John Ong1,2, Andrew Ming Liang Ong3,4, Sharon Ong5,6, Xiaohui Xin7, Yeong Yeh Lee8,9, Nonthalee Pausawasdi10,  Mark Anthony De Lusong11, Dadang Makmun12, Vui Heng Chong13,14, Shiaw Hooi Ho15, Wanyen Lim6,16,  David Ong17, Yock Young Dan1,17 *, Christopher Khor3,4 * 

1 Department of Medicine, National University of Singapore, Singapore
2 Department of Engineering, University of Cambridge, Cambridge, UK
3 Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
4 Duke-NUS Medical School, Singapore
5 Department of Surgical Intensive Care, Singapore General Hospital, Singapore
6 Department of Anaesthesiology, Sengkang General Hospital, Singapore
7 Health Services Research Unit, Singapore General Hospital, Singapore
8 School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
9 GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
10 Mahidol University Faculty of Medicine at Siriraj Hospital, Division of Gastroenterology, Department of Medicine, Bangkok, Thailand
11 Philippine General Hospital, Section of Advanced Endoscopy, Division of Gastroenterology, Department of Medicine, Manila, Philippines
12 Universitas Indonesia, Faculty of Medicine, Division of Gastroenterology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
13 Gastroenterology Unit, Department of Medicine, RIPAS Hospital, Brunei Darussalam
14 Institute of Health Sciences, PAPRSB Universiti of Brunei Darussalam, Brunei Darussalam
15 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
16 Department of Anaesthesiology, Singapore General Hospital, Singapore
17 Department of Medicine, Division of Gastroenterology & Hepatology, National University Hospital, Singapore 

* denotes joint last authors.

Background/Aims: The coronavirus disease-2019 (COVID-19) pandemic has placed significant stress on gastroenterologists worldwide. However, its toll on the mental health of gastroenterologists within Southeast Asia was unknown. A mixed methods, multi-national study was conducted to elucidate the prevalence of burnout and its stressors within the region.

Methods: A survey was disseminated electronically to 1,761 gastroenterologists via the gastroenterology and endoscopy societies of Brunei, Philippines, Indonesia, Malaysia, Singapore and Thailand from 1 September to 7 December 2020. This included the 22-item Maslach Burnout Inventory to detect burnout. Ethical approval was granted. Quantitative and qualitative data were collected. Logistic regression identified associations between variables and burnout. Qualitative data was analysed by content analysis method.

Results: The response rate was 38.8%. 66.6% reported significant stress. The regional prevalence of burnout was 17.1% although inter-country variation existed (Figure 1(A)). Depression, being a trainee, public sector work, and the lack of awareness or access to mental health support services increased burnout risk significantly (Figure 1(B)). 50.1% of gastroenterologists were unaware of or did not have access to support services. The onset of depression intra-pandemic was 2.1%; the pre-pandemic prevalence was 2.2%.

Stressors commonly involved service requirements (53.2%), difficult relationships with patients and relatives (23.0%), and difficult relationships with colleagues (20.5%). Specific to the pandemic, the three most common stressors were fear of getting infected (39.7%), reduced income (28.0%) and stringent infection control measures adding to workload (18.5%).

Conclusion: Burnout is common in gastroenterologists in Southeast Asia however better safeguards for mental health are urgently needed.

Keywords: Burnout, Stress, COVID-19, coronavirus disease 2019, Gastroenterology