ISSN 2007-734
Facultad de Psicología
Universidad Michoacana de San Nicolás de Hidalgo
Copyright © 2025 UARICHA
UARICHA, 2026, 24, 1-22
Recibido: 24 de octubre de 2024. Aceptado: 15 de febrero de 2026.
Correspondencia: Marcela Tiburcio Sainz. Instituto Nacional de Psiquiatría “Ramón de la Fuente Múñiz”. Calz. México-Xochimilco No. 101, Col. San
Lorenzo Huipulco, C.P. 14370 Tlalpan, CDMX. Correo electrónico: tibsam@imp.edu.mx
UARICHA, 2026, Vol. 24, pp. 1-22
1
Burnout'syndrome'in'psychiatric'and'emergency'nurses:''
Association'with'organizational'climate'and'coping'with'stress'
Síndrome de Burnout en enfermeras psiquiátricas y de urgencias:
Asociación con el clima organizacional y el afrontamiento del estrés
Guadalupe Dora Escamilla Roa 1 ORCID: https://orcid.org/0000-0001-9500-145X
Marcela Tiburcio Sainz 2 ORCID: https://orcid.org/0000-0001-7548-7800
Silvia Carreño García 2 ORCID: https://orcid.org/0000-0003-0391-8899
Morise Fernández Torres 2
ORCID: https://orcid.org/0000-0001-8573-5126
María Asunción Lara Cantú 3 ORCID: https://orcid.org/0000-0002-0536-8520
1 Facultad de Medicina, Universidad Nacional Autónoma de México (México).
2 Departamento de Ciencias Sociales en Salud, Instituto Nacional de Psiquiatría “Ramón de la Fuente Múñiz”
(México).
3 Departamento de Estudios Psicosociales en Poblaciones Especiales, Instituto Nacional de Psiquiatría “Ramón de la
Fuente Muñiz” (México).
Abstract'
Nurses are among the professionals most likely to
present Burnout Syndrome (BS), characterized by low
personal accomplishment, high depersonalization, and
high emotional exhaustion. Although the relationship
between BS and coping with stress has been
documented, less is known about the role of
organizational characteristics. This study aimed to
assess burnout syndrome in psychiatric and emergency
nurses in Mexico and examine its associations with
coping strategies and organizational climate. An
exploratory, cross-sectional, correlational study was
conducted with 168 nurses working in a psychiatric
hospital and two emergency rooms in central Mexico.
Participants completed a self-administered
questionnaire including the Maslach Burnout Inventory
(MBI), the Organizational Climate Questionnaire (OCQ),
and the Coping with Stress Questionnaire (CSQ).
Multiple linear regression analyses were performed
separately for each hospital type, using MBI dimensions
as dependent variables and OCQ and CSQ dimensions
as independent variables. BS was present in 3.0% of
nurses, with no differences between psychiatric and
emergency settings. The prevalence of emotional
exhaustion, depersonalization, and low personal
accomplishment was 16.2%, 16.2%, and 18.0%,
respectively. In psychiatric nurses, positive reappraisal
predicted higher personal accomplishment and better
workplace climate was associated with lower emotional
exhaustion. In emergency nurses, negative self-focus
predicted lower personal accomplishment, while
problem-solving predicted higher personal
accomplishment; additionally, lower hierarchical
interaction and higher workplace tension were linked to
greater emotional exhaustion, and better workplace
climate predicted lower depersonalization and higher
personal accomplishment. These findings highlight
opportunities to develop preventive programs aimed at
fostering healthy workplace environments for nursing
professionals.
Keywords:
Burnout syndrome, nursing, workplace,
organizational climate, coping strategies.
'
Escamilla Roa et al Burnout syndrome in psychiatric and emergency nurses
UARICHA 2026, Vol. 24, 1-22
2
Resumen'
Las enfermeras se encuentran entre las profesionales
con mayor probabilidad de presentar Síndrome de
Burnout (SB), caracterizado por baja realización
personal, alta despersonalización y alto agotamiento
emocional. Aunque se ha documentado la relación
entre el SB y el afrontamiento del estrés, se conoce
menos sobre el papel de las características
organizacionales. Este estudio tuvo como objetivo
evaluar el SB en enfermeras de hospitales psiquiátricos
y servicios de urgencias en México y examinar sus
asociaciones con estrategias de afrontamiento y clima
organizacional. Se realizó un estudio exploratorio,
transversal y correlacional con 168 enfermeras que
laboraban en un hospital psiquiátrico y dos servicios de
urgencias en el centro de México. Las participantes
respondieron un cuestionario autoadministrado que
incluyó el Maslach Burnout Inventory (MBI), el
Cuestionario de Clima Organizacional (CCO) y el
Cuestionario de Afrontamiento del Estrés (CAE). Se
realizaron análisis de regresión lineal múltiple por tipo
de hospital, utilizando las dimensiones del MBI como
variables dependientes y las del CCO y CAE como
variables independientes. El SB estuvo presente en el
3.0% de las enfermeras, sin diferencias entre entornos
psiquiátricos y de urgencias. La prevalencia de
agotamiento emocional, despersonalización y baja
realización personal fue de 16.2%, 16.2% y 18.0%,
respectivamente. En enfermeras psiquiátricas, la
reevaluación positiva predijo mayor realización
personal y un mejor clima laboral se asoció con menor
agotamiento emocional. En enfermeras de urgencias, la
focalización negativa predijo menor realización
personal, mientras que la resolución de problemas
predijo mayor realización personal; adicionalmente,
una menor interacción jerárquica y mayor tensión
laboral se vincularon con mayor agotamiento
emocional, y un mejor clima laboral predijo menor
despersonalización y mayor realización personal. Estos
hallazgos destacan oportunidades para desarrollar
programas preventivos orientados a promover
entornos laborales saludables para el personal de
enfermería.
