Evaluation of the prevalence and risk factors of burnout syndrome among healthcare workers: A cross-sectional study

Abstract

BACKGROUND

Burnout syndrome is a significant issue among healthcare professionals worldwide, marked by depersonalization, emotional exhaustion, and a reduced sense of personal achievement. This psychological and physical burden profoundly affects healthcare professionals' quality of care and overall well-being. In Somalia, where the healthcare system faces numerous challenges, the escalating demand for medical services and inadequate resources, coupled with overwhelming workloads, long hours, and high-stress levels, make healthcare providers particularly vulnerable to burnout syndrome. This, in turn, affects both the mental health of healthcare personnel and the quality of care they provide.

AIM

To examine the prevalence and determinants of burnout syndrome among healthcare practitioners in Mogadishu, Somalia.

METHODS

This cross-sectional prospective study was performed among 246 healthcare providers employed at a tertiary care hospital in Mogadishu, Somalia, who were recruited via random sampling. Data were collected using questionnaires that covered sociodemographic, psychological, work-related characteristics, and burnout syndrome. Bivariate and multivariate logistic regression analyses were performed to identify the variables that correlated with burnout syndrome. The results were presented using adjusted odds ratios (AORs), 95%CIs, and P values, with a cutoff of 0.05 for identifying significant associations.

RESULTS

Among the participants, 24% (95%CI: 18.8%–29.8%) exhibited symptoms of burnout syndrome. Factors associated with burnout included female gender (AOR = 6.60; 95%CI: 2.29-19.04), being married (AOR = 3.07; 95%CI: 1.14-8.28), being divorced or widowed (AOR = 5.84; 95%CI: 1.35-25.35), working more than 7 night shifts (AOR = 3.19; 95%CI: 1.30–7.82), having less than 5 years of job experience (AOR = 5.28; 95%CI: 1.29-21.65), experiencing poor sleep quality (AOR = 5.29; 95%CI: 1.88-14.89), and exhibiting depressive (AOR = 4.46; 95%CI: 1.59-12.53) and anxiety symptoms (AOR = 7.34; 95%CI: 2.49-21.60).

CONCLUSION

This study found that nearly one in four healthcare professionals suffers from burnout syndrome. Improving sleep quality, monitoring, and providing mental health support could enhance their well-being and patient care.

Key Words: Burnout syndrome; Risk factors; Healthcare workers; Mogadishu; Somalia

Core Tip: This study investigates the prevalence and risk factors associated with burnout syndrome among healthcare workers at a tertiary care hospital in Mogadishu, Somalia. The results reveal a significant correlation between various risk factors, including being female, experiencing poor sleep quality, and symptoms of depression and anxiety. These results indicate the necessity for interventions aimed at enhancing sleep quality, monitoring and providing mental health support, managing workloads, and fostering a supportive work environment to improve both the well-being of healthcare providers and the quality of patient care.

INTRODUCTION

The concept of burnout in healthcare professionals was first introduced by Freudenberger in the United States in 1974. He described burnout as a state of failing, wearing out, or becoming exhausted owing to overwhelming demands on one's energy, strength, and resources[1]. Maslach et al[2] later defined burnout as a condition marked by depersonalization (DP) towards patients, emotional exhaustion (EE), and a reduced sense of personal achievement (PA) among those in people-oriented professions. They further stressed that burnout was predominantly caused by continuous interpersonal pressures in the workplace[2]. Since its introduction, burnout has become a global issue, increasingly prevalent among healthcare workers, identified as a high-risk group. Reports indicate a prevalence of 44.2% among medical students[3], 51% among residents[4], up to 80% among doctors[5], and 30% among nurses[6]. Burnout syndrome is linked to poor job performance and serious health consequences, including prolonged fatigue, headaches, sleep disturbances, difficulty concentrating, irritability, depression, anxiety, high blood pressure, respiratory and gastrointestinal issues, reliance on psychotropic medications, and hospitalization for psychiatric and cardiovascular disorders[7-9]. Additionally, it may contribute to the development of drug and alcohol addiction.

