The DOI matches its Crossref record; 74 of the 74 references it cites were found in a registry or an index.
Burnout and depression in nurses: A systematic review and meta-analysis
Abstract
Background Nurses work in stressful and demanding settings and often suffer from depression and burnout. Despite overlapping symptoms, research has been inconclusive regarding the discriminant validity of measures of burnout with regard to measures of depression. Such inconclusive discriminant validity might cause clinicians to fail to recognize and manage depression separately from burnout.Objectives This meta-analysis aimed to clarify the distinctiveness of burnout as a separate construct by examining the size of the relationship between burnout and depression among nurses as well as potential moderators.Method A stepwise method was used by searching 4 databases (PubMed, CINAHL, PsycINFO, and EMBASE) to retrieve published papers in English examining the relationship between burnout and depression among nurses and reporting the effect sizes of their findings.Results We identified a total of 37 eligible studies. The pooled estimate showed a positive association between burnout and depression among nurses (r = 0.403, 95% CI [0.327, 0.474], p < 0.0001) and a slightly higher correlation coefficient for the Emotional Exhaustion subscale of the Maslach Burnout Inventory (MBI) measure (0.494, 95% CI [0.41, 0.57]).Conclusions and implications This review confirms a large burnout - depression correlation in nursing samples, adding to existing literature encompassing a variety of occupations. Future studies should focus on path analysis to assess the causal relationship as well as investigate potential moderators.
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“This is consistent with previous studies that relate cognitive fusion (54) and depression (49, 52) to emotional exhaustion, and low levels of resilience with burnout (55, 56).”
From Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved (2025) · cites this paper as [49]
In the citing paper
“This exponential increase in emotional exhaustion at the onset of the COVID-19 pandemic in HCW has been attributed to increased workload, lack of resources, fear of contagion, and generalized uncertainty (49–51).”
From Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved (2025) · cites this paper as [49]
In the citing paper
“it is initially the most affected component (49–51), as our findings show.”
From Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved (2025) · cites this paper as [49]
In the citing paper
“According to the existing literature, emotional exhaustion is closely related to levels of depressive symptomatology, especially in the early stages of the pandemic (49, 52).”
From Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved (2025) · cites this paper as [49]
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Mobile apps, AI, and teletherapy: a comprehensive review of digital mental health tools for nurses
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“These interventions cover a variety of approaches, such as: Applications for mobile mental health that provide stress management tools, mood monitoring, cognitive behavioral therapy (CBT) exercises, and mindfulness training (1, 2, 15).”
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Al-Hammouri, M., & Rababah, J. A. (2024) · International Journal of Nursing Practice · doi:10.1111/ijn.13305 · Cited by 5
Hanna, R., Banasiewicz, J., Katarzyna, B., Zaręba, K. T., & Jaworski, M. (2024) · Scientific Reports · doi:10.1038/s41598-024-77607-z · Cited by 8
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“This is why the consequences of burnout are diverse, associated with depression, anxiety and sleep disorders [1]–[4].”
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“Depressive symptoms can limit nurses’ psychosocial functioning, reduce their quality of life, and be unfavorable to their care work (8).”
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“Te most prevalent mental health issues suffered by nurses are compassion fatigue and burnout [1, 2], which are in turn associated with anxiety and depression [3, 4].”
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“This is consistent with previous studies that relate cognitive fusion (54) and depression (49, 52) to emotional exhaustion, and low levels of resilience with burnout (55, 56).”
InfluentialBozkurt, T. M., & Öztürk, M. A. (2025) · Psychiatry Investigation · doi:10.30773/pi.2024.0245 · Cited by 4
“These findings align with the results of Chidiebere Okechuk-wu et al., 7 Babapour et al., 8 Zakeri et al., 9 and Chen and Meier, 10 and suggest that working as a nurse can potentially result in psychological issues such as depression and stress.”
Liao, Y., Huang, M., Gu, Z., Li, C., Yu, Y., Zhang, Q., Lai, X., Liu, J., He, K., Chu, H., et al. (2025) · BMC Nursing · doi:10.1186/s12912-025-03754-x · Cited by 4
“As stress levels rise, nurses’ physical and psychological well-being becomes increasingly compromised, leading to a range of adverse outcomes, including job burnout [8], acute stress disorder [9], anxiety and depression [10], and even suicidal tendencies [11].”
Li, L., Zhou, J., Zhang, H., Diao, D., Lei, J., & Ma, L. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1707511 · Cited by 4
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“Research has consistently shown that emotional exhaustion in the workplace can serve as a precursor to depressive symptoms (49, 51, 52), leading to physical fatigue, hardly work, intentions to resign, and ultimately contribute to the development of depression (53).”
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Development and longitudinal validation of the Veterinary Stressors Questionnaire
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“Our study, like those conducted by other researchers [8,42,43], indicates that burnout and depression, although closely related, are not the same phenomenon.”
