Liu et al.

BMC Medical Education (2023) 23:317 BMC Medical Education

https://doi.org/10.1186/s12909-023-04316-y

RESEARCH Open Access

Factors associated with academic burnout

and its prevalence among university students:
a cross‑sectional study
Zheng Liu1†, Yujin Xie2†, Zhuhong Sun3, Di Liu4*, Hang Yin5* and Lei Shi6*

Abstract
Background This study aimed to evaluate the current state of academic burnout among Chinese college students
and its influencing factors.
Methods A cross-sectional study of 22,983 students was conducted using structured questionnaires and the
Maslach Burnout Inventory General Survey on sociodemographic characteristics, educational process, and personal
aspects. Multiple variables were statistically evaluated using logistic regression analysis.
Results The total score of the students’ academic burnout was 40.73 (± 10.12) points. The scores for the reduced
personal accomplishment, emotional exhaustion, and cynicism were 23.63 (± 6.55), 11.20 (± 6.05), and 5.91 (± 5.31),
respectively. Students with academic burnout accounted for 59.9% (13,753/22,983). Male students had higher burn-
out scores than female students, upper-grade students had higher burnout scores than lower-grade students, and
students who smoked had higher burnout than non-smokers during the school day.
Conclusions More than half of students experienced academic burnout. Gender, grade, monthly living expenses,
smoking, parents’ education level, study and life pressures, and the current degree of professional knowledge interest
significantly impacted academic burnout. An effective wellness program and an annual long-term burnout assess-
ment may sufficiently reduce student burnout.
Keywords Academic burnout, Prevalence, Factors associated, University students, China

†
Zheng Liu and Yujin Xie contributed equally to this work.
Introduction
College is a crucial stage of personal development with
*Correspondence:
Di Liu
increasing pressure to acquire knowledge and skills. In
diliu85@163.com addition to academic demands, other challenges, such
Hang Yin as peer pressure and competition, limited socioeco-
493725216@qq.com
Lei Shi
nomic power, and distance from home and family, act
hydleishi@126.com as stressors for students. Academic burnout has become
1
College of Computer Science and Technology, Harbin Engineering an essential factor that affects college students’ mental
University, Harbin, China
2
Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
health. “Job burnout” was first proposed by the American
3
College of Life Science, Northeast Agricultural University, Harbin, China clinical psychologist Fredenbeger in 1974 [1]. Maslach’s
4
5
School of Marxism, Harbin Medical University, Harbin, China three-dimensional theory was initially used to describe
Department of Human Resources, Sixth Affiliated Hospital of Harbin
Medical University, Harbin, China
burnout in the professional helpers’ industry, and its
6
School of Health Management, Southern Medical University, core contents were individual emotional exhaustion,
Guangzhou, China depersonalisation, and personal achievement reduction.

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Liu et al. BMC Medical Education (2023) 23:317 Page 2 of 13

