Exploring Stress, Fatigue, Burnout, and Resilience Among Healthcare Personnel in Southern and South-Eastern Asia: A Scoping Review

Abstract

Objectives:

This study aims to compare methods used to measure burnout, fatigue, stress, and resilience, as well as resilience-building interventions among healthcare personnel (HCP) in Southern and South-eastern Asia. Even before COVID-19, HCP faced high levels of burnout and stress, exacerbated by the pandemic. Identifying effective resilience-building strategies is essential to supporting a healthier workforce.

Methods:

Studies published from January 2016 to December 2021 focusing on burnout, stress, fatigue, and resilience were included. COVIDENCE software was used for screening.

Results:

A total of 55 studies were included in the review. Of these 55 studies, 51 measured burnout, stress, fatigue, or resilience, using 77 different instruments. The MBI-HSS, PSS-10, BRS, Brief-COPE, and CD-RISC were the most common tools to assess burnout, stress, and individual resilience. Four studies evaluated resilience interventions, using mindfulness training, meditation, progressive muscle relaxation, and yoga.

Conclusion:

There are many studies assessing burnout, stress, and resilience among HCP in Southern and South-eastern Asia, yet gaps remain in identifying effective resilience-building interventions. Further research is needed to assess the impact of individual resilience on health systems resilience.

Introduction

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [1]. In healthcare, there is frequently an overemphasis on physical conditions, such as comorbidities, while mental health is oftentimes overlooked. The COVID-19 pandemic has highlighted the critical need for mental health and resilience in healthcare personnel (HCP).

Resilience has been a focus of research for several decades, but its importance has become particularly evident during the COVID-19 pandemic. The American Psychological Association (APA) defines resilience as “the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands” [2]. Smith et al. (2008) provide a more concise and unidimensional definition, describing resilience as “resistance to illness, adaptation, and thriving—the ability to bounce back or recover from stress” [3].

Stressors of HCP during COVID-19 included fear of transmission of disease to friends and family, the uncertainty of the clinical implications of the virus, and emotional exhaustion and fatigue in caring for a larger volume of sick, often critically ill, patients. Support systems and a feeling of camaraderie amongst colleagues in the field is noted as a positive coping mechanism in reducing stress, preventing burnout, and improving efficiency in the workplace [4]. Similarly, resilience can be improved by both internal factors, such as mentorship, work-life balance, spirituality, and self-reflection, as well as external systemic supports like job sharing, and structured training programs [5].

While healthcare professions can be deeply rewarding, they are also a significant source of stress, often leading to burnout. The APA defines burnout as a state of “physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes toward oneself and others” [6]. Stress typically arises after prolonged periods of intense physical or mental exertion, especially when faced with overwhelming workloads or pressure.

Even before the COVID-19 pandemic, healthcare workers faced elevated risks of emotional exhaustion, fatigue, stress, burnout, depression, anxiety, substance abuse, and suicide [7]. The pandemic further exacerbated these issues, with increased workloads, a global sense of hopelessness, and social isolation leading to worsened mental health outcomes [8]. Frontline workers were especially susceptible to the pandemic’s negative effects, with numerous studies indicating higher rates of anxiety, emotional exhaustion, depression, mental distress, and fatigue [9]. This strain resulted in decreased job satisfaction, poorer patient outcomes, significant challenges in staging healthcare settings, and financial burdens.

Many scales have been developed for measuring perceived stress and burnout, these include the perceived stress scale (PSS-10) and Maslach Burnout Inventory Human Services Survey (MBI-HSS) [10, 11]. The PSS-10 and MBI-HSS are widely used, reliable, and valid instruments for assessing stress and burnout, respectively [12, 13].