The global prevalence of burnout among healthcare professionals remains uncertain because most studies have been performed mainly in high-income countries[10]. Additionally, the impact and extent of burnout syndrome on healthcare personnel in low- and middle-income countries are also unclear[11]. The literature indicates that factors such as the healthcare system, human behavior, and the volume of healthcare seekers play a role in contributing to burnout among healthcare workers[12,13]. Numerous studies have examined the prevalence of burnout syndrome and its contributing factors among healthcare workers in Sub-Saharan Africa, where the healthcare system faces challenges owing to a shortage of professionals and an overwhelming workload from the increasing demand for healthcare services. These studies have reported prevalence rates between 40% and 80%. Moreover, they have identified several factors linked to burnout, such as age, gender, marital status, intention to leave the job, profession, income, extended single-day shifts, reduced nighttime sleep, and years of work experience[13-16].

To our knowledge, no research has investigated the magnitude of burnout syndrome and its contributing factors among healthcare personnel in Somalia. Therefore, this study aims to assess the prevalence of burnout syndrome among healthcare staff at a tertiary care hospital in Somalia and identify potential risk factors associated with its development.

MATERIALS AND METHODS

Study design and setting

This cross-sectional study, conducted within an institutional setting, aimed to evaluate the extent of burnout syndrome among healthcare professionals at the Mogadishu Somali-Turkiye Recep Tayyip Erdogan Training and Research Hospital. Data was collected from the participants from April 1 to April 30, 2024. The hospital is a public, educational, and referral center that was established in the mid-20^th century. The hospital remained in operation until the early 1990s, at which point the civil war and the disintegration of the central government led to its shutdown. In January 2015, representatives from both governments finalized an agreement to enhance and upgrade the hospital, leading to its formal reopening.

Sample size and sampling methods

The sample size was determined using the formula for a single population proportion: N = [z]² × p × (1-p)/d². In this equation, n represents the minimum required sample size, P is the estimated prevalence rate, Z is the standard score corresponding to a 95%CI, and d is the margin of error, which is set at 0.05. In this study, we used a P value of 50% owing to the absence of a previous study investigating the prevalence of burnout syndrome among healthcare professionals in Somalia. The significant variation in reported prevalence rates of burnout syndrome, which ranged from 13.7% to 62%[15-18], resulted in the exclusion of studies from neighboring countries such as Ethiopia. After accounting for a 10% non-response rate, the study required a final sample size of 246 healthcare workers. The hospital had 536 healthcare workers, as reported by the human resources office. Study participants were chosen using stratified random sampling based on their profession (Figure 1), followed by random selection during their leisure time, allowing us to successfully reach our target sample size of 246 healthcare professionals.

Figure 1 Proportional allocation for studying the prevalence of burnout syndrome and its associated factors among healthcare professionals at the hospital.

Criteria for inclusion and exclusion

The study targeted healthcare workers who had been employed at the hospital for at least six months before data collection. Individuals excluded from the study were interns, students, and healthcare staff on annual leave or suffering from serious illnesses. Additionally, new employees with < 6 months of tenure were also not included.

Dependent variable

Status of burnout syndrome (burnout absent or burnout present).

Independent variables

The socio-demographic and behavioral factors considered in the study included sex, age, relationship status, number of children, occupation, educational status, monthly income, use of cigarettes, exercise levels, and body mass index. In addition, clinical and job-related characteristics covered work shifts, weekly working hours, monthly night shifts, years of work experience, sleep quality, and symptoms of depression and anxiety.

Data collection procedures and tools

Data were collected through four sets of self-administered questionnaires that encompassed sociodemographic and job-related characteristics, the Maslach Burnout Inventory (MBI), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). The socio-demographic and job-related data were collected using a detailed survey designed based on a comprehensive review of existing literature[13,18,19]. All variables, with the exception of age, were categorized and collected using questions with predefined response options.

The MBI is a standardized tool designed to measure burnout in individuals. It consists of 22 items and was created by Maslach and Jackson in 1981[20]. The MBI evaluates three components of burnout syndrome: DP with five items, EE with nine items, and PA with eight items. Participants evaluate their experiences on a scale from 0 to 6, with 0 indicating "never" and 6 representing "every day". In this study, burnout was diagnosed in healthcare workers who met the following criteria: A score of 27 or higher on the EE subscale, a score of 13 or higher on the DP subscale, and a score of 31 or lower on the PA subscale. In the original study, the reported Cronbach's alpha values for the MBI were 0.90 for EE, 0.71 for PA, and 0.79 for the DP subscale. In this study sample, the Cronbach's alpha values for the MBI were 0.79 for EE, 0.80 for PA, and 0.67 for the DP subscales.

