Burnout Among School Teachers During the COVID-19 Pandemic in Jazan Region, Saudi Arabia

Background: Burnout is a syndrome that results from stressors in the work environment that have not been successfully managed. The prevalence of burnout among schoolteachers was always controversial. COVID-19 pandemic added more stressors to teachers since they had to change their working styles in response to the pandemic lockdowns or curfews. In Saudi Arabia, the prevalence and determinants of burnout among school teachers were not measured by any other group during the COVID-19 pandemic stressors.

Methods: A cross-sectional survey was conducted among 879 teachers in the Jazan region, Saudi Arabia, using the Maslach Burnout Inventory (MBI), during April 2021. Multistage cluster random sampling was used.

Results: The mean age of the participants was 41.4 (±6.9) years. Male teachers represented 52.6% of the participants while females represented 47.4%. Most teachers showed burnout symptoms (69.6%). Consequences of burnout were observed, such as using psychotropic medications (4.6%), absenteeism (45.6%), lack of job satisfaction (7.7%), and changing schools (15.8%). Using the MBI scale, most teachers showed medium or high emotional exhaustion (57.6%), low depersonalization (62.2%), and low personal accomplishment (51.4%).

Conclusion: Most teachers showed symptoms of burnout during the COVID-19 pandemic. Being an expert and ability to adapt to technology during the COVID-19 pandemic proved to effectively reduce burnout symptoms. Increasing incentives, early detection, and improving the work environment is recommended to diminish burnout consequences.

Introduction

Burnout was defined as “a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job” (Maslach and Leiter, 2016). That is why it is considered as an occupational, psychological syndrome (Montero-Marin et al., 2009; Njim et al., 2019; Raymaker et al., 2020). It is usually developed in response to poor working circumstances, interpersonal interactions, poor work management, and administration (Moueleu Ngalagou et al., 2019; Ndongo et al., 2020; Civilotti et al., 2021; Goldstein and Alesbury, 2021; Losung et al., 2021; Sener et al., 2021; Wirkus et al., 2021). It usually affects medical professionals, teachers, police officers, army soldiers, as well as many other professionals (Burki, 2020; Ndongo et al., 2020; Goldstein and Alesbury, 2021; Grupe et al., 2021; Llorca-Pellicer et al., 2021; Mák et al., 2021; Márquez et al., 2021; Ribeiro et al., 2021; Righi et al., 2021; Wirkus et al., 2021). The syndrome is characterized by various symptoms ranging from emotional to psychiatric, cognitive, and psychosomatic symptoms with different severities (Bauer et al., 2006; Schilling et al., 2019; Lass-Hennemann et al., 2020; Civilotti et al., 2021; Juczynski and Oginska-Bulik, 2021; Oginska-Bulik and Juczynski, 2021; Righi et al., 2021). On the other hand, some studies detected relations between burnout and the personality types, emotional and spiritual intelligence (Pishghadam, 2012; Pishghadam et al., 2022). May be that why it could lead to premature retirement or even suicide in severe cases (Bauer et al., 2006; Christopher et al., 2020; Queiros et al., 2020; Harvey et al., 2021). Although some studies reported a low provenance of around 5% or less among teachers (Purdy et al., 1987; Maric et al., 2020; Pereira et al., 2021). Other studies reported a prevalence of 21% among Tunisian teachers and 24.5% among Iraqi teachers (Chennoufi et al., 2012; Al-Asadi et al., 2018).

Since December 2019, with the outbreak of the COVID-19 pandemic, burnout has increased dramatically not only among healthcare professionals but also among other professions (Afulani et al., 2021; Ma et al., 2021; Naldi et al., 2021; Oksanen et al., 2021). This would be due to changing work and lifestyles in response to the lockdowns and curfew that pushed the government to adopt working from home for some professions (Prado-Gasco et al., 2020; Price, 2020; Suliman et al., 2021).

The Kingdom of Saudi Arabia was also affected by the COVID-19 pandemic. Although the Ministry of Health implemented prevention strategies early in March 2020, the prevalence of COVID-19 increased to the extent that the Kingdom decided to go into lockdown for months and even partial or full curfew for sometimes (Alsofayan et al., 2020; MOH, 2020). In Saudi Arabia, the majority (73%) of teachers reported that they received online learning experiences and can support student learning through digital technology (Mann et al., 2020). However, challenges for teachers were raised during the COVID-19 pandemic, such as the inability to access modern technology, poor internet connection, and learner’s lack of motivation (Hakim, 2020). Consequently, schools and universities started employing online teaching strategies that were not previously used. These strategies put the teachers under different pressures to the extent that they might have experienced burnout (Raymaker et al., 2020). Moreover, data on burnout among school teacher in Saudi Arabia is scarce and nearly absent. That is why we hypothesized that these stressful conditions would positively affect the prevalence of burnout among school teachers. So, we aimed in this study to measure burnout prevalence and identify its determinants, among teachers in the Jazan region, in the far southwest of Saudi Arabia.

Materials and Methods

Study Design and Sample Size Calculation

We conducted a cross-sectional study involved 879 teachers of the Jazan region, in all levels of public and private schools in Saudi Arabia during April 2021.

The minimum sample size was calculated to be 844 teachers. It was calculated using the following formula (Pourhoseingholi et al., 2013):

$n=\frac{{\text{Z}}^{2}P(1-P)}{d^2}$

Where, n = Sample size.

Z = The level of confidence. We used level of confidence of 95% so we used Z = 1.96.

P = The expected prevalence. As the prevalence was unknown among teachers in Jazan we used 50%.

d = The precision (corresponding to the effect size). We used 5,

So $n=\frac{{(1.96)}^2\times 50\times \mathrm{\hspace{0.33em}50}}{5^2}=384$

We duplicated the sample size to reduce the cluster effect and considered 10% as non-response rate. So the sample size was calculated to be 844.

Sampling Technique and Study Population

We used a multistage cluster random sampling technique in this study. Jazan Province is one of the 13 provinces of Saudi Arabia. It is a highly populates (1.2 million) province that lies at the far southwest of the Kingdom. It is further subdivided into 13 governorates with Jazan City as a capital (Figure 1).