In 2008, the Brief Resilience Scale (BRS) was designed to assess an individual’s capacity to recover from health-related stressors [3]. Before the development of the BRS, several other assessments, such as the Connor-Davidson Resilience Scale (CD-RISC) [14], Brief Coping Orientation to Problems Experienced (Brief-COPE) [15], and Hospital Anxiety and Depression Scale (HADS) [16] were commonly used. These instruments offered in-depth assessments of personal traits that may promote positive adaptation. However, they did not directly assess resilience itself, as previously defined [3]. The BRS is a reliable and valid instrument whose widespread application has revealed poor resilience in HCPs that negatively impacts wellbeing, leading to increased depression, anxiety, fatigue, burnout, and stress. On the other hand, more resilience has been found to positively correlate with positive wellbeing indicators, such as life satisfaction, and good coping [17].

During the COVID-19 pandemic, the core authors in the USA and India recognized the urgent need for a more profound assessment of resilience and explored potential interventions to strengthen resilience among healthcare staff. This scoping review focuses on individual resilience, recognizing that while health systems resilience is critical, it is the resilience of individuals within those systems that often determines the success of the response to a crisis.

The primary aim is to identify and compare methods used to measure the level of stress, fatigue, and burnout, as well as methods used to measure resilience in individuals. The secondary aim is to identify and compare interventions used to build resilience among HCP in Southern and South-eastern Asian countries.

Inclusion Eligibility Criteria

Participants

We included all HCP as defined by the Centers for Disease Control and Prevention (CDC) [18]. We excluded medical students from our inclusion participants.

Concept

This scoping review focused on studies examining individual resilience, defined by the National Academy of Sciences as “the ability to prepare and plan for, absorb, recover from, or more successfully adapt to actual or potential adverse events” [19]. We included studies that explored factors contributing to or influencing resilience at the individual level. We excluded studies that focused on the resilience of health systems or organizational structures.

Context

We included all South-eastern Asian and Southern Asian countries as defined by the United Nations [20] and World Health Organization [21]. Setting of studies include Academic Centers (University, College), Non-Academic Hospitals, and Community. All studies included were published after January 2016. Pre-COVID-19 studies collected data before March 11, 2020, the date the WHO declared COVID-19 a global pandemic [22]. Intra-COVID-19 studies collected data on or after this date.

Types of Sources

This scoping review considered both experimental and quasi-experimental study designs including randomized controlled trials, non-randomized experimental trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including retrospective cohort studies, case-control studies, and analytical cross-sectional studies were considered for inclusion. This review also considered descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Qualitative studies were considered. In addition, systematic reviews that meet the inclusion criteria were considered, depending on the research question. Text and opinion papers were considered for inclusion in this scoping review. Clinical trials were excluded, in addition to editorials, theses or dissertations, commentaries, conference proceedings, and book chapters. Studies not published in journals, studies that were withdrawn, and studies where the full text was not available were excluded.

Methods

Search Sources and Strategy

A comprehensive and systematic literature search was conducted to identify peer-reviewed studies through seven databases (PubMed, PsycInfo, EMBASE, Scopus, Web of Science, CINAHL, Cochrane Library) from 2016 to Dec 22, 2021. The search terms reflected three concepts 1) resilience, 2) healthcare personnel, and 3) Southern and South-eastern Asian countries. Terminology for healthcare personnel was derived from PubMed Medical Subject Headings (MeSH), EMBASE Emtree, and CINAHL Subject Headings. The preliminary search terms were developed and refined through consultation with a core team member. The multiple combinations of search terms to the concepts were executed using Boolean operators (see the complete PubMed search in Supplementary Appendix as an example). The search results were restricted to journal articles published in English, excluding editorials, comments, letters, news, conference proceedings, book chapters, and dissertations using database built-in filters. The search strategies in PubMed were adapted to other databases mentioned above. To locate additional articles not captured by bibliographic database searching, a gray literature search was conducted, and a few hand-picked relevant articles were also added to the search results for screening. A protocol does not exist for this scoping review. This review was performed following PRISMA-ScR guidelines [23].

