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2023 HSR&D/QUERI National Conference Abstract

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1137 — Risk and Protective Factors for Burnout among VA Psychotherapists Treating PTSD Before and During the COVID-19 Pandemic

Lead/Presenter: Craig Rosen,  COIN - Palo Alto
All Authors: Rosen CS (National Center for PTSD Dissemination & Training Division), Rosen CS (National Center for PTSD Dissemination & Training Division, Palo Alto) Kaplan AN (Center for Chronic Disease Outcomes Research, Minneapolis) Nelson DB (Center for Chronic Disease Outcomes Research, Minneapolis) La Bash H (National Center for PTSD Dissemination & Training Division, Palo Alto) Chard K (Cincinnati VA Medical Center, Cincinatti) Eftekhari A (National Center for PTSD Dissemination & Training Division, Palo Alto) Kehle-Forbes S (Center for Chronic Disease Outcomes Research, Minneapolis) Stirman SW (National Center for PTSD Dissemination & Training Division, Palo Alto) Sayer NA (Center for Chronic Disease Outcomes Research, Minneapolis)

Objectives:
1) To assess changes in the prevalence and predictors of burnout among VA psychotherapists treating PTSD before and during the COVID-19 pandemic.

Methods:
Psychotherapists participating in an observational study (IIR 17-178) of evidence-based psychotherapies for PTSD in U.S. Department of Veterans Affairs facilities were surveyed prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic. Survey measures assessed burnout, implementation climate and leadership supporting use of evidence-based treatment, job resources (e.g., control over tasks), and job demands. Clinician workload (encounters per month) and case mix (proportion of patient with PTSD) were determined from administrative data.

Results:
Burnout prevalence increased from 40% prior to the pandemic to 56% during the pandemic (p < .001). Before the pandemic (at T1), risk for burnout was reduced by organizational climate supporting use of evidence-based psychotherapies (adjusted odds ratio = .47, p < .001) and implementation leadership (AOR = .70, p < .004). During the pandemic (T2), burnout was most strongly predicted by high pandemic-related stress (AOR = 35.71, p < .001 vs. low pandemic stress; AOR = 15.62, p < .011 vs. moderate pandemic stress) and by prior burnout at T1 (AOR = 7.47, p < .001). Higher burnout risk at T2 was also predicted by less control over when and how to deliver EBPs (AOR = 1.47, p < 02), being female (AOR = 5.52, p < .02), and being a psychologist rather than social worker (AOR = 7.33, p < .02). Risk for burnout risk at T2 was not associated with changes in workload, technical challenges in delivering telehealth, or leadership supporting use of evidence-based psychotherapies.

Implications:
Organizational support for using evidence-based treatments reduced burnout risk prior to but not during the pandemic. The strong association between pandemic related stress and burnout suggests that factors outside of work contributed to burnout during the pandemic. A comprehensive approach to reducing burnout must consider how both work demands and personal stressors impact staff well-being and provide work resources accordingly.

Impacts:
Under normal (non-pandemic) work conditions, leadership that helps clinicians deliver effective treatment can reduce staff burnout. During a long-lasting pandemic, staff need resources to help them address both work and personal stressors.