{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:58:59Z","timestamp":1790600339215,"version":"4.1.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Polyhandicap, known as Profound Intellectual Multiple Disabilities, is characterized by profound intellectual impairment and severe motor deficits, leading to a high level of dependence. Caring for these individuals has specific stressors, including lack of patient feedback or recognition, frequent unfavorable clinical trajectories, and complex relationships with families. This study aimed to assess burnout among health care workers caring for persons with PIMD\/polyhandicap, to identify associated factors, and to examine the stability of burnout over time within the French EVAL-PLH cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and method<\/jats:title>\n                    <jats:p>This study used complementary cross-sectional (2020) and longitudinal (2015\u20132020) designs. Burnout was assessed using the Maslach Burnout Inventory among health care workers caring for persons with PIMD\/polyhandicap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 2020, 208 health care workers were included; 79 (38%) presented severe burnout according to the French global MBI scoring. Higher emotional exhaustion was associated with self-reported mood disorders, use of mood disorder medication, employment in residential facilities, and more frequent avoidance coping. Higher depersonalization was associated with younger age and more frequent avoidance coping. Lower personal accomplishment was associated with single status and less frequent positive-thinking coping. In the longitudinal subsample (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f58), 21 HCWs (37%) experienced severe burnout in 2015, of whom 17 (81%) remained severely burned out in 2020; Cohen\u2019s kappa indicated moderate agreement between T1 and T2 burnout classifications (\u03ba\u202f=\u202f0.539,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), while McNemar\u2019s test showed no significant change in burnout status over time (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.267).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Burnout is highly prevalent among health care workers caring for persons with PIMD\/polyhandicap and shows partial temporal stability. Addressing modifiable associated factors, such as coping strategies and mental health support, should be a key focus of intervention programs to sustain the workforce and ensure continuity and quality of care for this highly dependent population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Identifier, NCT02400528.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1906622","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:09:41Z","timestamp":1790597381000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Burnout among French healthcare workers caring for individuals with profound intellectual and multiple disabilities\/polyhandicap: a complementary cross-sectional and longitudinal study"],"prefix":"10.3389","volume":"14","author":[{"given":"Houria","family":"El Ouazzani","sequence":"first","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]},{"name":"UR 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Rousseau","sequence":"additional","affiliation":[{"name":"UR 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University","place":["Marseille, France"]},{"name":"F\u00e9d\u00e9ration des H\u00f4pitaux de Polyhandicap et Multihandicap, San Salvadour Hospital, University Hospital of Paris","place":["Hy\u00e8res, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Any","family":"Beltran-Anzola","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibylle","family":"Del Duca","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyes","family":"Hamouda","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]},{"name":"UR 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Billette de Villemeur","sequence":"additional","affiliation":[{"name":"Clinical Research Group GRC ConCer-LD, Sorbonne University & Pierre-et-Marie-Curie University","place":["Paris, France"]},{"name":"Department of Neuropediatrics, Armand-Trousseau Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Auquier","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]},{"name":"UR 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Baumstarck","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Economy Department, Marseille Public University Hospital System","place":["Marseille, France"]},{"name":"UR 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","article-title":"Burn-out an \u201coccupational phenomenon\u201d","year":"2019"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"w30229","DOI":"10.4414\/SMW.2022.w30229","article-title":"Point prevalence of burnout in Switzerland: a systematic review and meta-analysis","volume":"152","author":"Al-Gobari","year":"2022","journal-title":"Swiss Med Wkly"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/j.mayocp.2024.11.031","article-title":"Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2023","volume":"100","author":"Shanafelt","year":"2025","journal-title":"Mayo Clin Proc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12960-024-00917-w","article-title":"Global estimate of burnout among the public health workforce: a systematic review and meta-analysis","volume":"22","author":"Nagarajan","year":"2024","journal-title":"Hum Resour Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jpsychires.2019.12.015","article-title":"Global prevalence of burnout symptoms among nurses: a systematic review and meta-analysis","volume":"123","author":"Woo","year":"2020","journal-title":"J Psychiatr Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.3390\/ijerph16142585","article-title":"Prevalence, related factors, and levels of burnout syndrome among nurses working in gynecology and obstetrics services: a systematic review and meta-analysis","volume":"16","author":"De La Fuente-Solana","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"171","DOI":"10.2147\/LRA.S240564","article-title":"Burnout in healthcare workers: prevalence, impact and preventative strategies","volume":"13","author":"De Hert","year":"2020","journal-title":"Local Regional Anesthesia"},{"key":"ref8","first-page":"42","article-title":"Physician burnout: its origin, symptoms, and five main causes","volume":"22","author":"Drummond","year":"2015","journal-title":"Fam Pract