Burnout Syndrome and Consumption of Alcohol and Illicit Substances in University Students

Andrade, Giovana Frazon; Menolli, Poliana Vieira da Silva; Clemente, Pedro Augusto; Mesas, Arthur Eumann; Silva, Dannyele Cristina; Girotto, Edmarlon

doi:10.1590/1982-4327e3134

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School and Educational Psychology • Paidéia (Ribeirão Preto) 31 • 2021 • https://doi.org/10.1590/1982-4327e3134 copy

Burnout Syndrome and Consumption of Alcohol and Illicit Substances in University Students

Síndrome de Burnout e Consumo de Álcool e Substâncias Ilícitas em Universitários

Síndrome de Burnout y Consumo de Alcohol y de Sustancias Ilícitas por Universitarios

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The consumption of alcohol and illicit substances has shown alarming levels among young university students, and its use may be associated with the coping strategy of academic burnout. This review aimed to synthesize the scientific evidence related to the consumption of alcohol and illicit substances associated with burnout syndrome in university students. Searches were carried out in: Biblioteca Virtual em Saúde, PubMed, Web of Science, PsycNet and Scopus databases, with no year limitation and based on the PRISMA guideline. Among the 2.269 articles identified, 16 met the inclusion criteria. All studies evaluated students in the health area, 12 studies found an association between the variables, with alcohol and illicit substances consumption strongly related to burnout syndrome. It was concluded that there is an association between the studied variables, indicating that the presence of burnout syndrome in university students can result in the use of negative strategies as a coping measure.

Keywords:
drug usage; alcohol abuse; students; coping behavior; occupational stress