Palabras clave:
Síndrome de Burnout, enfermería, lugar
de trabajo, clima organizacional, estrategias de
afrontamiento.
Introduction'
Nurses are among the professions most exposed to stress in the workplace, since their work
involves a high degree of personal commitment, as well as an intense and direct interaction with
the people they serve (Cañadas-de la Fuente et al., 2014; Gil-Monte, 2003; Manzano-García,
2007; Quesada-Puga et al., 2024; Rincón, 2005). For this reason, if they do not have adequate
strategies for coping with workplace stress, they can experience mental health problems (Lee et
al., 2016; Muñoz & Velásquez, 2016; Servian et al., 2019).
Burnout syndrome (BS) is one important consequence of workplace stress, defined as a
response to a chronic situation of workplace stress, occurring primarily in professions focused
on caring for the needs or interests of clients, with direct contact with those clients (Gil-Monte &
Peiró, 1996). BS has also been defined as a prolonged psychological state at work, with three
dimensions: Emotional Exhaustion (EE), Depersonalization (D), and Personal Accomplishment
(PA) (Maslach & Jackson, 1982; Maslach et al., 2001). It is frequently found in nurses, and studies
have found it to be associated with a lack of social recognition, working under pressure, lack of
autonomy, conflict within working groups continual contact with suffering, and the constant
demands of patients and family (Molina et al., 2022; Sánchez-Jiménez et al., 2018; Van Bogaert et
al., 2017).
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
3
Burnout among nurses is a public health concern because its consequences extend
beyond individual well-being to the safety and performance of health systems. Higher burnout
has been linked to increased clinical errors, lower patient satisfaction, absenteeism, turnover,
and reduced productivity (Jun et al., 2021; Mossburg & Himmelfarb, 2021). Prolonged exhaustion
and depersonalization are also associated with mental and physical health problems among
healthcare personnel, amplifying societal and system costs (Orrù et al., 2021). Framing nurse
burnout as a public health issue underscores the need to understand both individual coping
and organizational factors that may be modifiable in real-world settings.
International research has identified several factors associated with BS in healthcare
professionals. Individual factors include personality type (Geuens et al., 2015) and demographic
characteristics. Workplace factors include work overload, lack of social support, and poor
communication (Adriaenssens, De Gucht, & Maes, 2015; Lee, Chiang, & Kuo, 2019; Van Bogaert
et al., 2017). Other predictors of BS in health providers are lack of emotional support, workload,
and perception of a lack of resources (Albendín et al., 2016; Meredith et al., 2022; Wontorczyk et
al., 2023). Evidence also suggests that nurses working in high-demand settings, such as
emergency rooms, mental health services, and intensive care units are more affected by BS
(Adriaenssens et al., 2015; Ahmadi et al., 2014; Albendín et al., 2016). These studies highlight the
relevance of both organizational factors and individual coping strategies associated with BS.
Organizational climate, defined by Robbins and Judge (2009) as the personality of an
organization, is comparable to organizational culture, since it allows for the strengthening of
traditions, values, customs, and practices that are accepted within an organization. A healthy
organizational climate is essential not only for workers' health, but also for enhancing
productivity, motivation, work ethic, job satisfaction, and overall quality of life (OMS, 2010). In
many developed countries, nursing practice is associated with dissatisfaction at work, low
productivity, low quality of care, and uncertainty in patient care (in the administration of
medication and the taking of vital signs, for example), and also with BS (Leiter & Maslach, 2009;
Shirey, 2006).
Coping strategies also play a key role. Folkman and Lazarus (1980; Lazarus & Folkman,
1984) distinguish between direct coping (action aimed at the external source of stress) and
indirect coping (palliative action aimed at managing one’s own emotions). Active strategies, such
as control, confrontation, or seeking information or social support, are generally more effective
than emotional or avoidance strategies (Adriaenssens, De Gucht & Maes, 2015; Corrales et al.,
2012; Rendón-Montoya et al., 2020).
The theoretical model developed by Winnubst (1993) for health care workers integrates
these factors. It posits that organizational structure, culture, and climate, as well as the availability
of social support, are precursors to BS. In this model, a system of social support at work
significantly improves a worker’s perception of the organizational structure (Gil-Monte, 2001;
Leiter & Schaufeli,1996; Martínez, 2010).
