The effects of defensive functioning on perceived stress and burnout in the healthcare of chronic diseases

Working in the healthcare of chronic diseases affects healthcare professionals’ (HP) well-being and their psychological response to perceived stress. Implicit emotional regulation, conceptualized as defensive functioning, mediates individual’s reactions to internal and external stressors and is essential in protecting individuals from psychological distress. As symptoms of distress frequently occur in HP working with chronic medical conditions, our study aimed at exploring the relationship between defense mechanisms and perceived stress and burnout and how they change during the COVID-19 emergency. A convenience sample of 126 HP working with chronic diseases responded to an online survey to test the impact of defense mechanisms on stress and burnout before (August 2020) and during (December 2020) the second wave of COVID-19 in Italy. Self-report assessment was conducted using the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30), Perceived Stress Scale (PSS) and Maslach Burnout Inventory (MBI). Pearson correlations analyses showed significant association between overall defensive functioning (ODF) and psychological well-being in HP working with chronic medical conditions. In particular, immature defenses were found associated with higher levels of stress and burnout, while mature defenses were found associated with lower distress. Regression analyses showed that higher scores on ODF and mature defenses assessed before the second wave of COVID-19 predicted lower levels of stress and burnout during the second healthcare emergency for COVID-19. Defense mechanisms play an important role in dealing with work-related psychological distress experienced in the healthcare of chronic diseases, especially during healthcare crises as the COVID-19 pandemic. The systematic assessment of defense mechanisms among healthcare professionals might help the early detection of vulnerable workers and the timely activation of psychological support.