Results

Participant characteristics

The sociodemographic and work-related characteristics of the respondents are presented in Table 1. A total of 235 physicians participated in the study. The majority of respondents were female (62.1%), while males accounted for 37.9% of the sample. The average age of participants was 43.44 ± 11.30 years.

Characteristics | Value
Age (years) | 43.44 ± 11.30
Gender | 
Male | 89 (37.9)
Female | 146 (62.1)
Profession | 
Non-specialist physician | 87 (37.0)
Specialist physician | 148 (63.0)
Years of work experience | 15.74 ± 10.42
Type of healthcare institution | 
Primary level | 90 (38.3)
Secondary level | 48 (20.4)
Tertiary level | 97 (41.3)
Marital status | 
Married/cohabiting | 126 (53.6)
Not married/not cohabiting | 109 (46.4)
Number of children | 
No children | 88 (37.4)
One child | 38 (16.2)
Two or more children | 109 (46.4)

Regarding profession, most participants were specialist physicians (63.0%), whereas 37.0% were non-specialist physicians. The average work experience was 15.74 ± 10.42 years. In terms of the type of healthcare institution, most respondents were employed at the tertiary level (41.3%), followed by the primary (38.3%) and secondary levels (20.4%). Regarding marital status, more than half of the respondents were married or cohabiting (53.6%), while 46.4% were not married/not cohabiting. With respect to family characteristics, 37.4% of participants had no children, 16.2% had one child, while the largest proportion (46.4%) reported having two or more children.

Descriptive statistics of mentalizing, alexithymia, and burnout dimensions

Table 2 shows the descriptive statistics and reliability of the applied scales. Inspection of skewness and kurtosis indicated deviations from normality, particularly for depersonalization and uncertainty about mental states (RFQ-U). Therefore, nonparametric methods were used for group comparisons and correlation analyses. Internal consistency ranged from borderline to excellent, with Cronbach’s alpha coefficients ranging from 0.68 to 0.94 and the personal accomplishment subscale showing the lowest reliability (α = 0.68).

Scale | Min. | Max. | Mean | SD | Median | IQR | Skew | Kurt | α
EE | 0.00 | 54.00 | 37.28 | 12.47 | 41.00 | 17.00 | -0.97 | 0.14 | 0.94
DP | 0.00 | 48.00 | 9.00 | 6.56 | 8.00 | 9.00 | 1.30 | 4.41 | 0.73
PA | 10.00 | 47.00 | 35.37 | 5.31 | 36.00 | 7.00 | -0.72 | 2.14 | 0.68
RFQ-U | 0.00 | 3.00 | 0.48 | 0.62 | 0.25 | 0.75 | 1.50 | 1.82 | 0.70
RFQ-C | 0.00 | 2.75 | 0.72 | 0.73 | 0.50 | 1.25 | 0.87 | -0.26 | 0.72
TAS-20 | 24.00 | 100.00 | 57.32 | 13.08 | 55.00 | 15.00 | 0.73 | 0.56 | 0.86

Relationship among mentalizing, alexithymia, and burnout dimensions

Table 3 presents the differences in burnout dimensions according to sociodemographic and work-related characteristics. Statistically significant differences in all three burnout dimensions were observed between male and female participants. Male participants showed higher levels of emotional exhaustion and depersonalization (p < 0.05), whereas female participants had higher levels of personal accomplishment (p < 0.01). Age and years of work experience were positively correlated with emotional exhaustion (p < 0.001). In addition, age was weakly but significantly associated with depersonalization (p < 0.05), while years of work experience were not significantly associated with depersonalization. Neither age nor work experience was significantly associated with personal accomplishment (p > 0.05). Regarding professional status, physicians without specialization had lower levels of emotional exhaustion compared to specialist physicians (p < 0.001), whereas no significant differences were observed for depersonalization and personal accomplishment (p > 0.05). Significant differences in emotional exhaustion (p < 0.001) and depersonalization (p < 0.05) were observed across levels of healthcare institutions. Post hoc analysis indicated that participants working at the tertiary level had higher values of these burnout dimensions compared to those at the primary level. No significant differences were found in personal accomplishment across institutions. Marital status was not significantly associated with any burnout dimension. Although a statistically significant difference in emotional exhaustion was initially observed across categories of number of children (p < 0.05), this association was not retained after Bonferroni correction. No differences were found for depersonalization and personal accomplishment.