Maslach (1982) defined burnout as a syndrome of A study of more than 15,000 Chinese high school stu-
exhaustion comprising emotional exhaustion, deperson- dents showed that nearly 20% had suicidal thoughts, and
alisation, and low personal accomplishment [2]. Pines more than two-thirds felt pressured by intense study [13].
(1980) and Meier (1985) defined “academic burnout” as Currently, most research on academic burnout in China
the exhaustion of students’ energy due to long-term aca- focuses on nurses, high school and medical students, and
demic pressure and burden, the gradual loss of enthu- college students in the liberal arts, physical education,
siasm for schoolwork and activities, indifference and teaching, engineering, and other specialties. Although
alienation from classmates, and lack of enthusiasm for relevant research has been gaining attention, it remains
schoolwork [3, 4]. Soffeli (2002) proposed that academic somewhat limited. In addition, survey research on aca-
burnout combines emotional exhaustion, cynicism, and demic burnout among college students in Heilongjiang
academic inefficiency due to the persistent failure to Province is lacking. This study evaluated the level of
effectively manage learning stress [5]. During compulsory academic burnout among college students and its asso-
education, some students experience temporary stress ciation with influencing factors and proposes interven-
that prompts them to lose interest and commitment and tion strategies to promote the development of students’
doubt their ability to meet academic requirements. Tai- physical and mental health. Furthermore, it provides
wan scholar Yang Huizhen defined academic burnout as a theoretical basis for the implementation of preven-
students’ emotional exhaustion, lack of humanisation, tive interventions against academic burnout, which
and low personal sense of achievement due to academic will be valuable to parents, college administrators, and
pressure, academic load, or other personal psychological educators.
factors in the learning process [6]. The Maslach Burn-
out Inventory General Survey (MBI-GS) was adopted Methods
to measure academic burnout and modified the place, Study design and participants
object, and nature of work in the scale. Moreover, she From September to December 2021, a cross-sectional
believed that the items of this scale were more suitable for study was conducted among college students in Hei-
students’ situations than the scale focusing on education. longjiang Province using an online questionnaire survey
Based on previous studies, our study defined academic with respondent-driven sampling. Respondent-driven
burnout as students’ emotional exhaustion, cynicism, and sampling first selects a group of objects that meet the
low personal accomplishment due to academic pressure, inclusion criteria as seeds. The seeds recommend quali-
academic load, or other personal psychological factors in fied partners to enter the study, forming a first-class sam-
the learning process. pling population. When the sampling population reaches
A study of 4,061 college students from different coun- levels 5–6, the sample can better represent the popula-
tries and regions found that maintaining low burnout tion. First, we selected 13 universities in Heilongjiang
levels could effectively prevent students from dropping Province using purposive sampling. Second, we selected
out [7]. Another study indicated that the prevalence of 400 college students who met the inclusion criteria at
burnout syndrome and depressive symptoms among each university. Finally, we selected 26,000 college stu-
medical students in Oman were 7.4% and 24.5%, respec- dents across the five levels for our investigation. We
tively [8]. The adjusted prevalence of burnout among 872 recovered 24,890 questionnaires. However, owing to the
students in 15 public schools in Sri Lanka was 28.8% [9]. poor quality of some questionnaires, 22,983 valid ques-
A total of 187 students (70.6%) out of 330 first-year medi- tionnaires were included in the final analysis, with an
cal students in Brazil showed high levels of emotional effective recovery rate of 88.40%.
exhaustion, 140 (52.8%) showed high levels of cynicism, The inclusion criteria were as follows: (1) students cur-
and 129 (48.7%) showed low academic performance [9]. rently studying at colleges and universities; (2) informed
Of 468 undergraduate chemistry students in Nigeria, 245 consent and willingness to participate voluntarily in this
(54.3%) met the eligibility criteria for severe burnout [10]. research; and (3) the ability to express their opinions
Receiving a university education in China is a solemn clearly and with a good orientation to time, place, and
undertaking. Students must pass challenging exams to people. Individuals who reported a previous mental ill-
enter high school and university to determine their future ness or disturbance of consciousness were excluded from
career choices. Simultaneously, the quality of school the study.
teaching is often evaluated based on student grades.
Therefore, schools, teachers, and students face enormous Questionnaire
pressure. Researchers have repeatedly found that aca- The questionnaire included a general situation ques-
demic burnout has become a common problem among tionnaire and an academic burnout survey for college
college students in their educational experiences [11, 12]. students.
Liu et al. BMC Medical Education (2023) 23:317 Page 3 of 13