FIGURE 1

Figure 1. Jazan Province and its governorates.

From educational point of view, Jazan province is divided into two educational directorates namely, Jazan and Sabya. Jazan directorate included six administrative offices and Sabya directorate included nine administrative offices. Each administrative office was supervising a number of schools of all levels (Primary, Intermediate, and High Schools).

We randomly chose three offices from each directorate using simple random sample technique. Subsequently, according to the school level, the schools in each education office were stratified into three strata (primary, intermediate, and secondary schools). Then using a systematic random technique, we chose two boys’ and two girls’ schools from each of the three school levels. So we ended up with 72 schools (24 primary, 24 middle, and 24 high schools). In the last stage, we invited all teachers (1,032) of all targeted schools to participate in the study. We received 879 completed questionnaires. The response rate was 85.2%.

Study Tool

We used an online Google Forms Arabic questionnaire, including three main parts, to collect the data from the teachers.

The first part included questions regarding school teachers’ demographic and professional characteristics. These characteristics included; age, gender, marital status, number of children, level of education, residency, monthly income, school type, teaching level, his/her role/s in the school, number of working years, main daily teaching hours and main daily hours spent in preparation of lectures and other activities to be delivered to the students.

The second part of the questionnaire included questions on physical and mental health, social aspects, and future career plans. This section included questions about past history of treatment for depression or anxiety during the past 5 years, absenteeism during the COVID-19 pandemic, job satisfaction and planning to leave the school to another.

The third part included the validated Arabic version of Maslach Burnout Inventory (MBI) for educators (Abu-Hilal and Salameh, 1992; Maslach et al., 1996; Nesraoui and Zeroual, 2017; Chalghaf et al., 2019). This inventory is made up of 22 items on a 0–6 scale. These items were generated to measure the 3 components of burn out; emotional exhaustion, depersonalization, and personal accomplishment. We analyzed these components according to a previous study to describe each component as yes or no (Heidari and Gorjian, 2017). We then considered yes = 1 and no = 0. We then considered summation of the three components to get “No burnout” when the sum of the three components = 0, “Mild burnout” when the sum equal = 1, “Moderate burnout” hen the sum = 2 and “Severe burnout” when the sum = 3.

Before data collection, a pilot study was conducted to test whether the questionnaire’s wording was clear and understandable, as it was a translated version in Arabic. The reliability of the questionnaire was calculated using the Cronbach’s alpha test.

Statistical Analysis

The collected data were coded, tabulated, and statistically analyzed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 22.0, IBM Corp., Chicago, IL, United States, 2013 and Microsoft Office Excel 2007. Descriptive statistics were calculated for qualitative data as numbers and percentages. In contrast, inferential analyses were performed using the Chi-square test for differences between proportions and Fisher’s exact test for variables with small, expected numbers. A logistic regression model was used to identify independent factors affecting burnout and its subscales, and the selection of grades based on an in-depth analysis of each subscale. The level of significance was set at a P-value of < 0.050.

Ethical Consideration

The study was approved by the Jazan University Scientific Research Ethics Committee (reference number REC42/1/014). Teachers who agreed to participate in the study read, understood, and accepted online consent forms. All participants were informed of their right to not participate or withdraw from the study at any time. The privacy and confidentiality of the data was maintained.

Results

Performing Cronbach’s alpha test for our data showed that the emotional, personal accomplishment and for the whole scales were highly reliable (0.89, 0.87, and 0.90, respectively) and acceptable for the depersonalization scale (0.65). This data is not shown here but in the annex (1).

Table 1 shows the relationship between participants’ characteristics and their levels of burnout. A total of 879 teachers agreed to participate in the survey. Most of them (81.7%) were between 30 and 50 years. There were 462 male respondents, comprising 52.6% of the study sample, with a male-to-female ratio of 1.1. The majority (84.6%) of the study population were married, and 41.4% had more than three children. Approximately 88% of the participants had a bachelor’s degree, and 90.2% worked in governmental schools. Most teachers (78.2%, n = 687) worked only in teaching, while 157 (17.9%) had administrative roles. Regarding work experience, 376 (42.8%) had 10–20 years of teaching experience, 329 (37.4%) had more than 20 years of experience, and 174 (19.8%) had less than 10 years of experience. A total of 554 (63.0%) participants worked for 4–8 h a day. Participants aged 30–50 years, those who received salaries between SR 5,000 to 10,000, and those who lived in villages experienced significantly higher levels of burnout. Many demographic factors did not affect the levels of burnout among teachers. On the other hand, like age, residency, monthly income and the mean daily hours spent in preparation of the teaching materials were affecting the levels of the burnout among teachers. After using Bonferroni post hoc test for the chi square results, it was obvious that the middle age group (30–40 years showed higher levels of moderate and severe burnout. Moreover, low monthly income (<5,000 SR) was more associated with no to mild burnout while higher monthly income was more associated with higher levels of burnout. Finally, longer time spent in preparing the teaching materials was slightly associated with severe levels of burnout.

TABLE 1

Table 1. The general characteristics of study participants according to burnout risk factors (N = 879).

Table 2 shows the variables related to burnout among teachers, considering its severity. Among participating teachers (n = 879) in the Jazan region, 440 (50.1%) experienced mild burnout, 131 (14.9%) experienced moderate burnout, and 40 (4.6%) experienced severe burnout. No burnout was recorded in 268 (30.5%) teachers. All the factors used were significantly associated with burn out. However, after using post hoc Bonferroni test we find that those who were still using antipsychotic drugs, those who had more than twice absenteeism, those who not or never satisfied with their jobs and those who were looking to change their schools were experiencing more moderate to severe burnout.

TABLE 2

Table 2. Consequences of burnout among teachers considering its severity.