Variable | Category | EE Median (IQR)/ρ | Test statistic | p | Effect size | DP Median (IQR)/ρ | Test statistic | p | Effect size | PA Median (IQR)/ρ | Test statistic | p | Effect size
Gender | Male | 43.00 (14.00) | U = 5231.0 | 0.012* | 0.2 | 11.00 (9.00) | U = 4475.5 | <0.001* | 0.31 | 35.00 (6.00) | U = 5109.0 | 0.006* | 0.21
Female | 38.50 (19.25) | 6.00 (9.00) | 36.00 (6.00)
Age (years) | 0.397 |  | <0.001† |  | 0.161 |  | 0.013† |  | 0.032 |  | 0.630† | 
Profession | Physicians without specialization | 33.00 (19.00) | U = 3950.5 | <0.001* | 0.39 | 6.00 (10.00) | U = 5822.5 | 0.220* | 0.1 | 36.00 (8.00) | U = 6244.0 | 0.699* | 0.03
Specialist physicians | 44.00 (12.00) | 8.50 (9.75) | 36.00 (5.00)
Years of work experience | 0.293 |  | <0.001† |  | 0.101 |  | 0.122† |  | 0.025 |  | 0.706† | 
Type of healthcare institution | Primary | 35.50 (20.00)a | χ² = 18.1 | <0.001# | 0.07 | 6.00 (9.00)ᵃ | χ² = 6.2 | 0.045# | 0.02 | 36.00 (7.00) | χ² = 0.6 | 0.746# | 0.00
Secondary | 42.00 (13.75)ab | 8.00 (7.00)ᵃᵇ | 35.50 (6.00)
Tertiary | 44.00 (12.00)b | 10.00 (11.00)ᵇ | 36.00 (5.50)
Marital status | Married/cohabiting | 42.00 (18.00) | U = 6650.5 | 0.677* | 0.03 | 7.00 (9.00) | U = 6277.0 | 0.255* | 0.09 | 36.00 (7.00) | U = 6543.0 | 0.532* | 0.05
Single | 41.00 (16.00) | 8.00 (10.50) | 36.00 (6.00)
Number of children | No children | 37.00 (16.00) | χ² = 6.3 | 0.042# | 0.02 | 8.00 (10.00) | χ² = 0.1 | 0.943# | 0.00 | 36.00 (7.00) | χ² = 1.1 | 0.586# | 0.00
One child | 41.50 (20.50) | 8.50 (11.00) | 36.00 (8.25)
Two or more children | 43.00 (15.00) | 7.00 (9.00) | 36.00 (6.00)

The correlations between burnout dimensions, mentalizing capacity, and alexithymia are presented in Table 4. Emotional exhaustion was positively correlated with depersonalization (ρ = 0.56; p < 0.001) and hypomentalizing (ρ = 0.27; p < 0.001) and negatively correlated with hypermentalizing (ρ = -0.51; p < 0.001). No significant associations were observed between emotional exhaustion and personal accomplishment or alexithymia (p > 0.05).

Variable | EE | DP | PA | RFQ-u | RFQ-c | TAS-20
EE | 1 |  |  |  |  | 
DP | 0.56*** | 1 |  |  |  | 
PA | -0.08 | -0.35*** | 1 |  |  | 
RFQ-U | 0.27*** | 0.17** | -0.01 | 1 |  | 
RFQ-C | -0.51*** | -0.33*** | 0.12 | -0.43*** | 1 | 
TAS-20 | 0.13 | 0.10 | -0.13 | 0.53*** | -0.41*** | 1

Depersonalization was negatively correlated with personal accomplishment (ρ = -0.35; p < 0.001) and hypermentalizing (ρ = -0.33; p < 0.001) and positively correlated with hypomentalizing (ρ = 0.17; p < 0.05). No significant association was found between depersonalization and alexithymia (p > 0.05).

Hypomentalizing was positively correlated with alexithymia (ρ = 0.53; p < 0.001). In contrast, hypermentalizing was negatively correlated with both hypomentalizing (ρ = -0.43; p < 0.001) and alexithymia (ρ = -0.41; p < 0.001).

No statistically significant associations were observed between personal accomplishment and the examined mentalization dimensions or alexithymia (p > 0.05).

