Mentalization and training in psychiatry: protective factors against burnout. Evidence from a multicenter controlled longitudinal study
L. Tarchi, E. Cassioli, G. Castellini, V. Ricca, A. FiorilloIntroduction
According to mentalization theory, personal and interpersonal skills can be shaped by early adverse experiences and coping strategies, thus playing a key role in mitigating burnout during training. In this study, the interaction between these variables was tested in a multicenter longitudinal survey involving various Italian academic institutions.
Objectives
The primary objective was to investigate protective and risk factors for the development of burnout in psychiatry trainees. Secondary objectives included comparing burnout trajectories among psychiatry residents and those in other medical disciplines, identifying psychiatry -specific factors versus general training longitudinal trajectories, and analyzing the dynamic development of personal/interpersonal skills during psychiatry training.
Methods
A cohort of 1,803 medical residents (including 1,131 psychiatry residents) was assessed for emotional regulation, interpersonal skills, coping strategies, and burnout dimensions using the Difficulties in Emotion Regulation Scale (DERS); the Interpersonal Competence Questionnaire (ICQ); the Maslach Burnout Inventory (MBI). The assessment was repeated after one year of follow-up to examine longitudinal trends. Longitudinal mixed models and bivariate latent change models were used to examine burnout trajectories and related factors.
Results
An increase in burnout was observed in the first two years of specialization. This increase in burnout over the years was lower among psychiatry residents than among other medical residents. Psychiatry residents had a lower increase in burnout over time thanks to greater development of interpersonal skills and coping strategies during their training. In all residents, greater development of burnout was associated with insecure attachment, emotional dysregulation, maladaptive coping, and poorer interpersonal skills. Regular supervision by a supervisor protected against increased burnout. The bivariate latent change model showed that greater development of emotional regulation skills during specialization was associated with a lower increase in burnout.
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