{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T07:12:04Z","timestamp":1776323524437,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T00:00:00Z","timestamp":1610496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/05198\/2020"],"award-info":[{"award-number":["UIDB\/05198\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>During the COVID-19 pandemic, healthcare workers (HCW) have been exposed to multiple psychosocial stressors. Resilience might protect employees from the negative consequences of chronic stress. The aim of this study was to explore the mediating role of resilience in the relationship between depression and burnout (personal, work-related, and client-related). A cross-sectional study was performed using an online questionnaire distributed via social networks. A survey was conducted comprising standardized measures of resilience (Resilience Scale-25 items), depression (subscale of Depression Anxiety Stress Scales-21 items), and burnout (Copenhagen Burnout Inventory Scale-19 items). A total of 2008 subjects completed the survey, and a hierarchical regression model was estimated for each burnout dimension. The results revealed that depression had not only a directed effect on personal, work- and client-related burnout, but also an indirect small effect on it through resilience. Psychological resilience played a partial mediating role between depression and all burnout dimensions. This partial mediation suggests that there may be other possible variables (e.g., social connection, self-compassion, gratitude, sense of purpose) that further explain the associations.<\/jats:p>","DOI":"10.3390\/ijerph18020636","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T11:52:32Z","timestamp":1610538752000},"page":"636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":114,"title":["Burnout and Depression in Portuguese Healthcare Workers during the COVID-19 Pandemic\u2014The Mediating Role of Psychological Resilience"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6001-1164","authenticated-orcid":false,"given":"Carla","family":"Serr\u00e3o","sequence":"first","affiliation":[{"name":"School of Education-Polytechnic of Porto, Portugal and Centre for Research and Innovation in Education, 4200-465 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5160-7043","authenticated-orcid":false,"given":"Ivone","family":"Duarte","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, MEDCIDS-Department of Community Medicine, Information and Decision in Health, University of Porto, 4200-450 Porto, Portugal"},{"name":"Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-0154","authenticated-orcid":false,"given":"Lu\u00edsa","family":"Castro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, MEDCIDS-Department of Community Medicine, Information and Decision in Health, University of Porto, 4200-450 Porto, Portugal"},{"name":"Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal"},{"name":"School of Health Sciences-Polytechnic of Porto, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1199-2220","authenticated-orcid":false,"given":"Andreia","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, MEDCIDS-Department of Community Medicine, Information and Decision in Health, University of Porto, 4200-450 Porto, Portugal"},{"name":"Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal"},{"name":"IPVC\u2013Instituto Polit\u00e9cnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,13]]},"reference":[{"key":"ref_1","unstructured":"Centre Disease Prevention and Control (ECDC) (2020, November 27). Communicable Disease Threats Report. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/Communicable-disease-threatsreport-13-june-2020.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1213\/ANE.0000000000004912","article-title":"Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic","volume":"131","author":"Albott","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.genhosppsych.2020.06.007","article-title":"Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic","volume":"66","author":"Shechter","year":"2020","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/2048872620922795","article-title":"Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic","volume":"9","author":"Walton","year":"2020","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"24","DOI":"10.20344\/amp.6460","article-title":"Burnout em profissionais da sa\u00fade portugueses: Uma an\u00e1lise a n\u00edvel nacional","volume":"29","author":"Maroco","year":"2016","journal-title":"Acta Med. Port."},{"key":"ref_6","first-page":"176","article-title":"Preval\u00eancia de S\u00edndrome de Burnout em M\u00e9dicos de Fam\u00edlia da Sec\u00e7\u00e3o Regional do Norte da Ordem dos M\u00e9dicos","volume":"35","author":"Reis","year":"2019","journal-title":"Rev. Port. Med. Geral. Fam."},{"key":"ref_7","unstructured":"WHO (2020, August 01). Burn-Out an \u201cOccupational Phenomenon\u201d: International Classification of Diseases. Available online: https:\/\/www.who.int\/mental_health\/evidence\/burn-out\/en\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e203976","DOI":"10.1001\/jamanetworkopen.2020.3976","article-title":"Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1080\/08870440108405523","article-title":"Introduction to special issue on burnout and health","volume":"16","author":"Schaufeli","year":"2001","journal-title":"Psychol. