CoChat
Sign Up
Cited by 155Stress and Burnout ResearchPsychotherapy Techniques and ApplicationsHealthcare professionals’ stress and burnout

Associations between therapists’ occupational burnout and their patients’ depression and anxiety treatment outcomes

Open access
Delgadillo, Jaime, Saxon, David, Barkham, Michael·2018·Depression and Anxiety
DOI 10.1002/da.22766
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy. METHODS: We used multilevel modeling using depression (PHQ-9) and anxiety (GAD-7) outcomes data from 2,223 patients nested within 49 therapists. Therapists completed a survey including the Oldenburg Burnout Inventory (OLBI) and a job satisfaction scale (JDSS). RESULTS: After controlling for case-mix, around 5% of variability in treatment outcomes was explained by therapist effects (TE). Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate. Higher OLBI scores were also correlated with lower job satisfaction ratings. CONCLUSIONS: Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action.

AI snapshot

Written from the paper’s full text.

TL;DR

In a publicly funded IAPT psychological therapy service, higher therapist disengagement burnout and lower job satisfaction were linked to poorer patient depression and anxiety outcomes after case-mix adjustment. Therapist-level variables accounted for a substantial portion of between-therapist variability in outcomes.

Key findings

  • Therapist effects explained about 5.7% of depression outcome variability and 5.6% of anxiety outcome variability after case-mix adjustment.
  • Higher Oldenburg Burnout Inventory disengagement (OLBI-D) scores predicted less improvement in both depression and anxiety; the exhaustion subscale was not significant in either model.
  • Lower Job Discrepancy and Satisfaction Scale (JDSS) scores predicted poorer depression outcomes but not anxiety outcomes. The abstract reports these therapist variables explained 31–39% of the therapist-effect estimate; the results section reports approximately 38.6% for depression and 28.6% for anxiety.
  • OLBI-D was inversely correlated with job satisfaction (r = −0.51, P < .001). Role and JDSS explained about 13% and 34% of variance in OLBI-D, respectively; mental health nurses had the highest mean OLBI-D (2.34), followed by psychological well-being practitioners (2.29) and CBT therapists (1.92).

Methods

  • Observational study in a northern England IAPT service including psychological well-being practitioners, CBT therapists, and mental health nurses. Therapists completed an electronic survey with the OLBI and JDSS; patient outcomes were pre-post change scores on the PHQ-9 and GAD-7.
  • Primary analysis used multilevel modeling with 2,223 patients nested within 49 therapists, after excluding patients with only one session, missing pre/post outcomes, and therapists with fewer than 20 cases. A sensitivity analysis used multiple imputation (25 iterations, MCMC) on 2,393 patients.
  • Models included patient-level case-mix variables and therapist-level predictors; intracluster correlation coefficients estimated therapist effects. A second stage used ordinary least squares regression on therapist-level data to examine predictors of OLBI-D.

Limitations

  • The paper states that the sample size, especially patients per therapist, may be insufficient for reliable estimates of all model parameters; the cross-sectional survey cannot establish causal direction; burnout and job satisfaction may change over time; and longitudinal replication is needed.
  • The paper notes the IAPT stepped-care workforce may not represent other settings such as hospital or secondary care services.
  • Evident from the text: the abstract and results section report different percentages for the therapist-effect variance explained, and missing data required imputation with IMD scores not imputable, reducing the sensitivity sample.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/da.22766

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 9 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Mental health nurse practitioners showed the highest burnout scores among occupational groups.

    “Furthermore, MHN practitioners tended to have higher indices of burnout compared to the other occupational groups”
    • Also stated in: § 3.4 Correlates of therapist disengagement · hedged
      “On average, MHN practitioners tended to have the highest OLBI-D scores (M = 2.34, SD = 0.52), followed by PWPs (M = 2.29, SD = 0.47) and CBTs (M = 1.92,SD = 0.37).”
    Quote in the paperNot a substantial claim
  • Findingown data

    OLBI-D showed no association with any other therapist or caseload variable.