Manag"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e13325","DOI":"10.1111\/jar.13325","article-title":"A systematic review of burnout among staff working in services for adults with intellectual and developmental disabilities","volume":"38","author":"Baker","year":"2025","journal-title":"J Appl Res Intellect Disabil"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e13252","DOI":"10.1111\/cch.13252","article-title":"Physical health conditions in young children with profound intellectual and multiple disabilities: the prevalence and associations between these conditions","volume":"50","author":"Mol-Bakker","year":"2024","journal-title":"Child Care Health Dev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"102184","DOI":"10.1016\/j.respe.2023.102184","article-title":"Polyhandicap, profound intellectual multiple disabilities: concept and definition of a highly specific public health issue","volume":"71","author":"Rousseau","year":"2023","journal-title":"Rev Epidemiol Sante Publique"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1111\/jar.13019","article-title":"Meaningful moments of interaction with people with profound intellectual disabilities: reflections from direct support staff","volume":"35","author":"Penninga","year":"2022","journal-title":"J Appl Res Intellect Disabil"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1186\/s12913-022-07641-y","article-title":"Residential care staff are the key to quality of health care for adults with profound intellectual and multiple disabilities in Sweden","volume":"22","author":"Materne","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"807","DOI":"10.3233\/WOR-203414","article-title":"Patients in permanent vegetative or minimally conscious states: a literature review of the psychological and health impacts on healthcare personnel","volume":"68","author":"Pinel-Jacquemin","year":"2021","journal-title":"Work"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12912-026-04357-w","article-title":"Compassion fatigue in palliative care nurses: from empathy to emotional detachment","volume":"25","author":"Ghafarzadegan","year":"2026","journal-title":"BMC Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/jir.13199","article-title":"The needs of family members of people with severe or profound intellectual disabilities when collaborating with healthcare professionals: a systematic review","volume":"69","author":"van Beurden","year":"2025","journal-title":"J Intellect Disabil Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"12512","DOI":"10.1038\/s41598-022-16596-3","article-title":"The French EVAL-PLH cohort of persons with polyhandicap","volume":"12","author":"Hamouda","year":"2022","journal-title":"Sci Rep"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0316159","DOI":"10.1371\/journal.pone.0316159","article-title":"Validation of visual analog scales of mood and anxiety at the workplace","volume":"19","author":"Dutheil","year":"2024","journal-title":"PLoS One"},{"key":"ref19","first-page":"507","article-title":"Multidimensional assessment of coping: validation of the brief COPE among French population","volume":"29","author":"Muller","year":"2003","journal-title":"L'Enc\u00e9phale"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1207\/s15327558ijbm0401_6","article-title":"You want to measure coping but your protocol\u2019 too long: consider the brief cope","volume":"4","author":"Carver","year":"1997","journal-title":"Int J Behav Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12955-016-0581-9","article-title":"Assessment of coping: a new french four-factor structure of the brief COPE inventory","volume":"15","author":"Baumstarck","year":"2017","journal-title":"Health Qual Life Outcomes"},{"key":"ref22","volume-title":"Maslach Burnout Inventory Manual","author":"Maslach","year":"1996"},{"key":"ref23","first-page":"191","volume-title":"Evaluating Stress: A book of Resources","author":"Maslach","year":"1997"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/job.4030020205","article-title":"The measurement of experienced burnout","volume":"2","author":"Maslach","year":"1981","journal-title":"J Organ Behav"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1146\/annurev.psych.52.1.397","article-title":"Job Burnout","volume":"52","author":"Maslach","year":"2001","journal-title":"Annu Rev Psychol"},{"key":"ref26","volume-title":"Le burn out: le syndrome d\u2019\u00e9puisement professionnel des soignants","author":"Canou\u00ef","year":"2004"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3917\/th.802.0161","article-title":"The Maslach burnout inventory - human services survey (MBI-HSS): factor structure, wording effect and psychometric qualities of known problematic items","volume":"80","author":"Lheureux","year":"2017","journal-title":"Trav Hum"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1111\/jep.12771","article-title":"French validation of the Maslach burnout inventory-student survey (MBI-SS)","volume":"23","author":"Faye-Dumanget","year":"2017","journal-title":"J Eval Clin Pract"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"7050","DOI":"10.1111\/jocn.16838","article-title":"The prevalence, related factors and interventions of oncology nurses' burnout in different continents: a systematic review and meta-analysis","volume":"32","author":"Ma","year":"2023","journal-title":"J Clin Nurs"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3390\/healthcare14030304","article-title":"A systematic review of stress-related work and missed nursing care among clinical nurses","volume":"14","author":"Pakpahan","year":"2026","journal-title":"Healthcare (Basel)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"102526","DOI":"10.1016\/j.gaceta.2025.102526","article-title":"Prevalencia de burnout en profesionales de atenci\u00f3n primaria del Sistema Nacional de Salud: revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis [prevalence of burnout in primary care professionals of National Health System: systematic review and meta-analysis]","volume":"39","author":"Beltr\u00e1n-G\u00f3mez","year":"2025","journal-title":"Gac Sanit"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"11432","DOI":"10.3390\/ijerph182111432","article-title":"Prevalence, risk factors and burnout levels in intensive care unit nurses: a systematic review and