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1080\/02678370500297720","article-title":"The Copenhagen Burnout Inventory: A new tool for the assessment of burnout","volume":"19","author":"Kristensen","year":"2005","journal-title":"Work Stress"},{"key":"ref_11","unstructured":"L\u2019Abate, L. (2012). Epidemiology of Psychological Distress. Mental Illnesses\u2014Understanding, Prediction and Control, Intech Open. Available online: https:\/\/www.intechopen.com\/books\/mental-illnesses-understanding-prediction-and-control\/epidemiology-of-psychological-distress."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Gasparro, R., Scandurra, C., Maldonato, N.M., Dolce, P., Bochicchio, V., Valletta, A., Sammartino, G., Sammartino, P., Mariniello, M., and di Lauro, A.E. (2020). Perceived Job Insecurity and Depressive Symptoms among Italian Dentists: The Moderating Role of Fear of COVID-19. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155338"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Luce\u00f1o-Moreno, L., Talavera-Velasco, B., Garc\u00eda-Albuerne, Y., and Mart\u00edn-Garc\u00eda, J. (2020). Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155514"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wankowicz, P., Szyli\u0144ska, A., and Rotter, I. (2020). Assessment of mental health factors among health professionals depending on their contact with COVID-19 patients. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17165849"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Weilenmann, S., Ernst, J., Petry, H., Sazpinar, O., Pfaltz, M.C., Gehrke, M., Paolercio, F., Kaenel, R., and Spiller, T.R. (2020). Health care workers mental health during the first weeks of the SARS-CoV-2 Pandemic in Switzerland: A cross-sectional Study. medRxiv.","DOI":"10.1101\/2020.05.04.20088625"},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","doi-asserted-by":"crossref","first-page":"358","DOI":"10.7326\/0003-4819-136-5-200203050-00008","article-title":"Burnout and self-reported patient care in an internal medicine residency program","volume":"136","author":"Shanafelt","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_18","first-page":"85","article-title":"Psychological resources against the traumatic experience of COVID-19","volume":"17","author":"Gemignani","year":"2020","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cooke, G.P., Doust, J.A., and Steele, M.C. (2013). A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Med. Educ., 13.","DOI":"10.1186\/1472-6920-13-2"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"412","DOI":"10.4037\/ajcc2015291","article-title":"Burnout and Resilience Among Nurses Practicing in High-Intensity Settings","volume":"24","author":"Rushton","year":"2015","journal-title":"Am. J. Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e12535","DOI":"10.1111\/ijn.12535","article-title":"The influence of resilience on mental health: The role of general well-being","volume":"23","author":"Gao","year":"2017","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e031765","DOI":"10.1136\/bmjopen-2019-031765","article-title":"Resilience, burnout and coping mechanisms in UK doctors: A cross-sectional study","volume":"10","author":"McKinley","year":"2020","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1097\/01.AOG.0000258299.45979.37","article-title":"Predictors of physician career satisfaction, work-life balance, and burnout","volume":"109","author":"Keeton","year":"2007","journal-title":"Obstet. Gynecol."},{"key":"ref_24","unstructured":"(2020, August 21). American Psychological Association Building Your Resilience. Available online: https:\/\/www.apa.org\/topics\/resilience."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Serr\u00e3o, C., Castro, L., Teixeira, A., Rodrigues, A.R., and Duarte, I. (2021). Resili\u00eancia em m\u00e9dicos: Contributos para a valida\u00e7\u00e3o da vers\u00e3o portuguesa da Escala de Resili\u00eancia. Acta Med. Port., in press.","DOI":"10.20344\/amp.14657"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1146\/annurev.clinpsy.1.102803.144141","article-title":"Stress and health: Psychological, behavioral, and biological determinants","volume":"1","author":"Schneiderman","year":"2005","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/job.165","article-title":"The need for and meaning of positive organizational behavior","volume":"23","author":"Luthans","year":"2002","journal-title":"J. Organ. Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1176\/appi.ap.32.1.44","article-title":"A conceptual model of medical student well-being: Promoting resilience and preventing burnout","volume":"32","author":"Dunn","year":"2008","journal-title":"Acad. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e209385","DOI":"10.1001\/jamanetworkopen.2020.9385","article-title":"Resilience and Burnout Among Physicians and the General US Working Population","volume":"3","author":"West","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_30","first-page":"165","article-title":"Development and psychometric evaluation of the Resilience Scale","volume":"1","author":"Wagnild","year":"1993","journal-title":"J. Nurs. Meas."