    “No other therapist or caseload characteristics were associated with OLBI-D.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Adjusting for burnout lowered the estimated therapist effect.

    “Given the reduction of the magnitude of TE after controlling for burnout”
    Quote in the paperSubstantial claim
  • Findingown data

    Therapist effects accounted for roughly 5% of outcome variance in this sample.

    “The overall magnitude of TE in this sample was in the region of 5%”
    Quote in the paperSubstantial claim
  • Findingown data

    Regression models indicated that caseload size and severity did not account for the elevated burnout in this group.

    “and our regression analyses suggest that this was unlikely to be explained by other variables, such as caseload size or caseload severity.”
    Quote in the paperSubstantial claim
  • May combine two claims. 19
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingown data

    Higher therapist disengagement on the OLBI and lower job satisfaction on the JDSS were significantly linked to worse treatment outcomes, accounting for 31-39% of the therapist effect estimate.

    “Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Therapists' burnout levels measured at survey time are representative of their burnout during the treatment period.

  • The quote only partly states this claim.

    Findingown data

    In this IAPT sample, higher therapist burnout was linked to worse patient-reported depression and anxiety treatment outcomes.

    “Consistent with our hypothesis, we found that therapists' occupational burnout levels were associated with their patients' psychological treatment outcomes measured using patient-reported depression and”
    • Also stated in: § 5 CONCLUSIONS · plain
      “Therapists' occupational burnout is associated with poorer psychological treatment outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Treatment outcomes were unrelated to therapist role, experience, ethnicity, age, and similar characteristics.

    “Equally, therapist role, years of experience, ethnicity, age, etc., were not associated with treatment outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The data provided no indication that caseload size or severity affected therapist burnout.

    “We found no evidence that caseload-specific factors (e.g., caseload size or severity) influence burnout levels, although such aggregated metrics may not adequately capture aspects of stressful work involvement identified in other studies (Steel et al., 2015).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only the OLBI disengagement subscale, not the exhaustion subscale, was linked to treatment outcomes.

    “We found that specifically the disengagement domain of the OLBI measure was associated with treatment outcomes, but the exhaustion domain was not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the depression caterpillar plot, 10 therapists were ranked significantly below average and six better than average; in anxiety, two were below and three above average.

    “Regarding depression outcomes (Panel A), 10 therapists were ranked as significantly below average (i.e., their 95% CIs did not cross zero) and six were better than average.There was less variability in anxiety outcomes (Panel B), with two therapists ranked as below and three as above average.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    OLBI-D scores were significantly associated with therapist role (B = 0.174, SE = 0.061, 95% CI 0.025-0.323) and JDSS scores (B = -0.533, SE = 0.140, 95% CI -0.814 to -0.252).

    “A linear regression analysis indicated that OLBI-D scores were significantly associated (P < .05)with the therapist's role (B = 0.174, SD = 0.061, 95% CI = 0.025-0.323)and JDSS scores (B = -0.533,SD = 0.140, 95% CI = -0.814 to -0.252).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In fully adjusted multilevel models, higher therapist disengagement (OLBI-D) predicted less improvement in depression (coefficient -1.244, SE 0.328) and anxiety (coefficient -0.803, SE 0.264).

    “-1.244(0.328)OLBI_D_gmc j”
    • Also stated in: § Depression Model Anxiety Model · plain
      “-0.803(0.264)OLBI_D_gmc j”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    About 13% of OLBI-D variance was explained by role and about 34% by JDSS.

    “Overall, role explained approximately 13% and JDSS explained approximately 34% of variance in OLBI-D scores.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The intracluster correlation coefficient (therapist effect) was 0.035 for depression and 0.040 for anxiety in the imputed data models.

    “ICC = 0.035 ICC = 0.040”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapist JDSS was a significant predictor of depression outcomes but not anxiety outcomes.

    “Therapist JDSS was a significant predictor of PHQ-9 but not of GAD-7 outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Job satisfaction was inversely related to depression outcomes but showed no relationship with anxiety outcomes.