Screening

Search results were imported into COVIDENCE systematic review software (Veritas Health Innovation, Melbourne, Australia) and underwent two rounds of screening based on their (1) title and abstract and (2) full text. After deduplication, the three members (KGT, KM, and MMP) conducted screening and excluded studies based on exclusion criteria (e.g., no full text available, resilience of health systems, wrong settings or study designs, wrong population, etc.). The discrepancies were resolved through discussion and consensus by TAM, VAK, and MV.

Data Extraction

Data extraction was performed independently using Excel (by KGT). Data extracted includes specific details about the study settings, context, aims, time frame, participants, study design, study methods, outcomes, and key findings relevant to the review questions. A PRISMA flow diagram is listed below (Figure 1).

FIGURE 1

Results

A total of 8918 studies were screened, and 55 studies were included in this study based on inclusion and exclusion criteria. A total of 10 countries were represented, with the greatest number of studies from Singapore (Figure 2). Tables 1A, B shows a summary of the 51 studies with a total of 77 different instruments used. The MBI-HSS (10 studies) and PSS-10 (5 studies) were the most common tools to assess burnout and stress, respectively. The BRS (8 studies), Brief-COPE (7 studies), and CD-RISC (7 studies) were the most common tools to measure resilience. Table 2 shows a summary of the four studies that evaluated resilience interventions.

FIGURE 2

These studies were further categorized into main themes: fatigue, stress, burnout, satisfaction, and resilience.

Methods Used to Assess Fatigue, Stress, Burnout, Satisfaction, and Resilience

Fatigue

Two studies, both conducted in the Philippines during the COVID-19 pandemic, evaluated fatigue [9, 66]. They aimed to examine the role of resilience in mitigating the negative effects of pandemic-related stressors on nurses’ wellbeing and job outcomes. The first study focused on pandemic fatigue and its impact on clinical nurses’ mental health, sleep quality, and job contentment [9]. The second study investigated the relationship between compassion fatigue, job outcomes (satisfaction and turnover intention), and care quality among frontline nurses [66].

Both studies employed cross-sectional designs and used various scales to measure resilience, including the BRS and the Brief Resilience Coping Scale (BRCS). The outcomes of these studies consistently highlighted the protective role of resilience in the face of pandemic-related challenges. The first study found that resilience reduces the effects of pandemic fatigue on nurses’ mental health, sleep quality, and job contentment, with vaccinated nurses and those perceiving sufficient staffing reporting lower levels of fatigue [9]. The second study revealed that psychological resilience diminishes the negative impact of compassion fatigue on job satisfaction, turnover intention, and quality of care [66].

These findings underscore the importance of implementing resilience-promoting interventions and proactive measures to reduce fatigue and support nurses’ wellbeing. Both studies emphasize the need for nursing administrators to prioritize strategies that enhance resilience, as this can lead to improved job satisfaction, better retention rates, and higher quality of care in healthcare settings, particularly during challenging times such as a pandemic [9, 66].

Stress

The scale that was used most to measure stress was the PSS-10. This scale was used to assess stress and its effect on coping strategies and burnout. These studies were conducted among various healthcare professionals (including mental health workers, residents in training, nurses, and surgical residents) in different Southern and Souther-eastern Asian contexts (Singapore, Malaysia, and Pakistan), consistently finding that mindfulness, active coping strategies, and targeted interventions can help mitigate stress and improve mental health outcomes in these high-pressure medical environments. [25, 48, 51, 73].

Other methods to measure stress included individual interviews [32, 34] and the Generalized Anxiety Disorder 7-item (GAD-7) [45, 47], Depression Anxiety Stress Scale (DASS-21) [46], Kessler Psychological Distress Scale (K-10) [44], Secondary Traumatic Stress Scale (STSS) [54], State-Trait Anxiety Inventory (STAI) [61], and a modified instrument used during MERS-CoV [49, 63]. These studies consistently found high levels of stress and anxiety among healthcare workers, with contributing factors including fear of infection, perceived stigma, and heavy workloads. However, they also identified resilience as a significant protective factor. Outcomes emphasized the urgent need for psychological support and interventions to enhance resilience among healthcare workers. Recommendations included implementing programs to strengthen resilience, providing opportunities for stress reduction, and ensuring organizational support. The findings highlight the importance of addressing the mental health of healthcare professionals to maintain their wellbeing and ensure effective patient care, particularly during challenging times such as the COVID-19 pandemic [32, 34, 44–47, 49, 54, 61, 63].