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.iccn.2017.04.010","article-title":"Burnout and health among critical care professionals: The mediational role of resilience","volume":"42","author":"Arrogante","year":"2017","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.enfcli.2014.06.003","article-title":"Mediaci\u00f3n de la resiliencia entre burnout y salud en el personal de Enfermer\u00eda [Mediator effect of resilience between burnout and health in nursing staff]","volume":"24","author":"Arrogante","year":"2014","journal-title":"Enferm. Clin."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Treglown, L., Palaiou, K., Zarola, A., and Furnham, A. (2016). The Dark Side of Resilience and Burnout: A Moderation-Mediation Model. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156279"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5455\/aim.2015.23.22-28","article-title":"Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers","volume":"23","author":"Papathanasiou","year":"2015","journal-title":"Acta Inform. Med."},{"key":"ref_35","doi-asserted-by":"crossref","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":"ref_36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.cpr.2015.01.004","article-title":"Burnout\u2013depression overlap: A review","volume":"36","author":"Bianchi","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e017858","DOI":"10.1136\/bmjopen-2017-017858","article-title":"Road to resilience: A systematic review and meta-analysis of resilience training programmes and interventions","volume":"8","author":"Joyce","year":"2018","journal-title":"BMJ Open"},{"key":"ref_38","unstructured":"PORDATA (2020, November 27). SNS: Recursos Humanos [NHS: Human Resources]. Available online: https:\/\/www.pordata.pt\/Subtema\/Portugal\/Recursos+Humanos-36."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"579","DOI":"10.14417\/ap.105","article-title":"Tradu\u00e7\u00e3o e valida\u00e7\u00e3o da Escala de Resili\u00eancia para Estudantes do Ensino Superior","volume":"29","author":"Oliveira","year":"2011","journal-title":"An\u00e1l. Psicol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_41","first-page":"229","article-title":"Contribui\u00e7\u00e3o para o Estudo da Adapta\u00e7\u00e3o Portuguesa das Escalas de Ansiedade, Depress\u00e3o e Stress (EADS) de 21 itens de Lovibond e Lovibond","volume":"5","author":"Honrado","year":"2004","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_42","unstructured":"Fonte, C.M.S. (2011). Adapta\u00e7\u00e3o e Valida\u00e7\u00e3o para Portugu\u00eas do Question\u00e1rio de Copenhagen Burnout Inventory (CBI). [Master\u2019s Thesis, Universidade de Coimbra]. Available online: https:\/\/estudogeral.sib.uc.pt\/handle\/10316\/18118."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tan, B.Y.Q., Chew, N.W.S., Lee, G.K.H., Jing, M., Goh, Y., Yeo, L.L.L., Ka, Z., Chin, H., Ahmas, A., and Khan, F. (2020). Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann. Intern. Med.","DOI":"10.7326\/M20-1083"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jad.2020.05.081","article-title":"Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation","volume":"274","author":"Xiao","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_45","first-page":"100424","article-title":"Frontline nurses\u2019 burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study","volume":"24","author":"Hu","year":"2020","journal-title":"E Clin. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"664","DOI":"10.5005\/jp-journals-10071-23518","article-title":"Burnout among healthcare workers during COVID-19 pandemic in India: Results of a questionnaire-based Survey","volume":"24","author":"Khasne","year":"2020","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Lin, J., Ren, Y., Gan, H., Chen, Y., Huang, Y., and You, X. (2020). Factors influencing resilience of medical workers from other provinces to Wuhan fighting against 2019 Novel Coronavirus Pneumonia. BMC Psychiatry.","DOI":"10.21203\/rs.3.rs-17931\/v1"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1017\/S1092852900025797","article-title":"Recent advances in the understanding and treatment of anxiety disorders. Resilience: Determinants, measurement, and treatment responsiveness","volume":"11","author":"Connor","year":"2006","journal-title":"CNS Spectr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/cpp.719","article-title":"The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents","volume":"18","author":"Hjemdal","year":"2011","journal-title":"Clin. Psychol. Psychother."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/2\/636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:10:47Z","timestamp":1760159447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/2\/636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,13]]},"references-count":49,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["ijerph18020636"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18020636","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,13]]}}}