Prior to performing the hierarchical regression analyses, key statistical assumptions were evaluated. The results confirmed that the assumptions of normality, linearity, homoscedasticity, and absence of multicollinearity were satisfactorily fulfilled. Multicollinearity was not considered problematic, as variance inflation factor (VIF) values for all variables remained below the recommended cutoff of 5. The Durbin-Watson statistics were 1.470 for emotional exhaustion, 1.582 for depersonalization, and 2.038 for personal accomplishment, suggesting no meaningful autocorrelation of residuals. Due to elevated multicollinearity between age and years of work experience observed in preliminary analyses (VIF > 5), only age was retained in the final regression models to minimize redundancy and enhance model stability and interpretability [26].

The results presented in Table 5 indicate that sociodemographic and work-related variables accounted for a significant amount of explained variance in emotional exhaustion at the first step of the model (R2 = 0.182). Within this set of variables, age showed a positive association with emotional exhaustion (β = 0.38; p < 0.001), whereas no statistically significant relationships were identified for gender, profession, marital status, number of children, or type of healthcare institution.

Variable | Model 1 (Control variables) | Model 2 (Control variables + predictors)
β | t | VIF | 95% CI for B | β | t | VIF | 95% CI for B
Gender | -0.12 | -1.86 | 1.06 | -6.075 to 0.178 | -0.05 | -0.87 | 1.09 | -3.943 to 1.521
Age | 0.38*** | 3.97 | 2.48 | 0.209 to 0.621 | 0.29*** | 3.54 | 2.56 | 0.144 to 0.505
Profession | -0.06 | -0.60 | 2.71 | -6.550 to 3.513 | -0.09 | -1.06 | 2.78 | -6.762 to 2.024
Secondary level | 0.12 | 1.57 | 1.63 | -0.960 to 8.371 | 0.15* | 2.21 | 1.63 | 0.484 to 8.546
Tertiary level | 0.15 | 1.74 | 1.95 | -0.487 to 7.882 | 0.12 | 1.64 | 1.97 | -0.602 to 6.647
Marital status | -0.01 | -0.14 | 1.53 | -3.909 to 3.406 | -0.01 | -0.13 | 1.54 | -3.376 to 2.946
One child | -0.02 | -0.26 | 1.55 | -5.641 to 4.330 | 0.02 | 0.35 | 1.56 | -3.558 to 5.071
Two or more children | -0.05 | -0.52 | 2.30 | -5.673 to 3.295 | -0.05 | -0.61 | 2.31 | -5.080 to 2.673
RFQ-U | – | – | – | – | 0.17** | 2.66 | 1.51 | 0.877 to 5.910
RFQ-C | – | – | – | – | -0.47*** | -7.96 | 1.31 | -10.095 to -6.089
TAS-20 | – | – | – | – | -0.20** | -3.02 | 1.58 | -0.310 to -0.065
R2 | 0.182 |  | 0.400 | 
Adjusted R2 | 0.153 |  | 0.370 | 
F change | 6.29*** |  | 26.97*** | 
ΔR2 | 0.218***

After the inclusion of psychological variables in the second step, the model showed a substantial increase in explained variance (R2 = 0.400; ΔR2 = 0.218; p < 0.001). Age remained a significant positive predictor of emotional exhaustion (β = 0.29; p < 0.001). In addition, working at the secondary level of healthcare was associated with higher emotional exhaustion compared with the primary level (β = 0.15; p < 0.05).

Among psychological variables, higher levels of hypomentalizing were associated with higher emotional exhaustion (β = 0.17; p < 0.05), whereas higher levels of hypermentalizing were associated with lower emotional exhaustion (β = -0.47; p < 0.001). Alexithymia was also negatively associated with emotional exhaustion (β = -0.20; p < 0.01).

The results presented in Table 6 showed that sociodemographic and work-related variables explained a significant proportion of the variance in depersonalization in the initial model (R² = 0.115). Within this model, both gender and age emerged as significant predictors, with higher levels of depersonalization observed among male participants (β = -0.24; p < 0.001) and older individuals (β = 0.25; p < 0.05). No significant effects were found for profession, marital status, number of children, or type of healthcare institution.