Burnout

The Maslach Burnout Inventory Human Services Survey (MBI-HSS) was used in all the studies to measure burnout. These studies, conducted across various Southern and South-eastern Asian countries including Pakistan, India, Singapore, and Indonesia, aimed to assess burnout levels and associated factors among diverse healthcare professionals, ranging from physicians and residents to nurses and pharmacy technicians. The research collectively sought to identify prevalence rates of burnout, explore its relationship with factors such as workplace violence, resilience, coping strategies, and demographics, and in some cases, evaluate the effectiveness of burnout screening tools. Outcomes consistently revealed high levels of burnout across different healthcare specialties, with contributing factors including workload, inadequate sleep, poor work-life balance, and financial pressures. The studies emphasized the need for interventions to enhance resilience, promote effective coping mechanisms, and improve work environments. Recommendations included regular burnout screening, education on protective coping strategies, and organizational efforts to mitigate workplace stressors. Overall, these findings underscore the critical importance of addressing burnout in healthcare settings to maintain the wellbeing of professionals and ensure quality patient care [26, 35, 36, 41, 53, 62, 71, 72].

Satisfaction

There were only a couple of studies which examined job satisfaction and its influencing factors among psychiatric nurses in Singapore’s only tertiary psychiatric institution, finding a positive correlation between job satisfaction and resilience, with nurses generally satisfied but with room for improvement through enhancing personal resilience [24]. The other study by Achour et al. used an eight-item survey developed by Hackman and Oldham in 1975 and recommended different stress management interventions for older and younger nurses who had the least satisfaction [31].

Resilience

Of the 51 studies that identified methods used to assess burnout, fatigue, stress, or resilience, only four studies did not report any scales to measure resilience. Several studies used certain scales to measure resilience. Frequently used scales were BRS (eight studies) [9, 33, 41, 44, 45, 47, 54, 60], Brief-COPE (seven studies) [48, 51, 62, 64, 71–73], CD-RISC-25 (five studies) [37, 46, 53, 55, 61], CD-RISC-10 (two studies) [39, 64], and BRCS (three studies) (Figure 3) [56, 66, 67].

FIGURE 3

The eight studies that used BRS were published during the COVID-19 pandemic and were done in academic and community settings, in Bangladesh, India, Pakistan, Philippines and Singapore. These studies assessed resilience using BRS in nurses, physicians, pharmacists, and other HCP. Authors of various studies highlighted the need to develop resilience of HCP including providing support through organizational efforts. Of note, the study by Labrague 2021, noted that nurses who received the COVID-19 vaccine and had “perceived sufficient staffing in their units reported lower levels of pandemic fatigue” [9].

The Brief-COPE (Carver 1997) was used in seven studies [15]. The studies were published predominantly during the COVID-19 pandemic with one study published pre-pandemic in 2016. Some of the studies also used other instruments in combination with Brief-COPE. These studies were done in Indonesia, Malaysia, Pakistan and Singapore, in both academic and community settings and included nurses, physicians and residents. The authors of these studies noted stressors including inadequate sleep, significant work hours as contributing to burnout and studies provided solutions such as engaging in sports, “seeking social support, positive thinking” as “active coping strategies” [48, 51, 62, 64, 71–73].

