characterised by physical and emotional exhaustion. It manifests as a negative and detached attitude, leading to a loss of motivation and impaired physician–patient relationships, affecting diagnostic and therapeutic approaches.⁸,¹⁰ Burnout is linked to working conditions and individual characteristics, and its prevalence has increased since the COVID-19 pandemic.¹¹ This syndrome has severe consequences, as it is associated with various mental health disorders, including depression, substance use and suicide, the latter reaching alarming levels, with estimates of up to 400 physician deaths per year worldwide.^{8 9}

In Colombia, although the prevalence of burnout syndrome among healthcare professionals has been assessed, no specific research has been conducted for paediatricians. Globally, the prevalence of burnout in paediatrics varies widely, ranging from 17.6%¹² to 76% in a 2015 report, which found depersonalisation in 66% of respondents¹³ before the COVID-19 pandemic. The demand for paediatric services, access to care and working conditions for paediatricians present significant challenges. High demand and workload limit timely access to paediatric and subspecialty services, affecting child health outcomes, with mortality rates comparable to those in sub-Saharan Africa.¹⁴,¹⁷ Given these concerns, this study aims to answer the following question: What is the risk of mental illness and burnout syndrome among paediatricians working in Bogotá in 2023?

Methods

A cross-sectional survey was designed for paediatricians in Bogotá, Colombia. Participants were contacted through various digital channels, including email, text messages and WhatsApp distribution lists. A sample size of 179 respondents was calculated based on a total population of 1222 paediatricians in Bogotá, according to a 2017 study by Álvarez and colleagues.¹⁸ A 49.5% prevalence of burnout syndrome in paediatric emergency services was considered,⁹ with a 95% confidence level and 90% power, using EpiDat V.4.1. The sampling was non-probabilistic and based on a self-selection process to maintain the anonymity of the respondents. Access to the survey was provided through a mass dissemination process via digital channels (WhatsApp and email) of paediatricians registered in the city of Bogotá. The survey was designed following the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP), an instrument that has been validated in the Spanish language and in health personnel both at the professional and training level in Colombia.¹⁹,²¹ The survey used is available for free and open access on the internet through the following link: https://ie-inteligenciaemocional.com/wp-content/uploads/2021/06/Burnout_cuestionario-Maslach.pdf, the version for healthcare professionals and three dimensions: depersonalisation, emotional exhaustion and personal accomplishment.²⁰ Additionally, three other instruments were included to evaluate mental health risks: the Self-Report Questionnaire (SRQ), the Patient Health Questionnaire-2 (PHQ-2) for depression risk and the Generalised Anxiety Disorder-2 (GAD-2) for anxiety risk. All instruments have been validated for the Colombian population.^{7 22 23} Since 2020, these tools have been publicly accessible through the Ministry of Health website as part of the programme of integrations of routes in health, ‘Rutas Integradas de Atención en Salud’.²⁴

Sociodemographic data, economic status and workload information were also collected. The survey, including responses and data storage, was conducted using the Research Electronic Data Capture platform, affiliated with the Hospital Universitario Fundación Santa Fe de Bogotá (HU-FSFB), after participants read and accepted an informed consent form. Respondents answered anonymously, ensuring their responses could not be tracked. Upon completing the survey, each participant received recommendations, feedback on their results and guidance on accessing various individual, institutional and district-level support networks. This information was automatically generated without the possibility of tracking, thus guaranteeing anonymity. A descriptive analysis was conducted, presenting qualitative variables in absolute and relative frequencies and quantitative variables using statistical measures based on their distribution, assessed with the Kolmogorov-Smirnov test. Agreement and overlap between instruments were evaluated using Cohen’s Kappa coefficient. A bivariate analysis was performed between working conditions and mental health risk. In the MBI, any medium or high score in one of its domains was considered a risk; in the other instruments, risk was determined based on their binary classification. Finally, the correlation between workload and outcomes was assessed using Spearman’s rho, with statistical significance defined as p<0.05. The analysis was performed using SPSS software, V.21.