Author (year)	Date of study	Location	Population	Undergraduate course	Variables and collection instrument
Arango Agudelo et al. (2010Arango Agudelo, S., Castaño Castrillón, J. J., Henao Restrepo, C. J., Jimenez Aguirre, D. P., López Henao, A. F., & Páez Cala, M. L. (2010). Síndrome de Burnout y factores asociados en estudiantes de I a X semestre de la Facultad de Medicina de la Universidad de Manizales (Colombia), 2009 [Burnout syndrome and associated factors, in students from I to X semester of the Faculty of Medicine at the University of Manizales (Colombia), 2009]. Archivos de Medicina, 10(2), 110-126. doi:10.30554/archmed.10.2.1291.2010 https://doi.org/10.30554/archmed.10.2.12... )	2009	Colombia	N = 234	Medicine	BS (MBI-SS), alcohol consumption (CAGE), psychoactive substances (Y/N, which one)
			Male = 53.2%
			Fem = 46.8%
Calcides et al. (2019Calcides, D. A. P., Didou, R. N., Melo, E. V., & Oliva-Costa, E. F. (2019). Burnout Syndrome in medical internship students and its prevention with Balint Group. Revista da Associação Médica Brasileira, 65(11), 1362-1367. doi:10.1590/1806-9282.65.11.1362 https://doi.org/10.1590/1806-9282.65.11.... )	2018	Brazil	N = 186	Medicine	BS (MBI-SS), psychoactive substances (Y/N)
			Male = 39.1%
			Fem = 60.9%
M.S. Carlotto et al. (2010Carlotto, M. S., Câmara, S. G., Otto, F., & Kauffmann, P. (2010). Estudo da Síndrome de Burnout em estudantes de psicologia [Study of Burnout Syndrome in psychology students]. Boletim de Psicologia, 59(131), 167-178. Retrieved from http://pepsic.bvsalud.org/pdf/bolpsi/v59n131/v59n131a04.pdf http://pepsic.bvsalud.org/pdf/bolpsi/v59... )	2007	Brazil	N = 239	Psychology	BS (MBI-SS), alcohol and drug consumption (COPE Inventory)
			Male = 12.6%
			Fem = 87.4%
Cecil et al. (2014Cecil, J., McHale, C., Hart, J., & Laidlaw, A. (2014). Behaviour and burnout in medical students. Medical Education Online, 19, 25209.doi:10.3402/meo.v19.25209 https://doi.org/10.3402/meo.v19.25209... )	2012	England	N = 356	Medicine	BS (MBI), alcohol consumption (AUQ)
			Male = 34.8%
			Fem = 65.2%
Erschens et al. (2018Erschens, R., Loda, T., Herrmann-Werner, A., Keifenheim, K. E., Stuber, F., Nikendei, C.,... Junne, F. (2018). Behaviour-based functional and dysfunctional strategies of medical students to cope with burnout. Medical Education Online , 23(1), 1535738.doi:10.1080/10872981.2018.1535738 https://doi.org/10.1080/10872981.2018.15... )	-	Germany	N = 597	Medicine	BS (MBI-SS), consumption of alcohol and stimulant drugs (Y/N)
			Male = 37.7%
			Fem = 62.3%
Jackson et al. (2016Jackson, E. R., Shanafelt, T. D., Hasan, O., Satele, D. V., & Dyrbye, L. N. (2016). Burnout and alcohol abuse/dependence among U.S. medical students. Academic Medicine, 91(9), 1251-1256. doi:10.1097/ACM.0000000000001138 https://doi.org/10.1097/ACM.000000000000... )	2012	United States	N = 4,402	Medicine	BS (MBI), alcohol consumption (AUDIT-C)
			Male = 45.3%
			Fem = 54.7%
Lee et al. (2020Lee, K. P., Yeung, N., Wong, C., Yip, B., Luk, L., & Wong, S. (2020). Prevalence of medical students’ burnout and its associated demographics and lifestyle factors in Hong Kong. PLoS One, 15(7), e0235154.doi:10.1371/journal.pone.0235154 https://doi.org/10.1371/journal.pone.023... )	2017	China	N = 731	Medicine	BS (MBI), alcohol consumption (AUDIT-C)
			Male = 44.2%
			Fem = 55.8%
Mache et al. (2015Mache, S., Vitzthum, K., & Groneberg, D. A. (2015). Prevention of study-related stress symptoms: Health-promoting behavior among dental students. Wiener Medizinische Wochenschrift, 165(5-6), 100-106. doi:10.1007/s10354-014-0341-6 https://doi.org/10.1007/s10354-014-0341-... )	2012/2013	Germany	N = 239	Dentistry	BS (MBI), consumption of alcohol and illegal substances - cannabis, cocaine, ecstasy (Y/N)