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
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In Mexico, studies have found that 17.4% of nurses in Mexico City have a high level of EE,
1.1% a high degree of D, and 4.9% a low level of PA (Sánchez-Jiménez et al., 2018). However,
studies carried out in the northern border indicate that the prevalence of average BS reaches
65% and affects more women than men (Acosta-Ramos et al., 2021).
Studies of nursing professionals in Mexico have described demographic variables,
including age, sex, marital status, partner status, and employment variables such as work shift,
length of employment, double shifts, break time allowed, and type of contract (Juárez et al., 2014;
Rendón Montoya et al., 2020). These variables show important associations with each dimension
of BS, although some studies, such as Martínez-López and López-Solache (2005) use different
approaches to its evaluation. A systematic review identified that studies of BS in Mexico use
different cutoffs and scoring criteria (Juárez et al, 2014), making comparisons difficult. Some
research has even reported no cases meeting BS criteria (Castillo-Barrera et al., 2016). In
contrast, Corrales et al. (2012) found higher BS scores in health care staff in a level 3 hospital
than in a referral hospital, and observed that active coping strategies such as control,
confrontation, or the search for information or social support reduce burnout symptoms. This
variability in findings underscores the need for more consistent evidence on the manifestations
of BS among nurses in Mexico.
The aim of this study was to explore BS among nursing professionals working in
psychiatric hospitals and hospital emergency rooms in Mexico by comparing their
sociodemographic and workplace characteristics, and identifying the prevalence and
distribution of BS symptoms. Furthermore, it sought to analyze the associations of coping
strategies and organizational climate dimensions with each BS component through multiple
regression analyses. It was hypothesized that nurses meeting the criteria for BS would be more
likely to employ ineffective coping strategies and perceive their work environment less favorably.
Method
A cross-sectional, correlational study was carried out with nursing professionals who worked at
a psychiatric hospital and in two hospital emergency rooms in central Mexico.
Participants
A non-probabilistic convenience sample of 168 nursing professionals was recruited, 89 who
worked in a psychiatric hospital in Mexico City and 79 who worked in two hospital emergency
rooms in the neighboring state of Hidalgo. The sample size (n = 168) corresponded to the total
nursing staff available and eligible in the participating hospitals during the data collection period,
in accordance with previously defined inclusion (active nursing staff) and exclusion criteria. The
exclusion criteria were being in a temporary or substitute position, being on vacation, or having
administrative responsibilities. The non-response rate was 9.35% from the psychiatric hospital
and 23% from the hospital emergency rooms.
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
5
Instruments
The questionnaire included a section for demographic data, length of employment, and number
of patients cared for each day. It also included the following three scales for the variables of
interest.
● Maslach Burnout Inventory Human Services Survey (MBI) (Maslach & Jackson, 1982). The
MBI is a widely used self-administered inventory designed to assess work-related
attitudes and emotional responses among professionals in human services. It includes
22 items, distributed across three subscales: 1) Emotional Exhaustion (EE) evaluates the
feeling of being emotionally overextended and depleted by work demands, 2)
Depersonalization (D) assesses an impersonal and unfeeling attitude toward the
recipients of professional care, and 3) Personal Accomplishment (PA) measures the
sense of competence and successful achievement in working with people. Items are
rated on a 7-point Likert scale ranging from 0 (never) to 6 (every day). This study used the
Spanish version validated for Mexican health professionals (Juárez, Idrovo & Camacho,
2014; Meda-Lara et al., 2008), with internal consistency coefficients of α = .86 for EE, α =
.60 for D, and α = .75 for PA.
● Coping with Stress Questionnaire (CSQ) (Sandin & Chorot, 2003). The CSQ assesses seven
basic coping styles: Problem Solving (PS) α = .69, which refers to active and structured
efforts to resolve stressful situations; Negative Self-Focus (NSF) α = .62, which involves
self-blame and feelings of helplessness; Positive Reappraisal (PR) α = .54, characterized
by finding positive meaning or growth in adversity; Overt Emotional Expression (OEE) α =
.65, reflecting outward expressions of negative emotions; Avoidance (A) α = .67, defined
as attempts to distract oneself or disengage from the problem; Seeking Social Support
(SS) α = .76, which includes turning to others for advice or emotional support; and
Religion (R) α = .77, involving the use of faith or spiritual practices to cope. The 21-item
short version validated by González-Ramírez and Landero-Hernández (2007) was used
in the present study and showed good internal consistency (α = .83).
● Organizational Climate Questionnaire (OCQ) (Caraveo et al., 1988). The OCQ is a self- report
instrument based on the organizational diagnosis model of French and Bell (1996). It
consists of 36 items (α = .88) that assess individual perceptions about workplace climate,
using a 4-point Likert scale (1 = complete disagreement to 4 = total agreement). The items
are grouped into six subscales: 1) motivation (M, 11 items, α = .79), which evaluates
perceptions of personal drive; 2) hierarchical interaction (HI, 7 items, α = .86), assessing
the quality of communication and relations between employees and superiors; 3)
workplace tension (WT, 8 items, α = .52), which captures the presence of conflict, stress,
or emotional strain in the work environment; 4) workplace climate (WC, 4 items, α = .78),
reflecting the overall atmosphere of trust, support, and collaboration; 5) group
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
6
interactions (GI, 3 items, α = .76), examining the quality of relationships and cooperation
among peers; and 6) image of the institution (II, 3 items, α = .42) referring to how
employees perceive the organization's public reputation and internal coherence.