    “Lower job satisfaction was also associated with poorer depression outcomes, but not with anxiety outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Random slopes significantly improved model fit in both models, but there was uncertainty about the extent of slope differences between therapists in the GAD-7 model (coefficient 0.005, SE 0.003).

    “Although the random slopes significantly improved model fit in both models, there was some uncertainty regarding the extent of the differences in slopes between therapists in the GAD-7 model, as indicated by the large SE (coefficient: 0.005; SE: 0.003).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Therapists with higher burnout scores on the OLBI also reported lower job satisfaction.

    “Higher OLBI scores were also correlated with lower job satisfaction ratings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapist OLBI-E was not a significant predictor of depression or anxiety outcomes.

    “OLBI-E was not significant in either model.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Burnout and job satisfaction may change over time.

    “It is plausible that occupational burnout and job satisfaction vary over time.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    One plausible reading is that stressful working conditions raise burnout, which then reduces clinical benefit via disengagement and a weaker therapeutic alliance.

    “A plausible interpretation of our findings is that more stressful work conditions (reduced autonomy, working overtime, infrequent clinical supervision, and coping deficits) could increase burnout, which in turn attenuates clinical improvement through the mechanism of stressful disengagement and its influence on the therapeutic alliance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Another possibility is that poor outcomes, perhaps from complex cases or limited competence, demoralize therapists and cause burnout over time.

    “An alternative explanation could be that the observation of poorer clinical outcomes (e.g., due to case complexity or competency deficits) could demoralize and lead therapists to become burned out over time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this study sample, the JDSS had a Cronbach's alpha of .75.

    “Cronbach's alpha in this study sample was 𝛼 = .75.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work in a comparable setting linked organizational factors-overtime, more telephone-based work, and limited clinical supervision-to burnout.

    “A previous study in a similar setting has also indicated that wider organizational and contextual factors, such as working overtime, increased telephone-based work, and infrequent access to clinical supervision are implicated in occupational burnout (Westwood et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Westwood et al., 2017 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A sensitivity analysis using multiple imputation (25 iterations, MCMC) was conducted to address missing data.

    “Additionally, we repeated the above MLM strategy as a sensitivity analysis in a dataset where missing values were imputed by aggregating 25 iterations using the Markov Chain Monte Carlo method.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Empathy and therapeutic alliance are known to predict patient outcomes.

    “Both empathy and alliance are well-established predictors of treatment outcomes (Wampold, 2015), and occupational burnout may potentially mitigate improvement through the dampening of these common therapy processes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wampold, 2015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Factors such as esteem, pay, and supervision quality might explain why this role has greater burnout risk.

    “It may be that differences in the relative esteem, pay, supervisory quality, or other aspects of this role may increase this group's higher propensity towards burnout.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis used multilevel modelling to account for the nested structure of patients within therapists.

    “using a large sample and appropriate analytical procedures (MLM) that take account of the nested structure of patient and therapist variables.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    After exclusions, the study sample comprised 2,509 patients nested within 49 therapists.

    “This resulted in a study sample of 2,509 patients nested within 49 therapists.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Therapist role itself does not predict outcomes, yet some roles carry higher risk of burnout and low job satisfaction, and these factors are more directly tied to patient improvement.

    “This suggests that a therapist's role (e.g., therapeutic orientation and occupational group) is not associated with treatment outcomes, but certain roles may be more prone to burnout and lower job satisfaction, which are more directly associated with treatment outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The sensitivity analysis was conducted on 2,393 patients because IMD scores could not be imputed.

    “IMD scores could not be imputed; therefore, the sensitivity analysis was carried out on a sample of 2,393 patients, 116 less than the original sample.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Disengagement is conceptually similar to Maslach's depersonalization construct.

    “This aspect of disengagement, which is theoretically akin to Maslach's notion of depersonalization (Maslach, Jackson, & Leiter, 1996), is likely to be particularly important in psychological treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Maslach, Jackson, & Leiter, 1996

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The IAPT stepped-care workforce studied may differ from staff in hospital or secondary care settings.

