AccScience Publishing / JCBP / Volume 1 / Issue 1 / DOI: 10.36922/jcbp.1013
Cite this article
Journal Browser
Volume | Year
News and Announcements
View All

U-shaped relationship between burnout-related emotional exhaustion and work–family conflict among physicians in China

Junjun Liu1† Qingyuan Wang2† Xiaomin Zhu3† Wenxuan Zhang4 Diwen Shen5 Hailong Yang5 Qiuyun Cao5 Ning Zhang6 Xiangdong Du3*
Show Less
1 Department of Psychiatry, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
2 Department of Clinical Medical, The Second Clinical Medical College, Nanjing Medical University, Nanjing, China
3 Department of Psychiatry, Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu Province, China
4 Department of Psychosomatics and Psychiatry, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu Province, China
5 Department of Clinical Psychology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
6 Department of Clinical Psychology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
Submitted: 29 May 2023 | Accepted: 11 July 2023 | Published: 28 July 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Work–family conflict (WFC) and burnout-related emotional exhaustion (EE) are essential concerns for employees and organizations. This study examined the relationship between WFC and EE among Chinese physicians. A cross-sectional survey conducted in 2018 included 2530 participants using the WFC scale and the Chinese Maslach Burnout Inventory. The correlation between WFC and EE was calculated using smooth curve fitting and multivariate linear regression analysis. A two-piecewise linear regression model was used to investigate the threshold effect. Interaction and stratified analyses were performed, considering sex, age, education, marital status, hospital information, department, work experience, and title. The fully adjusted linear regression analysis results indicated a positive correlation between WFC and EE (β = 0.72, 95% CI: 0.67 – 0.77, P < 0.001). Smoothing graphs also demonstrated a non-linear link between WFC and EE, with an inflection point around 8.0 for WFC. On the left and right sides of the inflection point, the effect sizes and confidence intervals were −0.61 (−1.17 – −0.05, P = 0.034) and 0.79 (0.74 – 0.85, P < 0.001), respectively. These findings suggested a U-shaped association between WFC and EE among physicians in China, indicating that lower and higher WFC levels may lead to an increased risk of EE.

Emotional exhaustion
Work–family conflict
Medical Science and Technology Development Foundation, Nanjing Department of Health
Research Special Fund for Public Welfare Industry of Health
Suzhou Gusu Health Talents Scientific Research Project
Key Diagnosis and Treatment Program of Suzhou
Suzhou clinical Medical Center for Mood Disorders
  1. Harrad R, Sulla F, 2018, Factors associated with and impact of burnout in nursing and residential home care workers for the elderly. Acta Biomed, 89: 60–69.


  1. Maslach C, Leiter MP, 2017, New insights into burnout and health care: Strategies for improving civility and alleviating burnout. Med Teach, 39: 160–163.


  1. Koutsimani P, Montgomery A, Masoura E, et al., 2021, Burnout and cognitive performance. Int J Environ Res Public Health, 18: 2145.


  1. Kuhn G, Goldberg R, Compton S, 2009, Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine. Ann Emerg Med, 54: 106–113.e6.


  1. Alimoradi Z, Jafari E, Lin CY, et al., 2023, Estimation of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics, 30: 334–357.


  1. Wang A, Tang C, Zhou L, et al., 2023, How surface acting affects turnover intention among family doctors in rural China: The mediating role of emotional exhaustion and the moderating role of occupational commitment. Hum Resour Health, 21: 3.


  1. Montoro-Rodriguez J, Small JA, 2006, The role of conflict resolution styles on nursing staff morale, burnout, and job satisfaction in long-term care. J Aging Health, 18: 385–406.


  1. Scanlan JN, Still M, 2019, Relationships between burnout, turnover intention, job satisfaction, job demands and job resources for mental health personnel in an Australian mental health service. BMC Health Serv Res, 19: 62.


  1. Kuhn CM, Flanagan EM, 2016, Self-care as a professional imperative: Physician burnout, depression, and suicide. Can J Anaesth, 64: 158–168.


  1. Wurm W, Vogel K, Holl A, et al., 2016, Depression-burnout overlap in physicians. PLoS One, 11: e0149913.


  1. Molina-Praena J, Ramirez-Baena L, Gómez-Urquiza JL, et al., 2018, Levels of burnout and risk factors in medical area nurses: A meta-analytic study. Int J Environ Res Public Health, 15: 2800.


  1. Abdul Jalil NI, Tan SA, Ibharim NS, et al., 2023, The relationship between job insecurity and psychological well-being among Malaysian precarious workers: Work-life balance as a mediator. Int J Environ Res Public Health, 20: 2758.


  1. Yu K, 2016, Better and worse: A dual-process model of the relationship between core self-evaluation and work-family conflict. Front Psychol, 7: 1579.


