Occupational burnout, perceived stress and psychological well-being among healthcare workers: a PRISMA-guided systematic review

INTRODUCTION

Healthcare work is among the most psychologically demanding occupations, characterized by high patient loads, emotionally charged encounters, irregular shift schedules, and continuous exposure to suffering and mortality. These occupational demands have long been associated with elevated rates of occupational burnout, chronic perceived stress, and compromised psychological well-being among nurses, physicians, and allied health professionals.¹

In 2019, the World Health Organization formally recognized burnout as an occupational phenomenon in the eleventh revision of the International Classification of Diseases, describing it as a syndrome resulting from chronic workplace stress that has not been successfully managed.² Burnout, perceived stress, and psychological well-being are conceptually distinct yet empirically interconnected constructs. Burnout is typically operationalized as a three-dimensional syndrome comprising emotional exhaustion, depersonalization, and reduced personal accomplishment.³

Perceived stress refers to the degree to which individuals appraise situations as unpredictable, uncontrollable, and overwhelming.⁴ Psychological well-being, drawing on Ryff's multidimensional model, encompasses autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance.⁵ Despite an expanding evidence base, the literature remains fragmented across professions, countries, instruments, and theoretical frameworks, producing considerable heterogeneity in reported prevalence and inconsistent conclusions about risk and protective factors.⁶

This review applies a formal, PRISMA-guided search and screening protocol to address five questions: (a) how are burnout, perceived stress, and psychological well-being conceptualized and measured; (b) what is their documented prevalence among healthcare workers; (c) what antecedents and risk factors are most consistently reported; (d) how are the three constructs interrelated; and (e) what interventions have demonstrated effectiveness.

METHODS

This review followed the reporting structure recommended by the PRISMA 2020 statement to the extent feasible within a single-reviewer, tool-mediated search process; deviations from a full institutional systematic review protocol are stated explicitly in the limitations section.⁷

Information sources and search strategy

Searches were conducted using an AI-assisted academic search tool that indexes and retrieves content from PubMed/PMC, Scopus-indexed journals, JAMA, BMC, MDPI, Frontiers, ScienceDirect, Springer, and Wiley, among other publishers. This is a pragmatic, single-tool search process rather than a direct Boolean export from institutional database platforms (e.g., Ovid MEDLINE, CINAHL, PsycINFO); this constraint is discussed under limitations. Eleven structured search queries were run, combining terms for burnout, perceived stress, psychological well-being, and healthcare worker subgroups (Table 2). Searches were supplemented by backward citation searching: the reference list of one comprehensive, closely aligned primary study was hand-screened, yielding 15 additional named studies that were independently located and verified.⁸

*“Records returned” reflects the number of distinct result entries examined from each query; totals include duplicates across queries, which were subsequently removed during screening (see Figure 1).

Study selection and data extraction

Titles and abstracts of all retrieved and citation-chained records were screened by a single reviewer against the PICOS criteria above. Records excluded for population mismatch (e.g., students, general community samples, social workers), non-peer-reviewed/ promotional source type, clinical-trial registry entries without reported outcomes, superseded preprints, and insufficient topical alignment. Remaining records were assessed in full for eligibility, with further exclusions for insufficient extractable data on burnout, stress/ well-being outcomes, or duplicate reporting of the same cohort in a companion publication already included. For each included primary study, the following data were extracted where reported: authors and year, country, sample and setting, design, instruments used, and key findings relevant to burnout, perceived stress, or psychological well-being.

Quality considerations

Given the single-reviewer, non-registered nature of this review, a formal dual-reviewer risk-of-bias tool (e.g., the Newcastle-Ottawa Scale or JBI Critical Appraisal Checklists) was not applied with independent scoring. As a lighter-weight quality safeguard, included primary studies were required to report a named validated instrument, a defined sample and setting, and a peer-reviewed publication venue; studies relying solely on unvalidated/ ad hoc measures excluded. This represents a methodological limitation relative to a full institutional systematic review and is discussed further below.

Study selection results

The search process identified 96 candidate records (81 via direct search queries and 15 via backward citation searching). After removing duplicate records (n=24, chiefly mirror hosts of the same article across PMC, publisher sites, and repository copies, and repeat appearances across queries), 72 unique records were screened at the title/abstract level. Nineteen records were excluded at this stage for population mismatch, non-peer-reviewed source type, trial-registry status without results, or a superseded preprint. The remaining 53 records were assessed in full; 10 were further excluded for insufficient extractable data or duplicate cohort reporting, yielding a final set of 43 included sources. Figure 1 presents the PRISMA-style flow diagram.