The PSQI is a self-report questionnaire developed by Buysse and colleagues in 1989[21]. It comprises 19 items for individuals to rate themselves, along with five questions assessed by a bed partner or roommate. This instrument assesses patients' personal perception of their sleep quality during the preceding four weeks. The 19 self-reported questions are used to calculate seven component scores: Subjective sleep quality, sleep disturbances, sleep duration, sleep latency, sleep efficiency, use of sleep medication, and daytime dysfunction. Each component is evaluated on a scale from 0 to 3, where "0" represents no difficulty and "3" indicates severe difficulty in that component. The seven component scores are aggregated to produce a cumulative PSQI score, which ranges from 0 to 21 points. Higher scores indicate poorer sleep quality. Participants are categorized as poor sleepers if their overall PSQI score is greater than 5, whereas those with a score of 5 or below are classified as good sleepers. Responses from bed partners or roommates can be rated from 0 to 3 points based on symptom severity, but these do not contribute to the overall score. In the original study, Cronbach's alpha for the PSQI was reported as 0.83, while for the current study sample, it was 0.70.

The HADS is a 14-item self-report tool created by Zigmond and Snaith[22] to evaluate symptoms of anxiety and depression among patients visiting non-psychiatric hospitals and outpatient clinics. It includes two subscales: Anxiety (HADS-A) and depression (HADS-D) subscales, with each subscale having seven items rated on a scale of 0-4. Scores ranging from 0 to 7 are considered normal, scores of 8–10 suggest a mild disorder, scores of 11–15 suggest a moderate disorder, and scores from 16 to 21 indicate a severe disorder. In the initial study sample, the Cronbach's alpha coefficients were 0.88 for the anxiety subscale and 0.84 for the depression subscale of the HADS. The anxiety subscale for the Somali version of the HADS[23] has a Cronbach's alpha of 0.83, while the depression subscale has a value of 0.84. On the other hand, the current sample exhibited Cronbach's alpha values for anxiety and depression of 0.75 and 0.66, respectively.

Data management and statistical analysis

The data were initially input into an Excel database, where they were checked for errors and inconsistencies before being imported into SPSS for analysis. Statistical analysis was conducted using SPSS version 26 (IBM Corp., Armonk, NY, United States). Descriptive statistics were employed to report frequencies and percentages for categorical variables, while means and SD were calculated for continuous variables. Bivariate and multivariate logistic regression analyses were conducted to identify the variables related to the outcome variable. Variables with a P value less than 0.20 in the bivariate logistic regression were considered as potential predictors and were therefore incorporated into the multivariate logistic regression analysis for further evaluation. Bursac et al[24] suggest that a P value < 0.20 in univariate logistic regression may imply a potential association with the outcome variable in the final analysis due to the influence of possible confounding factors. In the multivariate logistic regression model, the Hosmer–Lemeshow goodness-of-fit test was applied to assess the final model's fit[25]. Variables with a P value below 0.05 were considered statistically significant in the multivariate logistic regression analysis and are reported as the adjusted odds ratio (AOR) along with a 95%CI.

Ethical approval

The institutional review board of the Mogadishu Somali-Turkiye Recep Tayyip Erdogan Training and Research Hospital granted ethical approval for the study (MSTH/17683). The authors explained the study objectives to the target population and invited them to participate. Written informed consent was obtained from each participant, and only those who chose to volunteer were included in the study. Once consent was acquired, participants were provided with the questionnaires for self-administration and instructed to return the completed forms anonymously to the principal investigator. Furthermore, participants were informed that they had the right to withdraw from the study at any time, without facing any repercussions. We ensured the confidentiality of the questionnaires, upheld anonymity, and pledged not to disclose any personally identifiable information.

RESULTS

Socio-demographic and behavioral characteristics of healthcare workers

In this study, 246 healthcare workers were recruited with a 100% response rate. Most participants were male (129; 52.4%), and the majority were under 30 years old (153; 62.2%), with a mean age of 28.5 years and an SD of 3.3 years. Almost half of the study subjects reported being single (116; 47.2%) and did not have children (132; 53.7%). Almost all participants were non-smokers (236; 95.9%), and the majority of participants engaged in regular physical activity (129; 52.4%) (Table 1).