  1. Komlenac N, Stockinger L, Vogler T, et al., 2021, Psychometric analysis of a German-language version of the work-family conflict and family-work conflict scale. Front Psychol, 12: 782618.


  1. Ammons SK, 2013, Work-family boundary strategies: Stability and alignment between preferred and enacted boundaries. J Vocat Behav, 82: 49–58.


  1. Chen L, Liu J, Yang H, et al., 2018, Work-family conflict and job burn-out among Chinese doctors: The mediating role of coping styles. Gen Psychiatr, 31: e000004.


  1. Yang S, Liu D, Liu H, et al., 2017, Relationship of work-family conflict, self-reported social support and job satisfaction to burnout syndrome among medical workers in Southwest China: A cross-sectional study. PLoS One, 12: e0171679.


  1. Wang Y, Chang Y, Fu J, et al., 2012, Work-family conflict and burnout among Chinese female nurses: The mediating effect of psychological capital. BMC Public Health, 12: 915.


  1. Zhou X, Jin L, Wang Y, et al., 2022, The influence of family supportive supervisor behavior on employee creativity: The mediating roles of psychological capital and positive emotion. Front Psychol, 13: 824840.


  1. Carlson D, Kacmar KM, Zivnuska S, et al., 2011, Work-family enrichment and job performance: A constructive replication of affective events theory. J Occup Health Psychol, 16: 297–312.


  1. Landolfi A, Barattucci M, Lo Presti A, 2020, A time-lagged examination of the Greenhaus and Allen work-family balance model. Behav Sci (Basel), 10: 140.


  1. Zhang H, Tang L, Ye Z, et al., 2020, The role of social support and emotional exhaustion in the association between work-family conflict and anxiety symptoms among female medical staff: A moderated mediation model. BMC Psychiatry, 20: 266.


  1. Lambert EG, Hogan NL, 2010, Work-family conflict and job burnout among correctional staff. Psychol Rep, 106: 19–26.


  1. Terry DL, Woo MJ, 2021, Burnout, job satisfaction, and work-family conflict among rural medical providers. Psychol Health Med, 26: 196–203.


  1. Li YX, Bai Y, Li HM, 2004, Measurement and diagnosis of job burnout [Chinese]. J Henan Med Coll Staff Work, 16: 349–351.


  1. Wang Z, Xie Z, Dai J, et al., 2014, Physician burnout and its associated factors: A cross-sectional study in Shanghai. J Occup Health, 56: 73–83.


  1. Ge P, Yang YJ, Liu SY, et al., 2023, Validity and reliability of the Chinese version of the work-family conflict scale in working parents [Chinese]. Chin Ment Health J, 37: 145–150.


  1. Von Elm E, Altman DG, Egger M, et al., 2014, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg, 12: 1495–1499.


  1. Cañadas-de la Fuente GA, Albendín-García L, Cañadas GR, et al., 2018, Nurse burnout in critical care units and emergency departments: Intensity and associated factors. Emergencias, 30: 328–331.


  1. Dall’Ora C, Ball J, Reinius M, et al., 2020, Burnout in nursing: A theoretical review. Hum Resour Health, 18: 41.


  1. Li X, Jiang T, Sun J, et al., 2021, The relationship between occupational stress, job burnout and quality of life among surgical nurses in Xinjiang, China. BMC Nurs, 20: 181.


  1. Luan X, Wang P, Hou W, et al., 2017, Job stress and burnout: A comparative study of senior and head nurses in China. Nurs Health Sci, 19: 163–169.


  1. The Lancet, 2012, Ending violence against doctors in China. Lancet, 379: 1764.


  1. The Lancet, 2010, Chinese doctors are under threat. Lancet, 376: 657.


  1. Wu H, Liu L, Wang Y, et al., 2013, Factors associated with burnout among Chinese hospital doctors: A cross-sectional study. BMC Public Health, 13: 786.


  1. Al-Dubai SA, Rampal KG, 2010, Prevalence and associated factors of burnout among doctors in Yemen. J Occup Health, 52: 58–65.


  1. Santos A, Roberto MS, Camilo C, et al., 2023, Information and communication technologies-assisted after-hours work: A systematic literature review and meta-analysis of the relationships with work-family/life management variables. Front Psychol, 14: 1101191.


  1. Jang S, Shen W, Allen TD, et al., 2018, Societal individualism-collectivism and uncertainty avoidance as cultural moderators of relationships between job resources and strain. J Organ Behav, 39: 507–524.


  1. Wong SW, Yuen M, 2012, Work values of university students in Chinese Mainland, Taiwan, and Hong Kong. Int J Adv Couns, 34: 269–285.


  1. Lu L, Kao SF, Siu OL, et al., 2011, Work stress, Chinese work values, and work well-being in the Greater China. J Soc Psychol, 151: 767–783.
Conflict of interest
All the authors declare that none of them has a conflicts of interest.
Back to top
Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Published by AccScience Publishing