General information questionnaire compare the academic burnout scores of students with
The general situation questionnaire included the inves- different demographic characteristics. Homogeneity
tigation of gender (male and female), place of origin of variances was also tested during one-way analysis
(urban and non-urban), grade (freshman, sophomore, of variance. LSD method was adopted to make multi-
junior year, senior year, fifth year of college, master, doc- ple comparisons for meaningful indicators of one-way
tor), whether an only child (only son, non-only child), analysis of variance. The risk factors for burnout among
residential experience in middle and high school, the students were analysed using multiple linear regres-
highest level of education received by his or her par- sion. The total academic burnout score was used as the
ents (primary school and below, junior high school, high dependent variable, and the sociodemographic charac-
school or technical secondary school, junior college, teristics of the respondents were used as independent
undergraduate, master degree and above), monthly living variables. P < 0.05 indicated that differences were statis-
expenses (< 1,000 yuan, 1,000–1,500 yuan, 1,500–2,000 tically significant.
yuan, 2,500–3,000 yuan, > 3,000 yuan), the pressure of
study and life in the past two months (1-extremely lit-
tle stressed, 2-very little stressed, 3-little stressed,4- Results
much stressed, 5-very much stressed, 6-extremely much Sociodemographic characteristics of respondents
stressed), the degree of interest in professional knowl- A total of 22,983 students participated in the survey,
edge (very interested, have interest, generally, less inter- including 12,217 males (53.2%) and 10,766 females
est, no interest), weekly exercise time (1 h, 2 h, 3 h, 4 h), (46.8%). A total of 13,721 (59.7%) students were from
and smoking (smoking, quit smoking, never smoked), urban areas, and 52.5% of the students were only chil-
drinking (drinking, quit drinking, never drank), overall dren. More than half (n = 12,633, 55.0%) of the students
satisfaction with study and life (very satisfied, satisfied, were in their first year of university, and 60.6% of the
generally, dissatisfied,very dissatisfied), and sleep quality students did not hold any position at school. Most par-
in the past two months (very bad, pretty bad, generally, ents’ highest education level was junior high school
good, very good). (n = 8,012, 34.9%). Among the participants, 93.3% had
Investigation on academic burnout of college students. never smoked, 71.5% never drank alcohol, 55.3% exer-
The survey of college students’ academic burnout cised at least once a week, and 38.8% reported good
adopted the MBI-GS [5]. The scale was divided into three sleep quality. Most students (n = 9,755, 42.4%) reported
dimensions: emotional exhaustion (five items), cynicism living on a budget of approximately 1,000–1,500 yuan
(four items), and reduced personal accomplishment (six per month.
items). These items were rated on a seven-point Likert Notably, only 9.5% of the respondents said that the
scale (0 represents ‘never’, 1 represents ‘rarely’, 2 repre- impact of studying and life pressures in the past two
sents ‘occasionally’, 3 represents ‘general’, 4 represents months was minimal. Only 40.2% of the respondents
‘often’, 5 represents ‘frequent’, and 6 represents ‘every- expressed interest in the professional knowledge they
day’). The score was divided by 15 to obtain an average were currently acquiring. Almost 40% of the respond-
score, and the average score was multiplied by 20 (con- ents reported satisfaction with their studies and lives
verted to 100 standard scores). A score below 50 indi- (n = 9,077, 39.5%). Table 1 shows the basic respondent
cates a good working condition, 50–75 indicates a certain information.
degree of burnout, 75–100 indicates severe burnout and
more than 100 indicates very serious burnout. The reli-
ability of the study scale was confirmed using Cronbach’s Academic burnout
alpha with 0.89 for emotional exhaustion, 0.87 for cyni- The total score of the students’ academic burnout was
cism, and 0.79 for reduced personal accomplishment. 40.73 (± 10.12) points. The scores for the reduced per-
sonal accomplishment, emotional exhaustion, and cyni-
cism were 23.63 (± 6.55), 11.20 (± 6.05), and 5.91 (± 5.31),
Data analysis respectively. Students with academic burnout accounted
SPSS Version 25.0 was used for the statistical analy- for 20.5% (4,731/22,983).
sis. General demographic data were summarised using Table 2 analyzes the degree of burnout of all students.
descriptive statistics. Enumeration data were expressed The study found that 40.01% of students had a good
as n (%), and measurement data were expressed as learning condition, 55.16% had a certain degree of aca-
mean ± standard deviation (SD). A normality test was demic burnout, 3.55% of students had a relatively severe
performed on each scale score. A independent sam- degree of academic burnout, and 1.28% had a very severe
ple t-test or one-way analysis of variance was used to degree of academic burnout.
Liu et al. BMC Medical Education (2023) 23:317 Page 4 of 13

Table 1 Sociodemographic information of the participants

Variable Number Percentage (%)

Gender Male 12,217 53.2

Female 10,766 46.8
Place of origin Urban 13,721 59.7
Non-urban 9,262 40.3
Grade Freshman 12,633 55.0
Sophomore 5,789 25.2
Junior year 2,651 11.5
Senior year 794 3.5
Fifth year of college 30 0.1
Master 933 4.1
Doctor 153 0.6
Whether an only child Only son 12,077 52.5
Non-only child 10,906 47.5
Whether you hold a position in the university Student leaders (class/ student/society, etc.) 7,850 34.2
No job 13,922 60.6
Student leader in the past 1,211 5.2
Residential experience in middle and high school Yes 13,469 58.6
No 9,514 41.4
The highest level of education received by his or her parents Primary school and below 1,434 6.2
Junior high school 8,012 34.9
High school or technical secondary school 7,048 30.7
Junior college 2,526 11.0
Undergraduate 3,476 15.1
Master degree or above 487 2.1
Monthly living expenses(Yuan) < 1,000 1,409 6.1
1,000–1,500 9,755 42.4
1,500–2,000 8,121 35.3
2,500–3,000 2,655 11.6
> 3,000 1,043 4.6
The pressure of study and life in the past two months 1-Extremely little stressed 2,177 9.5
2-Very little stressed 4,217 18.3
3-Little stressed 8,363 36.4
4-Much stressed 6,122 26.6
5-Very much stressed 1,497 6.5
6-Extremely much stressed 607 2.7
The degree of interest in professional knowledge Very interested 5,014 21.8
Have interested 9,243 40.2
Generally 5,216 22.7
Less interest 3,019 13.1
No interest 491 2.2
Weekly exercise time (hours) 1 12,709 55.3
2 6,430 28.0
3 2,152 9.4
4 1,682 7.3
Smoking Smoking 979 4.3
Quit smoking 557 2.4
Never smoked 21,447 93.3
Liu et al. BMC Medical Education (2023) 23:317 Page 5 of 13

Table 1 (continued)
Variable Number Percentage (%)