RESULTS

Overview of included studies

Of the 43 included sources, 8 were foundational theoretical or instrument papers underpinning the burnout, stress, and well-being constructs; 15 were systematic reviews or meta-analyses synthesizing prevalence, risk factors, or intervention effectiveness; and 20 were primary empirical (mostly cross-sectional) studies. Included primary studies spanned the Czech Republic, Singapore, the United Kingdom, Poland, Finland, Sweden, China, Peru, Lithuania, Saudi Arabia, the United States, and India, with sample sizes ranging from 76 to 3,537 participants. Table 3 summarizes the primary empirical studies most central to the synthesis.

Conceptual and theoretical foundations

The dominant conceptualization of burnout derives from Maslach and Jackson's multidimensional theory, operationalized through the Maslach Burnout Inventory and later reframed by Maslach and Leiter as a chronic mismatch between an individual and six dimensions of the work environment: workload, control, reward, community, fairness, and values.^1,3,9 Perceived stress is measured through Cohen et al Perceived Stress Scale, rooted in transactional stress theory, while psychological well-being draws on Ryff's 6-dimension eudaimonic model.^4,5 Two integrative frameworks recur throughout the included literature: the Job Demands-Resources (JD-R) model, which holds that excessive job demands drive burnout while adequate resources buffer this effect, and Hobfoll's.^10,11 Conservation of resources theory, which frames chronic stress as a depletion of personal, social, and material resources that cascades into burnout and diminished well-being.

Prevalence of burnout and stress among healthcare workers

Reported burnout prevalence varied substantially across the included studies, from approximately 11% of nurses globally in a pre-pandemic meta-analysis of 113 studies to 54.6% among physicians during the COVID-19 pandemic across 45 observational studies, and as high as 80% among ICU staff in an Indian tertiary hospital, where burnout was markedly more prevalent among nurses (69%) than doctors (6%).^12,13 A multinational study of 3,537 healthcare workers across the United Kingdom, Poland, and Singapore found that 67% screened positive for burnout, with doctors and nurses in patient-facing roles at significantly elevated risk.¹⁴ Indian evidence was broadly consistent with this global pattern: a 10-state cross-sectional study of 967 healthcare workers found that over half reported high psychological distress during the COVID-19 pandemic, while facility-level studies from northern and southern India similarly documented high perceived stress and burnout, concentrated among nursing staff.¹⁵ A systematic review of physicians across 45 countries found prevalence estimates ranging from below 10% to nearly 80%, a spread attributable largely to inconsistent burnout definitions and cut-points rather than true underlying differences.⁶

The COVID-19 pandemic substantially intensified these risks across the included evidence base. A systematic review and meta-analysis of healthcare workers during COVID-19 documented markedly elevated burnout compared with pre-pandemic baselines, consistent with a Latin American scoping review reporting burnout prevalence between 13.2% and 70.3% across included studies (2019-2023).¹⁶ Notably, longitudinal U.S. physician data suggest a decline from a 2021 pandemic peak (62.8%) to 45.2% by 2023, indicating that elevated pandemic-era rates were not a permanent shift.

Antecedents and risk factors

Across the included literature, risk factors cluster into individual, interpersonal, and organizational categories, consistent with the JD-R model's distinction between job demands and resources. High workload, excessive administrative burden, and insufficient staffing were the most frequently cited organizational demands.¹⁷ A path-analytic study of Chinese frontline medical staff found workload and anxiety/depression symptoms positively predicted burnout, while self-compassion and organizational support were protective.¹⁸ A large Finnish survey of 2,115 nurses found that job resources produced the greatest reduction in burnout, while destructive leadership and job demands increased it.¹⁹ Among junior nurses in China, low psychological capital, particularly among introverted individuals, was associated with greater vulnerability to burnout and stress.²⁰ Emotional labor and interpersonal demands also emerged as salient risk factors: emotional exhaustion was significantly associated with anxiety and depressive symptoms among South Korean nurses.²¹