InfluentialXu, Q., Yu, Z., Fan, S., Wu, Y., Wang, Y., Zou, D., Hu, J., & Zhang, X. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1616354 · Cited by 6
“In contrast, “quiet quitting,” often seen as a subtle form of burnout, remains less understood (Chen and Meier, 2021).”
Xue, J.-M., Lin, P., Guo, W., & Yang, L. (2025) · BMC Nursing · doi:10.1186/s12912-025-03889-x · Cited by 3
“Notably, the latest edition of the International Classification of Diseases (ICD-11) by the World Health Organization classifies burnout as an occupational health syndrome [6].”
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“…has important practical implications, as elevated burnout levels in nursing students may contribute to long-term psychological consequences, in line with evidence suggesting an association between burnout and future depression in nursing populations (Chen and Meier, 2021; Zhang et al., 2024).”
Wang, B., Bai, Y., Wu, S., Lin, W., & Guo, J. (2024) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2299666 · Cited by 3
“In line with previous studies (Chen & Meier, 2021; Hao, 2023), a higher burnout level could predict an increase in psychological symptoms.”
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Factors Associated With Turnover Intention Among Nurses: A Quantile Regression Analysis
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“Furthermore, several studies have indicated a statistically significant relationship be-tween burnout and depressive symptoms 16) .”
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Síndrome de burnout, ansiedad y depresión en residentes de dermatología: un estudio transversal
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“While authors have repeatedly posed whether burnout as a whole is repetitive with depression, it may instead be that only this dimension is repetitive, which would bring clarity to ongoing debates on this topic (Bianchi et al., 2015; Chen and Meier, 2021; Koutsimani et al., 2019).”
Wolf, L. A. (2025) · Nursing Clinics of North America · doi:10.1016/j.cnur.2025.09.008 · Cited by 2
Lan, H., Lewis, F. M., Tsai, Y., Liaw, J., & Chang, Y. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.70367 · Cited by 3
Jawhar, S., Khaywa, J., Jaber, D., Jammal, G. A., Massouh, A. R., Bawadi, H., & Romani, M. (2026) · BMC Nursing · doi:10.1186/s12912-026-04655-3 · Cited by 2
“Internationally, pre-pandemic reviews reported lower rates of 15–30% [51], whereas pandemic-era meta-analyses documented rates of 22–35% among nurses [52, 53].”
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“7,14 The results regarding the prevalence of burnout in our study are consistent with the results of a cross-sectional survey of 650 French dermatologists, in which a moderate risk of burnout was present in 15.6% of the sample.”
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“Burnout among healthcare professionals, particularly nurses, has emerged as a critical issue in occupational health, signi fi cantly impacting staff well-being, patient care quality, and healthcare system ef fi ciency [1 e 6].”
Nurses’ stress, anxiety, depression, and burnout in the workplace: A correlational study
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Gadelha, G. O., Moreno, C. R. D. C., Gonzalez, T. N., & Vasconcelos, S. P. (2024) · Journal of Nursing and Health · doi:10.15210/jonah.v14i1.25689 · Cited by 3
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“A recent meta-analysis of 37 studies found a positive association between depression and burnout among nurses (Chen & Meier, 2021).”
Prevalence of Depression in Physical Therapists Versus Nurses in Karachi Pakistan
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THE RELATIONSHIP BETWEEN RUMINATION AND DEPRESSION IN NURSES WORKING IN THE INTENSIVE CARE UNITS
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“…(as low energy and selfesteem), the overlap between depression and burnout symptoms has also been found in the correlations between emotional exhaustion, one core facet of burnout, and depressive symptoms in psychometric analyses (Ahola et al. 2014, Schonfeld et al. 2019, Chen & Meier 2021).”