Table 3 shows the correlations between factors affecting burnout and its subscales. Regarding moderate/severe burnout, time spent usually in preparing lectures and activities to be delivered to the students in the next days (preparation time) of ≥2.0 h was a significant risk factor for moderate/severe burnout, while age >40 years and living in a village were significant protective factors. Regarding medium/high emotional exhaustion, a bachelor’s degree, teaching in preparatory schools (Teaching preparatory is grade 7–9), and time spent in preparing lectures and other activities to be delivered to the students (preparation time) >2 h were significant risk factors, while age >40.0 was a significant protective factor. The prevalence of emotional exhaustion was low in 373 (42.4%) participants, medium in 257 (29.2%) participants, and high in 249 (28.3%) participants. Depersonalization was low in 547 (62.2%) participants, medium in 174 (19.8%) participants, and high in 158 (18.0%) participants. Teaching for preparatory students, preparation time ≥2.0 h, and being male were significant risk factors, while residing in a village was a significant protective factor. Personal accomplishment was low in 452 (51.4%) participants, medium in 142 (16.2%) participants, and high in 285 (32.4%) participants. Notably, salary ≥15000.0 was a trigger factor for medium and high accomplishment.

TABLE 3

Table 3. Logistic regression analysis for factors affecting burnout and its subscales.

Discussion

Many researchers used Maslach Burnout Inventory for educators all over the world. The inventory was reputedly validated in it original English language and in different languages including the Arabic language. We also validated the Arabic version of the inventory in our study. Our validation went with most of the other validation when the inventory showed higher Cronbach’s alpha for the subsections of the emotional and personal accomplishment, 0.89 and 0.87, respectively. The inventory as a whole also showed high Cronbach’s alpha (0.90). The only subscale that was questionable was the depersonalization subsection (Cronbach’s alpha 0.65). We presented the data of the Cronbach’s alpha tests in annex 1. Our results were in agreement of most of those who tested the validation of the inventory where always depersonalization subscales shoed the lowest Cronbach’s alpha (Abu-Hilal and Salameh, 1992; Shan and Gerstenberger, 2017; Szigeti et al., 2017; Chalghaf et al., 2019; Amri et al., 2021).

This study measured burnout and identified its determinants among teachers in the Jazan region in the far southwest of Saudi Arabia during the COVID-19 pandemic. Unfortunately, we could not find any published data on burnout among school teachers in Saudi Arabia, particularly in the Jazan region. However, few reports have been published in Tunisia Iraq and Iran (Chennoufi et al., 2012; Pishghadam, 2012; Pishghadam et al., 2014, 2022; Al-Asadi et al., 2018). That is why we included big sample of teachers with different experiences, school levels, residency, income, and both genders. Our study found that most teachers (69.6%) experienced different levels of burnout during the COVID-19 pandemic. However, nearly half of them experienced mild (50.1%), and to lesser extent, moderate (14.9%) levels. On the other hand, only 4.6% of our participants experienced severe symptoms of burnout.

Our study showed that burnout among Saudi teachers was associated with several demographic and work-related factors. This is consistent with other studies (Maslach, 2001; Borrelli et al., 2014; Saloviita and Pakarinen, 2020). Age was related to burnout levels and specially, emotional exhaustion. Teachers aged 50 years or older were less likely to report severe forms of burnout. Logistic regression analysis showed that age was an independent predictor of self-reported burnout. The same was reported in a recent publication (Al-Asadi et al., 2018; Silva et al., 2021). In our opinion, it is logical that older age groups usually have a better teaching experience that can help them shifting from face-to-face teaching to online teaching easily and without too much stress. We were thinking that working from home and using online technology in teaching would affect older age groups, but it did not.

The relation between gender and burnout is controversial. In some studies, burnout rates were higher among male teachers, while other studies found a higher prevalence of burnout among women (Unterbrink et al., 2007; Al-Asadi et al., 2018; Aziz et al., 2018; Greinacher et al., 2019; Ptacek et al., 2019). In our study, being a male teacher was independently associated with higher depersonalization. However, we did not detect any gender differences in reporting burnout. This result was also reported by different other studies where burnout affects male and female teachers equally (Maslach, 2001; Deguchi et al., 2018; Castaldelli-Maia et al., 2019; Borgonovi and Han, 2021). Different studies have offered several explanations, including the role of coping skills among teachers of each gender, work expectations, and social support. We can also attribute these to cultural differences and the role of males and females in carrying out the burdens of life according to different cultures, and how this would change with a pandemic. Actually, in Saudi Arabia during the pandemic males and females were trying to help each other more and were having more time to stay home together as well.

Monthly income influenced the level of burnout experienced by participants. Teachers who were well paid felt significantly high accomplishment than underpaid teachers. This is consistent with the findings of other authors who concluded that a lack of reward is strongly related to a feeling of inefficiency (Maslach, 2001; Gan et al., 2019; Selamu et al., 2019; Li et al., 2020). This is mainly a matter of satisfaction, rather than the amount of money.

Regarding the workload, many studies have shown that workload (expressed in our study as long hours spent for preparation of materials to be delivered to the students and teaching preparatory students, who are at the beginning of the teen age and need more time to understand and do better job in studying) was closely related to burnout in the form of emotional exhaustion and depersonalization among teachers, including Saudi teachers (Santana et al., 2012; Chalghaf et al., 2019; Amri et al., 2020; Salvagioni et al., 2020; Cobo-Vazquez et al., 2021; Kalynychenko et al., 2021; Li et al., 2021; Melanda et al., 2021; Ribeiro et al., 2021). Moreover, the notion of burnout as a response to job demands has been supported by both self-reports of experienced stress and more objective assessments of demands, such as the number of students and number of working hours (Maslach, 2001; Perry et al., 2014; Peterson et al., 2019; Hart et al., 2020; Ndongo et al., 2020; Shah et al., 2021).

Although living in cities is usually more stressful, our results showed that burnout was more likely to affect teachers living in rural areas than those in urban areas. This finding is consistent with that of a few studies conducted during the COVID-19 pandemic (Xin et al., 2020; Mueller et al., 2021; Peterson et al., 2021; Righi et al., 2021; Simaes et al., 2021). This might be because compared with the cities, internet in the villages is poor; thus, the pressure on teachers living in villages, to use online teaching is greater and may be the cause of higher burnout. Additionally, the loss of social contact during the curfew was the principal cause of burnout during this period. Moreover, usually those living in the village would have less spiritual intelligence as well (Pishghadam et al., 2022). However, these findings should be interpreted cautiously and replicated after the pandemic.