Although the internal consistency of the image of the institution subscale was low, this
dimension was retained in the analyses. Its exclusion would have reduced comparability
with previous studies using the same version of the instrument; therefore, all OCQ
dimensions were included.
Procedure
Data were collected. In the psychiatric hospital, the questionnaires were administered in a group,
with the assistance of the head of nursing and the shift supervisor, with whom a date, time, and
place were arranged. Participants were gathered in a meeting room, and informed of the study
objectives, the confidentiality of the data, and the risks and benefits. The average time for
completing the questionnaire was 30 minutes. The emergency nurses were given the
questionnaire individually when they had time to complete it.
Statistical analyses
Descriptive statistics were calculated for sociodemographic and workplace variables. Differences
between psychiatric and emergency nurses in categorical variables were assessed using chi-
square (Χ²) tests, while differences in continuous variables were examined with Mann–Whitney
U tests, as the data did not have a normal distribution. Burnout syndrome (BS) levels were
determined according to the established cut-off points for each of the three Maslach Burnout
Inventory (MBI) subscales (EE, P and PA), and the distribution of the number of BS symptoms
was compared between hospital types using chi-square tests. Median scores for BS subscales,
coping strategies, and organizational climate dimensions were compared between groups using
Mann–Whitney U tests. To examine associations between coping strategies and BS dimensions,
and between organizational climate dimensions and BS dimensions, multiple linear regression
analyses were conducted separately for each nursing specialty, using the introduction method
and entering each set of predictors simultaneously. All analyses were performed using SPSS
version 21, with a significance level set at p < .05.
Ethical considerations
The Research Ethics Committees of each of the participating hospitals reviewed and approved
the research protocol. Participants were told of the purpose of the study, were informed that
their participation was voluntary, and provided written informed consent. To safeguard the
confidentiality of the information provided, questionnaires were identified only with an
alphanumeric code.
'
'
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
7
Results'
Demographic and Workplace Characteristics
Women represented 73.8% of the total sample. Of all participants, 52.9% worked in the
psychiatric hospital and 47.1% in hospital emergency rooms (Table 1). Among psychiatric nurses,
41.6% were aged 40-50 years, while emergency nurses were significantly younger: 82.3% aged
18-39. Consistent with these age differences, 46.1% of the psychiatric nurses reported 16-25
years of employment, compared to 46.8% of emergency nurses who reported 2-5 years
reported. Regarding educational level, 37% of psychiatric nurses held a bachelor’s degree or
higher, compared to 49.4% of the emergency nurses. Workload also differed: 84% of psychiatric
nurses reported caring for an average of 8-15 patients per shift, whereas 57% of emergency
nurses reported caring for 1-7 patients (Table 1).
Table 1
Sociodemographic Characteristics of the Participants
Variables
Psychiatric Nurses
(n = 89)
Emergency Nurses
(n = 79)
Total
(n = 168)
Sex
F
%
f
%
f
%
Male
24
27.0
20
25.3
44
26.2
Female
65
73.0
59
74.7
124
73.8
Age (years)
18-28
16
18.0
33
41.8
49
29.2
29-39
31
34.8
32
40.5
63
37.5
40-50
37
41.6
11
13.9
48
28.6
51-60
5
5.6
3
3.8
8
4.8
Children
Yes
80
89.9
62
78.5
142
84.5
No
9
10.1
17
21.5
26
15.5
Marital Status
Single
23
25.8
42
53.2
65
38.7
Married
39
43.8
23
29.1
62
36.9
Partnered
20
22.5
9
11.4
29
17.3
Divorced or Widowed
7
7.8
5
6.3
12
7.2
Shift
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
8
Morning
16
18.0
20
25.3
36
21.4
Afternoon
15
16.9
12
15.2
27
16.1
Night
28
31.5
26
32.9
54
32.1
Special
30
33.7
21
26.6
51
30.4
Length of Employment (years)
2-5
10
11.2
37
46.8
47
28.0
6-15
30
33.7
20
25.3
50
29.8
16-25
41
46.1
14
17.7
55
32.7
26-35
5
5.6
8
10.1
13
7.7
36-45
3
3.4
0
0.0
3
1.8
Other Employment
Yes
8
9.1
29
36.7
37
22.0
No
81
90.9
50
63.3
131
78.0
Patients per Shift
1-7
3
3.4
45
57.0
48
28.7
8-15
75
84.3
20
25.3
95
56.3
15-22
2
2.2
5
6.3
7
4.2
23 or more
9
10.1
9
11.4
18
10.8
Position
Chief of Service
1
1.1
4
5.1
5
3.0
Specialist
10
11.2
6
7.6
16
9.6
General Nurse
37
41.6
34
43.0
71
41.9
Nursing Assistant
39
43.8
35
44.3
74
44.3
Other
2
2.2
0.0
0.0
2
1.2
Educational Level
Doctorate
1
1.1
0
0.0
1
0.6
Master’s Degree
5
5.6
3
3.8
8
4.8
Bachelor’s Degree
27
30.3
36
45.6
63
37.7
High School
23
25.8
29
36.7
52
30.5
Technical School
33
37.2
11
13.9
44
26.3
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
9
Burnout Syndrome Evaluation by type of Hospital
Burnout syndrome (BS) was assessed using the established cut-off points proposed by Maslach
and Jackson (1986) for the three subscales. Overall, 16.2% of participants scored high in EE,
16.2% in D, and 18.0% had low PA (Table 2). No statistically significant differences were observed
between psychiatric (EE: 15.9%; D: 17.0%; PA: 21.6%) and emergency nurses (EE: 16.5%; D:
15.2%; PA: 13.9%) in any of the BS dimensions.