Patient and public involvement

This study focused on a specific population group in which the research subjects were not patients but healthcare professionals. This creates a particular situation when involving participants, as the researchers themselves belong to the same population.

Nevertheless, an engagement process was carried out with healthcare personnel from the HU-FSFB. This included professionals participating in the ‘Cuido para Cuidarme’ programme, which is aimed at monitoring and supporting the mental health of medical staff. As part of the project, two psychiatrists from the programme participated; they contributed to the formulation of the research question, provided guidance on the use of validated scales and the development of the questionnaire, and supported the feedback process for individuals at risk of mental health disorders.

Regarding the communication of results to participants, this was conducted in two phases. The first phase was individual and anonymous: each participant received immediate feedback on their survey results and risk scores for burnout syndrome and mental health disorders (depression and anxiety). In addition, professional support recommendations and contact information for various healthcare centres, both within the institution and across the city of Bogotá, were provided.

In the second phase, an infographic (attached) was created and shared with paediatric medical associations in Bogotá. The results were also disseminated at the institutional level and through academic discussion forums.

Results

The survey was conducted in November 2023 and involved the participation of 194 paediatricians. Out of the respondents, 186 completed the questionnaire. One respondent registered but did not finish the survey, leading to a data loss rate between 0.5% and 2.1%.

Before examining the sociodemographic characteristics, history of mental disorders and working conditions of paediatricians, an agreement analysis was conducted between the questionnaires used to identify the risk of burnout syndrome and other mental health conditions, such as depression, alcoholism and anxiety. The analysis revealed no significant overlap in risk detection, as indicated by the low concordance coefficients. However, the two instruments used to assess depression risk showed an acceptable agreement, with a kappa index of 0.36.

Study population characteristics

The sociodemographic characteristics of the respondents revealed a predominance of females, with a ratio of four women for every man in the specialty. The average age was 43±10 years, with most participants identifying as heterosexual. Only 5% identified with a diverse sexual orientation, with same-gender attraction being the most common. 64.6% of respondents were in a relationship, with 47.9% being married. Additionally, 26% were single, and fewer than 10% were separated or divorced. Most respondents have a privileged socioeconomic position, comprising 76.6% of the sample, and none are at risk of poverty or economic vulnerability. Two-thirds of the respondents were born in Bogotá. All participants were affiliated with the General Social Security Health System, and more than 85% had additional health insurance.

Approximately 75% of respondents reported having a religious belief, with Catholicism being the most prevalent, followed by Christianity. Additionally, about 65% of respondents participated in physical activity, dedicating an average of 2.6–3 hours per week.

Working conditions

Outpatient consultation was the primary job for 36.2% of respondents, followed by emergency services (25.4%) and paediatric critical care units (19.7%), surpassing hospitalisation services by 10–15 percentage points. The most common primary work shift was a full day (12 hours) for 36.8%, followed by morning shifts (34.2%). A higher proportion of paediatricians worked night shifts than afternoon shifts (15.5% vs 13.5%).

Many paediatricians maintain multiple employment positions (most with two jobs), with some holding as many as five concurrent roles. The average work time was 50 hours per week (±18 hours), exceeding the standard full-time workload. 65% worked between 32 and 68 hours weekly, with reports of up to 150 hours per week, covering 89% of the total weekly time. More than 80% worked on weekends. At least half of the respondents saw 15 or more patients daily, most seeing between 10 and 20. The maximum reported patient load was 60 per day, with consultation times ranging from 20 to 30 min per patient, with 20 min being the most common.

Approximately one-third of respondents did not take annual vacations, and more than 70% relied exclusively on medical practice as their source of income. At least 50% had been practising as paediatricians for 11 years or more.

Mental health and burnout risk

23% of respondents reported a history of psychiatric disorders, with depression being the most common (62.5%), followed by anxiety (50%), either individually or as a comorbid condition. For half of those diagnosed, the duration of the condition ranged between 1 and 5 years, with 2 years as the cut-off point. Over 80% of individuals undergo some form of treatment, with 75% receiving psychotherapy alone or in combination with medication. Only two respondents reported a history of burnout syndrome, and a history of psychiatric disorders was not identified as a risk factor for burnout syndrome among them.

