No CrossRef data available.
Article contents
Risk and protective factors against burnout increase during psychiatry training: evidence from a longitudinal multicentre controlled study
Published online by Cambridge University Press: 23 March 2026
Abstract
Background
Mentalising skills may be conceptualised as composed by both personal and interpersonal competencies, in turn shaped by early adverse experiences and coping strategies. Although cross-sectional observations described a role for mentalising skills in burnout development, large-scale longitudinal studies on the topic remain limited, especially in relation to psychiatry training.
Aims
The primary aim was to investigate protective and risk factors for higher burnout scores across time. Secondary aims included testing whether psychiatry exhibited different burnout scores across time in comparison to other medical residents.
Method
A cohort of 1803 medical residents (1131 psychiatry residents) was assessed for mentalising skills, conceptualised as composed of emotional regulation (Difficulties in Emotion Regulation Scale), interpersonal competencies (Interpersonal Competence Questionnaire), coping strategies (Coping Orientation to Problems Experienced) and burnout dimensions (Maslach Burnout Inventory). One-year follow-up was available for 520 psychiatry residents (73.03% response rate) and 234 other medical residents (35.94% response rate). Longitudinal mixed models and bivariate latent change models were employed.
Results
Across all residents, greater levels of burnout were associated with higher scores in insecure attachment, emotional dysregulation and maladaptive coping, as well as lower scores in interpersonal skills. Attending at least one supervision per month was associated with lower burnout scores across time. According to a bivariate latent change model, emotional regulation improvements through years were associated with lower burnout scores across time. In psychiatry residents, lower burnout scores across time were observed as compared to other medical residents. Psychiatry residents benefited from a higher protective effect of interpersonal competencies (group by moderator by time interaction) and coping strategies against burnout.
Conclusions
Mentalising skills may mitigate burnout development. Training in psychiatry emerged as a potential mitigating factor against burnout increases. Structured supervisions may foster professional development and emotional resilience.
Keywords
Information
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists
References
Brittlebank, A, Hermans, M, Bhugra, D, Pinto da Costa, M, Rojnic-Kuzman, M, Fiorillo, A, et al. Training in psychiatry throughout Europe. Eur Arch Psychiatry Clin Neurosci 2016; 266: 155–64.10.1007/s00406-016-0679-4CrossRefGoogle ScholarPubMed
Brittlebank, A, Picker, LD, Krysta, K, Seker, A, Riboldi, I, Hanon, C, et al. Benchmarking psychiatry in Europe and beyond: The European Board Exam of Psychiatry. Eur Psychiatry 2024; 67: e39.10.1192/j.eurpsy.2024.1746CrossRefGoogle ScholarPubMed
Fiorillo, A, Sampogna, G, Del Vecchio, V, Luciano, M, Del Gaudio, L, De Rosa, C, et al. What is the current status of training and practice of early intervention in psychiatry? Results from a survey in 35 countries. Early Interv Psychiatry 2015; 9: 70–5.10.1111/eip.12085CrossRefGoogle Scholar
Ryland, H, da Costa, MP, Baker, L, Elkholy, H, Melapi, TAS, Santos, MP, et al. Unmet needs during residency training programmes in psychiatry. In New Directions in Psychiatry (eds Pompili, M, McIntyre, R, Fiorillo, A, Sartorius, N): 157–79. Springer International Publishing, 2020.10.1007/978-3-030-42637-8_10CrossRefGoogle Scholar
World Health Organization, Regional Office for Europe. Health and Care Workforce in Europe: Time to Act. WHO, 2022 (https://www.who.int/europe/publications/i/item/9789289058339).Google Scholar