When considering the combination of symptoms, 63.1% of the sample showed no BS
symptoms, 26.8% presented one symptom, 7.1% had two symptoms, and 3.0% met the criteria
for BS (high EE and D with low PA). The distribution of the number of symptoms did not differ
significantly between hospital types.
Table 2
Burnout Syndrome by Type of Hospital
Psychiatric
(n = 89)
Emergency
(n = 79)
Total
(n = 168)
Statistical test
n
%
n
%
n
%
Emotional Exhaustion (EE)
14
15.9
13
16.5
27
16.2
X2 = 0.000, df = 1, p = 1.00
Depersonalization (D)
15
17.0
12
15.2
27
16.2
X2 = 0.013, df = 1, p = .90
Low Personal Accomplishment
(PA)
19
21.6
11
13.9
30
18.0
X2 = 1.141, df = 1, p = .285
No BS symptoms
54
60.7
52
65.8
106
63.1
X2 = 0.844, df = 3, p = .837
One symptom
24
27.0
21
26.6
45
26.8
Two symptoms
9
10.1
3
3.8
12
7.1
Three symptoms
2
2.2
3
3.8
5
3.0
Comparison of Burnout, Coping Strategies, and Organizational Climate by type of Hospital
A comparison of BS, coping strategies, and organizational climate scores between psychiatric
and emergency nurses revealed no significant differences in emotional exhaustion,
depersonalization, or personal accomplishment. Similarly, most coping strategy scores did not
differ significantly between groups. However, psychiatric nurses scored significantly higher in
overt emotional expression (OEE; U = 2438.5, p = .026), indicating a greater tendency to
outwardly express negative emotions.
Escamilla Roa et al. Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
10
Regarding organizational climate, psychiatric nurses reported significantly higher levels
of motivation (M; U = 2529.0, p = .002) and workplace tension (U = 1952.5, p = .027), whereas
emergency nurses reported significantly higher scores in hierarchical interaction (HI; U = 2442.0,
p = .001) and perceived institutional image (U = 2838.5, p = .039). No significant differences were
found in the remaining coping or organizational climate subscales (Table 3).
Table 3
BS, Coping Strategies, and Organizational Climate scores, by Type of Hospital
Psychiatric
Hospital
(n = 89)
Hospital
EmergencyRooms
(n = 79)
Statistical
test
Mdn (Range)
Mdn (Range)
U
p
Burnout Syndrome
Emotional Exhaustion (EE)
8.00(48)
8.00(31)
3422.0
.862
Depersonalization (D)
2.00(17)
2.00(12)
3169.0
.316
Low Personal Accomplishment
(PA)
41.00(40)
42.00(38)
3289.5
.549
Coping
Problem Solving (PS)
21.00(22)
21.00(24)
2977.5
.744
Negative Self-focus (NSF)
12.00(18)
11.00(16)
2768.5
.288
Positive Reappraisal (PR)
20.00(22)
19.00(24)
3018.0
.854
Over Emotional Expression (OEE)
11.00(17)
10.00(16)
2438.5
.026
Avoidance (A)
16.00(21)
15.00(21)
3062.5
.978
Seeking Social Support (SS)
18.00(24)
17.00(24)
2850.5
.439
Religion (R)
12.00(24)
14.00(22)
2788.5
.322
Organizational Climate
Motivation (M)
37.50(25)
35.00(31)
2529.0
.002
Hierarchical Interaction (HI)
21.00(21)
22.00(19)
2442.0
.001
Workplace Tension (WT)
21.00(17)
19.00(17)
1952.5
.027
Workplace Climate (WC)
14.00(10)
15.00(11)
3043.0
.157
Group Interactions (GI)
10.00(9)
11.00(9)
3025.0
.138
Image of the Institution (II)
8.00(9)
9.00(7)
2838.5
.039
Association between Coping Strategies and Burnout Dimensions
Multiple linear regression analyses were conducted separately for psychiatric and emergency
nurses to examine whether coping strategies predicted Emotional Exhaustion (EE),
Depersonalization (D), and Personal Accomplishment (PA) (Table 4).