The CD-RISC-25 is a 25-item self-rating tool, developed by Kathryn M. Connor and Jonathan R.T. Davidson in 2003 [14]. The CD-RISC measures various aspects of resilience such as adaptability, control under pressure, and personal strength. Individuals with higher CD-RISC scores typically demonstrate better coping mechanisms and are better equipped to handle stress and recover from setbacks [78].

The studies using CD-RISC-25 and CD-RISC were done in Malaysia, India, Indonesia and Singapore. Nurses, pharmacists, medical technicians, social workers and residents (trainees) participated in these studies from both academic and non-academic settings. Setiawati 2021 et al noted an inverse correlation of level of resilience and anxiety of HCP [61]. Other studies summarized the need for “effective interventions for improving resilience” and the need to support frontline staff by organizations, with social support [37, 46, 53, 55].

During the COVID-19 period, three studies, all done in the Philippines, reported using the BRCS (Sinclair and Walston 2004) [79]. These three studies evaluated nurses (predominantly females - 74.5%–74.8%) perceptions of discrimination and resilience during COVID-19. These studies advocated for the need for nurses to be supported and to develop resilience [56, 66, 67].

Some studies also used resilience assessments using questionnaires related to religious beliefs and practices and one study used the Brief Religious Coping Scale (BRCOPE) (Pargament 1997) [80].

Interventions Used to Build Resilience

Four intervention studies involving 172 participants were conducted to enhance individual resilience among healthcare workers. The studies varied in design: one cohort, one case-control, one randomized controlled trial, and one non-randomized controlled trial. They targeted community settings, non-academic hospitals, and an academic university but did not address systemic resilience [74–77].

The studies employed diverse interventions: Mindfulness-Integrated Cognitive Behavioral Therapy (MiCBT). This combines Cognitive Behavioral Therapy with mindfulness practices for a holistic approach. Progressive Muscle Relaxation, developed by Dr. Jacobson, is a technique involving tensing and relaxing muscle groups to achieve deep relaxation and alleviate stress. Yoga integrates physical postures, breath control, meditation, and ethical principles to enhance overall wellbeing [74–77].

Participants included healthcare professionals such as staff nurses, palliative cancer care professionals, and mental health professionals. The studies were primarily conducted in India, with one in Singapore. Most participants were female (68%–94%), with a significant representation of those under 40-years old. A possible reason for the high female representation could be the high rate of nurse recruitment. Age reporting varied across studies, while Kaur 2021 and Mandal 2021 reported average age, the other studies mentioned the percentage of the age range.

The findings indicate that these interventions can positively influence resilience and reduce stress among healthcare workers, though effectiveness may differ by population and context. Notably, Suyi’s 2017 study focused on mental health professionals; while stress levels decreased, burnout did not show a similar reduction [77].

The interventions demonstrate promise for improving individual resilience, highlighting the need for further research to explore their effectiveness across different healthcare contexts and populations.

Discussion

HCP have experienced burnout even pre-pandemic. However, very early on with the start of the COVID-19 pandemic, strategies to develop resilience of HCP were emphasized [81]. This study is a scoping review and not a meta-analysis because of the lack of uniformity and varied data. However, we have identified certain key aspects of assessing and developing individual resilience as noted below.

Mindfulness

The APA defines mindfulness as “awareness of one’s internal states and surroundings” [82]. Many mindfulness interventions have been practiced, including mindfulness-based cognitive behavior therapy, mindfulness-based stress reduction (MBSR), and mindfulness meditation. MBSR was originally developed by Professor Jon Kabat-Zinn as a tool combining mindfulness meditation, yoga, and body awareness strategies to help individuals become more aware of their surroundings and attune to their present sensations and feelings to understand and relieve present stress and anxiety [83].

Two of the five studies exploring interventions to improve individual resilience utilized mindfulness-based interventions [74, 77]. Kaur’s study, conducted in India, defines mindfulness through the Pali word “Vipassana,” meaning “to observe in a special way,” or being present “here and now.” The study aimed to evaluate the effects of mindfulness integrated cognitive behavioral interventions (MICBI) on HCP to improve compassion satisfaction, reduce secondary traumatic stress, decrease workload, enhance overall wellbeing, and improve mindfulness skills. Kaur developed a unique MICBI program based on a comprehensive literature review, comprising six separate two-hour weekly sessions of mindfulness meditation, followed by interactive face-to-face discussions, and daily homework assignments, including guided meditations [74].