Castellini, G, Tarchi, L, Cassioli, E, Ricca, V, Abbate Daga, G, Aguglia, A, et al. The interplay between mentalization, personality traits and burnout in psychiatry training: results from a large multicenter controlled study. Acta Psychiatr Scand 2024; 149: 177–94.10.1111/acps.13649CrossRefGoogle ScholarPubMed
Volpe, U, Luciano, M, Palumbo, C, Sampogna, G, Del Vecchio, V, Fiorillo, A. Risk of burnout among early career mental health professionals. J Psychiatr Ment Health Nurs 2014; 21: 774–81.10.1111/jpm.12137CrossRefGoogle ScholarPubMed
Jovanović N, Podlesek, A, Volpe, U, Barrett, E, Ferrari, S, Kuzman, MR, et al. Burnout syndrome among psychiatric trainees in 22 countries: risk increased by long working hours, lack of supervision, and psychiatry not being first career choice. Eur Psychiatry 2016; 32: 34–41.Google Scholar
Garcia C de L, de Abreu, LC, Ramos, JLS, de Castro, CFD, Smiderle, FRN, dos Santos, JA, et al. Influence of burnout on patient safety: systematic review and meta-analysis. Medicina (Kaunas) 2019; 55: 553.Google Scholar
Chan, MK, Chew, QH, Sim, K. Burnout and associated factors in psychiatry residents: a systematic review. Int J Med Educ 2019; 10: 149–60.10.5116/ijme.5d21.b621CrossRefGoogle ScholarPubMed
Bykov, KV, Zrazhevskaya, IA, Topka, EO, Peshkin, VN, Dobrovolsky, AP, Isaev, RN, et al. Prevalence of burnout among psychiatrists: a systematic review and meta-analysis. J Affect Disorders 2022; 308: 47–64.10.1016/j.jad.2022.04.005CrossRefGoogle ScholarPubMed
Fonagy, P, Gergely, G, Jurist, EL, Target, M. Affect Regulation, Mentalization, and the Development of the Self. Other Press, 2002.Google Scholar
Fonagy, P. Mentalizing psychiatric training. Acta Psychiatr Scand 2024; 149: 173–6.10.1111/acps.13662CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–81.10.1016/j.jbi.2008.08.010CrossRefGoogle ScholarPubMed
Brugnera, A, Zarbo, C, Farina, B, Picardi, A, Greco, A, Coco, GL, et al. Psychometric properties of the Italian version of the Experience in Close Relationship Scale 12 (ECR-12): an exploratory structural equation modeling study. Res Psychother Psychopathol Process Outcome 2019; 22: 392.Google ScholarPubMed
Giromini, L, Velotti, P, de Campora, G, Bonalume, L, Cesare Zavattini, G. Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian Version. J Clin Psychol 2012; 68: 989–1007.10.1002/jclp.21876CrossRefGoogle ScholarPubMed
Giromini, L, de Campora, G, Brusadelli, E, Zennaro, A, Zavattini, GC, Lang, M. Validity and reliability of the interpersonal competence questionnaire: empirical evidence from an Italian study. J Psychopathol Behav Assess 2016; 38: 113.10.1007/s10862-015-9499-5CrossRefGoogle Scholar
Sica, C, Magni, C, Ghisi, M, Altoé, G, Sighinolfi, C, Chiri, LR, et al. Coping orientation to problems experienced -- Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoterap Cogn Comportamentale 2008; 14: 27–53.Google Scholar
Sacchi, C, Vieno, A, Simonelli, A. Italian validation of the Childhood Trauma Questionnaire-Short Form on a college group. Psychol Trauma 2018; 10: 563–71.10.1037/tra0000333CrossRefGoogle ScholarPubMed
Sirigatti, S, Stefanile, C. Adattamento e taratura per l’Italia [Adaptation and calibration for Italy]. In MBI Maslach Burnout Inventory (eds Maslach, C, Jackson, S): 33–42. Firenze, 1993.Google Scholar
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation, 2024 (https://www.R-project.org).Google Scholar
Pinheiro, J, Bates, D, DebRoy, S, Sarkar, D. nlme: Linear and Nonlinear Mixed Effects Models. R Foundation, 2023 (https://cran.r-project.org/web/packages/nlme/index.html).Google Scholar
Kuznetsova, A, Brockhoff, PB, Christensen, RHB. lmerTest: tests in linear mixed effects models. J Stat Soft 2017; 82: 1–26.10.18637/jss.v082.i13CrossRefGoogle Scholar