Table 1 Socio-demographic and behavioral characteristics of healthcare workers in Mogadishu, Somalia (2024) (n = 246).

Variable	Category	Frequency	Percentage
Age	< 30	153	62.2
	≥ 30	93	37.8
Gender	Female	117	47.6
	Male	129	52.4
Marital status	Single	116	47.2
	Married	111	45.1
	Divorced/Widowed	19	7.7
Have children	Yes	114	46.3
	No	132	53.7
Education status	Diploma	20	8.1
	Undergraduate	85	34.6
	Postgraduate	141	57.3
Profession	Specialist doctor	30	12.2
	Resident doctor	59	24.0
	Nurse	137	55.7
	Others	20	8.1
Monthly income	500–999 USD	157	63.8
	1000–1999 USD	59	24.0
	≥ 2000 USD	30	12.2
Smoke cigarette	Yes	10	4.1
	No	236	95.9
Physically active	Yes	129	52.4
	No	117	47.6
Body mass index	Underweight	6	2.4
	Normal weight	146	59.3
	Overweight	82	33.3
	Obese	12	4.9

Job-related and psychological characteristics of healthcare workers

Most respondents worked seven or more night shifts (130; 52.4%) and had < 5 years of job experience (140; 57.0%). Ninety-two participants, accounting for 37.4% of the sample, reported experiencing poor sleep quality. Furthermore, 94 participants (38.2%) experienced symptoms of depression, while 103 participants (41.9%) showed symptoms of anxiety (Table 2).

Table 2 Work-related and psychological characteristics of healthcare workers in Mogadishu, Somalia (2024), (n = 246).

Variable	Category	Frequency	Percentage
Work shift	Day shift	75	30.5
	Night shift	58	23.6
	Mixed day and night shifts	113	45.9
Night shift	< 7 night shifts	116	47.2
	≥ 7 night shifts	130	52.4
Working hours per week	≤ 50 hours	161	65.4
	> 50 hours	85	34.6
Work experience	≤ 4 years	140	57.0
	5–8 years	69	28.0
	> 8 years	37	15.0
Sleep quality	Good	154	62.6
	Poor	92	37.4
Depression status	Not depressed	152	61.8
	Depressed	94	38.2
Anxiety status	Not anxious	143	58.1
	Anxious	103	41.9

Overall burnout syndrome prevalence among healthcare workers

The study found that 24.0% (95%CI: 18.8%–29.8%) of healthcare workers in Mogadishu, Somalia, had burnout syndrome. In terms of burnout syndrome components, 28.9% of participants reported high EE, 30.5% reported high DP, and 62.6% exhibited low PA (Figure 2).

Figure 2 Overall burnout syndrome prevalence among healthcare workers in Mogadishu, Somalia.

Factors associated with burnout syndrome among healthcare workers

Bivariate and multivariate logistic regression models were applied to identify the factors associated with the prediction of burnout syndrome among healthcare workers. The bivariate analysis showed significant associations between burnout syndrome and factors such as gender, profession, marital status, monthly income, weekly work hours, night shifts per month, work experience, sleep quality, and symptoms of depression and anxiety. In the multivariate analysis, significant associations with burnout syndrome were maintained for variables including gender, marital status, weekly working hours, monthly night shifts, work experience, sleep quality, depressive symptoms, and anxiety symptoms, all at a significance level of 0.05.