			Male = 36%
			Fem = 64%
Mbanga et al. (2018Mbanga, C. M., Efie, D. T., Aroke, D., & Njim, T. (2018). Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: A cross sectional analysis. BMC Research Notes, 11(1), 515. doi:10.1186/s13104-018-3631-z https://doi.org/10.1186/s13104-018-3631-... )	2018	Cameroon	N = 852	Medicine and Nursing	BS (OLBI), recreational drugs - cannabis (Y/N)
			Male = 31.4%
			Fem = 68.6%
Njim et al. (2019Njim, T., Makebe, H., Toukam, L., Kika, B., Fonkou, S., Fondungallah, J., & Fondong, A. (2019). Burnout Syndrome amongst medical students in Cameroon: A cross-sectional analysis of the determinants in preclinical and clinical students. Psychiatry Journal, 2019, 4157574. doi:10.1155/2019/4157574 https://doi.org/10.1155/2019/4157574... )	2018	Cameroon	N = 413	Medicine	BS (OLBI), alcohol and recreational drug use - cannabis (Y/N)
			Male = 45.3%
			Fem = 54.7%
Njim et al. (2018Njim, T., Mbanga, C., Mouemba, D., Makebe, H., Toukam, L., Kika, B., & Mulango, I. (2018). Determinants of burnout syndrome among nursing students in Cameroon: Cross-sectional study. BMC Research Notes , 11(1), 450. doi:10.1186/s13104-018-3567-3 https://doi.org/10.1186/s13104-018-3567-... )	2018	Cameroon	N = 447	Nursing	BS (OLBI), alcohol and recreational drug use - cannabis (Y/N)
			Male = 18.8%
			Fem = 81.2%
Nteveros et al. (2020Nteveros, A., Kyprianou, M., Artemiadis, A., Charalampous, A., Christoforaki, K., Cheilidis, S.,... Zis, P. (2020). Burnout among medical students in Cyprus: A cross-sectional study. PLoS One , 15(11), e0241335. doi:10.1371/journal.pone.0241335 https://doi.org/10.1371/journal.pone.024... )	2020	Cyprus	N = 182	Medicine	BS (MBI-SS), alcohol consumption (Y/N)
			Male = 33.5%
			Fem = 66.5%
Talih et al. (2018Talih, F., Daher, M., Daou, D., & Ajaltouni, J. (2018). Examining Burnout, depression, and attitudes regarding drug use among Lebanese medical students during the 4 years of medical school. Academic Psychiatry, 42(2), 288-296. doi:10.1007/s40596-017-0879-x https://doi.org/10.1007/s40596-017-0879-... )	2016	Lebanon	N = 172	Medicine	BS (BMS), alcohol consumption (AUDIT), substance use (DAST-10)
			Male = 51.1%
			Fem = 48.9%
Tavares et al. (2020Tavares, H. H. F., Silva, H. R. S., Miranda, I. M. M., Braga, M. S., Santos, R. O., & Guerra, H. S. (2020). Factors associated with Burnout Syndrome in medical students. Mundo da Saúde, 44(1), 280-289.doi:10.15343/0104-7809.202044280289 https://doi.org/10.15343/0104-7809.20204... )	-	Brazil	N = 419	Medicine	BS (MBI-SS), consumption of alcohol and stimulant drugs (Y/N)
			Male = 35.3%
			Fem = 64.7%
Vilchez-Cornejo et al. (2016Vilchez-Cornejo, J., Huamán-Gutiérrez, R., Arce-Villalobos, L., Morán-Mariños, C., Mihashiro-Maguiña, K., Melo-Mallma, N., ... Rojas-Valle, C. (2016). Síndrome de burnout en estudiantes de medicina: Frecuencia, características y factores asociados [Burnout syndrome in medical students: Frequency, characteristics and associated factors] Acta Médica Peruana, 33(4), 282-288.doi:10.35663/amp.2016.334.221 https://doi.org/10.35663/amp.2016.334.22... )	2014/2015	Peru	N = 583	Medicine	BS (MBI-SS), alcohol consumption (Y/N)
			Male = 50.6%
			Fem = 49.4%
Zivojinović et al. (2020Zivojinović, J. I., Backović, D., Belojević, G., Valčić, O., Soldatović, I., & Janković, J. (2020). Predictors of burnout among Belgrade veterinary students: A cross-sectional study. PLoS One , 15(3), e0230685.doi:10.1371/journal.pone.0230685 https://doi.org/10.1371/journal.pone.023... )	2014	Serbia	N = 416	Veterinary Medicine	BS (MBI-SS), alcohol consumption (Y/N)
			Male = 66.3%
			Fem = 33.7%

