What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Figures & data

Figure 1 Systematic review flow diagram adopted in this study based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Notes: PRISMA figure adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. doi: 10.1136/bmj.n71. Creative Commons.

Table 1 Characteristics of Included Studies

First Author, Year, Country	Design	Participants (N)	Profession (Nurses/Physicians)	Gender	Age (Years)	Study Population	Empathy Measure	Burnout Measure	Quality Assessment
Altman, 2020, Germany	Longitudinal	186	N	Male: 18.5%	M = 38.8 (SD 11.3)	Nurses in four university hospitals	Toronto Empathy Questionnaire, Geneva Emotion Recognition Test, Social Mindfulness Paradigm	Irritation Scale, Copenhagen Burnout Inventory	Medium
Beckman, 2012, USA	Cross-sectional Correlational	202	P	Female: 42.6% Male: 57.4%	Age 24–30 years old 85.5% ≥31 years old 14.5%	Internal medicine residents	IRI	MBI	Medium
Bogiatzaki, 2019, Greece	Cross-sectional Correlational	173	N P	Female: 85.5% Male: 14.5%	42.2% was 40–49 years old	Healthcare professionals: Doctor: 15.7% Nurse: 51.2% Nurse assistant: 7.6% Other: 25.6%	JSPE	MBI	High
Carmel, 1996, Israel	Cross-sectional Correlational	214	P	Male: 82%	M = 43.2 (SD 9.3)	Doctors in hospital settings: General practitioner: 28% Surgery: 22% Gynecology: 16% Pediatrics: 14% Other: 20%	IRI	MBI	High
Correia, 2020, Portugal	Cross-sectional Correlational	229 physicians and 268 nurses	N P	Physicians: 52% female; 48% male. Nurses: 73.1% female; 26.9% male	Physicians aged M = 36.54 (SD 10.72); and nurses aged M = 34.96 (SD 9.52).	Physicians and nurses	(BES-A)	(OLBI)	Medium
Delgado, 2021, Spain	Cross-sectional Correlational	184	N P	Female: 77.2% Male: 22.8%	M = 44.6 (SD 10.46)	Healthcare professionals (56.8% nurses, 30.3 doctors, 7.6% Nursing assistants, and 5.4% other categories)	IRI	MBI	Medium
Fülöp, 2011, Hungary	Cross-sectional Correlational	67	P	Female: 77% Male: 23%	M = 31.45 (SD 5.789)	Psychiatry residents and medical specialist candidates	IRI	MBI	Medium
Galam, 2017, France	Cross-sectional Transversal and longitudinal analysis	304 (start) 169 (T1) and 174 (T2)	P	At the three time points, an average of 76.1% were women.	Average age of 25.4	GPTs starting their internship	JSPE	MBI	Medium
Kelly-Hedrick, 2020, USA	Cross-sectional online survey	92	P	Female: 58%	M = 30.1 (SD 3.0)	Internal medicine residents: 52% Psychiatry residents: 48%	IRI (EC)	MBI	High
Krasner, 2009, USA	Cross-sectional Quasi-experimental	70	P	Female: 46%, Male: 54%	-	Internal medicine: 49% Family medicine: 41% Pediatrics: 10%	JSPE	MBI	Medium
Lee, 2018, Singapore	Cross-sectional cohort study	446	P	Female: 55.2% Male: 46.6%	M = 29.4 (SD 2.60)	Residents	JSPE	MBI	High
Lusilla-Palacios, 2015, Spain	Quasi-experimental pre-post control design	45	N P	Female: 75.6% Male: 24.4%	M = 45.2 (SD 10.5)	Professionals working in a spinal cord injury unit: Nurses 31%, Assistant nursing 20%, Physiotherapist 13.3% Physiotherapist assistant 2.2%, Fitness monitor 4.4% Rehabilitation physician 6.6%, Occupational therapist 2.2%, Social worker 6.7% Hospital attendants 13.3%	JSPE	MBI	Medium
McManus, 2011, UK	Cross sectional.- Correlational	2845	P	Differed between the cohorts: Females 1981: 43.7%, 1986: 48.6%, 1991: 56.7% 1990/92: 55.2%.	M = 46.9, 41.9, 37.0 and 36.9 years old (SDs 3.23, 1.87, 1.84, and 2.00).	Different specialties	IRI	MBI	High
Omdahl, 1999, USA	Cross-sectional Correlational	164	N	Female: 97.6% Male: 2.4%	-	Nurses working in several areas	IRI	MBI	Medium
Penšek, 2018, Slovenian	Cross-sectional Correlational	316	P	Female: 82% Male: 18%	M = 40 (SD 10.2)	Family medicine: 38.9% family medicine trainees and 61.1% were specialists	JSE-HP	MBI	High
Reed, 2018, USA	Cross-sectional Correlational Transversal and longitudinal analysis	108	P	Female: 63% Male: 31.5% No answer: 5.5%	M = 28.56 (SD 2.69)	Pediatric residents	IRI	MBI	High
Ren, 2020, China	Cross-sectional Correlational	786	N	Female: 97.96% Male: 2.04%	≤25 M = 41.58 (SD 12.88) 26–30 M = 40.31 (SD 13.19) 31–35 M = 39.46 (SD 13.91) 36–40 M = 35.02 (SD 11.72) ≥41 M = 32.23 (SD 12.45)	Nurses working in hospital	IRI	MBI	High
Salvarani, 2019, Italy	Cross-sectional Correlational	97	N	Female: 61.86% Male: 38.14%	M = 38 (SD 9.48)	Emergency room	IRI	MBI	Medium
Seo, 2020, Korea	Cross-sectional Correlational	105	N P	Female: 91.4% Male: 8.6%	51.4% below 30.	Healthcare professional including nurses and doctors in their residency training program in a hospital in Seoul	JSPE	MBI	High
Sturzu, 2019, France	Cross-sectional Observational	241	N P	Female: 48% Male: 52%	M = 39.77 (SD 11.26)	Psychiatric nurse 67%; Chief nurse 12%; Psychiatry Resident 12%; Psychiatrist 20%	JSPE	MBI	High
Verweij, 2018, The Netherlands	Cross-sectional Quasi-experimental	138	P	Female: 88%	M = 31.2 (SD 4.6)	Residents’ Specialty: Surgical specialties: 11% Medical specialties: 38% Supportive specialties: 12% Psychiatry: 7% Primary care specialties: 32%	JSPE	MBI	High
West, 2006, USA	Prospective longitudinal study	184	P	Women: 35.9% Male: 51.1% Missing: 13%	≤ 30: 70.1% >30: 16.3% Missing: 13.6%	Internal medicine residents	IRI	MBI	High
Winkel, 2016, USA	Cross sectional, pre-post intervention	66	P	–	–	Resident in obstetrics	JSPE	MBI	Medium