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For both specialties, no coping strategy significantly predicted EE. Among psychiatric
nurses, D was positively predicted by negative self-focus (NSF; β = 0.291, t = 2.042, p = .044);
however, the overall model was not statistically significant (F = 1.327, df = 7, R² = .104, p = .248).
For emergency nurses, religion was positively associated with D (R; β = 0.304, t = 2.068, p = .043),
although the overall model was likewise not significant (F = 1.609, df = 7, R² = .156, p = .150).
Regarding PA, psychiatric nurses scored higher when using positive reappraisal (PR; β =
0.367, t = 2.657, p = .010), which explained 23% of variance (F = 3.422, df = 7, R² = .233, p = .003).
Among emergency nurses, PA was negatively predicted negative self-focus (NSF; β = –0.333, t =
–2.369, p = .021) and positively predicted by problem solving (PS; β = 0.378, t = 2.438, p = .018),
jointly explaining 42% of the variance (F = 6.137, df = 7, R² = .417, p < .001).
Association between Coping Strategies and Burnout Dimensions
Multiple linear regression analyses were conducted separately for psychiatric and emergency
nurses to examine whether dimensions of organizational climate predicted EE, D, PA.
For psychiatric nurses, EE was negatively predicted by workplace climate (WC; β = –0.407,
t = –2.039, p = .046), explaining 24.7% of the variance (F = 3.006, df = 6, R² = .247, p = .013),
indicating that a more favorable perception of the workplace climate was associated with lower
EE.
For emergency nurses, EE was negatively predicted by hierarchical interaction (HI; β = –
0.455, t = –2.208, p = .030) suggesting that poorer communication, lack of collaboration, or
unsatisfactory treatment from supervisors was associated with higher EE. EE was also positively
predicted by workplace tension (WT; β = 0.249, t = 2.178, p = .033), meaning that perceptions of
interpersonal conflict, bureaucratic obstacles, and unsafe working conditions were linked to
greater EE. Together, these predictors explained 19.9% of the variance (F = 2.980, df = 6, R² =
.199, p = .012).
Regarding D, no significant predictors emerged for psychiatric nurses. In emergency
nurses, D was positively predicted by HI (β = 0.536, t = 2.656, p = .010), indicating that poor
supervisor relationships were associated with greater depersonalization; and negatively
predicted by WC (β = –0.557, t = –3.080, p = .003), suggesting that a better workplace climate
was linked to lower depersonalization. This model explained 23.1% of the variance (F = 3.615, df
= 6, R² = .231, p = .003).
For PA, the model was significant only for emergency nurses, where WC was a positive
predictor (β = 0.594, t = 3.632, p = .001), indicating that a favorable perception of workplace
climate was associated with higher personal accomplishment. This model explained 37.4% of
the variance (F = 7.083, df = 6, R² = .374, p < .001).
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Table 4. Association of Strategies for Coping with Stress and Burnout Syndrome, by Nursing Specialty
Dependent
Variable
Psychiatric Hospital
(n = 89) 88
Hospital Emergency Rooms
(n = 79) 69
EE
β
t
p
CI
F(df)
R2
p
β
t
p
CI
F(df)
R2
p
Independent Variables
Constant
0.887
.378
-5.881
15.334
567.965(
7)
.090
.355
3.478
.001
5.176
19.182
2.059(7)
.191
.062
NSF
0.010
0.071
.943
-0.580
0.623
0.257
1.537
.129
-0.129
0.990
PR
-0.143
-0.956
.342
-0.806
0.283
-0.130
-0.604
.548
-0.747
0.401
OEE
0.256
1.615
.110
-0.148
1.420
0.004
0.025
.980
-0.643
0.659
A
0.080
0.608
.545
-0.344
0.646
-0.041
-0.232
.817
-0.539
0.427
SS
0.095
0.606
.546
-0.342
0.641
0.254
1.589
.117
-0.074
0.648
R
-0.163
-1.315
.192
-0.659
0.135
-0.038
-0.265
.792
-0.374
0.286
PS
0.026
0.179
.858
-0.465
0.557
-0.354
-1.959
.055
-0.829
0.009
D
β
t
p
CI
F(df)
R2
p
β
t
p
CI
F(df)
R2
p
Constant
0.362
.718
-3.632
5.250
1.327(7)
.104
.248
4.222
.000
3.786
10.600
1.609(7)
.156
.150
NSF
0.291
2.042
.044
0.007
0.511
-0.205
-1.199
.235
-0.436
0.109
PR
-0.227
-1.531
.130
-0.403
0.053
-0.137
-0.624
.535
-0.366
0.192
OEE
-0.080
-0.509
.612
-0.412
0.244
-0.001
-0.005
.996
-0.317
0.316
A
-0.010
-0.077
.939
-0.215
0.199
-0.162
-0.887
.379
-0.339
0.131
SS
0.278
1.788
.078
-0.021
0.390
0.139
0.851
.398
-0.101
0.250
R
-0.028
-0.225
.823
-0.185
0.147
0.304
2.068
.043
0.006
0.327
PS
0.039
0.274
.785
-0.184
0.243
-0.186
-1.00
.317
-0.306
0.101
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PA (+)
β
t
p
CI
F(df)
R2
p
β
t
p
CI
F(df)
R2
p
Constant
6.407
.000
22.743
43.245
3.422(7)
.233
.003
5.577
.000
14.61
8
30.968
6.137(7)
.417
<.001
NSF
-0.257
-1.944
.055
-1.150
0.014
-0.333
-2.369
.021
-1.429
-0.121
PR
0.367
2.657
.010
0.176
1.231
0.318
1.729
.089
-0.090
1.238
OEE
-0.111
-0.752
.454
-1.050
0.474
0.059
0.416
.679
-0.596
0.909
A
0.136
1.103
.273
-0.217
0.755
0.082
0.539
.592
-0.410
0.713
SS
-0.079
-0.541
.590
-0.627
0.359
0.015
0.112
.911
-0.395
0.442
R
-0.042
-0.366
.715
-0.455
0.314
-0.124
-1.017
.313
-0.579
0.189
PS
0.012
0.091
.928
-0.471
0.516
0.378
2.438
.018
0.106
1.075
Note: Multiple linear regression using the introduction method to predict Emotional Exhaustion (EE), Depersonalization (D), and Personal Accomplishment (PA+). Negative
self-focus (NSF), Positive Reappraisal (PR), Overt Emotional Expression (OEE), Avoidance (A), Seeking Social Support (SS), Religion (R) y Problem Solving (PS).