Author (year)	Alcohol consumption	Consumption of illicit substances	Prevalence of burnout syndrome	Consumption of alcohol or illicit substances x burnout syndrome
Arango Agudelo et al. (2010Arango Agudelo, S., Castaño Castrillón, J. J., Henao Restrepo, C. J., Jimenez Aguirre, D. P., López Henao, A. F., & Páez Cala, M. L. (2010). Síndrome de Burnout y factores asociados en estudiantes de I a X semestre de la Facultad de Medicina de la Universidad de Manizales (Colombia), 2009 [Burnout syndrome and associated factors, in students from I to X semester of the Faculty of Medicine at the University of Manizales (Colombia), 2009]. Archivos de Medicina, 10(2), 110-126. doi:10.30554/archmed.10.2.1291.2010 https://doi.org/10.30554/archmed.10.2.12... )	68.2% yes; CAGE: 58.6% non-dependent, 25.3% dependent; 16.1% probable dependence.	10.5% yes; 45.0% cannabis; 23.5% others	EE: 19.5% (low); 38.2% (moderate); 42.3% (high); DP: 35.7% (low); 35.7% (moderate); 28.6% (high); PA: 39.0% (high); 33.0% (moderate); 28.0% (low)	Use of psychoactive substances associated with high levels of DP
Calcides et al. (2019Calcides, D. A. P., Didou, R. N., Melo, E. V., & Oliva-Costa, E. F. (2019). Burnout Syndrome in medical internship students and its prevention with Balint Group. Revista da Associação Médica Brasileira, 65(11), 1362-1367. doi:10.1590/1806-9282.65.11.1362 https://doi.org/10.1590/1806-9282.65.11.... )	-	21.7% yes	10.3% two-dimensional (EE; DP); 35.9% three-dimensional; EE: 17.9% (light); 23.4% (moderate); 53.3% (high); DP: 13.6% (light); 31.5% (moderate); 52.2% (high); PA: 53.3% (high); 22.8% (moderate); 19.0% (light)	Use of psychoactive substances associated with BS
M.S. Carlotto et al.(2010Carlotto, M. S., Câmara, S. G., Otto, F., & Kauffmann, P. (2010). Estudo da Síndrome de Burnout em estudantes de psicologia [Study of Burnout Syndrome in psychology students]. Boletim de Psicologia, 59(131), 167-178. Retrieved from http://pepsic.bvsalud.org/pdf/bolpsi/v59n131/v59n131a04.pdf http://pepsic.bvsalud.org/pdf/bolpsi/v59... )	Average 1.27±0.57	-	EE: mean 2.50 (sd 1.45); DP: mean 1.20 (sd 1.12); PR: mean 5.14 (sd 0.78)	Alcohol use was associated with the highest average of EE
Cecil et al. (2014Cecil, J., McHale, C., Hart, J., & Laidlaw, A. (2014). Behaviour and burnout in medical students. Medical Education Online, 19, 25209.doi:10.3402/meo.v19.25209 https://doi.org/10.3402/meo.v19.25209... )	1st year: 38.47 ± 13.92; 2nd year: 32.44 ± 8.68; 3rd year: 37.45 ± 7.75; 4th year: 32.65 ± 8.68	-	26.7% total; EE: 54.8% (high); DP: 34.0% (high); PA: 46.6% (low)	Alcohol use associated with higher PA scores
Erschens et al. (2018Erschens, R., Loda, T., Herrmann-Werner, A., Keifenheim, K. E., Stuber, F., Nikendei, C.,... Junne, F. (2018). Behaviour-based functional and dysfunctional strategies of medical students to cope with burnout. Medical Education Online , 23(1), 1535738.doi:10.1080/10872981.2018.1535738 https://doi.org/10.1080/10872981.2018.15... )	15.1% yes	Stimulant drugs: 4.5%; Tranquilizer drugs: 6.7%	32.6% total; EE: 23.5% (high); DD: 17.8% (high); PA: 35.8% (low)	BS associated with the use of alcohol and stimulant drugs
Jackson et al. (2016Jackson, E. R., Shanafelt, T. D., Hasan, O., Satele, D. V., & Dyrbye, L. N. (2016). Burnout and alcohol abuse/dependence among U.S. medical students. Academic Medicine, 91(9), 1251-1256. doi:10.1097/ACM.0000000000001138 https://doi.org/10.1097/ACM.000000000000... )	32.4% alcohol abuse/dependence	-	Does not present descriptive data	Alcohol use associated with EE and DP
Lee et al. (2020Lee, K. P., Yeung, N., Wong, C., Yip, B., Luk, L., & Wong, S. (2020). Prevalence of medical students’ burnout and its associated demographics and lifestyle factors in Hong Kong. PLoS One, 15(7), e0235154.doi:10.1371/journal.pone.0235154 https://doi.org/10.1371/journal.pone.023... )	Frequency: Never: 29.7%; 2-4x/month: 18.3%; 2-3x/week: 5.2%; 4-5x/week: 1.4% Abusive consumption: Never: 73.1%; 26.9% yes	-	27.9% total; EE: 21.6% (low), 29.2% (moderate), 49.3% (high); DP: 23.4% (low), 22.8% (moderate), 53.8% (high); PA: 5.1% (high), 23.2% (moderate)	BS associated with greater chance of using alcohol 4-5 x a week
Mache et al. (2015Mache, S., Vitzthum, K., & Groneberg, D. A. (2015). Prevention of study-related stress symptoms: Health-promoting behavior among dental students. Wiener Medizinische Wochenschrift, 165(5-6), 100-106. doi:10.1007/s10354-014-0341-6 https://doi.org/10.1007/s10354-014-0341-... )	53.0% yes	Cannabis: 8.0%; Cocaine: 0.8%; Ecstasy: 0.4%	EE: mean 18.1 ± 8.8; DP: mean 6.5 ± 4.8; PA: mean 31.3 ± 7.9	Cannabis use associated with high DP, stimulant use associated with low PA
