. 2018 Sep 18;320(11):1131–1150. doi: 10.1001/jama.2018.12777

Table 1. Selected Characteristics of the 45 Studies Included in the Qualitative Synthesis^a.

Source	Continent/Region	Country	Survey Years	Specialty	No. of Participants^b	Age, y^c	Men, No. (%)^c	Burnout Assessment Instrument^d	Emotional Exhaustion Definition^e^,^f	Depersonalization Definition^e^,^f	Low Personal Accomplishment Definition^e^,^f	Overall Burnout Definition^e^,^f	Depression Screening Instrument and Definition^e
Wu et al,⁵⁵ 2013	Asia	China	2010	Multiple	1202	Mean, 38.7 (SD, 8.8)	555 (46.2)	16-Item MBI-GS	NR	NR	NR	EX ≥14, CY ≥10, and PE ≤17	NR
Wang et al,⁵⁴ 2014	Asia	China	2008	Multiple	457	Mean, 39.1 (SD, 9.6)	185 (40.5)	19-Item revised Chinese MBI-HSS	NR	NR	NR	Score ≥4.5	NR
Li et al,³⁶ 2018	Asia	China	2015	Anesthesia	1696	NR	NR	22-Item MBI-HSS	NR	NR	NR	EE ≥27 and/or DP ≥13	NR
Nishimura et al,³⁸ 2014	Asia	Japan	2011	Multiple	2635	Mean, 47.2	2422 (91.9)	16-Item MBI-GS	NR	NR	NR	EX >4.0 and (CY >2.6 and/or PE <4.17)	NR
Saijo et al,⁴⁶ 2014	Asia	Japan	2009	Multiple	488	NR	391 (80.1)	16-Item MBI-GS	NR	NR	NR	EX >4.2 and (CY >2.4 and/or PE <2.5)	PHQ-9 ≥5
Asai et al,²³ 2007	Asia	Japan	2000	Multiple	697	Mean, 45 (SD, 8.2)	639 (93.7)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	NR	GHQ-1 ≥4
Chen et al,²⁷ 2013	Asia	Taiwan	2012	Multiple	531	NR	NR	16-Item MBI-GS	EX ≥3.2	CY >2.2	PE ≤4.0	NR	NR
Wurm et al,⁵⁶ 2016	Europe	Austria	2010-2011	Multiple	5897	Mean, 44.4 (SD, 10.5)	3273 (55.5)	40-Item HBI	NR	NR	NR	Score ≥145	MDI ≥20
Vandenbroeck et al,⁵³ 2017	Europe	Belgium	2012	Multiple	1169	Mean, 43.5 (SD, 10.9)	617 (52.7)	20-Item UBOS	EE ≥2.5	Women: DP ≥1.6; men: DP ≥1.8	PA ≤3.7	EE ≥2.5, DP ≥1.6 (women)/DP ≥1.8 (men), and PA ≤3.7	NR
Pedersen et al,⁴¹ 2013	Europe	Denmark	2004, 2012	General Practice	381	NR	232 (60.9)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR
Pedersen et al,⁴³ 2016	Europe	Denmark	2014	Multiple	1186	NR	690 (54.6)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR
Pedersen et al,⁴² 2018	Europe	Denmark	2012	General practice	588	NR	306 (52.4)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27 and/or DP ≥10	NR
Brøndt et al,²⁴ 2008	Europe	Denmark	2004	General practice	379	Mean, 51.8 (SD, 6.7)	229 (60.7)	22-Item MBI-HSS	NR	NR	NR	EE ≥27, DP ≥10, and PA ≤33	NR
Lesage et al,³⁵ 2013	Europe	France	2011	Occupational medicine	1440	Mean, 52.6	418 (29.0)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤31	EE ≥27, DP ≥10, and PA ≤33	NR
Dréano-Hartz et al,²⁹ 2016	Europe	France	2012-2013	Palliative care	309	Mean, 47.2 (SD, 9.2)	101 (32.7)	22-Item MBI-HSS	EE ≥30	DP ≥12	PA ≤38	NR	NR
Pantenburg et al,⁴⁰ 2016	Europe	Germany	2012-2013	Multiple	1784	Mean, 32.8 (SD, 4)	698 (39.1)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR
O’Kelly et al,³⁹ 2016	Europe	Ireland, United Kingdom	2014	Urology	575	NR	503 (87.5)	22-item MBI-HSS	EE ≥27	DP ≥13	PA ≤31	EE ≥27 and (DP ≥13 and/or PA ≤31)	NR
Grassi and Magnani,¹³ 2000	Europe	Italy	NR	Internal medicine	328	Mean, 39.9	228 (69.5)	22-item MBI-HSS	EE >top tertile	DP >top tertile	PA <lowest tertile	NR	GHQ-12 ≥4
van der Wal et al,¹⁹ 2016	Europe	The Netherlands	2012	Anesthesia	514	Mean, 47.2 (range, 30-67)	335 (62.5)	20-Item UBOS	NR	NR	NR	EE >top quartile and (DP >top quartile and/or PA <lowest quartile)	GHQ-12 ≥2
Twellaar et al,¹⁷ 2008	Europe	The Netherlands	2002	General practice	349	Mean, 45.9 (SD, 7)	180 (51.6)	20-Item UBOS	NR	NR	NR	EE >top quartile and (DP >top quartile and/or PA <lowest quartile)	NR
Marôco et al,¹⁴ 2016	Europe	Portugal	2011-2013	Multiple	466	Mean, 38.7 (SD, 11)	196 (42)	15-Item modified MBI-HSS	NR	NR	NR	Mean subscale score ≥3	NR