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Tjasink, M., Keiller, E., Stephens, M., Carr, C. E., & Priebe, S. (2023) · Research Square · doi:10.21203/rs.3.rs-2681299/v1
Martínez‐Rodríguez, A., Martínez‐Faneca, L., & Fabrellas, N. (2023) · Nursing Inquiry · doi:10.1111/nin.12579 · Cited by 1
Pérez, C., Bernal, R., Macias, M., & Barrueco, S. (2023) · Research Square · doi:10.21203/rs.3.rs-3326867/v1
L'impatto del COVID-19 sul Change Management: una revisione narrativa
Palermo, N., Limonti, F., Semeraro, A., Ermanno, D., Paludi, M. A., & Ramacciati, N. (2023) · Scenario - Il Nursing nella sopravvivenza · doi:10.4081/scenario.2023.550
Hernández-Mariano, J. Á., Blanco-Hernández, D. M. R., Ricardez-Romero, M. A., & Sarmiento-Cortes, P. (2024) · XIKUA Boletín Científico de la Escuela Superior de Tlahuelilpan · doi:10.29057/xikua.v12i23.11834
The psychological capital questionnaire for newly licensed nurses: A validity and reliability studyPreprint
Jin, M., Wang, J., Qian, R., Yang, H., Huang, S., Liao, M., Liu, X., Liao, D., & Qi, S. (2024) · Research Square · doi:10.21203/rs.3.rs-4120162/v1
Factores influyentes del síndrome de desgaste profesional en el personal médico
Calderón-Sánchez, A. G., Peralta-Beltrán, Á. R., González-Salas, R., & Flores-Pilco, D. A. (2023) · Revista Arbitrada Interdisciplinaria de Ciencias de la Salud Salud y Vida · doi:10.35381/s.v.v7i2.3382
Prevalencia del síndrome de burnout a causa de Covid 19
Albán-Espinoza, C. G., Peralta-Beltrán, Á. R., González-Salas, R., & Flores-Pilco, D. A. (2023) · Revista Arbitrada Interdisciplinaria de Ciencias de la Salud Salud y Vida · doi:10.35381/s.v.v7i2.3362
Evaluación de estrés y síndrome de burnout en el personal de enfermería del área de hospitalización
Borja-Caiza, C. E., Peralta-Beltrán, Á. R., González-Salas, R., & Matheu-González, C. (2023) · Revista Arbitrada Interdisciplinaria de Ciencias de la Salud Salud y Vida · doi:10.35381/s.v.v7i2.3379
Prevalencia del síndrome de burnout y depresión en docentes universitarios
Guilcamaigua-Quilachamin, K. R., Peralta-Beltrán, Á. R., Rodríguez, R. C., & Noroña-Salcedo, D. R. (2023) · Revista Arbitrada Interdisciplinaria de Ciencias de la Salud Salud y Vida · doi:10.35381/s.v.v7i2.3422
Medidas preventivas y correctivas para la gestión del estrés laboral
Yumbay-Taris, R. T., Peralta-Beltrán, Á. R., González-Salas, R., & Matheu-González, C. (2023) · Revista Arbitrada Interdisciplinaria de Ciencias de la Salud Salud y Vida · doi:10.35381/s.v.v7i2.3522
Tekin, A. Y., & Karadağ, H. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1402422
Yin, L., Qiu, L., & Zhang, G. (2024) · medRxiv · doi:10.1101/2024.09.10.24313443
“Frequently, the studies on nurse turnover surveyed the prevalence of turnover intention and explored its risk factors or predictive factors 5,12 –18 .”
BackgroundSoto-Moreno, A., Martínez-López, A., Ureña‐Paniego, C., Martínez-García, E., Buendía‐Eisman, A., & Arias‐Santiago, S. (2024) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2024.09.009 · Cited by 1
“…induciendo o agravando trastornos de salud mental como la ansiedad y la depresión, en un continuo en el que parece mediar el síndrome de burnout 13,14 , al mismo tiempo que estas enfermedades psiquiátricas son conside-radas entidades clínicas independientes en sí mismas por la decimoprimera…”
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Schuller, K. A., & Burke, E. C. (2025) · Pain Management Nursing · doi:10.1016/j.pmn.2024.12.003
Using group peer reflection to support learning disability nursing students during placements
Greene, T., & Marsh, L. (2025) · Learning Disability Practice · doi:10.7748/ldp.2025.e2265
Automation and Gender: Analysing the Labour Market Impacts of RobotizationPreprint
Dobranschi, M., Hospodková, P., Semerád, P., & Luty, P. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5124235
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“Burnout is associated with higher incidences of depression, anxiety, and stress among nurses, as well as greater morbidity/mortality among patients cared for by nurses who experience burnout (Chen & Meier, 2021; Mousavi et al., 2017; Schlak et al., 2021).”
Burnout and resilience among moroccan healthcare professionals: a comprehensive multi-hospital study
Guider, H., Jaouhar, S., Bouzid, J., Fadil, W., Himmouche, N., Cigarroa, I., Alaiki, A. E., Hilali, A., Hami, H., & Hadrya, F. (2025) · Jurnal NERS · doi:10.20473/jn.v20i2.65721
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Metadata
- Authors
- Chen, C., & Meier, S. T.
- Affiliations
- University at Buffalo, State University of New York (US)
- Corresponding author
- Chen, Chiahui
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 124
- Pages
- 104099
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W3203781834
- Cited by
- 246
- References
- 74
- Citations by year
- 2026: 45 · 2025: 74 · 2024: 60 · 2023: 45 · 2022: 21 · 2021: 1
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-03-01)
- Open access
- closed
- Licence
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- burnout, depression, nurses, emotional exhaustion, Maslach Burnout Inventory, discriminant validity, occupational stress, nursing workforce
- MeSH terms
- Burnout, Psychological, Burnout, Professional, Depression, Emotions, Humans, Nurses
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