Although some factors lost their significance when combined in multivariate logistic regression, such as the use of psychotropic medications, overall satisfaction, and absenteeism, they are still risk factors of burnout among school teachers. They comprise a network of interacting, contributing factors that substantiate each other and negatively impact teachers’ quality of daily and professional life. This study suggests that serious efforts have been made to detect burnout through periodic psychological assessment, especially during the pandemic or outbreak times.

The current study is valuable as it is the first study in Saudi Arabia, particularly in the Jazan region, to use a validated scale (MBI) to measure burnout levels among teachers. Additionally, the results of this study are significant because it included a large sample of teachers (879), working at a number of different levels of schools (72), selected using multistage cluster sampling, with nearly 1:1 male to female ratio.

Limitations

The present study had some limitations that should be considered when interpreting and generalizing its findings. The study’s cross-sectional design could not explain the temporal relationship between the study variables, which is consistent with findings of other studies (Maric et al., 2020). Moreover, since the current study was conducted during the COVID-19 pandemic, and we did not have burnout data before the pandemic, our results can only be generalized to the exact situation. Some other burnout predictors were not studied in this study like the personality traits, emotional and spiritual intelligence as well as the conceptions of assessments (Pishghadam, 2012; Pishghadam et al., 2022). However, as the population in Jazan area are homogenous and the evaluation of the teachers is following the same rules, these factors would have no effect on burnout in this area but should be considered in further researches.

Future Research

Other burnout predictors should be studied including the personality traits, emotional and spiritual intelligence as well as the conceptions of assessments. Moreover, intervention studies should be conducted to find out the best methods to alleviate the burnout among teachers.

Conclusion

Although burnout affected most of the teaches but its severity was mild to moderate. However, teachers living rural area, with less facilities, expressed more burnout during the pandemic. In Saudi Arabia, men and women are equally affected by burnout. It is recommended to increase teacher salaries and incentives, especially during stressful conditions, such as during a pandemic. It is good to repeat this work, especially after the pandemic, taking into consideration studying the personality traits, emotional and spiritual intelligence to have better information that would help in alleviating burnout symptoms among teachers.

Data Availability Statement

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Statement

The studies involving human participants were reviewed and approved by the Jazan University Scientific Research Ethics Committee. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

MS, AAA, MA, AD, ZM, AW, and MM contributed to the data and references collection, and helped in writing the first draft and tables. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

We would like to acknowledge the help of Jazan and Sabya Education Departments that facilitated the research project. We would also like to appreciate the efforts of the Family and Community Medicine Department at the Faculty of Medicine at Jazan University, which launched this research project.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.849328/full#supplementary-material

References

Abu-Hilal, M., and Salameh, K. (1992). Validity and Reliability of the Maslach Burnout Inventory for a Sample of Non-Western Teachers. Educ. Psychol. Meas. 52, 161–169. doi: 10.1177/001316449205200121

CrossRef Full Text | Google Scholar

Afulani, P. A., Gyamerah, A. O., Nutor, J. J., Laar, A., Aborigo, R. A., Malechi, H., et al. (2021). Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana. PLoS One 16:e0250294. doi: 10.1371/journal.pone.0250294

PubMed Abstract | CrossRef Full Text | Google Scholar

Al-Asadi, J., Khalaf, S., Al-Waaly, A., Abed, A., and Shami, S. (2018). Burnout among primary school teachers in Iraq: prevalence and risk factors. East Mediterr. Health J. 24, 262–268. doi: 10.26719/2018.24.3.262

PubMed Abstract | CrossRef Full Text | Google Scholar

Alsofayan, Y. M., Althunayyan, S. M., Khan, A. A., Hakawi, A. M., and Assiri, A. M. (2020). Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study. J. Infect. Publ. Health 13, 920–925. doi: 10.1016/j.jiph.2020.05.026

PubMed Abstract | CrossRef Full Text | Google Scholar

Amri, A., Abidli, Z., Bouzaaboul, M., Rabea, Z., Ahami, A. O. T., and Soulaymani, A. (2021). Psychometric Validation of the Maslach Burnout Inventory (MBI) Adapted to Moroccan Teachers. Medico Legal Update, 21, 1–6. doi: 10.37506/mlu.v21i1.2267

CrossRef Full Text | Google Scholar

Amri, A., Abidli, Z., Elhamzaoui, M., Bouzaboul, M., Rabea, Z., and Ahami, A. O. T. (2020). Assessment of burnout among primary teachers in confinement during the COVID-19 period in Morocco: case of the Kenitra. Pan Afr. Med. J. 35:92. doi: 10.11604/pamj.supp.2020.35.2.24345

PubMed Abstract | CrossRef Full Text | Google Scholar

Aziz, A. A., Kahlout, B. H., and Bashir, K. (2018). Female Physicians Suffer a Higher Burnout Rate: A 10-Year Experience of the Qatar EM Residency Training Programme. J. Coll. Physicians Surg. Pak. 28, 651–652. doi: 10.29271/jcpsp.2018.08.651

PubMed Abstract | CrossRef Full Text | Google Scholar

Bauer, J., Stamm, A., Virnich, K., Wissing, K., Muller, U., Wirsching, M., et al. (2006). Correlation between burnout syndrome and psychological and psychosomatic symptoms among teachers. Int. Arch. Occup. Environ. Health 79, 199–204. doi: 10.1007/s00420-005-0050-y

PubMed Abstract | CrossRef Full Text | Google Scholar

Borgonovi, F., and Han, S. W. (2021). Gender disparities in fear of failure among 15-year-old students: The role of gender inequality, the organisation of schooling and economic conditions. J. Adolesc. 86, 28–39. doi: 10.1016/j.adolescence.2020.11.009

PubMed Abstract | CrossRef Full Text | Google Scholar

Borrelli, I., Benevene, P., Fiorilli, C., D’Amelio, F., and Pozzi, G. (2014). Working conditions and mental health in teachers: a preliminary study. Occup. Med. 64, 530–532. doi: 10.1093/occmed/kqu108

PubMed Abstract | CrossRef Full Text | Google Scholar

Burki, T. K. (2020). Burnout among cancer professionals during COVID-19. Lancet Oncol. 21:1402. doi: 10.1016/S1470-2045(20)30584-2

