Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic

• Published in: Journal of affective disorders Vol. 320; pp. 517 - 524
• Main Authors: Rosen, Craig S., Kaplan, Adam N., Nelson, David B., La Bash, Heidi, Chard, Kathleen M., Eftekhari, Afsoon, Kehle-Forbes, Shannon, Wiltsey Stirman, Shannon, Sayer, Nina A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-01-2023
• Subjects: Burnout; Burnout, Professional - epidemiology; Burnout, Professional - psychology; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; Female; Healthcare professionals; Humans; Implementation climate; Job demands-resources; Job Satisfaction; Male; Pandemics - prevention & control; Psychotherapists; Surveys and Questionnaires; Veterans; COVID-19; Healthcare professionals; Implementation climate; Burnout; Job demands-resources
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.09.141

The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout.
Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic.
Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2.
This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery.
Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.
•PTSD psychotherapists' burnout rose from 40 % to 56 % during the COVID-19 pandemic.•Pre-COVID-19, support for using evidence-based psychotherapy (EBP) reduced burnout.•During COVID-19, pandemic-related stress and prior burnout increased burnout risk.•During COVID-19, more control over when and how to deliver EBPs reduced burnout.•Staff need resources to address both work and personal stressors during pandemics.