The COVID-19 virus was first identified in Wuhan, China, and has rapidly spread across several countries, including Kosovo, significantly impacting individuals, particularly healthcare professionals, who are directly at risk of contracting the virus of COVID-19 [1-3]. Frontline healthcare professionals face a heavier workload, moral dilemmas during care, and a constantly changing clinical practice environment in addition to the risk of exposure [1]. These factors can cause significant psychological pressure, leading to feelings of loneliness, helplessness, stress, irritability, physical and mental fatigue, and despair [4]. The COVID-19 pandemic has severely impacted the emotional and mental health of healthcare professionals [5, 6].

Burnout syndrome, defined as a chronic response to workplace stress, is a growing global concern. It is characterized by feelings of energy loss or fatigue, increased mental distance from one's job, negative feelings or pessimism about the job, and reduced professional effectiveness [3]. Burnout not only affects work but also has a profound impact on individuals' quality of life [7]. It typically occurs about one year after starting work at an institution. Healthcare professionals who are in daily contact with seriously ill patients are at high risk of burnout [6]. Those experiencing burnout may develop symptoms such as loss of motivation, appetite, detachment, and a sense of failure [8, 9]. A study has shown that burnout during the COVID-19 pandemic is more frequent among workers who work overtime and report sleeping problems [2].

Coping mechanisms are essential in managing stress, and burnout is closely linked to coping styles [10]. Coping refers to a set of cognitive and behavioral activities used to manage internal or external pressures that exceed one's resources [11]. Positive coping can improve communication, and problem-solving skills and prevent the exacerbation of mental health issues [12].

To reduce burnout, it is crucial to understand its determinants and individual coping mechanisms. Understanding the factors that influence burnout and identifying supportive resources can facilitate its early recognition, prevention, and treatment. This study aims to assess the prevalence and development of burnout among healthcare professionals and related factors concerning mental health.

The sample consists of 691 healthcare professionals, with an average age of 41.6 years (SD = 10.79) where nurses (n = 550), and physicians (n = 138). The mean age of work experience was 16 years (SD = 11.31), the education level 42.4% was in high school, 31% were in B.Sc., 12.7% with MSc, and 12.4% with PhD.

Based on the results shown in Table 2, which measures burnout, it appears that the emotional fatigue of healthcare professionals is at an average of 29% and a high level of 19.7%. During the COVID-19 pandemic, the depersonalization of healthcare professionals is at an average of 55.2% and a high level of 31.8%, and healthcare professionals feel that they experience personal success at a high level of 78.4%. The results are consistent when we analyze them for specific professions like Nursing and Physicians.

The data were gathered through an MBI questionnaire.

The data presented in Table 3 of this study indicate that a considerable proportion of healthcare professionals experienced high levels of clinical symptoms or distress, as measured by the General Health Questionnaire (GHQ) scales. Specifically, 50.2% of participants reported clinical somatic symptoms, 44.4% reported clinical symptoms of anxiety and insomnia, 38.8% reported clinical social dysfunction, 34.5% reported clinical symptoms of depression, and 43.3% scored high on the GHQ-28 scale. These findings highlight the significant mental health burden experienced by healthcare professionals during the COVID-19 pandemic.

The Shapiro–Wilk normality presented in Table 4 test results indicate that scores from the scales of three questionnaires did not follow a normal distribution. Therefore, a nonparametric analysis was performed.

Table 5 shows the Mann–Whitney U test for testing differences between physicians and nurses. Both groups differed significantly on depersonalization, somatic symptoms, anxiety, and coping skills. Nurses scored significantly higher on depersonalization, somatic symptoms, anxiety, and general mental health, while physicians scored significantly higher on coping skills. Regarding the effect sizes, the rule-breaking behavior problems scale showed the highest effect size (n2 =.072), followed by the externalizing problems (n2 =.026) and anxious-depressed (n2 =.025) scales.

Table 6 shows the differences between physicians and nurses, which also revealed significant differences in Depersonalization. We found that 190 nurses scored high in Depersonalization compared to only 24 physicians who scored high. Additionally, the female sample scored significantly higher in Depersonalization.

Differences between physicians and nurses are also shown for mental health problems, with nurses being more affected in all scales of the GHQ. Detailed results can be found in Table 7.

Table 8 provides information on the correlation coefficients between general mental health problems, burnout, and coping skills. The burnout scales, Emotional Fatigue, and Depersonalization have positive and significant correlations with all scales of the general health questionnaires, including Somatic Symptoms, Anxiety, Social Dysfunction, Depression, and GHQ-28 scores. On the other hand, personal success is significantly negatively correlated with GHQ scales. Similar trends were also observed for coping skills, indicating that lower levels of coping skills are associated with higher levels of burnout and mental health problems. The coefficients of correlation provide insight into the relationships between variables and inform further analysis of the data.

Regression analysis was conducted to examine the impact of mental health coping skills and other experiences during COVID-19 on emotional fatigue. The model was found to explain 31% of the variance, indicating partial effectiveness since it is less than 0.5. However, it is still significant and adequate for determining outcomes. The results from the analysis revealed that emotional fatigue was significantly associated with high levels of anxiety and depression, low coping skills, lower education, and less experienced healthcare professionals. For further details, please refer to Table 9.

Upon conducting regression analysis to investigate the impact of mental health coping skills and other experiences during the COVID-19 pandemic on depersonalization, our study revealed that the model accounted for 23% of the variance and had a partial effect, as it was below 0.5. Despite this, the model was deemed significant and adequate for determining the outcomes of interest. Specifically, the results in Table 10 indicate that high levels of somatic symptoms and anxiety, as well as less experienced healthcare professionals and those who had contracted COVID-19, were found to have a significant impact on depersonalization.