Drinking Drinking 5,569 24.2

Quit drinking 986 4.3
Never drank 16,428 71.5
Overall satisfaction with study Very satisfied 3,569 15.5
Satisfied 9,077 39.5
Generally 8,823 38.4
Dissatisfied 1,196 5.2
Very dissatisfied 318 1.4
Sleep quality in the past two months Very bad 431 1.9
Pretty bad 1,696 7.4
Generally 7,728 33.6
Good 8,924 38.8
Very good 4,204 18.3

Table 2 Analysis of academic burnout degree

Score Burnout level N Percentage (%)

0–50 Good learning condition 9173 40.01

50–75 There is a certain degree of academic burnout 12,646 55.16
75–100 Academic burnout is relatively serious 813 3.55
More than 100 points Academic burnout is very serious 294 1.28

Comparison of reduced personal accomplishment scores campus for one month in middle and high school, had
with different demographic characteristics lower emotional exhaustion scores than other groups.
Table 3 shows score comparisons for students’ reduced Students whose parents had a master’s degree or above
personal accomplishment organized by demographic reported a monthly living cost of over 3,000 yuan,
characteristics. Students who drank and then chose to smoked and drank alcohol, and had higher emotional
abstain had lower reduced personal accomplishments exhaustion scores. The result of pairwise comparisons
than those who never drank. Higher parental educa- among different demographic variables in emotional
tion levels were associated with longer weekly exercise exhaustion dimension (seen in Additional file 2).
times, better quality sleep over the past two months,
more substantial overall satisfaction with learning and Comparison of cynicism scores with different demographic
life in general, and higher reduced personal accomplish- characteristics
ment scores. Students who were very interested in their Students whose parents’ highest level of education
current majors reported higher reduced personal accom- was primary school and lower, whose monthly living
plishment scores than other groups. The result of pair- expenses were less than 1,000 yuan, who exercised less
wise comparisons among different demographic variables than one hour per week, and who had quit smoking or
in reduced personal accomplishment dimension (seen in drinking scored higher on cynicism. See Table 5 for the
Additional file 1). other detailed results. The result of pairwise compari-
sons among different demographic variables in cynicism
dimension (seen in Additional file 3).
Comparison of emotional exhaustion scores with different
demographic characteristics Results of linear regression analysis of academic burnout
Table 4 lists the results of a comparison of emotional among students
exhaustion scores with different demographic charac- Table 6 displays that gender, grade, parents’ education,
teristics. Female students who served as student leaders, monthly living expenses, the degree of study and life
were in the first year, had siblings, and were not living on pressure experienced over the past two months, interest
Liu et al. BMC Medical Education (2023) 23:317 Page 6 of 13

Table 3 Comparison of reduced personal accomplishment scores with different demographic characteristics
Variable n Reduced t/F P Effect size
personal
accomplishment
scores
Mean SD

Gender Male 12,217 24.07 6.96 10.994 < 0.001 0.005

Female 10,766 23.13 6.02
Place of origin Urban 13,721 23.97 6.71 9.808 0.101 0.004
Non-urban 9,262 23.12 6.28
Grade Freshman 12,633 24.16 6.48 42.768 < 0.001 0.011
Sophomore 5,789 22.62 6.38
Junior year 2,651 23.38 7.15
Senior year 794 22.67 6.44
Fifth year of college 30 20.87 7.88
Master 933 24.14 6.02
Doctor 153 24.42 6.23
Whether an only child Only son 12,077 23.97 6.80 8.362 < 0.001 0.003
Non-only child 10,906 23.25 6.23
Whether you hold a position in the university Student leaders (class/ student/society, etc.) 7,850 24.49 6.55 10.974 < 0.001 0.009
No job 13,922 23.15 6.50
Student leader in the past 1,211 23.64 6.60
Residential experience in middle and high Yes 13,469 23.38 6.41 -6.756 < 0.001 0.002
school No 9,514 23.98 6.73
The highest level of education received by his Primary school and below 1,434 22.10 6.25 35.991 < 0.001 0.008
or her parents Junior high school 8,012 23.28 6.29
High school or technical secondary school 7,048 23.75 6.53
Junior college 2,526 23.91 6.66
Undergraduate 3,476 24.45 6.90
Master degree and above 487 24.78 7.44
Monthly living expenses(Yuan) < 1,000 1,409 23.66 6.97 8.058 < 0.001 0.001
1,000–1,500 9,755 23.40 6.42
1,500–2,000 8,121 23.67 6.47
2,500–3,000 2,655 24.17 6.56
> 3,000 1,043 23.98 7.61
The pressure of study and life in the past two 1-Extremely little stressed 2,177 23.66 6.97 8.058 < 0.001 0.066
months 2-Very little stressed 4,217 23.41 6.42
3-Little stressed 8,363 23.67 6.47
4-Much stressed 6,122 24.17 6.56
5-Very much stressed 1,497 23.98 7.61
6-Extremely much stressed 607 23.66 6.97
The degree of interest in professional knowl- Very interested 5,014 28.04 6.70 82.919 < 0.001 0.171
edge Have interested 9,243 23.80 5.68
Generally 5,216 20.82 5.57
Less interest 3,019 21.57 5.71
No interest 491 17.86 8.43
Weekly exercise time (hours) 1 12,709 22.49 6.26 39.629 < 0.001 0.049
2 6,430 24.28 6.20
3 2,152 25.71 6.64
4 1,692 27.03 7.63
Liu et al. BMC Medical Education (2023) 23:317 Page 7 of 13