The results of the study showed that female healthcare professionals had roughly 6.6 times higher odds of experiencing burnout syndrome compared to their male colleagues (AOR = 6.60; 95%CI: 2.29-19.04). Married healthcare professionals faced a 3.07 times increased risk of burnout syndrome compared to single healthcare workers (AOR = 3.07; 95%CI: 1.14-8.28). Additionally, divorced or widowed healthcare workers had 5.84 times higher odds of experiencing burnout syndrome compared to singles (AOR = 5.84; 95%CI: 1.35-25.35). Healthcare workers working more than 50 hours per week were 6.06 times more likely to suffer from burnout syndrome (AOR = 6.06; 95%CI: 2.14-17.20). Those who completed seven or more night shifts each month had a 3.19 times higher likelihood of experiencing burnout compared to colleagues working fewer than seven-night shifts (AOR = 3.19; 95%CI: 1.30-7.82). Additionally, healthcare workers with less than five years of experience faced a 5.28 times greater risk of burnout than those with five or more years of experience (AOR = 5.28; 95%CI: 1.29-21.65). Furthermore, healthcare workers reporting inadequate sleep (AOR = 5.29; 95%CI: 1.88-14.89), depressive symptoms (AOR = 4.46; 95%CI: 1.59-12.53), or anxiety symptoms (AOR = 7.34; 95%CI: 2.49-21.60) were five times, four times, and seven times more likely to experience burnout syndrome, respectively (Table 3).

Table 3 Bivariate and multivariate logistic regression analyses to identify risk factors associated with burnout syndrome among healthcare workers in Mogadishu, Somalia (2024), (n = 246), n (%).

Variable	Category	Burnout syndrome		COR (95%CI)	AOR (95%CI)	P value
		No (%)	Yes (%)
Gender	Female	83 (70.9)	34 (29.1)	1.70 (0.94-3.08)	6.60 (2.29-19.04)	< 0.001
	Male	104 (80.6)	25 (19.4)	12	12
Marital status	Single	95 (81.9)	21 (18.1)	12	12
	Married	82 (73.9)	29 (26.1)	1.60 (0.848-3.01)	3.07 (1.14-8.28)	0.027
	Others1	10 (52.6)	9 (47.6)	4.07 (1.47-11.25)	5.84 (1.35-25.35)	0.018
Work hours per week	≤ 50 hours/week	128 (79.5)	33 (20.5)	12	12
	> 50 hours/week	59 (69.4)	26 (30.6)	1.71 (0.939-3.11)	6.06 (2.14-17.20)	< 0.001
Night shifts per month	< 7 nights	98 (84.5)	18 (15.5)	12	12
	≥ 7 nights	89 (68.5)	41 (31.5)	2.51 (1.34-4.68)	3.19 (1.30-7.82)	0.011
Work experience	≤ 4 years	93 (66.4)	47 (33.6)	4.17 (1.39-12.47)	5.28 (1.29-21.65)	0.021
	5–8 years	61 (88.4)	8 (11.6)	1.08 (0.303-3.86)	1.51 (0.302-7.56)	0.615
	> 8 years	33 (89.2)	4 (10.8)	12	12
Sleep quality	Good	138 (89.6)	16 (10.4)	12	12
	Poor	49 (53.3)	43 (46.7)	7.57 (3.91-14.65)	5.29 (1.88-14.89)	0.002
Depression status	Not depressed	137 (90.1)	15 (9.9)	12	12
	Depressed	50 (53.2)	44 (46.8)	8.04 (4.12-15.70)	4.46 (1.59-12.53)	0.005
Anxiety status	Not anxious	132 (92.3)	11 (7.7)	12	12
	Anxious	55 (53.4)	48 (46.6)	10.47 (5.06-21.66)	7.34 (2.49-21.60)	< 0.001

¹Divorced/widowed.

²Reference categories.

COR: Crude odds ratio; AOR: Adjusted odds ratio.

DISCUSSION

This study represents the first attempt to investigate the prevalence and factors influencing burnout syndrome among healthcare professionals at a specialized medical facility in Mogadishu, Somalia. Out of 246 participants, 24% exhibited symptoms of overall burnout syndrome, with 28.9% reporting high EE, 30.5% showing high DP, and 62.6% experiencing low PA. Factors such as gender, marital status, weekly working hours, monthly night shifts, years of experience, sleep quality, depressive symptoms, and anxiety symptoms were all linked to a higher risk of severe burnout syndrome.

