The hidden cost of specialization: a mixed-methods study on burnout, mental health, and financial ınstability in dental trainees.

The prevalence of high burnout was 75.4% among postgraduate dental trainees based on a mean OLBI-SS item score ≥3.0.

• Burnout was measured using the Oldenburg Burnout Inventory Student Survey (OLBI-SS).
• The threshold for high burnout was defined as a mean OLBI-SS item score ≥3.0.
• The study used a cross-sectional survey design with an embedded qualitative component.
• Participants were postgraduate dental trainees.

Positive screening rates for anxiety and depressive symptoms were elevated among postgraduate dental trainees.

• 53.3% of trainees screened positive for anxiety symptoms.
• 50.0% of trainees screened positive for depressive symptoms.
• Mental health symptoms were assessed using the PHQ-4 validated instrument.
• These rates accompanied the high burnout prevalence of 75.4%.

Higher mental health symptoms significantly predicted burnout in the multivariable regression model.

• Higher mental health symptoms were associated with burnout (β = +1.25, p = 0.001).
• This finding was derived from a multiple linear regression analysis.
• Mental health symptoms were measured using the PHQ-4.
• This predictor remained significant after controlling for other variables in the multivariable model.

Lower institutional support significantly predicted higher burnout in the multivariable regression model.

• Lower institutional support was associated with burnout (β = -3.15, p = 0.002).
• Institutional support was measured using a perceived institutional and supervisory support instrument.
• This was one of two statistically significant predictors in the multivariable model.
• The finding suggests that quality of the educational environment is a more significant determinant of well-being than clinical workload volume alone.

Male gender emerged as a strong independent predictor of burnout after controlling for anxiety and depressive symptoms, indicating a suppressor effect.

• Male gender was not significant in bivariate analysis.
• After controlling for anxiety and depressive symptoms, male gender became a strong independent predictor (β = +3.61, p = 0.041).
• This pattern was described as a suppressor effect, 'where general distress masked specific risks in male trainees.'
• Gender was assessed as part of the multivariable regression model.

Qualitative analysis identified four major stressors reported by postgraduate dental trainees.

• The four major stressors were: financial instability, institutional uncertainty, advisor communication difficulties, and conflicts between clinical and academic responsibilities.
• Qualitative data were analyzed using inductive thematic analysis (also described as inductive content analysis).
• Data were collected through open-ended responses embedded in the cross-sectional survey.
• Qualitative findings were used to contextualize the quantitative results.

The frequency of advisor meetings and quality of the educational environment were identified as more significant determinants of well-being than clinical workload volume alone.

• This finding emerged from the combined quantitative and qualitative analyses.
• Advisor communication difficulties were identified as one of four major qualitative stressors.
• Institutional support (β = -3.15, p = 0.002) was a significant multivariable predictor of burnout.
• The authors recommend prioritizing 'organized supervision, clear organization, and financial help' as interventions.

The study measured multiple psychological constructs using validated instruments in addition to burnout.

• Burnout was assessed with the OLBI-SS.
• Mental health symptoms were assessed with the PHQ-4.
• Perceived stress was assessed with the PSS-4.
• Resilience was assessed with the Brief Resilience Scale (BRS).
• Perceived institutional and supervisory support were also measured with validated tools.