Screening tool results

The answers indicated that the most affected aspects related to the risk of burnout syndrome were depersonalisation, followed by emotional exhaustion (figure 1). These factors were present in more than half of the paediatricians at elevated risk and 95% of those with moderate to high scores. In contrast, personal accomplishment showed a low-risk profile in most participants. Integration of questionnaire scores revealed that 95% of paediatricians were at risk of burnout syndrome due to the impairment of at least one of the three evaluated aspects.

Figure 1. Maslach Burnout Inventory results for paediatricians in Bogotá, Colombia, 2023.

Regarding the risk of other mental health conditions, the SRQ identified a higher risk of depression (20.5%), followed by alcohol dependence (8.5%). Additionally, the PHQ-2 indicated a depression risk in 52.4% of respondents, while the GAD-2 identified an anxiety risk in 19.8%.

Burnout syndrome and mental health risk assessment

The analysis of sociodemographic characteristics, history of mental disorders (sex p=0.69; age p=0.29–mean difference −3.6 years; gender p=0.91; previous psychiatric diagnosis p=0.12), workplace, work schedule and working on weekends did not show an association with the risk of burnout syndrome (table 1).

Table 1. Sociodemographic characteristics and work aspects according to the risk of burnout syndrome in paediatricians in the city of Bogotá, 2023.

Variable	Category	Burnout risk				P value
		Yes		No
		N	%	N	%
		x	s	x	s
		p50	RIC	p50	RIC
Job place	Public consultation	49	26.20%	2	1.10%	0.92*
	Private consultation	17	9.10%	1	0.50%
	Emergency room	44	23.50%	2	1.10%
	Hospitalisation	17	9.10%	2	1.10%
	Paediatric intensive care unit	36	19.30%	1	0.50%
	Neonatal care unit	14	7.50%	1	0.50%
	Neonatal delivery room	1	0.50%	0	0.00%
Total		178	95.20%	9	4.80%
Shift	Morning	58	31.00%	5	2.70%	0.42*
	Afternoon	26	13.90%	0	0.00%
	Full day	66	35.30%	3	1.60%
	Night	28	15.00%	1	0.50%
Total		178	95.20%	9	4.80%
Works on weekends	Yes	148	79.10%	6	3.20%	0.19†
	No	30	16.00%	3	1.60%
Total		178	95.20%	9	4.80%
Weekly work time (hours)		50.26	±17.73	35.89	±17.14	0.02 ‡
						Mean difference: 14.37
Number of workplaces		2	1–2	1	1–2	0.03§
Number of daily patients		15	10–20	10	8–20	0.21§
Time per patient (min/patient)		25	20–30	30	20–30	0.67§

Italic values: statistical significance p<0.05

^*χ2 test.

^†Fisher’s exact test.

^‡Student’s t-test.

^§Mann-Whitney U test.

The analysis of working conditions revealed a higher risk of burnout syndrome in paediatricians with two or more jobs and those who worked more than 50 hours per week (table 1). This trend remained consistent for depression risk, as measured by both SRQ and PHQ-2, where working more than 50 hours per week increased the likelihood of depression (table 2). Additionally, a higher number of daily patients (16 or more) and shorter consultation times (≤24 min) were associated with an increased risk of depression (table 2). No sociodemographic or occupational variables were associated with a higher risk of anxiety.

Table 2. Work aspects according to the risk of depression (SRQ and PHQ2) in paediatricians in the city of Bogotá, 2023.