Variable | Model 1 (Control variables) | Model 2 (Control variables + predictors)
β | t | VIF | 95% CI for B | β | t | VIF | 95% CI for B
Gender | -0.24*** | -3.73 | 1.06 | -4.949 to -1.529 | -0.19** | -3.12 | 1.09 | -4.273 to -0.966
Age | 0.25* | 2.51 | 2.48 | 0.031 to 0.256 | 0.20* | 2.14 | 2.56 | 0.009 to 0.228
Profession | -0.16 | -1.56 | 2.71 | -4.929 to 0.575 | -0.19 | -1.86 | 2.78 | -5.165 to 0.151
Secondary level | 0.01 | 0.11 | 1.63 | -2.412 to 2.692 | 0.02 | 0.30 | 1.63 | -2.063 to 2.815
Tertiary level | 0.10 | 1.11 | 1.95 | -0.995 to 3.583 | 0.08 | 0.99 | 1.97 | -1.089 to 3.297
Marital status | 0.06 | 0.76 | 1.53 | -1.234 to 2.766 | 0.05 | 0.74 | 1.54 | -1.197 to 2.628
One child | -0.06 | -0.71 | 1.55 | -3.704 to 1.750 | -0.03 | -0.43 | 1.56 | -3.178 to 2.044
Two or more children | -0.10 | -1.07 | 2.30 | -3.783 to 1.122 | -0.10 | -1.14 | 2.31 | -3.698 to 0.993
RFQ-U | – | – | – | – | 0.19* | 2.54 | 1.51 | 0.436 to 3.481
RFQ-C | – | – | – | – | -0.26*** | -3.80 | 1.31 | -3.551 to -1.127
TAS-20 | – | – | – | – | -0.15 | -1.95 | 1.58 | -0.147 to 0.001
R2 | 0.115 |  | 0.206 | 
Adjusted R2 | 0.084 |  | 0.166 | 
F change | 3.68*** |  | 8.44*** | 
ΔR2 | 0.091***

After the inclusion of psychological variables in the second step, the model showed an increase in explained variance (R2 = 0.206; ΔR2 = 0.091; p < 0.001). Gender and age remained significant predictors of depersonalization.

Among psychological variables, higher levels of hypomentalizing were associated with higher depersonalization (β = 0.19, p < 0.05), whereas higher levels of hypermentalizing were associated with lower depersonalization (β = −0.26, p < 0.001). Alexithymia was not significantly associated with depersonalization in the final model, although the association approached the conventional threshold for statistical significance (β = −0.15, p = 0.053).

The results presented in Table 7 showed that hierarchical regression analysis did not identify sociodemographic and work-related variables entered in the first step, nor psychological variables added in the second step, as significant predictors of personal accomplishment. Although the inclusion of psychological variables resulted in a small increase in explained variance (ΔR² = 0.022), the overall model remained non-significant. Therefore, no further interpretation of individual predictors was undertaken.

Variable | Model 1 (Control variables) | Model 2 (Control variables + predictors)
 | β | t | VIF | 95% CI for B | β | t | VIF | 95% CI for B
Gender | 0.17 | 2.58 | 1.06 | 0.446 to 3.318 | 0.16 | 2.33 | 1.09 | 0.263 to 3.159
Age | 0.05 | 0.52 | 2.48 | −0.070 to 0.120 | 0.09 | 0.90 | 2.56 | −0.052 to 0.139
Profession | -0.04 | -0.39 | 2.71 | −2.768 to 1.854 | -0.07 | -0.65 | 2.78 | −3.102 to 1.555
Secondary level | -0.04 | -0.52 | 1.63 | −2.712 to 1.575 | -0.04 | -0.51 | 1.63 | −2.693 to 1.580
Tertiary level | 0.05 | 0.51 | 1.95 | −1.422 to 2.423 | 0.07 | 0.72 | 1.97 | −1.216 to 2.627
Marital status | -0.03 | -0.32 | 1.53 | −1.957 to 1.403 | -0.02 | -0.30 | 1.54 | −1.929 to 1.422
One child | 0.10 | 1.20 | 1.55 | −0.898 to 3.683 | 0.09 | 1.15 | 1.56 | −0.957 to 3.617
Two or more children | 0.08 | 0.84 | 2.30 | −1.183 to 2.937 | 0.07 | 0.70 | 2.31 | −1.324 to 2.786
RFQ-U | – | – | – | – | 0.05 | 0.61 | – | −0.918 to 1.750
RFQ-C | – | – | – | – | 0.08 | 1.04 | – | −0.503 to 1.620
TAS-20 | – | – | – | – | -0.13 | -1.62 | – | −0.118 to 0.011
R2 | 0.048 | 0.070
Adjusted R2 | 0.014 | 0.024
F change | 1.42 | 1.74
ΔR2 | 0.022 |