The overall prevalence of burnout syndrome identified in this study is comparable to findings from studies performed in Egypt[26] and China[27]. However, this study's results are lower than those from previous research performed in Ethiopia[13], Sudan[15], and Saudi Arabia[28]. Conversely, this prevalence is higher than the rates reported in earlier studies from China[29] and Iran[30]. Additionally, a multinational study involving 23,159 nurses across 10 European countries revealed varying levels of burnout among nurses in different countries. The reported prevalence of burnout was as follows: 10% in the Netherlands, 15% in Switzerland, 22% in Finland, 24% in Norway, 25% in Belgium, 29% in Spain, 30% in Germany, 40% in Poland, 41% in Ireland, and 42% in England[31]. The burnout prevalence among nurses in Belgium, Norway, and Finland was similar to the findings of this study, while it was higher than in the Netherlands and Switzerland. Additionally, this study's results were lower than those from the other five countries. These variations may be attributed to social, cultural, and demographic factors of the participants, as well as differences in the healthcare systems of their respective countries. Moreover, they could also be influenced by variations in the specific study locations.

In terms of burnout components, 28% of the participants in this study experienced high EE, which aligns with findings from China[32], Ethiopia[18], and Brazil[33]. Likewise, a previous systematic review and meta-analysis of burnout syndrome in primary care nursing reported results consistent with our findings[34]. However, this rate is higher than that observed in a study performed in France[35]. Additionally, the results of the present study were comparatively lower than the findings reported in studies from Tanzania[16], Iran[36], and Ethiopia[13]. Among healthcare workers, 30.5% experienced high DP. This percentage aligns with the results of a study performed among emergency department staff in France[35] and a meta-analysis of emergency nurses[37]. However, this finding is higher than that observed in a study performed in China[31]. Similarly, a previous systematic review and meta-analysis of burnout syndrome among nurses reported a lower percentage than what was found in our study[34]. In contrast, the results of this study were lower than those reported in Ethiopia[13] and Saudi Arabia[28,38].

Furthermore, consistent with previous studies performed in China[27] and Syria[39], this study revealed that a greater percentage of participants (62.6%) reported a low level of PA. In contrast, research from Ethiopia[13,18] and Iran[36] indicated a higher prevalence of low personal achievement. Conversely, a study from Saudi Arabia[38] and a systematic review and meta-analysis[34] reported lower levels than those observed in our research. The differences in results may be attributed to the various methods used to define the three components of burnout. Additionally, variations in the fields of study and socio-cultural differences among participants could also play a role.

In terms of associated factors, female healthcare workers were found to have a greater likelihood of experiencing burnout syndrome, a finding supported by previous studies in the literature[13,38]. However, the current body of research presents mixed results regarding gender. Some studies found no significant gender association with burnout syndrome among healthcare workers[40,41], while others indicated that men experienced higher levels of burnout than women[17,18,42]. This discrepancy may be attributed to the socio-cultural factors related to being female. In many Muslim societies, women often face additional cultural and social obligations in addition to their professional commitments, potentially leading to heightened stress and exhaustion. This study found that married healthcare professionals were more likely to experience burnout syndrome than their single counterparts, which is consistent with previous research findings[15,41]. Likewise, divorced or widowed healthcare professionals also showed increased odds of burnout compared to singles, consistent with other studies[13,42]. One possible explanation for this trend is that an unstable marital relationship can lead to increased stress and a reduced interest in one's job, potentially increasing the risk of burnout syndrome. However, it is crucial to acknowledge that other studies have reported findings that contradict ours. For example, a recent study performed in Saudi Arabia observed no significant relationship between marital status and burnout syndrome[38], while another study in Iran indicated higher odds of burnout among single healthcare workers[36].

Current literature has demonstrated a connection between hours worked and the incidence of burnout syndrome among healthcare workers. Those who worked over 60 hours per week were found to be twice as likely to experience burnout syndrome compared to their counterparts working a standard 40-hour week[43]. Furthermore, the study revealed that burnout syndrome was more prevalent among healthcare professionals working more than 50 hours a week than among those working fewer hours, aligning with findings from previous research[44]. Therefore, recognizing extra working hours as a significant factor contributing to burnout syndrome underscores the importance of interventions focused on alleviating workload or promoting better time management practices within the workplace. Contrary to our findings, a study from Eastern Ethiopia reported no association between weekly hours worked and burnout syndrome[13]. In our research, we observed that healthcare workers with seven or more night shifts experienced higher levels of burnout, consistent with earlier studies[17,33]. However, our results contradict those of another Ethiopian study, which indicated that healthcare workers without night shifts[45] faced increased odds of burnout, whereas another study from Tanzania reported no association between the outcome variable and night shifts[16].