CrossRef Full Text | Google Scholar

Castaldelli-Maia, J. M., Lewis, T., Marques Dos, Santos, N., Picon, F., Kadhum, M., et al. (2019). Stressors, psychological distress, and mental health problems amongst Brazilian medical students. Int. Rev. Psychiatry 31, 603–607. doi: 10.1080/09540261.2019.1669335

PubMed Abstract | CrossRef Full Text | Google Scholar

Chalghaf, N., Guelmami, N., Slimani, M., Del Puente, G., Re, T. S., Zerbetto, R., et al. (2019). Development and Preliminary Validation of the “Teacher of Physical Education Burnout Inventory” (TPEBI) in Arabic Language: Insights for Sports and Occupational Psychology. Front. Psychol. 10:456. doi: 10.3389/fpsyg.2019.00456

PubMed Abstract | CrossRef Full Text | Google Scholar

Chennoufi, L., Ellouze, F., Cherif, W., and Mersni, M. (2012). [Stress and burnout among Tunisian teachers]. Encephale 38, 480–487. doi: 10.1016/j.encep.2011.12.012

PubMed Abstract | CrossRef Full Text | Google Scholar

Christopher, M., Bowen, S., and Witkiewitz, K. (2020). Mindfulness-based resilience training for aggression, stress and health in law enforcement officers: study protocol for a multisite, randomized, single-blind clinical feasibility trial. Trials 21:236. doi: 10.1186/s13063-020-4165-y

PubMed Abstract | CrossRef Full Text | Google Scholar

Civilotti, C., Di Fini, G., and Maran, D. A. (2021). Trauma and Coping Strategies in Police Officers: A Quantitative-Qualitative Pilot Study. Int. J. Environ. Res. Publ. Health 18:982. doi: 10.3390/ijerph18030982

PubMed Abstract | CrossRef Full Text | Google Scholar

Cobo-Vazquez, C. M., Martin, C., Saez-Alcaide, L. M., Meniz-Garcia, C., Baca, L., Molinero-Mourelle, P., et al. (2021). Burnout syndrome assessment among Spanish oral surgery consultants: A two populations comparative pilot study. Med. Oral Patol. Oral Cir. Bucal. 27, e1–e9. doi: 10.4317/medoral.24725

PubMed Abstract | CrossRef Full Text | Google Scholar

Deguchi, Y., Iwasaki, S., Kanchika, M., Nitta, T., Mitake, T., Nogi, Y., et al. (2018). Gender differences in the relationships between perceived individual-level occupational stress and hazardous alcohol consumption among Japanese teachers: A cross-sectional study. PLoS One 13:e0204248. doi: 10.1371/journal.pone.0204248

PubMed Abstract | CrossRef Full Text | Google Scholar

Gan, Y., Jiang, H., Li, L., Yang, Y., Wang, C., Liu, J., et al. (2019). Prevalence of burnout and associated factors among general practitioners in Hubei, China: a cross-sectional study. BMC Public Health 19:1607. doi: 10.1186/s12889-019-7755-4

PubMed Abstract | CrossRef Full Text | Google Scholar

Goldstein, J. Z., and Alesbury, H. S. (2021). Self-reported levels of occupational stress and wellness in forensic practitioners: Implications for the education and training of the forensic workforce. J. Forensic. Sci. 66, 1307–1315. doi: 10.1111/1556-4029.14699

PubMed Abstract | CrossRef Full Text | Google Scholar

Greinacher, A., Derezza-Greeven, C., Herzog, W., and Nikendei, C. (2019). Secondary traumatization in first responders: a systematic review. Eur. J. Psychotraumatol. 10:1562840. doi: 10.1080/20008198.2018.1562840

PubMed Abstract | CrossRef Full Text | Google Scholar

Grupe, D. W., McGehee, C., Smith, C., Francis, A. D., Mumford, J. A., and Davidson, R. J. (2021). Mindfulness training reduces PTSD symptoms and improves stress-related health outcomes in police officers. J. Police Crim. Psychol. 36, 72–85. doi: 10.1007/s11896-019-09351-4

PubMed Abstract | CrossRef Full Text | Google Scholar

Hakim, B. (2020). Technology Integrated Online Classrooms and the Challenges Faced by the EFL Teachers in Saudi Arabia during the COVID-19 Pandemic. Int. J. Appl. linguist. Eng. Literat. 9:7. doi: 10.7575/aiac.ijalel.v.9n.5p.33

CrossRef Full Text | Google Scholar

Hart, A. M., Crowley, C., Janis, J. E., and Losken, A. (2020). Survey Based Assessment of Burnout Rates Among US Plastic Surgery Residents. Ann. Plast. Surg. 85, 215–220. doi: 10.1097/SAP.0000000000002353

PubMed Abstract | CrossRef Full Text | Google Scholar

Harvey, S. B., Epstein, R. M., Glozier, N., Petrie, K., Strudwick, J., Gayed, A., et al. (2021). Mental illness and suicide among physicians. Lancet 398, 920–930. doi: 10.1016/S0140-6736(21)01596-8

CrossRef Full Text | Google Scholar

Heidari, S., and Gorjian, B. (2017). The effect of the level of English teachers’ burnout on the EFL learners’ general English achievement at senior high school. J. Appl. Linguist. Lang. Learn. 3, 41–47.

