Spiritual health and Burnout

Problem

Staff burnout is a pressing concern during the covid pandemic. A link between the concepts of spiritual health (the soul along with meaning and purpose, transcendence, and religious and ethical practice) and burnout, and also moral injury has been hypothesised. Burnout is seen by the World Health Organisation as not primarily a physical or mental health issue, and was described by Christina Maslach as ‘erosion of the soul’. Unfortunately, discussion of spiritual health, and what keeps our spirits up, is often stigmatised and uncomfortable. In order to take an holistic approach to staff wellbeing, and mitigate the expected burnout crisis, it’s important we investigate the relationship between spiritual health and burnout, to allow effective intervention.

Approach

An evidence synthesis was undertaken, to assess current knowledge, and the weaknesses in previous research on this topic. A survey of UK GPs is planned, assessing burnout and spiritual health, as we start to recover from the covid pandemic. If the hypothesis of a link between the concepts is supported, depth interviews will follow, with staff who have lived experience with burnout, to investigate their experiences of burnout and spiritual health.

Findings

A review of the literature identified 33 studies worldwide after systematic searching, where quantifications of burnout had been compared with spiritual health, wellbeing, general spirituality or religiosity. These 34 studies were heterogeneous, often of poor quality, vulnerable to sampling and response bias. Most studies were based in the USA, similar to other aspects of spiritual health research. There lacks a ‘gold standard’ to assess spiritual health, and this limits comparison of the studies, as does the diversity of settings, and sampling methods. The larger studies found asked solely about religiosity, rather than the wider concept of spirituality. While many studies found an association between spiritual health and burnout, this was not always consistent across burnout domains, and the effect was often small and/or not statistically significant. There were no studies focussing on Northern Europe, and only 3 in primary care.

While the evidence for an effect of spiritual health on burnout is limited, it does deserve further exploration, as evidence from the UK and in primary care is lacking. To explore this gap, a nationwide survey using validated tools (Maslach Burnout Inventory, and the FACIT-Spiritual Wellbeing-Non-Illness score) will be carried out in GPs in the UK.

Consequences

An understanding of burnout, its predisposing, precipitating, perpetuating and protective factors, needs to include spiritual health to be fully holistic. Identifying whether improving spiritual health, and identifying systemic and workplace approaches to this, could be a way to develop effective interventions to prevent and mitigate burnout in staff.