Table 3 (continued)
Variable n Reduced t/F P Effect size
personal
accomplishment
scores
Mean SD

Smoking Smoking 979 23.41 7.37 0.0685 0.504 0.001

Quit smoking 557 23.50 6.94
Never smoked 21,447 23.64 6.50
Drinking Drinking 5,569 22.74 6.50 72.647 < 0.001 0.006
Quit drinking 986 23.27 6.93
Never drank 16,428 23.95 6.52
Overall satisfaction with study Very satisfied 3,569 29.62 6.63 82.594 < 0.001 0.0241
Satisfied 9,077 24.65 5.55
Generally 8,823 21.06 5.22
Dissatisfied 1,196 18.83 5.82
Very dissatisfied 318 16.76 9.83
Sleep quality in the past two months Very bad 431 20.08 8.51 50.018 < 0.001 0.080
Pretty bad 1,696 21.06 6.48
Generally 7,728 22.13 5.99
Good 8,924 24.08 5.95
Very good 4,204 26.83 7.11

in the current professional knowledge, sports, overall sat- Studies on the relationship between gender and aca-
isfaction with one’s studies and life influence student aca- demic burnout presented varied results [19–22]. Men
demic burnout. The adjusted r-square value is 0.108. had higher burnout scores across all dimensions than
women. This finding was inconsistent with the finding
Discussion that women had significantly higher burnout scores [23].
This cross-sectional study explored academic burnout The results of our study may reflect the differences in
levels and the factors influencing them among univer- gender roles and achievement motivation between men
sity students. Previous studies have shown that academic and women. In college, men frequently exhibit stronger
burnout presents a dilemma between not wanting to achievement expectations than women, a more robust
learn and not wanting to give up completely. Unlike sense of competition, and more intense achievement self-
learning boredom, academic burnout is reversible [14– evaluation. Thus, when men’s achievement expectations
16]. If detected and addressed promptly, burnout can are not met, they exhibit more negative emotions, avoid-
be relieved. Burnout reduction interventions can help ant behaviours, and a lower sense of achievement.
students embark on a path of enjoying learning from a In terms of grades, doctoral, master’s, and first-year
declining state of weariness. Therefore, research on aca- university students had higher levels of reduced personal
demic burnout is critical. accomplishment and lower emotional exhaustion and
cynicism scores. This result suggests that they have more
Analysis of academic burnout levels mental energy for learning. Freshmen who have just
We found that more than half of the college students who entered university have not fully adapted to life and stud-
participated in the survey had academic burnout: 55.16% ies at the university, so they maintain the same enthusi-
had mild burnout, 3.55% had serious burnout, and 1.28% asm for learning that they had in high school. At the same
had very serious burnout. Previous studies have shown time, they are full of expectations and have a longing for
that students with academic burnout accounted for university life. In a new learning environment, classmates
27% ~ 75% of all students [17, 18]. and teachers may inspire students to express themselves
Factors affecting academic burnout include gender, more effectively. From the perspective of the established
grade, parents’ education level, monthly living expenses, curriculum, many courses are available to freshmen.
the pressure of study and life in the past two months,the They are required to take basic public and professional
degree of interest in professional knowledge, smoking. courses. Therefore, they were not relaxed about their
Liu et al. BMC Medical Education (2023) 23:317 Page 8 of 13

Table 4 Comparison of emotional exhaustion scores with different demographic characteristics