Interrelationships among burnout, perceived stress, and psychological well-being

A consistent body of evidence links burnout and perceived stress to poorer psychological well-being. A systematic review and meta-analysis of 101 studies confirmed a significant association between emotional exhaustion and both anxiety and depression.²² In a large Czech sample, emotional exhaustion explained 63% of the variance in depressive symptoms, while personal accomplishment consistently functioned as a protective factor, positively predicting well-being.⁸ Among Peruvian nursing personnel, perceived stress negatively predicted quality of life in a structural equation model.²³ Among Chinese physicians, burnout was negatively associated with subjective well-being, an effect moderated by perceived social support.²⁴ These findings support the Conservation of Resources framework: chronic occupational stress and burnout appear to deplete the psychological resources that sustain well-being, while social and organizational resources buffer this depletion.¹¹

Interventions and mitigation strategies

Individual-level psychological interventions, particularly mindfulness-based programs, were the most extensively studied. A systematic review and meta-analysis among primary healthcare professionals found significant reductions in emotional exhaustion and depersonalization alongside increases in personal accomplishment, a pattern echoed in a meta-analysis focused specifically on nurses.^25,26 A meta-analysis of 22 randomized controlled trials among physicians found a significant reduction in burnout following prevention programs, predominantly mindfulness-based stress reduction, though only two of the 22 trials targeted structural rather than individual-level change. This imbalance recurs throughout the intervention literature: organizational strategies such as workload management, adequate staffing, and supportive leadership are consistently identified as necessary complements to individual coping-skills training, yet remain comparatively under-evaluated in controlled trial designs.^18,27

DISCUSSION

The included literature converges on several conclusions. First, burnout, perceived stress, and psychological well-being are theoretically distinct but empirically intertwined, connected through the resource-depletion mechanisms described by the JD-R model and Conservation of Resources theory.^10,11 Second, emotional exhaustion is consistently the burnout dimension most strongly associated with anxiety, depression, and declining well-being, while personal accomplishment and organizational resources function as protective factors.^19,22 Third, prevalence estimates vary widely across professions, countries, and instruments, reflecting genuine contextual differences as well as persistent inconsistency in operationalizing burnout.⁶ Fourth, evidence from India specifically mirrors the global pattern, with facility-level studies reporting burnout and perceived stress concentrated among nursing staff and intensified during the COVID-19 pandemic, consistent with the facility-level literature gap that motivates continued research in this area.¹⁵ Fifth, the COVID-19 pandemic served as an acute amplifier of these risks, with some evidence of partial normalization in subsequent years.

This review's search and screening approach carries specific limitations beyond those typical of narrative systematic reviews. First, searches were conducted through a single AI-assisted search tool rather than direct Boolean export from institutional databases (e.g., Ovid MEDLINE, CINAHL, PsycINFO, Scopus); consequently, the review may not have exhaustively captured all eligible literature, and true total-record counts for each search string are not verifiable against a database export log. Second, screening and eligibility assessment were performed by a single reviewer without independent dual screening or inter-rater reliability statistics, which is a departure from best-practice systematic review conduct and increases the risk of selection bias. Third, no formal, tool-scored risk-of-bias or quality appraisal (e.g., Newcastle-Ottawa Scale, JBI Checklists) was applied to included primary studies. Fourth, the review was not prospectively registered (e.g., with PROSPERO). Fifth, most included primary studies remain cross-sectional, precluding causal inference about the direction of relationships among stress, burnout, and well-being. These limitations mean the review is best characterized as a rigorous, PRISMA-informed narrative/thematic systematic review rather than a fully compliant systematic review or meta-analysis suitable for direct clinical guideline use; readers seeking the latter should consult the primary systematic reviews and meta-analyses cited herein e. g., directly.^6,12,22