Suyi’s study, conducted in Singapore, does not explicitly define mindfulness; however, it highlights the beneficial impact of mindfulness training in reducing stress and burnout while improving attitudes of HCP. The study examined the effectiveness of a modified MBSR program in enhancing mindfulness and compassion while reducing stress and burnout among HCP. The traditional 8-week MBSR course was shorted to a 6-week program [77]. This condensed format proved to be equally effective as the standard MSBR program [77, 84].

A scoping review by Kriakous et al. [84], which included 30 studies conducted primarily in North America and Europe, confirmed that MBSR effectively reduces anxiety, depression, and stress experienced by HCP, while also increasing individual mindfulness and self-compassion. However, the review noted that MBSR programming did not significantly reduce burnout or improve resilience amongst HCP [84]. Similarly, Suyi [77] found that while MBSR led to reductions in stress and improvement in mindfulness and compassion among HCP, it did not impact burnout levels [77]. In contrast, Kaur’s (2021) MICBI program demonstrated significant reductions in both stress and burnout, as well as improvements in compassion satisfaction, wellbeing, and mindfulness skills after 3 months [74]. This difference may be attributed to the daily individual mindfulness practices, such as meditation, which were integral to the MICBI program. Daily practice was associated with enhanced psychological function and outlook [84].

CD-RISC Score Interpretation

CD-RISC scores are interpreted based on populations and geographic settings [78]. In cross-cultural comparisons, higher or lower average scores might reflect different cultural approaches to stress and coping, rather than actual differences in resilience levels. For example, in the initial validation study by Connor and Davidson, the mean score among the general US population was 80.4, indicating a high resilience [14]. However, a study conducted by Yu and Zhang (2007) with Chinese participants (including those from Hong Kong) found a mean CD-RISC score of 52.6 [85]. This study confirmed the scale’s reliability but also noted that cultural attitudes toward self-reporting can lead to differences in scores. The US culture emphasizes individualism and personal achievement, which may encourage individuals to report higher levels of personal resilience. There is a cultural acceptance of acknowledging personal strengths and coping abilities, potentially leading to higher self-reported resilience.

On the other hand, Hong Kong’s culture places a strong emphasis on collectivism and interdependence, which may influence individuals to be more modest when self-reporting resilience [86].

The CD-RISC is a robust tool for assessing resilience across cultures, but interpretation of scores must account for cultural differences. A lower score in Hong Kong does not necessarily indicate less resilience but may reflect different cultural expressions of resilience. This difference in the interpretation of CD-RISC scores across various countries highlights that resilience-building programs should also be culturally implemented. In Hong Kong, interventions might focus on enhancing family support and community connections, whereas in the US, fostering individual coping strategies may be more effective.

Individual Versus Health Systems Resilience

This scoping review focused specifically on individual resilience, rather than health systems resilience (population health of system). Individual psychological resilience refers to the ability of HCP to adapt and thrive despite the stressors and challenges they face. It includes emotional regulation, coping strategies, and the ability to recover from stress while continuing to provide effective care. Studies have shown that higher individual resilience is associated with lower levels of stress, anxiety, and burnout among healthcare workers. For instance, Huffman et al. found that higher resilience was linked to lower stress, anxiety, fatigue, and sleep disturbances among healthcare providers during the pandemic [87]. Similarly, Fleuren et al. demonstrated that personal resilience negatively correlates with depressive complaints and worries about infections [88].

Health system resilience refers to the capacity of health systems to prepare for, respond to, and recover from crises while maintaining core functions and learning from these events to improve future responses [89–91]. This concept encompasses both the ability to handle known shocks and the intrinsic flexibility to adapt to unpredictable events [92, 93].