Variable n Emotional t/F P Effect size
exhaustion
scores
Mean SD

Gender Male 12,217 11.28 6.39 2.367 0.018 0.001

Female 10,766 11.09 5.65
Place of origin Urban 13,721 11.18 6.23 -0.321 0.748 0.001
Non-urban 9,262 11.21 5.77
Grade Freshman 12,633 10.70 6.03 31.975 < 0.001 0.008
Sophomore 5,789 11.83 5.95
Junior year 2,651 11.79 6.37
Senior year 794 11.92 5.82
Fifth year of college 30 13.50 6.00
Master 933 11.40 5.66
Doctor 153 11.54 6.23
Whether an only child Only son 12,077 11.11 6.34 -2.132 0.033 0.001
Non-only child 10,906 11.28 5.72
Whether you hold a position in the university Student leaders (class/ student/society, etc.) 7,850 10.95 6.21 13.888 < 0.001 0.001
No job 13,922 11.27 5.94
Student leader in the past 1,211 11.81 6.18
Residential experience in middle and high school Yes 13,469 11.27 5.85 2.310 0.021 0.001
No 9,514 11.08 6.33
The highest level of education received by his or Primary school and below 1,434 11.29 5.64 1.328 < 0.001 0.001
her parents Junior high school 8,012 11.17 5.73
High school or technical secondary school 7,048 11.11 6.06
Junior college 2,526 11.13 6.18
Undergraduate 3,476 11.34 6.62
Master degree and above 487 11.62 7.12
Monthly living expenses(Yuan) < 1,000 1,409 11.59 6.31 3.828 0.004 0.001
1,000–1,500 9,755 11.11 5.84
1,500–2,000 8,121 11.16 6.02
2,500–3,000 2,655 11.19 6.35
> 3,000 1,043 11.69 6.99
The pressure of study and life in the past two 1-Extremely little stressed 2,177 7.59 7.30 9.084 < 0.001 0.114
months 2-Very little stressed 4,217 9.21 5.27
3-Little stressed 8,363 11.07 5.23
4-Much stressed 6,122 12.59 5.48
5-Very much stressed 1,497 14.56 6.07
6-Extremely much stressed 607 17.19 8.57
The degree of interest in professional knowledge Very interested 5,014 8.76 6.87 77.225 < 0.001 0.077
Have interested 9,243 10.82 5.40
Generally 5,216 12.91 5.29
Less interest 3,019 12.56 5.63
No interest 491 16.27 7.69
Weekly exercise time (hours) 1 12,709 11.82 5.76 15.841 < 0.001 0.015
2 6,430 10.69 5.92
3 2,152 10.09 6.19
4 1,692 9.79 7.68
Smoking Smoking 979 12.36 6.76 28.297 < 0.001 0.002
Quit smoking 557 12.22 6.68
Never smoked 21,447 11.11 5.99
Liu et al. BMC Medical Education (2023) 23:317 Page 9 of 13

Table 4 (continued)
Variable n Emotional t/F P Effect size
exhaustion
scores
Mean SD

Drinking Drinking 5,569 12.11 5.98 10.568 < 0.001 0.001

Quit drinking 986 11.98 6.46
Never drank 16,428 10.83 6.01
Overall satisfaction with study Very satisfied 3,569 8.06 7.42 73.342 < 0.001 0.113
Satisfied 9,077 10.17 5.31
Generally 8,823 12.83 5.12
Dissatisfied 1,196 14.52 5.90
Very dissatisfied 318 11.75 8.24
Sleep quality in the past two months Very bad 431 16.22 7.27 48.760 < 0.001 0.078
Pretty bad 1,696 13.99 5.69
Generally 7,728 12.47 5.44
Good 8,924 10.42 5.53
Very good 4,204 8.83 6.85

studies. Sophomore, junior, and senior students gradually social economy. The consumption of college students has
become familiar with the school environment after more subtly changed. To meet their growing material needs or
than one year of study, but they also found that the uni- for reasons of vanity and social comparisons, they form
versity is not as pleasant as they had imagined. Therefore, unhealthy consumption habits. Some college students
disappointment may be expressed emotionally. Some stu- exhibit serious excessive and advanced consumption
dents were disappointed with their school, while others which may lead to psychological problems [30, 31].
were dissatisfied with their studies and gradually shifted The work demand resource theory first pointed out
their interests to other areas. Some individuals exhibit that work resources can buffer the negative impact
destructive behaviours, skipping or not attending classes of work on stress [32]. Social support, autonomy, and
and not handing in assignments. The results of this study performance feedback can help employees cope with
are consistent with those of previous ones [24–26]. high work requirements and prevent burnout and
This study found that students who never smoke expe- other health problems. This suggests that we should
rienced a greater reduction in personal accomplishment. constantly improve the social support system of col-
Students who never smoke had significantly lower emo- lege students. Specifically, college students’ family
tional exhaustion and cynicism scores. College students members should try to maintain the stability of the
may choose to smoke when they encounter problems and family structure and good economic status. College
difficulties in their studies and daily lives. However, pro- students’ friends, counsellors, teachers, and others
longed smoke consumption causes psychological prob- should pay more attention to college students, form
lems and creates a vicious circle. Other studies have also interactive relationships, and enable them to obtain
confirmed this phenomenon [27–29]. spiritual and material support. Second, work-demand-
This study found that students with monthly living resource theory shows that employees who actively
expenses of 2500–3000 yuan had the highest levels of participate in work are motivated to maintain partici-
reduced personal accomplishment. Excessively high pation. In the context of college students when learn-
or low monthly living expenses can lead to emotional ing requirements become too high or they lack work
exhaustion and high cynicism scores. Students experi- resources, they should learn to use personal initiatives
encing poor economic conditions tend to have inferi- to change their environments. For example, they can
ority complexes. They may have more trouble meeting actively ask for feedback on their performance, vol-
academic expenses, leading to burnout. In contrast, stu- untarily participate in new projects, or strengthen
dents with monthly living expenses of more than 3000 their cooperation with others in a learning environ-
yuan respond to the rapid changes in contemporary soci- ment. By carefully designing their learning condi-
ety’s consumption structure with the development of the tions and improving their work needs and resources,
Liu et al. BMC Medical Education (2023) 23:317 Page 10 of 13