Google Scholar

Juczynski, Z., and Oginska-Bulik, N. (2021). Ruminations and occupational stress as predictors of post-traumatic stress disorder and burnout among police officers. Int. J. Occup. Saf. Ergon. 28, 743–750. doi: 10.1080/10803548.2021.1907986

PubMed Abstract | CrossRef Full Text | Google Scholar

Kalynychenko, I. O., Latina, H. O., Uspenska, V. M., Zaikina, H. L., and Kalynychenko, D. O. (2021). Physiological and Hygienic Correlates of Teachers’ Occupational Burnout Syndrome Development. Wiad Lek 74, 1661–1665. doi: 10.36740/wlek202107119

PubMed Abstract | CrossRef Full Text | Google Scholar

Lass-Hennemann, J., Schafer, S. K., Sopp, M. R., and Michael, T. (2020). The Relationship between Dog Ownership, Psychopathological Symptoms and Health-Benefitting Factors in Occupations at Risk for Traumatization. Int. J. Environ. Res. Public Health 7:17. doi: 10.3390/ijerph17072562

PubMed Abstract | CrossRef Full Text | Google Scholar

Li, J. B., Yang, A., Zhang, R., Leung, T. Y., and Li, Z. (2021). Occupational Well-Being in Beginning Early Childhood Educators of Hong Kong and the Prediction of Job-Related Factors: Variable-Centered and Person-Centered Approaches. Front. Psychol. 12:746123. doi: 10.3389/fpsyg.2021.746123

PubMed Abstract | CrossRef Full Text | Google Scholar

Li, L., Gan, Y., Jiang, H., Yang, Y., Zhou, X., Zheng, Y., et al. (2020). Job Satisfaction and Its Associated Factors Among General Practitioners in China. J. Am. Board Fam. Med. 33, 456–459. doi: 10.3122/jabfm.2020.03.190126

PubMed Abstract | CrossRef Full Text | Google Scholar

Llorca-Pellicer, M., Soto-Rubio, A., and Gil-Monte, P. R. (2021). Development of Burnout Syndrome in Non-university Teachers: Influence of Demand and Resource Variables. Front. Psychol. 12:644025. doi: 10.3389/fpsyg.2021.644025

PubMed Abstract | CrossRef Full Text | Google Scholar

Losung, R. K., De Paoli, T., Kebbell, M., and Bond, A. (2021). The Role of Empathy in Professional Quality of Life: a Study on Australian Police Officers Working in Sexual Assault and Child Abuse Investigation. J. Police Crim. Psychol. [Epub ahead of print]. doi: 10.1007/s11896-021-09468-5

PubMed Abstract | CrossRef Full Text | Google Scholar

Ma, K., Chutiyami, M., Zhang, Y., and Nicoll, S. (2021). Online teaching self-efficacy during COVID-19: Changes, its associated factors and moderators. Educ. Inf. Technol. 26, 6675–6697. doi: 10.1007/s10639-021-10486-3

PubMed Abstract | CrossRef Full Text | Google Scholar

Mák, K., Kapus, K., Tóth, G., Hesszenberger, D., Pohl, M., Pusch, G., et al. (2021). Neuropathic Low Back Pain and Burnout among Hungarian Workers. Int. J. Environ. Res. Publ. Health 18:2693. doi: 10.3390/ijerph18052693

PubMed Abstract | CrossRef Full Text | Google Scholar

Mann, A., Schwabe, M., Fraser, P., Fülöp, G., and Ansah, G. A. (2020). How the COVID-19 Pandemic is Changing Education: A Perspective From Saudi Arabia. France: Organisation for Economic Co-operation and Development (OECD).

Google Scholar

Maric, N., Mandic-Rajcevic, S., Maksimovic, N., and Bulat, P. (2020). Factors Associated with Burnout Syndrome in Primary and Secondary School Teachers in the Republic of Srpska (Bosnia and Herzegovina). Int. J. Environ. Res. Publ. Health 10:17. doi: 10.3390/ijerph17103595

PubMed Abstract | CrossRef Full Text | Google Scholar

Márquez, M. A., Galiana, L., Oliver, A., and Sansó, N. (2021). The impact of a mindfulness-based intervention on the quality of life of Spanish national police officers. Health Soc. Care Commun. 29, 1491–1501. doi: 10.1111/hsc.13209

PubMed Abstract | CrossRef Full Text | Google Scholar

Maslach, C. (2001). What have we learned about burnout and health? Psychol. Health 16, 607–611. doi: 10.1080/08870440108405530

PubMed Abstract | CrossRef Full Text | Google Scholar

Maslach, C., Jackson, S. E., and Leiter, M. P. (1996). “The Maslach Burnout Inventory,” in ManualEvaluating Stress: A Book of Resources, eds C. P. Zalaquett and R. J. Wood (Maryland: The Scarecrow Press), 191–218.

Google Scholar

Maslach, C., and Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psych. 15, 103–111. doi: 10.1002/wps.20311

PubMed Abstract | CrossRef Full Text | Google Scholar

Melanda, F. N., Salvagioni, D. A. J., Mesas, A. E., Gonzalez, A. D., Cerqueira, P. H. R., Alencar, G. P., et al. (2021). Cross-sectional and longitudinal relationships between psychological violence and teacher burnout. Int. Arch. Occup. Environ. Health 94, 1211–1221. doi: 10.1007/s00420-020-01633-3

PubMed Abstract | CrossRef Full Text | Google Scholar

MOH (2020). MOH Reports First Case of Coronavirus Infection. Retrieved from moh.gov.sa: https://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2020-03-02-002.aspxSingapore: MOH.

Google Scholar

Montero-Marin, J., Garcia-Campayo, J., Mosquera Mera, D., and Lopez, del Hoyo, Y. (2009). A new definition of burnout syndrome based on Farber’s proposal. J. Occup. Med. Toxicol. 4:31. doi: 10.1186/1745-6673-4-31

PubMed Abstract | CrossRef Full Text | Google Scholar

Moueleu Ngalagou, P. T., Assomo-Ndemba, P. B., Owona Manga, L. J., Owoundi Ebolo, H., Ayina Ayina, C. N., Lobe Tanga, M. Y., et al. (2019). Burnout syndrome and associated factors among university teaching staff in Cameroon: Effect of the practice of sport and physical activities and leisures. Encephale 45, 101–106. doi: 10.1016/j.encep.2018.07.003

PubMed Abstract | CrossRef Full Text | Google Scholar

Mueller, J. T., McConnell, K., Burow, P. B., Pofahl, K., Merdjanoff, A. A., and Farrell, J. (2021). Impacts of the COVID-19 pandemic on rural America. Proc. Natl. Acad. Sci. U S A. 118, doi: 10.1073/pnas.2019378118

PubMed Abstract | CrossRef Full Text | Google Scholar

Naldi, A., Vallelonga, F., Di Liberto, A., Cavallo, R., Agnesone, M., Gonella, M., et al. (2021). COVID-19 pandemic-related anxiety, distress and burnout: prevalence and associated factors in healthcare workers of North-West Italy. Br. J. Psych. Open 7:e27. doi: 10.1192/bjo.2020.161

PubMed Abstract | CrossRef Full Text | Google Scholar

Ndongo, J. M., Lele, C. B., Manga, L. O., Ngalagou, P. M., Ayina, C. A., Tanga, M. L., et al. (2020). Epidemiology of burnout syndrome in four occupational sectors in Cameroon-impact of the practice of physical activities and sport. AIMS Publ. Health 7, 319–335. doi: 10.3934/publichealth.2020027

PubMed Abstract | CrossRef Full Text | Google Scholar

Nesraoui, S., and Zeroual, F. B. (2017). Adapt the Maslash Burnout Inventory Intended “MBI-HSS” to the University Staff in Algeria. J. Psychol. Educat. Sci. 3, 240–256.