Chivato Pérez et al,²⁸ 2011	Europe	Spain	2008	Allergy and immunology	404	Mean, 43.9 (SD, 8.8)	183 (45.2)	22-item MBI-HSS	EE ≥25	DP ≥10	PA ≤32	NR	NR
Riquelme et al,¹⁶ 2018	Europe	Spain	2015	Multiple	301	NR	196 (65.1)	22-Item MBI-HSS	EE >top quartile	DP >top quartile	PA <lowest quartile	EE >top quartile, DP >top quartile, and PA <lowest quartile	NR
Escribà-Agüir and Pérez-Hoyos,³⁰ 2007	Europe	Spain	2000-2001	Emergency medicine	353	NR	233 (65.4)	9-Item MBI-HSS for EE only	EE ≥27	NR	NR	NR	NR
Arigoni et al,²² 2009	Europe	Switzerland	NR	Multiple	371	NR	241 (65.5)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	GHQ-12 ≥4
Goehring et al,³¹ 2005	Europe	Switzerland	2002	Primary care	1755	Mean, 50.8	1468 (83.6)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR
Upton et al,¹⁸ 2012	Europe	United Kingdom	NR	Surgery	313	NR	282 (92.2)	16-Item MBI-GS	EX >top tertile	CY >top tertile	NR	EX >top tertile and CY >top tertile	NR
Taylor et al,⁵² 2005	Europe	United Kingdom	2002	Multiple	1294	NR	1059 (81)	22-Item MBI-HSS	EE ≥27	NR	NR	NR	GHQ-12 ≥4
Al-Dubai and Rampal,²¹ 2010	Middle East	Yemen	2006-2007	Multiple	563	Mean, 33.3 (SD, 5.7)	335 (59.5)	22-Item MBI-HSS	EE ≥27	DP ≥13	PA ≤31	EE ≥27, DP ≥13, and PA ≤31	NR
Puffer et al,¹⁵ 2017	North America	United States	NR	Primary care	2099	NR	NR	10-Item Mini Z	NR	NR	NR	Score ≥3	NR
Rao et al,⁴⁵ 2017	North America	United States	2014	Multiple	1774	NR	1027 (57.9)	16-Item MBI-GS	NR	NR	NR	EX ≥3.2, CY ≥2.6, and PE ≤3.8	NR
Shanafelt et al,⁴⁹ 2014	North America	United States	2012-2013	Oncology	1083	Median, 52	554 (50.4)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤32	EE ≥27 and/or DP ≥10	NR
Golub et al,³² 2008	North America	United States	2005	Otolaryngology	351	Mean, 52 (range, 33-87)	306 (87.2)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR
Shanafelt et al,⁴⁷ 2012	North America	United States	2011	Multiple	7288	Median, 55	5241 (71.9)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27 and/or DP ≥10	PRIME-MD ≥1
Shanafelt et al,⁵⁰ 2015	North America	United States	2014	Multiple	6822	Median, 56	4497 (67.5)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27 and/or DP ≥10	PRIME-MD ≥1
Shanafelt et al,⁵¹ 2009	North America	United States	2007	Internal medicine	459	NR	345 (77.2)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27 and/or DP ≥10	NR
Busis et al,²⁵ 2017	North America	United States	2016	Neurology	1616	Mean, 51 (SD, 12)	1091 (65.3)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27 and/or DP ≥10	NR
Campbell et al,²⁶ 2001	North America	United States	NR	Surgery	577	Mean, 50	492 (94.4)	22-Item MBI-HSS	EE ≥27	DP ≥13	PA ≤31	NR	NR
Kamal et al,³³ 2016	North America	United States	2013	Palliative care	691	NR	NR	22-Item MBI-HSS	EE ≥27	DP ≥13	NR	EE ≥27 and/or DP ≥13	NR
Shanafelt et al,⁴⁸ 2009	North America	United States	2008	Surgery	7830	Median, 51 (IQR, 43-59)	6815 (86.7)	22-Item MBI-HSS	EE ≥28	DP ≥11	PA ≤32	EE ≥28	PRIME-MD ≥1
Qureshi et al,⁴⁴ 2015	North America	United States	2010	Surgery	1605	Mean, 50.8 (range, 33-74)	1243 (73.5)	22-Item MBI-HSS	EE ≥28	DP ≥11	PA ≤32	EE ≥28 and/or DP ≥11	NR
Yoon et al,⁵⁷ 2010	North America	United States	2008-2009	Obstetrics and gynecology	1128	Mean, 47.8 (SD, 9.2)	617 (53.5)	5-Item MBI-GS for EX only	EX≥3.2	NR	NR	NR	NR
Kluger et al,³⁴ 2003	Oceania	Australia	NR	Anesthesia	422	NR	350 (83)	22-Item MBI-HSS	EE ≥28	DP ≥11	PA ≤39	NR	NR
Winefeld and Amstey,²⁰ 1991	Oceania	Australia	1987	General practice	929	Mean, 42.8	748 (79.7)	22-Item MBI-HSS	Mean EE >3	Mean DP >3	Mean PA <3	NR	NR
Maticorena-Quevedo et al,³⁷ 2016	South America	Peru	2014	Multiple	2228	NR	1697 (76.2)	22-Item MBI-HSS	EE ≥27	DP ≥10	PA ≤33	EE ≥27, DP ≥10, and PA ≤33	NR