Abbreviations: N, nurses; P, physicians; IRI, Interpersonal Reactivity Index; JSPE, Jefferson Scale of Physician Empathy; MBI, Maslach Burnout Inventory.

Table 2 Meta-Analysis Correlation Coefficient Estimates Between the Subscales for Empathy and Subscales for Burnout

Correlation Data				Heterogeneity
	Efect Size	95% CI	z	Q (df)	I² (95% CI)	H
EC_EmExh	0.0157	[−0.0769; 0.1080]	0.33	9.05 (4) n.s	55.8% [0–83.7%]	1.50
EC_Deper	− 0.2525	[−0.3138; −0.1891]	−7.59**	3.94 (4) n.s	0.00% [0–79%]	1.00
EC_Pacc	0.1373	[0.0204; 0.2506]	2.30**	9.84 (3)**	70.00% [12.2–89.4%]	1.81
PD_EmExh	0.0272	[−0.4192; 0.4631]	0.11	88.24 (2)	92.0% [95.7%; 98.8%]	6.64
PD_Deper	−0.0215	[−0.1989; 0.1572]	−0.23	12.46 (2)**	84.0% [51.8%; 94.7%]	2.50
PD_Pacc	−0.1879	[−0.4782; 0.1394]	−1.13	42.03 (2)**	95.2% [89.4%; 97.9%]	4.58
PT_EmExh	−0.0589	[−0.1449; 0.0281]	−1.33	7.44 (4) n.s.	46.2% [0.0%; 80.3%]	1.36
PT_Deper	−0.27	[−0.3639; −0.1767]	−5.41**	10.57 (4)**	62.2% [0.0%; 85.7%]	1.63
PT_Pacc	0.3063	[0.2153; 0.3920]	6.35**	6.73 (3) n.s.	55.00% [0.0%; 85.2%]	1.50

Note: THeterogeneity index and pooled effect size are presented. ** p<0.01.

Abbreviations: EC, Emotional Concern; PD, Personal Distress; PT, Perspective Taking; EmExh, Emotional Exhaustion; Deper, Depersonalization; Pacc, Personal Accomplishment; COR, correlation; CI, confidence interval; Q, Q statistic for heterogeneity; df, degrees of freedom; I², Heterogeneity Index; H, observed variation ratio.

Figure 2 Forest plot for sstimates of the sffects of significant correlations between empathy and burnout.