meta-analysis","volume":"18","author":"Ram\u00edrez-Elvira","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e070442","DOI":"10.1136\/bmj-2022-070442","article-title":"Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis","volume":"378","author":"Hodkinson","year":"2022","journal-title":"BMJ"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e2443059","DOI":"10.1001\/jamanetworkopen.2024.43059","article-title":"Nurse burnout and patient safety, satisfaction, and quality of care: a systematic review and Meta-analysis","volume":"7","author":"Li","year":"2024","journal-title":"JAMA Netw Open"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.3390\/medicina59101866","article-title":"Organizational and individual interventions for managing work-related stress in healthcare professionals: a systematic review","volume":"59","author":"Catapano","year":"2023","journal-title":"Medicina"},{"key":"ref36","first-page":"29","article-title":"The use of yoga and mindfulness-based interventions to reduce stress and burnout in healthcare workers: an umbrella review","volume":"29","author":"Di Mario","year":"2023","journal-title":"Altern Ther Health Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/0269216320956825","article-title":"Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: a systematic literature review","volume":"35","author":"Dijxhoorn","year":"2021","journal-title":"Palliat Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1186\/s12913-023-09958-8","article-title":"Art therapy-based interventions to address burnout and psychosocial distress in healthcare workers\u2014a systematic review","volume":"23","author":"Tjasink","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3389\/fpsyg.2019.00284","article-title":"The relationship between burnout, depression, and anxiety: a systematic review and Meta-analysis","volume":"10","author":"Koutsimani","year":"2019","journal-title":"Front Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"213","DOI":"10.2105\/AJPH.2023.307556","article-title":"Addressing health care workers\u2019 mental health: a systematic review of evidence-based interventions and current resources","volume":"114","author":"Anger","year":"2024","journal-title":"Am J Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4054","DOI":"10.1111\/jonm.13845","article-title":"Association between coping strategies and professional quality of life in nurses and physicians during COVID-19: a cross-sectional study","volume":"30","author":"Calegari","year":"2022","journal-title":"J Nurs Manag"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"w20074","DOI":"10.4414\/smw.2019.20074","article-title":"Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals","volume":"149","author":"Cheval","year":"2019","journal-title":"Swiss Med Wkly"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12955-018-0983-y","article-title":"Coping strategies and quality of life: a longitudinal study of high-grade glioma patient-caregiver dyads","volume":"16","author":"Baumstarck","year":"2018","journal-title":"Health Qual Life Outcomes"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.2147\/PPA.S112750","article-title":"Age-related hearing loss in individuals and their caregivers: effects of coping on the quality of life among the dyads","volume":"10","author":"Lazzarotto","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3390\/medicina58020327","article-title":"Coping strategies of healthcare professionals with burnout syndrome: a systematic review","volume":"58","author":"Maresca","year":"2022","journal-title":"Medicina"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"400","DOI":"10.3390\/bs14050400","article-title":"Empathy and coping strategies predict quality of life in Japanese healthcare professionals","volume":"14","author":"Shoji","year":"2024","journal-title":"Behav Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.neurol.2023.02.072","article-title":"Dyadic coping strategies and quality of care experience: an original study of patients living with multiple sclerosis and their caregivers","volume":"179","author":"Veillard","year":"2023","journal-title":"Rev Neurol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e70016","DOI":"10.1111\/inm.70016","article-title":"Effectiveness of interventions to improve coping and resilience of frontline mental healthcare professionals towards workplace violence on psychiatric wards\u2014a systematic review","volume":"34","author":"Doedens","year":"2025","journal-title":"Int J Ment Health Nurs"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"4434","DOI":"10.1111\/jan.15690","article-title":"The impact of pandemics on healthcare providers' workloads: a scoping review","volume":"79","author":"Doleman","year":"2023","journal-title":"J Adv Nurs"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"S282","DOI":"10.4103\/0972-6748.328830","article-title":"Impact of COVID-19 pandemic on healthcare workers","volume":"30","author":"Gupta","year":"2021","journal-title":"Ind Psychiatry J"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e089885","DOI":"10.1136\/bmjopen-2024-089885","article-title":"Gender differences in burnout among US nurse leaders during COVID-19 pandemic: an online cross-sectional survey study","volume":"14","author":"Alenezi","year":"2024","journal-title":"BMJ Open"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/jppi.12384","article-title":"Healthcare of persons with complex developmental disabilities from three European experiences: France, Italy, and Norway","volume":"18","author":"Rousseau","year":"2021","journal-title":"J Policy Pract Intellect Disabil"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e0257840","DOI":"10.1371\/journal.pone.0257840","article-title":"The major worldwide stress of healthcare professionals during the first wave of the COVID-19 pandemic - the international COVISTRESS survey","volume":"16","author":"Couarraze","year":"2021","journal-title":"PLoS One"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e44195","DOI":"10.2196\/44195","article-title":"Use of the Maslach burnout inventory among public health care professionals: scoping review","volume":"10","author":"Soares","year":"2023","journal-title":"JMIR Ment Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1906622\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:09:43Z","timestamp":1790597383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1906622\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2026.1906622"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1906622","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1906622"}}