Rosseel, Y. lavaan: an R package for structural equation modeling. J Stat Softw 2012; 48: 1–36.10.18637/jss.v048.i02CrossRefGoogle Scholar
Fonagy, P, Bateman, A (eds). Introduction. In Handbook of Mentalizing in Mental Health Practice 2nd ed.: 211–28. American Psychiatric Association Publishing, 2019.Google Scholar
Salgado, RM, von Doellinger, O. Psychotherapy training in psychiatry residencies: a review of trainees’ perspectives. Eur J Psychiatry 2024; 38: 100263.10.1016/j.ejpsy.2024.100263CrossRefGoogle Scholar
Demerouti, E, Bakker, AB, Nachreiner, F, Schaufeli, WB. The job demands-resources model of burnout. J Appl Psychol 2001; 86: 499–512.10.1037/0021-9010.86.3.499CrossRefGoogle ScholarPubMed
Boni, RAS, Paiva, CE, de Oliveira, MA, Lucchetti, G, Fregnani, JHTG, Paiva, BSR, et al. Burnout among medical students during the first years of undergraduate school: prevalence and associated factors. PLOS One 2018; 13: e0191746.10.1371/journal.pone.0191746CrossRefGoogle ScholarPubMed
Brennan, N, Corrigan, O, Allard, J, Archer, J, Barnes, R, Bleakley, A, et al. The transition from medical student to junior doctor: today’s experiences of tomorrow’s doctors. Med Educ 2010; 44: 449–58.10.1111/j.1365-2923.2009.03604.xCrossRefGoogle ScholarPubMed
Paice, E, Heard, S, Moss, F. How important are role models in making good doctors? BMJ 2002; 325: 707–10.10.1136/bmj.325.7366.707CrossRefGoogle ScholarPubMed
Tarchi, L, Castellini, G, Ricca, V. Mentalizing during training: epistemic trust, transformative experiences and the role of the mentor in occupational identity development. In The Psychology of Mentalizing (eds Khalaf, PT, Abi-Habib, R): 35–50. Nova Science Publishers, 2024.Google Scholar
Tohme, P, Kolev, M. Mentalizing glasses: multifocal attention in mentalization-based treatment and the role of the supervision. Front Psychol 2021; 12: 708393.10.3389/fpsyg.2021.708393CrossRefGoogle ScholarPubMed
Bevington, D, Fuggle, P. AMBIT: engaging the client and communities of minds. In Handbook of Mentalizing in Mental Health Practice 2nd ed. (eds Batman, AW, Fonagy, P): 211–28. American Psychiatric Association Publishing, 2019.Google Scholar
Klinkosz, W, Iskra, J, Artymiak, M. Interpersonal competences of students, their interpersonal relations, and emotional intelligence. Curr Issues Personal Psychol 2021; 9: 125–34.10.5114/cipp.2021.105733CrossRefGoogle ScholarPubMed
Parker, JDA, Summerfeldt, LJ, Walmsley, C, O’Byrne, R, Dave, HP, Crane, AG. Trait emotional intelligence and interpersonal relationships: results from a 15-year longitudinal study. Person Ind Differ 2021; 169: 110013.10.1016/j.paid.2020.110013CrossRefGoogle Scholar
Bateman, AW, Fonagy, P. Handbook of Mentalizing in Mental Health Practice 1st ed. American Psychiatric Publications, 2011.Google Scholar
Fonagy, P, Campbell, C, Luyten, P. Attachment, mentalizing and trauma: then (1992) and now (2022). Brain Sci 2023; 13: 459.10.3390/brainsci13030459CrossRefGoogle ScholarPubMed
You, D, Kealy-Bateman, W. Outcomes of mentoring programs in psychiatry training: a literature review. Australas Psychiatry 2019; 27: 234–40.10.1177/1039856219839488CrossRefGoogle ScholarPubMed
Whitmore, CA, Cook, J, Salg, L. Supporting residents in the wake of patient suicide. Am J Psychiatry Resid J 2017; 12: 5–7.10.1176/appi.ajp-rj.2017.120102CrossRefGoogle Scholar
Castellini et al. supplementary material 1
Castellini et al. supplementary material
File
17.4 KB
Castellini et al. supplementary material 2
Castellini et al. supplementary material
File
61.2 KB
Castellini et al. supplementary material 3
Castellini et al. supplementary material
File
47.2 KB
Castellini et al. supplementary material 4
Castellini et al. supplementary material
File
86.5 KB
eLetters
No eLetters have been published for this article.