*3.4. Statistical Analysis*

Firstly, a descriptive analysis of the most representative variables was developed considering sociodemographic aspects and perceptions of stress and anxiety of health professionals. Subsequently, a cross-table analysis was developed with the aim of observing the relationships between the different variables according to their level of significance (*p* < 0.005).

Finally, with the purpose of knowing the probability of the phenomenon of the three subscales of burnout, three logistic regressions were carried out, establishing as a dependent variable in each one of them the risk of suffering a medium-high level of burnout, taking into account the independent variables.

#### **4. Results**

The descriptive analysis shows the following results (Table 1). First, with respect to sociodemographic variables, 79% are women and 21% men; the percentage of female participation is higher. This has occurred with other studies with very similar percentages [108–110]. The mean age is 41.8 years. If we make a distribution by age, the sample is widely distributed among all the intervals except among people aged 61 years and older. In terms of professional category, the nurses who accounted for more than 50% of the participants are noteworthy.

As for the MBI scale, the average value is 3.3. If we carry out a more detailed analysis of the MBI scale, we observe that the highest values are concentrated in the depersonalization subscale whose high levels reach 38.9%, almost doubling the values of the EE and PA subscales. Finally, with respect to the data related to subjective issues, the following data were obtained. In the first place, only a small percentage of health professionals consider that they need psychological and psychiatric support, but, nevertheless, 90.4% of the persons surveyed consider that this service should be provided from the work centers in view of the current health crisis.

Related to the above, 43.3% of the persons surveyed considered that they might need psychological or psychiatric treatment in the future. In other words, health professionals do not currently perceive a situation of emotional vulnerability, but they are aware of the intensity of it and the repercussions it may have for them in the future. Finally, when asked how the absence of PPE is affecting their daily work, 85.4% stated that it is generating an increase in their level of stress and anxiety.


**Table 1.** Descriptive analysis of the variables.

Once the descriptive analysis was done, a cross-table analysis was performed. Before performing this analysis, a classification of burnout risk variables was carried out in each of the subscales of the MBI, differentiating between low/medium risk and medium/high risk.

The results that obtained a Pearson chi-square with a significance level *p* < 0.05 will be presented; that is, those that show a significant relevance and whose association is not determined by chance.

First, it highlights the association between emotional exhaustion and the subjective perception of needing psychological or psychiatric treatment in the future. Regarding this subscale, a significant relationship is also observed between the risk of suffering emotional exhaustion and the professional category. Second, with respect to depersonalization, we observe how the lack of resources of individual protection is associated with this subscale. This result is very interesting given that during the first wave of the pandemic, health professionals had to carry out their work with insufficient resources of individual protection, putting their personal and family health at risk. This fact has important connotations since the lack of individual protection equipment could have caused an increase in the subscale of depersonalization, and with it, cause a detachment of health professionals from their problems, even to blame their patients for the problems caused by the COVID-19 at the professional level. With respect to personal accomplishment, no significant associations were observed. Therefore, the three independent variables that most significantly influence the increase in the level of burnout, taking into account the level of significance of Pearson's chi-square, are: professional category, subjective perception of the need to receive psychological or psychiatric treatment in the future, and the absence of PPE.

Thirdly, we proceeded to use the technique of binary logistic regression to evaluate the effect of sex, age, professional category and subjective perceptions regarding the present and future needs for psychological and psychiatric treatment in health professionals; if this should be provided by hospital centers, as well as if the lack of resources of individual protection is affecting the increase in burnout in health professionals (Table 2). The only subscale that showed an acceptable model was emotional exhaustion.


**Table 2.** Variables used in binary logistic regression.

The logistic regression model was statistically significant, X2 = 29.942, *p* < 0.0005. The model explains 24.6% (Nagelkerke's R2) of the variance in the emotional exhaustion subscale and correctly classifies 75.2% of the cases. The Hosmer–Lemeshow test showed that there were no significant differences between the results observed and those predicted in the model with a *p* = 0.830.

From these results, the less significant variables were eliminated through the automatic "forward" or "backward" method. Considering the seven predictor variables, only two were associated with the probability of suffering emotional exhaustion: the professional category and the subjective perception of needing psychological or psychiatric treatment in the future (WNMS). Regarding the professional categories, physicians and nurses have a higher risk of suffering from emotional exhaustion than other

professions, including clinical assistants, professionals who in Spain spend the most time with patients performing the most elementary care with basic needs. The results of the logistic regression are shown below (Table 3).



In the specific case of physicians, the OR was = 4.270, 95%CI (1.180–15.445), *p* = 0.027. Nurses had an OR = 3.782, 95%CI (1.419–10.078), *p* = 0.008. Therefore, physicians and nurses are at risk of suffering from emotional exhaustion. Their risks are 4.27 and 3.78 times greater than other health professionals, respectively. In case of both, physicians and nurses, the contact with patients and the time they spent with them was superior to that of other health professionals, and it was these same professionals, during the time of the greatest number of active cases of COVID-19, who were responsible for trying to restore the health of the patients, at the risk of infecting themselves due to the shortage, in the first few weeks, of personal protective equipment. Likewise, the fact of seeing their patients die every day has been key to the realization that, in the future, when the situation improves, they would need to address this issue in the personal sphere, with professional intervention at the psychological and/or psychiatric level.

Finally, in relation to the subjective perception of needing psychological and psychiatric treatment in the future, the data show OR = 0.244, 95% CI (0.109–0.547), *p* = 0.001. Therefore, and contrary to what might initially be thought, the probability of a person who considers that they may need psychological and psychiatric treatment in the future decreases by 0.24 with respect to those who do not perceive that they consider these treatments necessary. This result suggests that, despite a future perception of the need for psychological treatment, the health demands caused by the COVID-19 pandemic focus their attention on patient care, over and above their own concerns. High-stress situations, in which health personnel do not perceive the need for psychological care, reinforce the fact that they behave homogeneously in the context of this pandemic and that sociodemographic conditions, such as age and sex, are not highlighted. This is essential information that we believe must be considered in any future preventive planning to face these harsh adversities. Prevention is a key factor.