CONCLUSION

This PRISMA-guided systematic review synthesized 43 sources on occupational burnout, perceived stress, and psychological well-being among healthcare workers, drawing on foundational theory and recent empirical evidence spanning nurses, physicians, and allied health professionals across more than a dozen countries, including facility-level evidence from India. The evidence confirms that healthcare work carries substantial and unevenly distributed psychological risk, with emotional exhaustion as the central mechanism linking occupational stress to declining well-being, and organizational conditions as the most actionable intervention target. Future work would benefit from formally registered, dual-reviewer systematic reviews with full database access, longitudinal designs, standardized measurement, and rigorous evaluation of organizational-level interventions delivered alongside individual psychological support.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. Maslach C, Leiter MP. Burnout. In: Fink G, editor. Stress: Concepts, Cognition, Emotion, and Behavior. Academic Press. 2016;351-7.
2. 2. World Health Organization. Burn-out an "occupational phenomenon": International classification of diseases. 2019. Available at: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases. Accessed on 25 June 2026.
3. 3. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav. 1981;2(2):99-113.
4. 4. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.
5. 5. Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57(6):1069-81.
6. 6. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131-50.
7. 7. 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.
8. 8. Dobešová Cakirpaloglu S, Cakirpaloglu P, Skopal O, Kvapilová B, Schovánková T, Vévodová Š, et al. Strain and serenity: exploring the interplay of stress, burnout, and well-being among healthcare professionals. Front Psychol. 2024;15:1415996.
9. 9. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory manual. 3^rd ed. Palo Alto (CA): CPP, Inc. 1996.
10. 10. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001;86(3):499-512.
11. 11. Hobfoll SE. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513-24.
12. 12. Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis. J Psychiatr Res. 2020;123:9-20.
13. 13. Macaron MM, Segun-Omosehin OA, Matar RH, Beran A, Nakanishi H, Than CA, et al. A systematic review and meta-analysis on burnout in physicians during the COVID-19 pandemic: a hidden healthcare crisis. Front Psychiatry. 2023;13:1071397.
14. 14. Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, et al. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the COVID-19 pandemic: a multinational cross-sectional study. PLoS One. 2021;16(4):e0238666.
15. 15. Menon GR, Yadav J, Aggarwal S, Singh R, Kaur S, Chakma T, et al. Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-a cross-sectional study. PLoS One. 2022;17(3):e0264956.
16. 16. Ghahramani S, Lankarani KB, Yousefi M, Heydari K, Shahabi S, Azmand S. A systematic review and meta-analysis of burnout among healthcare workers during COVID-19. Front Psychiatry. 2021;12:758849.
17. 17. Molina-Praena J, Ramirez-Baena L, Gómez-Urquiza JL, Cañadas GR, De la Fuente EI, Cañadas-De la Fuente GA. Levels of burnout and risk factors in medical area nurses: a meta-analytic study. Int J Environ Res Public Health. 2018;15(12):2800.
18. 18. Wei Z, Xia B, Jiang L, Zhu H, Li L, Wang L, et al. Factors affecting occupational burnout in medical staff: a path analysis based on the job demands-resources perspective. Front Psychiatry. 2024;15:1490171.
19. 19. Palvimo T, Vauhkonen A, Hult M. The associations among destructive leadership, job demands and resources, and burnout among nurses: a cross-sectional survey study. Biomed Res Int. 2023;2023:4289450.
20. 20. Zhang X, Chen S, Zheng Z, Zhao M, Song L, Zhao Y, et al. The relationship between psychological capital, burnout and perceived stress in junior nurses: a latent profile analysis. Front Public Health. 2024;12:1374941.
21. 21. Choi BS, Kim JS, Lee DW, Paik JW, Lee BC, Lee JW. Factors associated with emotional exhaustion in South Korean nurses: a cross-sectional study. Psychiatry Investig. 2018;15(7):670-6.
22. 22. Koutsimani P, Montgomery A, Georganta K. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Front Psychol. 2019;10:284.
23. 23. Baños Chaparro J, Buitron Saavedra AE, Quispe Caballero AC. Burnout and perceived stress as predictors of quality of life in nurses. Cuidarte. 2025;16(2):1.
24. 24. Wang L, Wang H, Shao S, Jia G, Xiang J. Job burnout on subjective well-being among Chinese female doctors: the moderating role of perceived social support. Front Psychol. 2020;11:435.
25. 25. Salvado M, Marques DL, Pires IM, Silva NM. Mindfulness-based interventions to reduce burnout in primary healthcare professionals: a systematic review and meta-analysis. Healthcare (Basel). 2021;9(10):1342.
26. 26. Wang Q, Wang F, Zhang S, Liu C, Feng Y, Chen J. Effects of a mindfulness-based intervention on stress, burnout in nurses: a systematic review and meta-analysis. Front Psychiatry. 2023;14:1218340.
27. 27. Dall'Ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: a theoretical review. Hum Resour Health. 2020;18:41.