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Table 5. Association of Organizational Climate and Burnout Syndrome, by Nursing Specialty
Dependent
Variable
Psychiatric Hospital
(n = 87)
Dependen
t Variable
Hospital Emergency Rooms
(n = 79)
EE
β
t
p
CI
F(df)
R2
p
EE
β
t
p
CI
F(df)
R2
p
Independent
Variable
Independe
nt Variable
Constant
2.913
.005
7.859
42.506
3.006(
6)
.247
.013
Constant
2.639
.010
3.365
24.142
2.980(6
)
.199
.012
M
0.220
1.211
.231
-0.232
0.942
M
0.020
0.112
.911
-0.370
0.414
HI
0.142
0.939
.352
-0.232
0.640
HI
-0.455
-2.208
.030
-1.357
-0.069
WT
0.054
0.417
.678
-0.409
0.624
WT
0.249
2.178
.033
0.040
0.912
WC
-0.407
-2.039
.046
-2.882
-0.025
WC
0.041
0.221
.826
-0.891
1.113
GI
-0.250
-1.347
.184
-2.500
0.490
GI
-0.096
-0.464
.644
-1.636
1.018
II
-0.176
-1.275
.208
-1.447
0.322
II
0.105
0.799
.427
-0.560
1.309
D
β
t
p
CI
F(df)
R2
p
D
β
t
p
CI
F(df)
R2
p
Constant
3.069
.003
5.206
24.791
2.103(
6)
.187
0.68
Constant
3.620
.001
3.973
13.713
3.615(6
)
.231
.003
M
-0.129
-0.683
.498
-0.445
0.219
M
-0.181
-1.027
.308
-0.278
0.089
HI
0.115
0.733
.467
-0.156
0.337
HI
0.536
2.656
.010
0.100
0.704
WT
-0.031
-0.229
.820
-0.325
0.259
WT
-0.026
-0.234
.816
-0.228
0.180
WC
-0.414
-1.995
.051
-1.611
0.004
WC
-0.557
-3.080
.003
-1.195
-0.256
GI
0.008
0.043
.966
-0.827
0.863
GI
-0.158
-0.778
.439
-0.865
0.379
II
0.158
1.096
.278
-0.227
0.773
II
0.119
0.930
.356
-0.234
0.642
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PA (+)
β
t
p
CI
F(df)
R2
p
PA (+)
β
t
p
CI
F(df)
R2
p
Constant
-0.345
.731
-22.811
16.103
4.538(
6)
.331
.001
Constant
0.768
.445
-7.495
16.883
7.083(6
)
.374
<.001
M
0.327
1.907
.062
-0.032
1.287
M
-0.024
-0.148
.883
-0.494
0.426
HI
-0.152
-1.064
.292
-0.750
0.230
HI
-0.061
-0.333
.740
-0.881
0.629
WT
0.129
1.060
.294
-0.273
0.887
WT
0.065
0.643
.522
-0.346
0.676
WC
0.305
1.619
.111
-0.308
2.901
WC
0.594
3.632
.001
0.964
3.313
GI
-0.090
-0.515
.609
-2.110
1.248
GI
0.022
0.118
.907
-1.463
1.647
II
0.123
0.942
.350
-0.526
1.460
II
0.087
0.750
.456
-0.686
1.514
Note: Multiple linear regression using the introduction method to predict Emotional Exhaustion (EE), Depersonalization (D), and Personal
Accomplishment (PA+), Motivation (M), Hierarchical Interaction (HI), Workplace Tension (WT), Workplace Climate (WC), Group Interactions (GI)
Image of the Institution (II).