Abbreviations: BDI, Beck Depression Inventory; CY, cynicism; DP, depersonalization; EE, emotional exhaustion; EX, exhaustion; GHQ-12, 12-item General Health Questionnaire; HBI, Hamburg Burnout Inventory; IQR, interquartile range; MBI, Maslach Burnout Inventory; MBI-GS, MBI–General Survey; MBI-HSS, MBI–Human Services Survey; UBOS, Utrechtse Burnout Schaal (Dutch adaptation of the MBI); MDI, Major Depression Inventory; Mini Z, Zero Burnout Program Survey; NR, not reported; PA, personal accomplishment; PE, professional efficacy; PHQ-9, 9-item Patient Health Questionnaire; PRIME-MD, Primary Care Evaluation of Mental Disorders.

^{^a}

Studies are ordered alphabetically by continent and then by country and medical specialty.

^{^b}

Number of participants who were practicing physicians (ie, not medical students or resident physicians) for whom burnout data were available.

^{^c}

If age and sex data for the entire population of included practicing physicians were not explicitly reported by the study, they were back-calculated or inferred when possible.

^{^d}

If the burnout assessment method was not explicitly reported by the study, it was inferred when possible based on the articles or manuals the study cited.

^{^e}

If the cutoff was not explicitly reported by the study, it was inferred when possible based on the articles or manuals the study cited.

^{^f}

Note that the MBI-GS uses the terms exhaustion, cynicism, and professional efficacy rather than emotional exhaustion, depersonalization, and personal accomplishment.

Table 1. Selected Characteristics of the 45 Studies Included in the Qualitative Synthesisa.

Table 1. Selected Characteristics of the 45 Studies Included in the Qualitative Synthesis^a.