Table 5 Comparison of cynicism scores with different demographic characteristics

Variable n Cynicism scores t/F P Effect size

Mean SD

Gender Male 12,217 5.97 5.58 1.994 0.046 0.075

Female 10,766 5.75 4.99
Place of origin Urban 13,721 5.75 5.37 -5.652 0.068 0.001
Non-urban 9,262 6.15 5.21
Grade Freshman 12,633 5.29 5.12 69.612 < 0.001 0.018
Sophomore 5,789 6.70 5.37
Junior year 2,651 6.88 5.74
Senior year 794 6.54 5.19
Fifth year of college 30 8.23 5.26
Master 933 6.09 5.16
Doctor 153 5.56 5.26
Whether an only child Only son 12,077 5.76 5.43 -4.454 < 0.001 0.001
Non-only child 10,906 6.07 5.16
Whether you hold a position in the university Student leaders (class/ student/society, etc.) 7,850 5.47 5.22 44.807 < 0.001 0.004
No job 13,922 6.09 5.32
Student leader in the past 1,211 6.58 5.58
Residential experience in middle and high school Yes 13,469 6.08 5.27 5.896 0.115 0.002
No 9,514 5.66 5.36
The highest level of education received by his or her parents Primary school and below 1,434 6.65 5.22 7.853 < 0.001 0.002
Junior high school 8,012 5.97 5.12
High school or technical secondary school 7,048 5.84 5.32
Junior college 2,526 5.61 5.23
Undergraduate 3,476 5.84 5.70
Master degree and above 487 5.70 5.92
Monthly living expenses(Yuan) < 1,000 1,409 6.42 5.62 6.775 < 0.001 0.001
1,000–1,500 9,755 5.94 5.25
1,500–2,000 8,121 5.73 5.17
2,500–3,000 2,655 5.94 5.44
> 3,000 1,043 6.25 6.06
The pressure of study and life in the past two months 1-Extremely little stressed 2,177 3.61 5.73 8.301 < 0.001 0.077
2-Very little stressed 4,217 4.32 4.49
3-Little stressed 8,363 5.89 4.86
4-Much stressed 6,122 6.79 5.12
5-Very much stressed 1,497 8.19 5.68
6-Extremely much stressed 607 10.90 7.64
The degree of interest in professional knowledge Very interested 5,014 3.58 5.29 69.443 < 0.001 0.108
Have interested 9,243 5.35 4.75
Generally 5,216 7.98 4.97
Less interest 3,019 7.03 5.06
No interest 491 11.16 6.86
Weekly exercise time (hours) 1 12,709 6.46 5.22 10.670 < 0.001 0.014
2 6,430 5.34 5.06
3 2,152 4.89 5.20
4 1,692 5.19 6.40
Smoking Smoking 979 7.19 6.16 53.852 < 0.001 0.005
Quit smoking 557 7.38 6.13
Never smoked 21,447 5.81 55.23
Drinking Drinking 5,569 6.77 5.47 12.020 < 0.001 0.010
Quit drinking 986 6.72 5.59
Never drank 16,428 5.57 5.20
Liu et al. BMC Medical Education (2023) 23:317 Page 11 of 13

Table 5 (continued)
Variable n Cynicism scores t/F P Effect size

Mean SD

Overall satisfaction with study Very satisfied 3,569 3.47 5.76 37.909 < 0.001 0.127

Satisfied 9,077 4.68 4.54

Generally 8,823 7.49 4.89

Dissatisfied 1,196 9.25 5.03

Very dissatisfied 318 12.08 7.78

Sleep quality in the past two months Very bad 431 10.44 6.86 48.478 < 0.001 0.075
Pretty bad 1,696 8.11 5.29
Generally 7,728 7.11 5.18
Good 8,924 5.12 4.73
Very good 4,204 4.01 5.44

Table 6 Multiple linear regression analysis of risk factors for student academic burnout
Variable Dummy variable Nonstandardized Standard error Standardization Effect size t/F P Nonstandardized Coefficient
coefficient coefficient 95%CI