Google Scholar

Njim, T., Mbanga, C. M., Tindong, M., Fonkou, S., Makebe, H., Toukam, L., et al. (2019). Burnout as a correlate of depression among medical students in Cameroon: a cross-sectional study. BMJ Open 9:e027709. doi: 10.1136/bmjopen-2018-027709

PubMed Abstract | CrossRef Full Text | Google Scholar

Oginska-Bulik, N., and Juczynski, Z. (2021). Burnout and posttraumatic stress symptoms in police officers exposed to traumatic events: the mediating role of ruminations. Int. Arch. Occup. Environ. Health 94, 1201–1209. doi: 10.1007/s00420-021-01689-9

PubMed Abstract | CrossRef Full Text | Google Scholar

Oksanen, A., Savolainen, I., Savela, N., and Oksa, R. (2021). Psychological Stressors Predicting Increased Drinking During the COVID-19 Crisis: A Longitudinal National Survey Study of Workers in Finland. Alcohol. Alcohol. 56, 299–306. doi: 10.1093/alcalc/agaa124

PubMed Abstract | CrossRef Full Text | Google Scholar

Pereira, H., Goncalves, V. O., and Assis, R. M. (2021). Burnout, Organizational Self-Efficacy and Self-Esteem among Brazilian Teachers during the COVID-19 Pandemic. Eur. J. Investig. Health Psychol. Educ. 11, 795–803. doi: 10.3390/ejihpe11030057

PubMed Abstract | CrossRef Full Text | Google Scholar

Perry, L., Rech, D., Mavhu, W., Frade, S., Machaku, M. D., Onyango, M., et al. (2014). Work experience, job-fulfillment and burnout among VMMC providers in Kenya, South Africa, Tanzania and Zimbabwe. PLoS One 9:e84215. doi: 10.1371/journal.pone.0084215

PubMed Abstract | CrossRef Full Text | Google Scholar

Peterson, J. A., Chesbro, G., Larson, R., Larson, D., and Black, C. D. (2021). Short-Term Analysis (8 Weeks) of Social Distancing and Isolation on Mental Health and Physical Activity Behavior During COVID-19. Front. Psychol. 12:652086. doi: 10.3389/fpsyg.2021.652086

PubMed Abstract | CrossRef Full Text | Google Scholar

Peterson, S. A., Wolkow, A. P., Lockley, S. W., O’Brien, C. S., Qadri, S., Sullivan, J. P., et al. (2019). Associations between shift work characteristics, shift work schedules, sleep and burnout in North American police officers: a cross-sectional study. BMJ Open 9:e030302. doi: 10.1136/bmjopen-2019-030302

PubMed Abstract | CrossRef Full Text | Google Scholar

Pishghadam, R. (2012). Personality and Emotional Intelligence in Teacher Burnout. Span. J. Psychol. 15, 227–36. doi: 10.5209/rev_SJOP.2012.v15.n1.37314

CrossRef Full Text | Google Scholar

Pishghadam, R., Adamson, B., Sadafian, S. S., and Kan, F. L. F. (2014). Conceptions of assessment and teacher burnout. Assess. Educ. 21, 34–51. doi: 10.1080/0969594X.2013.817382

CrossRef Full Text | Google Scholar

Pishghadam, R., Yousofi, N., Amini, A., and Tabatabayeeyan, M. S. (2022). Interplay of psychological reactance, burnout, and spiritual intelligence: A case of Iranian EFL teachers. Rev. Psicodidáct. 27, 76–85. doi: 10.1016/j.psicoe.2021.06.002

CrossRef Full Text | Google Scholar

Pourhoseingholi, M. A., Vahedi, M., and Rahimzadeh, M. (2013). Sample size calculation in medical studies. Gastroenterol. Hepatol. Bed. Bench 6, 14–17.

Google Scholar

Prado-Gasco, V., Gomez-Dominguez, M. T., Soto-Rubio, A., Diaz-Rodriguez, L., and Navarro-Mateu, D. (2020). Stay at Home and Teach: A Comparative Study of Psychosocial Risks Between Spain and Mexico During the Pandemic. Front. Psychol. 11:566900. doi: 10.3389/fpsyg.2020.566900

PubMed Abstract | CrossRef Full Text | Google Scholar

Price, S. (2020). Testing Boundaries COVID-19 made the USMLE, Clerkships a Moving Target for Med Students. Tex. Med. 34:116.

PubMed Abstract | Google Scholar

Ptacek, R., Vnukova, M., Raboch, J., Smetackova, I., Sanders, E., Svandova, L., et al. (2019). Burnout Syndrome and Lifestyle Among Primary School Teachers: A Czech Representative Study. Med. Sci. Monit. 25, 4974–4981. doi: 10.12659/MSM.914205

PubMed Abstract | CrossRef Full Text | Google Scholar

Purdy, R. R., Lemkau, J. P., Rafferty, J. P., and Rudisill, J. R. (1987). Resident physicians in family practice: who’s burned out and who knows? Fam. Med. 19, 203–208.