Results confirm the high level of mental health problems and a moderate level of burnout, where coping skills are impacting the way of reaction towards the overwhelming during the pandemic.

This study aimed to assess the level of burnout and the factors related to burnout, coping skills, and demographic variables concerning mental health.

The findings of this study are in line with previous research [15], The study also found a difference in burnout levels between nurses and physicians, with nurses reporting higher scores than physicians in depersonalization, one of the subscales of MBI. This difference can be attributed to the fact that nurses are usually the first point of contact with clients, and they regularly communicate with clients, often facing stressful situations that may lead to higher levels of burnout. Additionally, the study found a significant gender difference, with female participants scoring significantly higher in depersonalization and the dominant sample being female nurses. The results of a meta-analysis by Purvanova and Muros [16]on the relationship between gender and burnout show inconsistent results. However, our findings support a longitudinal study by Houkes et al. [17] which found a higher prevalence of depersonalization among male healthcare professionals. It is necessary to further investigate whether the process of burnout is also triggered by depersonalization for female healthcare professionals.

The study found several factors associated with burnout, particularly emotional fatigue, and depersonalization. These factors included lower levels of education, less working experience, and having been infected with COVID-19. These findings are consistent with similar studies conducted in similar contexts, which have also found that nurses with lower education and less working experience and those who have been infected with COVID-19 are more likely to experience burnout [18]. However, our findings contrast with predictors of burnout in the general population, where longer work experience and higher education were found to be associated with burnout. The possible explanation for these findings is that less experienced healthcare professionals may face higher uncertainty in sudden events such as disasters and pandemics, which can lead to a lack of coping skills. Additionally, those who have experienced COVID-19 infection may have increased their likelihood of burnout due to the impact of the illness on their mental and physical health.

The high level of clinical symptoms of anxiety, insomnia, social dysfunction, and depression found among healthcare professionals in this study (Table 2) is a significant finding. These results are consistent with previous research conducted during the pandemic in similar and different contexts [19-21], which found that physicians and nurses experienced clinical symptoms of anxiety and depression, particularly in the early stages of the pandemic. The life-threatening nature of COVID-19, combined with the lack of vaccines during the initial stages of the pandemic, may have contributed to the high levels of clinical symptoms among healthcare professionals. It is important to acknowledge and address these symptoms in healthcare professionals to ensure that they receive appropriate support and care during these challenging times.

The present study also identified that lower levels of education and less working experience among healthcare professionals were associated with poorer coping skills, which in turn led to a higher risk of burnout (Table 7). These findings are consistent with previous studies that have suggested that healthcare professionals with more experience and education tend to be better equipped to manage the challenges of their work and are less likely to experience burnout [22]. This may be because more experienced professionals have developed better coping strategies, are more comfortable with the demands of their job, and are better able to navigate difficult situations. Conversely, less experienced professionals may feel overwhelmed by the demands of their work, lack effective coping strategies, and be less able to manage the stressors associated with the pandemic.

Overall, the results of this study suggest that the mental health and well-being of healthcare professionals during the COVID-19 pandemic is a critical issue that requires attention. The high levels of burnout, anxiety, and depression observed among healthcare professionals in this study are concerning and have important implications for the quality of care provided to patients. Given the ongoing nature of the pandemic and the continued demands placed on healthcare professionals, it is important to develop and implement strategies to support their mental health and well-being. This may include interventions aimed at promoting coping skills, providing emotional support, and addressing the root causes of burnout among healthcare professionals.

In conclusion, this study highlights the high prevalence of burnout and mental health problems among healthcare professionals during the COVID-19 pandemic. Factors such as lower education level, less working experience, and being infected with COVID-19 were found to be predictors of burnout. Additionally, high anxiety, depression, and low coping skills were found to be associated with emotional fatigue and depersonalization. The study also revealed significant differences in mental health, burnout, and coping skills between nurses and physicians. Based on these findings, appropriate interventions are necessary to prevent or reduce burnout and improve the mental health of healthcare professionals. Future studies can build upon these findings while considering the limitations of this study.

The primary limitation of this study is the absence of triangulation with other research methods, as it solely relies on quantitative data. Self-report measures were employed as the primary source of data collection, which may result in self-selection bias. Furthermore, the cross-sectional design of the study precludes the establishment of a causal relationship between variables. As a result, the findings should be interpreted with caution, and future research should incorporate multiple research methods to provide a more comprehensive understanding of the phenomenon under investigation.

This study provides valuable insights into the prevalence and factors associated with burnout among healthcare professionals during the COVID-19 pandemic. The findings demonstrate that healthcare professionals with lower levels of education, less working experience, and those who have been infected with COVID-19 are at a higher risk of experiencing burnout. Furthermore, the study highlights the significant impact of mental health and coping skills on burnout, with high anxiety, depression, and low coping skills being associated with emotional fatigue and high somatic and anxiety symptoms being associated with depersonalization.

These findings have important implications for the development of effective interventions aimed at preventing and reducing burnout among healthcare professionals. Given the high levels of burnout observed, urgent action is needed to implement psychological interventions at the individual and group levels to help healthcare professionals recover from mental health struggles and reduce burnout. The implementation of effective management systems that foster healthcare professionals' coping strategies may prove highly beneficial in alleviating burnout effectively.

Despite the study's contributions, it is worth noting that the findings are limited by the exclusive use of self-report measures, which may introduce self-choice deviation. Furthermore, the cross-sectional design of the study does not allow for the establishment of a causal-effect relationship between burnout and associated factors. Future research should employ a mixed-methods approach and longitudinal design to provide a more comprehensive understanding of the complex nature of burnout among healthcare professionals.