Variable	Category	Depression risk				P value
		(SRQ and PHQ2)
		Yes		No
		N	%	N	%
		x	s	x	s
		p50	RIC	p50	RIC
Job place	Public consultation	26	13.50%	26	13.50%	0.82* 0.06*
		31	16.40%	21	11.10%
	Private consultation	9	4.70%	9	4.70%
		9	4.80%	8	4.20%
	Emergency room	26	13.50%	23	12.00%
		32	16.90%	17	9.00%
	Hospitalisation	7	3.60%	12	6.30%
		6	3.20%	13	6.90%
	Paediatric intensive care unit	21	10.90%	17	8.90%
		14	7.40%	23	12.20%
	Neonatal care unit	8	4.20%	7	3.60%
		6	3.20%	8	4.20%
	Neonatal delivery room	1	0.50%	0	0.00%
		1	0.50%	0	0.00%
Total		98	51.00%	94	41.00%
		99	52.40%	90	47.60%
Shift	Morning	32	16.70%	33	17.20%	0.40* 0.37*
		30	15.90%	35	18.50%
	Afternoon	17	8.90%	9	4.70%
		17	9.00%	9	4.80%
	Full day	36	18.80%	35	18.20%
		38	20.10%	31	16.40%
	Night	13	6.80%	17	8.90%
		14	7.40%	15	7.90%
Total		98	51.00%	94	49.00%
		99	52.40%	90	47.60%
Works on weekends	Yes	82	42.70%	77	40.10%	0.19* 0.01*
		89	47.10%	68	36.00%
	No	16	8.30%	17	8.90%
		10	5.30%	22	11.60%
Total		99	52.40%	90	47.60%
		99	52.40%	90	47.60%
Weekly work time (hours)		52.69	±18.43	46.66	±16.45	0.02 †
						Mean difference 6.03
		53.01	±19.31	46.43	±15.18	0.01 †
						Mean difference 6.58
Number of workplaces		2	1–2	2	1–2	0.166 ‡
		2	1–2	2	1–2	0.84‡
Number of daily patients		16	10–20	12	8–20	0.01 ‡
		17	12–21	12	8–19	<0001‡
Time per patient (min/patient)		24	20–30	30	20–30	0.04 ‡
		20	20–30	30	20–40	<0001‡

Italicised values correspond to the results of the SRQ questionnaire, and bold values correspond to the PHQ-2 questions.

p50 is median and RIC is interquartile range.

Fisher’s exact test.

^*2 test.

^†Student’s t-test

^‡Mann-Whitney U test.

PHQ-2, Patient Health Questionnaire-2; SRQ, Self-Report Questionnaire.

Finally, correlation analysis (table 3) confirmed these trends, showing a proportional correlation between weekly working hours, higher risk scores for emotional exhaustion and depersonalisation in burnout syndrome and higher depression scores in the SRQ. Similarly, a higher number of daily patients correlated with increased risk scores in all three aspects of burnout syndrome, as well as an elevated risk of depression (SRQ and PHQ-2) and even a heightened risk of anxiety.

Table 3. Correlation between mental pathology risk scores and work aspects in paediatricians in the city of Bogotá, 2023.

Variable	Correlation	Weekly work time (hours)	Number of daily patients	Time per patient (min/patient)
Burnout—emotional exhaustion score	ρ (rho)	0.242**	0.336**	−0.286**
	p	0.001	<0001	<0001
Burnout—depersonalisation score	ρ (rho)	0.223**	0.328**	−0.245**
	p	0.002	<0001	0.001
Burnout—personal accomplishment score	ρ (rho)	−0.075	−0.173*	0.212**
	p	0.305	0.017	0.003
Self-Report Questionnaire depression score	ρ (rho)	0.176*	0.306**	−0.272**
	p	0.017	<0001	<0001
Patient Health Questionnaire-2 depression score	ρ (rho)	0.121	0.267**	−0,270**
	p	0.098	<0001	<0001
Generalised Anxiety Disorder-2 anxiety score	ρ (rho)	0.088	0.229**	−0.208**
	p	0.228	0.001	0.004

* and ** both correspond to: Sperman's Rho

ρ (rho), Spearman's rho.

In contrast, consultation time showed an inverse correlation, where shorter consultation times were associated with higher risk scores for all burnout syndrome aspects, depression and anxiety.