PubMed Abstract | Google Scholar

Queiros, C., Passos, F., Bartolo, A., Marques, A. J., da Silva, C. F., and Pereira, A. (2020). Burnout and Stress Measurement in Police Officers: Literature Review and a Study With the Operational Police Stress Questionnaire. Front. Psychol. 11:587. doi: 10.3389/fpsyg.2020.00587

PubMed Abstract | CrossRef Full Text | Google Scholar

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., et al. (2020). “Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout. Autism Adulthood 2, 132–143. doi: 10.1089/aut.2019.0079

PubMed Abstract | CrossRef Full Text | Google Scholar

Ribeiro, B., Martins, J. T., and Dalri, R. (2021). Burnout syndrome in primary and secondary school teachers in southern Brazil. Rev. Bras. Med. Trab. 18, 337–342. doi: 10.47626/1679-4435-2020-519

PubMed Abstract | CrossRef Full Text | Google Scholar

Righi, M. P., De Godoi, A. P. T., Venezian, G. C., Degan, V. V., and de Menezes, C. C. (2021). Temporomandibular disorder symptoms, sleep quality, and burnout syndrome in teachers. Cranio. [Epub ahead of print]. doi: 10.1080/08869634.2021.1966585

PubMed Abstract | CrossRef Full Text | Google Scholar

Saloviita, T., and Pakarinen, E. (2020). Teacher burnout explained: Teacher-, student-, and organisation-levelvariables. Teach. Teacher Educat. 97:103221. doi: 10.1016/j.tate.2020.103221

CrossRef Full Text | Google Scholar

Salvagioni, D. A. J., Mesas, A. E., Melanda, F. N., Dos Santos, H. G., Gonzalez, A. D., Girotto, E., et al. (2020). Prospective association between burnout and road traffic accidents in teachers. Stress Health 36, 629–638. doi: 10.1002/smi.2958

PubMed Abstract | CrossRef Full Text | Google Scholar

Santana, A., De Marchi, D., Junior, L. C., Girondoli, Y. M., and Chiappeta, A. (2012). Burnout syndrome, working conditions, and health: a reality among public high school teachers in Brazil. Work 41, 3709–3717. doi: 10.3233/WOR-2012-0674-3709

PubMed Abstract | CrossRef Full Text | Google Scholar

Schilling, R., Colledge, F., Brand, S., Ludyga, S., and Gerber, M. (2019). Psychometric Properties and Convergent Validity of the Shirom-Melamed Burnout Measure in Two German-Speaking Samples of Adult Workers and Police Officers. Front. Psych. 10:536. doi: 10.3389/fpsyt.2019.00536

PubMed Abstract | CrossRef Full Text | Google Scholar

Selamu, M., Hanlon, C., Medhin, G., Thornicroft, G., and Fekadu, A. (2019). Burnout among primary healthcare workers during implementation of integrated mental healthcare in rural Ethiopia: a cohort study. Hum. Resour. Health 17:58. doi: 10.1186/s12960-019-0383-3

PubMed Abstract | CrossRef Full Text | Google Scholar

Sener, H., Arikan, I., Gunduz, N., and Gulekci, Y. (2021). Detecting the Relationship between the Stress Levels and Perceived Burnout in Law-enforcement Officers during the COVID-19 Outbreak: A Cross-sectional Study. Soc. Work Public Health 36, 486–495. doi: 10.1080/19371918.2021.1915910

PubMed Abstract | CrossRef Full Text | Google Scholar

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., and Ali, M. K. (2021). Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Netw Open 4:e2036469. doi: 10.1001/jamanetworkopen.2020.36469

PubMed Abstract | CrossRef Full Text | Google Scholar

Shan, G., and Gerstenberger, S. (2017). Fisher’s exact approach for post hoc analysis of a chi-squared test. PLoS One 12:e0188709. doi: 10.1371/journal.pone.0188709

PubMed Abstract | CrossRef Full Text | Google Scholar

Silva, L. P., Dos Santos, J. S. P., da Silva, L. L., Cezar, I. S., de Abreu, J. S. D., de Cerqueira, V. P., et al. (2021). Prevalence of burnout syndrome and associated factors in university professors working in Salvador, state of Bahia. Rev. Bras. Med. Trab. 19, 151–156. doi: 10.47626/1679-4435-2020-548

PubMed Abstract | CrossRef Full Text | Google Scholar

Simaes, C., Rodrigues, J., Goncalves, A. M., Faria, S., and Gomes, A. R. (2021). Work-family conflicts, cognitive appraisal, and burnout: Testing the mediation effect with structural equation modelling. Br. J. Educ. Psychol. 91, 1349–1368. doi: 10.1111/bjep.12420

PubMed Abstract | CrossRef Full Text | Google Scholar

Suliman, W. A., Abu-Moghli, F. A., Khalaf, I., Zumot, A. F., and Nabolsi, M. (2021). Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study. Nurse Educ. Today 100:104829. doi: 10.1016/j.nedt.2021.104829

PubMed Abstract | CrossRef Full Text | Google Scholar

Szigeti, R., Balázs, N., Bikfalvi, R., and Urbán, R. (2017). Burnout and depressive symptoms in teachers: Factor structure and construct validity of the Maslach Burnout inventory-educators survey among elementary and secondary school teachers in Hungary. Stress Health 33, 530–539. doi: 10.1002/smi.2737

PubMed Abstract | CrossRef Full Text | Google Scholar

Unterbrink, T., Hack, A., Pfeifer, R., Buhl-Griesshaber, V., Muller, U., Wesche, H., et al. (2007). Burnout and effort-reward-imbalance in a sample of 949 German teachers. Int. Arch. Occup. Environ. Health 80, 433–441. doi: 10.1007/s00420-007-0169-0

PubMed Abstract | CrossRef Full Text | Google Scholar

Wirkus, L., Babicka-Wirkus, A., Opora, R., and Stasiak, K. (2021). Burnout among Probation Officers in Poland and the Role of Preferred Styles of Coping with Stress. Int. J. Environ. Res. Publ. Health 18:355. doi: 10.3390/ijerph18010355

PubMed Abstract | CrossRef Full Text | Google Scholar

Xin, M., Luo, S., She, R., Yu, Y., Li, L., Wang, S., et al. (2020). Negative cognitive and psychological correlates of mandatory quarantine during the initial COVID-19 outbreak in China. Am. Psychol. 75, 607–617. doi: 10.1037/amp0000692

PubMed Abstract | CrossRef Full Text | Google Scholar