In this study, we found that healthcare workers with less than 4 years of experience were more prone to experiencing burnout syndrome than those with greater experience, which aligns with the results observed in previous research[13,19]. However, the literature presents mixed findings. For example, a recent study from Saudi Arabia indicated that healthcare workers with over 20 years of experience had higher odds of developing burnout syndrome, while studies performed in Palestine[46] and Ethiopia[41] reported no correlation between years of experience and burnout. This can be explained by the fact that less experienced healthcare workers are still adapting to their roles, attempting to balance their professional and personal lives, and may feel pressured to exert extra effort to meet job and supervisor expectations. In contrast, seasoned professionals are more likely to have successfully adjusted to their work environments and found a suitable balance between work and personal life.

Obtaining adequate quality sleep is essential for maintaining personal health and well-being, achieving optimal performance, and ensuring public safety. Current literature supports a correlation between poor sleep quality and the onset of burnout syndrome in healthcare professionals[47,48]. Our study found that inadequate sleep quality was linked to burnout syndrome among these professionals. Consistent with our findings[16,49], several studies have reported similar conclusions. These results highlight the urgent need for developing and implementing strategies at both institutional and personal levels. These strategies should focus on improving work-life balance, providing adequate opportunities for rest and recovery, managing stress effectively, and promoting better sleep quality. Such initiatives are crucial for addressing current problems in healthcare environments, guaranteeing superior patient care, and prioritizing the well-being of frontline healthcare professionals. However, a study performed in Ethiopia presented conflicting results, revealing no correlation between sleep quality and burnout syndrome among nurses[19].

Several studies in the literature have established a direct association between burnout and depression[50]. This study found that healthcare workers with depressive symptoms were more likely to experience burnout syndrome, aligning with previous findings[19,42]. In contrast to our results, some researchers argue that owing to the moderate to high correlation between these two concepts, burnout syndrome may not be a distinct psychological phenomenon but rather a subset of depression[51]. Similarly, a study by Schonfeld and Bianchi assessed whether burnout and depression were separate or interconnected, concluding that burnout was likely a manifestation of depression. As a result, treatments for depression may be advantageous for individuals identified as "burned out"[52]. However, this notion is not universally accepted among researchers. While burnout and depression share certain similarities, such as diminished energy, many experts view them as distinct concepts[53].

Finally, anxiety appears to be another factor associated with burnout syndrome, although it has been studied less often than depression. In our research, we observed that healthcare workers exhibiting anxiety symptoms were more susceptible to experiencing burnout syndrome compared to those without such symptoms, aligning with existing literature[54]. However, Koutsimani et al[55] concluded in their review that, despite a statistical association between burnout syndrome and both depression and anxiety, these two conditions were distinct psychological disorders.

Limitations

This study has several limitations that must be taken into account. First, the use of a cross-sectional study design restricted the ability to evaluate the cause-and-effect relationships of the observed associations. Second, the small number of participants poses a limitation, potentially reducing the generalizability of the results to larger populations. Third, the data were collected through self-reported questionnaires, which can inevitably introduce recall bias. Finally, the study questionnaire did not account for other potential characteristics that might lead to burnout syndrome among healthcare providers, including workplace violence, job satisfaction, intentions to leave, substance use, and others[14,19,30]. Regardless of these limitations, the study effectively met its objectives and, to the best of our knowledge, is the first to investigate the prevalence of burnout syndrome and its associated factors among healthcare workers in Somalia.

CONCLUSION

This study revealed that burnout syndrome impacted nearly one in four healthcare professionals (24%), with a significant majority (62.6%) reporting low PA. Factors such as gender, marital status, weekly working hours, monthly night shifts, years of work experience, sleep quality, depressive symptoms, and anxiety symptoms were all significantly linked to a higher probability of experiencing burnout syndrome. The findings of our study underscore the importance of developing and executing strategies that prioritize improving work-life balance, providing adequate opportunities for relaxation and recovery, effectively managing stress, reducing workloads, establishing efficient time management practices in the workplace, and enhancing sleep quality among healthcare workers. These measures are essential for tackling current issues in healthcare institutions, ensuring a higher standard of patient care, and prioritizing the well-being of frontline healthcare professionals.