The two forms of resilience are interdependent as they both aim to reduce burnout among healthcare personnel. As shown by Shanafelt et al., individual psychological resilience directly impacts the functioning of healthcare systems, particularly during crises. Similarly, a well-functioning health system provides the support necessary for healthcare workers to maintain their resilience [94].

Interestingly, Burau et al. [95] found that when investigating health system resilience with a particular focus on the health workforce, the health workforce seemingly had little impact on the health system during the first wave of the COVID-19 pandemic [95]. However, a recent UK-based study by Martin et al. (2024) found that nearly half of HCP considered or acted on leaving the healthcare workforce, linked to higher burnout scores and mental health issues like depression and anxiety [96]. This does indicate that further studies are needed to understand the complex relationships of resilience of individual HCP and the resilience of health systems they work in, especially with regards to the COVID-19 pandemic given the fact that we know both individual and health systems resilience do work hand in hand in response to health crises, such as the COVID-19 pandemic.

When comparing the two forms of resilience, individual resilience focuses on the personal capacity of healthcare workers to adapt to stress and trauma, while system resilience pertains to the broader infrastructure’s capacity to respond to emergencies. Individual-level resilience is developed through internal coping mechanisms and is crucial to the overall health system resilience and response. Interventions for building psychological resilience often involve personal development programs such as mindfulness training, cognitive-behavioral strategies, and stress management programs [97]. In contrast, health system resilience is bolstered by governance reforms, resource allocation, and systemic policies that improve the capacity of the workforce and infrastructure to handle crises, as noted by Kruk et al [91, 98]. Figure 4 illustrates how individual-level resilience fits within a broader health systems resilience framework.

FIGURE 4

Limitations

This study has several limitations that must be considered. First, the review was restricted to articles published in English. Additionally, the study focused exclusively on individual psychological resilience among HCP and did not address resilience at the system level (facility or hospital). Moreover, individual physiological resilience, such as the presence of comorbidities or physical health factors, was not considered in this analysis. Another limitation that became clear during data analysis is that while the CD-RISC has been shown to be a robust tool for assessment of resilience across cultures, the interpretation of results requires knowledge of the countries’ cultural context. This may limit comparison of data across multiple countries given the assumption that cultural context informs an individual’s responses on the CD-RISC tool. Furthermore, a formal analysis of study quality was not conducted; therefore, results are summarized without weighing for the risks of bias. Finally, the initial search of publications for this scoping review was concluded in December 2021. We acknowledge other studies may have been published since the initial search and further analysis will be needed to assess resilience of HCP. Future research should examine psychological resilience among HCP in more diverse settings outside of Southern and South-eastern Asia to enhance understanding across different healthcare and cultural environments.

Conclusion

This scoping review of publications from 2016 to 2022 highlights the extensive body of research conducted across Southern and South-eastern Asia to assess burnout, fatigue, stress, and resilience amongst HCP. Several widely used and validated tools, including BRS, CD-RISC, and Brief-COPE, have been employed to measure resilience. The CD-RISC is notable for its variability in interpretation across different populations and settings. Moving forward, further studies using the CD-RISC should consider the demographic and geographic context of their subjects to ensure more accurate and meaningful results.

This review underscores the pressing need for effective resilience-building interventions at both individual and systemic levels. The findings emphasize the critical role of resilience in mitigating pandemic-related challenges, such as job satisfaction, HCP mental health, and overall quality of patient care. By providing an overview of some of the scales used to measure these factors, this scoping review offers valuable insights into the mental health of Southern and South-eastern Asia’s healthcare workforce, both before and after the COVID-19 pandemic. As we continue to face increasing stressors—ranging from emerging pathogens to environmental changes and natural disasters—building resilience among healthcare professionals will become increasingly essential to maintaining both their wellbeing and the quality of care they provide.

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