    “Another caveat to note is that this study was carried out within the context of stepped care, in an IAPT service with a workforce that may not be representative of that in other settings (e.g., hospital or secondary care services).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Burnout and resilience might interact, with coping styles potentially sustaining or reducing burnout.

    “From a theoretical perspective, burnout and resilience could be seen as related factors, such that one may be moderated by the other, and could be plausibly influenced by individual ways of coping that may serve to either mitigate or maintain burnout (Tyrrell, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tyrrell, 2010 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The primary analysis used a complete-case dataset of 2,223 patients.

    “The primary analysis was applied in a dataset where complete data were available for all predictor variables (N = 2,223).”
    Quote in the paperSubstantial claim
31 of 31

  • The authors state this as an assumption.

    There is no published evidence supporting an association between therapist burnout and poorer treatment outcomes.

    “In these circumstances, it is plausible that therapist burnout could be associated with poorer treatment outcomes, although there is as yet no published evidence in support of this hypothesis.”

  • The paper relies on this without support.

    Therapists' burnout levels measured at survey time are representative of their burnout during the treatment period.

    “Therapists who treated less than 20 cases within 1 year after completing the survey were excluded”

  • The paper relies on this without support.

    The case-mix variables included in the models adequately control for confounding of the therapist burnout–outcome association.

    “After adjusting for relevant case-mix variables, multilevel models that included random intercepts yielded TE of 5.7% (PHQ-9 model) and 5.6% (GAD-7 model).”

  • The paper relies on this without support.

    The findings from this single IAPT service generalize to other psychological therapy settings.

    “Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Using measurement-based care results in more clinically effective, cost-effective, and efficient treatment.

    “Using MBC results in more clinically effective,17 cost-effective,18 and efficient treatment.19”

    From Using Machine Learning to Match Clients and Therapy Providers: Evaluating Clinical Quality and Cost of Care (2025) · cites this paper as [17]

    The Patient-level data section says patients completed outcome measures each session to monitor treatment response. The study examines therapist burnout and patient outcomes; the passages found for treatment efficiency and outcome monitoring do not say that using measurement-based care makes treatment more efficient. In the citing sentence, this source is attached to the efficiency claim (citation 19), not the separate clinical- or cost-effectiveness claims. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Clinician burnout is associated with worse patient outcomes and is increasingly recognized as a problem which must be more adequately addressed.

    “Clinician burnout is associated with worse patient outcomes and is increasingly recognized as a problem which must be more adequately addressed (57, 58).”

    From Key Considerations for Incorporating Conversational AI in Psychotherapy (2019) · cites this paper as [57]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • MHN disengagement standard deviation differs between table and text

    Minor

    Table 1 gives the MHN group's OLBI-D standard deviation as 0.65, whereas the results text gives 0.52 for the same group.

  • Abstract range excludes the reported anxiety therapist effect

    Minor

    The abstract says the therapist variables explain 31-39% of therapist effects, but the results report 28.6% for the anxiety model.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Maslach, 1982, Burnout: The cost of caring

Cited by

Sorted by citations

Related

Authors
Delgadillo, J., Saxon, D., & Barkham, M.
Affiliations
University of Sheffield (GB)
Corresponding author
Delgadillo, Jaime
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2018-05-02
Volume
35
Issue
9
Pages
844-850
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22766
OpenAlex
W2795805535
Semantic Scholar
f0ee5d8c29eab7fd2887e3696f95726c466b3b2f
Cited by
151
References
35
Citations by year
2026: 20 · 2025: 27 · 2024: 20 · 2023: 30 · 2022: 19 · 2021: 13 · 2020: 11 · 2019: 10 · 2018: 1
FWCI
11.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
occupational burnout, therapists, psychotherapy, treatment outcomes, depression, anxiety, therapist effects, job satisfaction, disengagement, mental health professionals, burnout prevention
MeSH terms
Adult, Anxiety, Anxiety Disorders, Burnout, Professional, Depression, Depressive Disorder, Female, Health Personnel, Humans, Male, Middle Aged, Psychotherapy, Outcome Assessment, Health Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review