Discussion

Burnout syndrome among healthcare professionals has increased since the COVID-19 pandemic, with global prevalence around 49.5% and 45.6% in Colombia. Previous studies have identified risk factors such as sex, marital status, income level and work area (especially emergency departments),^{11 13} in addition to an imbalanced work structure characterised by irregular hours and high workload.² This study provides a unique approach as, in addition to analysing factors associated with burnout syndrome, it seeks to establish cut-off points for these factors and assess their impact on other mental health conditions, such as depression and anxiety. Various validated instruments were employed to accomplish this, which showed no significant overlap.

In this investigation, the risk of burnout syndrome reached a 95% prevalence; the criteria included both high- and moderate-risk classifications in the different evaluated aspects. This strategy was adopted to enhance screening sensitivity and propose cut-off points aimed at prevention. However, if only the high-risk classification were considered, the prevalence would be 64%, still reflecting a significant impact on the mental health of paediatricians in Bogotá. Additionally, it was found that 24% of respondents had a history of depression and/or anxiety, with more than 80% of these professionals undergoing treatment.

Although studies have described classic risk factors for burnout syndrome,¹¹²⁵,²⁹ the findings of this study indicate that workload is the most significant factor, regardless of the work area or schedule. Significant associations were identified between the risk of burnout, as well as depression and anxiety, with the following variables: (1) working more than 46 hours per week or in more than two workplaces, (2) seeing more than 16 patients per day and/or (3) having consultation times of less than 30 min, regardless of the work shift (morning, afternoon or night) or the work area (hospitalisation, emergency, intensive care units or outpatient consultation).

These findings allow for the design of surveillance and prevention strategies focused on these occupational factors, as they are easily measurable and monitorable within the work environment. While the results may not apply to all healthcare professionals, they provide a basis for future studies that explore various medical specialties and compare these findings with established occupational and sociodemographic risk factors.

Strengths and limitations

One of the main strengths of this study is the absence of interviewer bias, as participants responded anonymously. This minimises the chances of responses being affected by employer evaluations or job security concerns. However, a limitation is that participants were affiliated with the Colombian Society of Paediatrics (Bogotá regional division) and FSFB, implying a self-selection process when completing the survey.

Another limitation is measurement bias, as the presence of pre-existing psychiatric disorders or symptom somatisation before entering the workforce could influence responses. However, the concordance analysis conducted at the beginning of the study helped partially control for this bias.

Additionally, there is a risk of over-representation of responses from professionals most affected by workload and/or mental illness. However, this was mitigated by employing an adequate sample size calculation, ensuring the validity of the findings due to representative coverage of the paediatrician population in Bogotá.

Final recommendations

The results highlight the significant mental health needs of the study population and emphasise the importance of monitoring, detecting, supporting and treating psychiatric conditions in physicians. Regardless of the professionals’ socioeconomic conditions—which show notable heterogeneity and do not correlate with the risk of burnout—it is crucial to strengthen occupational health programmes. At HU-FSFB, the care ‘Cuido para Cuidarme’ programme has been established to monitor and provide mental and emotional support to institutional staff. This initiative gained prominence during the COVID-19 pandemic.

In conclusion, the evidence points to a significant association between demanding working conditions and the deterioration of mental health. Factors such as excessive patient loads and long working hours can trigger various conditions. Therefore, further research is needed to confirm a causal relationship and to establish thresholds that can guide interventions by health authorities and professional organisations. To begin, implement workplace policies that address the following:

• Reducing work hours and the number of patients seen per shift.

• Increasing consultation time per patient.

• Enhancing psychosocial support for healthcare professionals.

It is crucial to understand the impact of these changes, as the healthcare system is shaped by complex factors such as training costs, the demand for paediatricians and the stigma surrounding mental health support and diagnoses. Also, future research should prioritise specific, evidence-based strategies to mitigate these risks, benefiting both physicians and their patients.

Data availability statement

Data are available upon reasonable request.