Mbanga et al. (2018Mbanga, C. M., Efie, D. T., Aroke, D., & Njim, T. (2018). Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: A cross sectional analysis. BMC Research Notes, 11(1), 515. doi:10.1186/s13104-018-3631-z https://doi.org/10.1186/s13104-018-3631-... )	-	1.64% yes	37.58% total	Use of recreational drugs associated with BS
Njim et al. (2019Njim, T., Makebe, H., Toukam, L., Kika, B., Fonkou, S., Fondungallah, J., & Fondong, A. (2019). Burnout Syndrome amongst medical students in Cameroon: A cross-sectional analysis of the determinants in preclinical and clinical students. Psychiatry Journal, 2019, 4157574. doi:10.1155/2019/4157574 https://doi.org/10.1155/2019/4157574... )	30.0% yes	2.21% yes	EE: mean 16.64 ± 3.39; DP: mean 20.49 ± 3.53	Use of alcohol and recreational drugs associated with BS
Njim et al. (2018Njim, T., Mbanga, C., Mouemba, D., Makebe, H., Toukam, L., Kika, B., & Mulango, I. (2018). Determinants of burnout syndrome among nursing students in Cameroon: Cross-sectional study. BMC Research Notes , 11(1), 450. doi:10.1186/s13104-018-3567-3 https://doi.org/10.1186/s13104-018-3567-... )	28.48% yes	1.13% yes	EE: mean 20.94 ± 3.04; DP: mean 17.10 ± 3.09	There was no association between BS, alcohol and drug use
Nteveros et al. (2020Nteveros, A., Kyprianou, M., Artemiadis, A., Charalampous, A., Christoforaki, K., Cheilidis, S.,... Zis, P. (2020). Burnout among medical students in Cyprus: A cross-sectional study. PLoS One , 15(11), e0241335. doi:10.1371/journal.pone.0241335 https://doi.org/10.1371/journal.pone.024... )	44.2% yes	-	18.1% total; 51.1% 1 dimension; 23.6% 2 dimensions; 7.1% in all dimensions	There was no association between BS and alcohol use.
Talih et al. (2018Talih, F., Daher, M., Daou, D., & Ajaltouni, J. (2018). Examining Burnout, depression, and attitudes regarding drug use among Lebanese medical students during the 4 years of medical school. Academic Psychiatry, 42(2), 288-296. doi:10.1007/s40596-017-0879-x https://doi.org/10.1007/s40596-017-0879-... )	58.1% yes 9.2% abusive consumption	34.9% yes; 31.9% cannabis. DAST: 1.7% severe problem; 8.3% moderate problem; 43.4% light problem	43.0% total	There was no association between BS, alcohol and substance use
Tavares et al. (2020Tavares, H. H. F., Silva, H. R. S., Miranda, I. M. M., Braga, M. S., Santos, R. O., & Guerra, H. S. (2020). Factors associated with Burnout Syndrome in medical students. Mundo da Saúde, 44(1), 280-289.doi:10.15343/0104-7809.202044280289 https://doi.org/10.15343/0104-7809.20204... )	62.5% yes	25.1% sometimes 9.3% always	EE: 3.6 ± 1.2; High EE: 38.4% DP: 1.7 ± 1.4; High DP: 29.4% PE: 4.3 ±0.9; Low PE: 32.7% BS: 9.5%	Alcohol use associated with EE and PE and stimulant use associated with EE
Vilchez-Cornejo et al. (2016Vilchez-Cornejo, J., Huamán-Gutiérrez, R., Arce-Villalobos, L., Morán-Mariños, C., Mihashiro-Maguiña, K., Melo-Mallma, N., ... Rojas-Valle, C. (2016). Síndrome de burnout en estudiantes de medicina: Frecuencia, características y factores asociados [Burnout syndrome in medical students: Frequency, characteristics and associated factors] Acta Médica Peruana, 33(4), 282-288.doi:10.35663/amp.2016.334.221 https://doi.org/10.35663/amp.2016.334.22... )	36.9% overall	-	24.1% with two or more components; EE: 52.5% (light); 31% (moderate); 16.5% (high); DP: 30.5% (light); 21.8% (moderate), 47.7% (high); PA: 42.7% (high); 22.0% (average); 35.3% (low).	Alcohol use associated with two or more BS components
Zivojinović et al. (2020Zivojinović, J. I., Backović, D., Belojević, G., Valčić, O., Soldatović, I., & Janković, J. (2020). Predictors of burnout among Belgrade veterinary students: A cross-sectional study. PLoS One , 15(3), e0230685.doi:10.1371/journal.pone.0230685 https://doi.org/10.1371/journal.pone.023... )	Does not present descriptive data	-	43.3% total; EE: mean 25.60 ± 11.61 (45.0% high); DP: mean 15.40 ± 6.56 (79.4% high); PA: mean 32.18 ± 8.50 (50.5% low)	There was no association between BS and alcohol use.

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[1] Correspondence address: Giovana Frazon Andrade. Universidade Estadual do Centro-Oeste. Alameda Élio Antonio Dalla Vechia, 838, Guarapuava-PR, Brazil. CEP 85.015-430. E-mail: giovanafrazon@hotmail.com