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Discussion
The objective of this study was to analyze the relationship between coping strategies,
organizational climate, and BS among nursing staff working in a psychiatric hospital in Mexico
City and in two hospital emergency rooms in the state of Hidalgo.
The Maslach Burnout Inventory (MBI) was used to evaluate BS symptomatology. This
instrument has shown adequate characteristics in other studies (Corrales et al., 2012; Martínez-
López & López-Solache, 2005; Ramirez-Baena et al., 2019). In the present study, none of the
participants met the three MBI cutoffs proposed by its creators (EE ≥ 27, D ≥ 10, and PA ≤ 33)
(Maslach & Jackson, 1982). This may reflect the need to determine different cutoff scores for the
Mexican population (Castillo-Barrera et al., 2016; Juárez-García et al., 2014), as suggested by
another study that also found no participants meeting the full criteria (Geuens et al., 2020).
Therefore, in this study, high scores for each dimension were defined as the mean plus one
standard deviation. Using this criterion, 3% of the participants met all three criteria, with no
significant differences between psychiatric and emergency nurses. This contrasts with findings
from other studies summarized by Albendín et al. (2016), which have reported higher levels of
BS among emergency nurses.
For the overall sample, regression analyses showed that two coping strategies were the
strongest predictors of BS: Negative self-focus, which increased BS symptoms, and positive
reappraisal, which reduced them. When analyzing each specialty separately, psychiatric nurses
with NSF reported greater depersonalization (10% explained variance), whereas those who used
more PR reported greater PA (23% explained variance). Among emergency nurses, NSF
predicted lower PA, while PS predicted greater personal accomplishment. The latter model had
the highest explained variance (42%). These findings are consistent with previous studies in
healthcare personnel showing the protective role of active coping strategies (Corrales et al.,
2012). Overall, the results underscore the need to train nursing personnel in coping strategies,
such as PR and PS, and to discourage passive strategies like NSF, which increase D and reduce
PA.
Regarding the organizational climate, in the overall sample, a better workplace climate
was an essential predictor for reducing BS. In the specialty-specific models, psychiatric nurses
who perceived a better workplace climate reported lower EE, though no associations with D or
PA were observed. In emergency nurses, lower HI and higher WT were linked to greater EE, while
a better WC predicted both lower D (23% explained variance) and greater PA (37% explained
variance). Although the reliability of the image of the institution dimension was low, it was
retained to preserve comparability with previous studies using the same instrument version,
which should be considered when interpreting these results. These patterns suggest that
targeted improvements in specific aspects of the work environment may help mitigate BS.
Escamilla Roa et al Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
17
The present findings highlight two main preventive avenues: (1) promoting proactive
coping strategies, and (2) improving the organizational climate, through actions such as clarifying
team goals and responsibilities, reducing workplace tension, and ensuring adequate workload
distribution and rest periods. Similar conclusions have been reported in previous research
(Adriaenssens, De Gucht, & Mae, 2015; Muñoz-Seco et al., 2006; Van Bogaert et al., 2017).
Strengths and limitations
Strengths
The study identifies risk factors for BS among nurses and suggests areas for preventive
programs that can help to promote healthier workplace environments. It emphasizes
continuous preventive measures across multiple workplace dimensions, including leadership
training to improve the workplace climate, reduction of workplace tension, optimal workload
distribution, and rest time allocation. It supports the development of self-care practices (break
times, vacations, healthy eating and sleep habits) and aggression self-regulation strategies to
reduce patient-provider conflicts.
Limitations
The main limitation is the sample size, as some invited participants declined due to time
constraints. This limits the generalization of the results. The verification of univariate and
multivariate normality, as well as the calculation of skewness, kurtosis, and the Shapiro–Wilk test
for the evaluated subscales, was not performed due to the exploratory nature of the study and
the available sample size. We acknowledge that including these analyses would have added
methodological rigor, and we recommend their incorporation in future studies with larger
samples. The regression models did not include sociodemographic variables. Although
descriptive comparisons by demographic and workplace characteristics were conducted, their
absence from the regression models means that potential confounding or moderating effects
could not be assessed.
Future research should
Increase the number of participants to allow more complex analyses of variable interactions.
Evaluate the suitability for the Mexican population of the cutoff scores recommended by the
creators of the MBI, given the discrepancies between different studies, as well as that of the
depersonalization subscale (Adriaenssens et al., 2015; Cañadas-de la Fuente et al., 2014;
Falgueras et al., 2015; Juárez, Idrovo & Camacho, 2014; Merino-Soto & Calderón-De la Cruz,
2018). Include sociodemographic and workplace characteristics in regression models to identify
their role in BS development. Given that BS develops over time, future longitudinal studies
should examine the long-term effects of training in active coping strategies, self-care, and
workplace improvements on the prevention and reduction of BS symptoms.
Escamilla Roa et al Burnout syndrome in psychiatric and emergency nurses
UARICHA, 2026, Vol. 24, pp. 1-22
18
Funding'
None
Conflicts'of'Interest'
The authors declare that they have no conflicts of interest.
Acknowledgements'
The authors wish to thank the participants and the Institutions that contributed to this study.
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