Mental Health Gap Action Programme (mhGAP)

Background
The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district.

Methods
We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors.

Results
A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally.

Conclusion
In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout.

Rank: 92

First Author: Selamu

Outcome: Stress,Emot. Exhaust./Comp. Fatig.,General Health,Job Satisfaction,Social Support,Demands,Decision Latitude

Outcome p-value: Stress:⭑⭑, Emotional Exhaustion/Compassion Fatigue:●, General Health:⭑⭑⭑, Job Satisfaction:⭑⭑⭑, Social Support:⭑⭑, Demands:●, Decision Latitude:⭑⭑

Intervention Category: Peer Support

Time per Employee (hours): No time specified.

D&B Study Quality Rating: 12

Reviewer Confidence: 2

Country: Ethiopia

Study Design Type: Quasi-experimental

Materials Available to Implement: The WHO-recommended programme (with extensive materials and guides) can be accessed at: https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme. Corresponding author: medhins10@gmail.com

Materials Available: yes

Organiz./Individ. Focus: Individual

Prevention Category: Secondary

Effect size Small:

Effect size Medium:

Reference: Selamu, M., Hanlon, C., Medhin, G., Thornicroft, G., & Fekadu, A. (2019). Burnout among primary healthcare workers during implementation of integrated mental healthcare in rural Ethiopia: A cohort study. Human Resources for Health, 17(1), 58. https://doi.org/10.1186/s12960-019-0383-3