Lower limit Upper limit

Constant 44.75 0.93 47.99 < 0.001 42.93 46.58

Gender -1.21 0.19 -0.05 0.01 -6.50 < 0.001 -1.58 -0.85
Place of origin -0.26 0.20 -0.01 0.01 -1.33 0.19 -0.65 0.13
Grade Sophomore 1.14 0.21 0.04 0.01 5.48 < 0.001 0.74 1.55
Junior year 1.72 0.28 0.041 0.01 6.11 < 0.001 1.17 2.28
Senior year 0.46 0.48 0.01 0.01 0.95 0.34 -0.48 1.39
Fifth year of college -0.36 2.34 -0.00 0.01 -0.15 0.88 -4.94 4.22
Master 1.56 0.45 0.02 0.01 3.46 < 0.001 0.68 2.45
Doctor 0.38 1.05 0.00 0.01 0.36 0.72 -1.67 2.43
Whether an only child 0.20 0.19 0.01 0.01 1.04 0.30 -0.18 0.57
Whether you hold a Student leaders 0.29 0.19 0.01 0.01 1.58 0.12 -0.07 0.66
position in the (class/ student/
university society, etc.)
Student leader in 0.59 0.41 0.01 0.01 1.45 0.15 -0.21 1.39
the past
Residential experience in 0.09 0.18 0.00 0.01 0.48 0.63 -0.27 0.45
middle and high school
The highest level of 0.43 0.08 0.04 0.01 5.40 < 0.001 0.27 0.58
education received by
his or her parents
Monthly living 0.20 0.10 0.01 0.002 1.96 0.05 0 0.39
expenses(Yuan)
The pressure of study and 1.19 0.09 0.10 0.05 13.76 < 0.001 1.02 1.36
life in the past two months
The degree of interest in 0.26 0.09 0.02 0.01 2.81 0.01 0.08 0.44
professional knowledge
Weekly exercise time 0.51 0.10 0.04 0.01 5.18 0.11 0.32 0.74
(hours)
Smoking Smoking 1.08 0.44 0.02 0.01 2.44 0.02 0.21 1.94
Quit smoking 1.78 0.57 0.02 0.01 3.11 < 0.001 0.66 2.91
Drinking Drinking -0.30 0.44 -0.00 0.01 -0.67 0.50 -1.16 0.57
Quit drinking 4.13 0.11 0.28 0.01 37.69 0.00 3.92 4.35
Overall satisfaction with -1.17 0.12 -0.07 0.01 -9.58 < 0.001 -1.41 -0.93
study
Sleep quality in the past -0.01 0.11 -0.00 0.02 -0.08 0.93 -0.22 0.20
two months
Liu et al. BMC Medical Education (2023) 23:317 Page 12 of 13

they can create a better match between the people Acknowledgements

The authors wish to thank all the participants and collaborating universities for
and their environments. Third, the work demand- the work on this study.
resource-theory indicates that employees with high
work requirements may be exhausted and enter a loss Authors’ contributions
Z.L.and Y.X—Conceptualisation, Data curation, Investigation, Methodology,
cycle. This indicates that we should focus more on the Project administration, Visualisation, Writing—original draft, Writing—review
senior undergraduate group. They often have higher and editing, Z.S—Conceptualisation, Methodology, Project administration,
self-requirements and face heavier employment pres- Visualisation, Writing—original draft, Writing—review and editing, D.L.and
Y.H—Conceptualisation, Project administration, Visualisation, Supervision,
sures, making them more likely to accumulate fatigue Writing—original draft, Writing—review and editing, L.S.—Conceptualisation,
and lead to self-destructive behaviours such as making Visualisation, Writing—original draft, Writing—review and editing. All authors
mistakes, avoiding, and having conflicts with class- approved the final manuscript as submitted and agree to be accountable for
all aspects of the work. All authors participated in the revision of the manu-
mates. Society, schools, and parents should give them script and approved the final version.
more attention, resources, and support, which can
help them reduce academic burnout and pressure and Funding
This work was funded by the Heilongjiang Province economic and social
avoid self-destructive behaviours caused by high aca- development key research projects (22220), Heilongjiang province philoso-
demic burnout. phy and social science Research Planning project (22GLE375), Heilongjiang
Province education science planning key projects(GJB1423203),the Guang-
dong Basic and Applied Basic Research Foundation (2023A1515010902),
Project funded by China Postdoctoral Science Foundation (2021M701592),
Limitations the Directive Project of Medical Scientific Research Foundation in Guang-
Our study has some limitations. The cross-sectional dong (A2022379), National Nature Science Foundation of China (72104098),
Higher Education Teaching Reform Fund of Heilongjiang Province
design is a limitation of this study. However, we could (SJGSY2020021),and Ideological and Political Education for Postgraduates in
not establish a causal relationship among the identified Harbin Medical Universities (YJSSZKT2021-2HYD).
associations. Therefore, longitudinal studies are neces-
Availability of data and materials
sary to establish variables that show true causal rela- The data set used and/or analyzed in the current study may be obtained from
tionships with burnout syndrome in this population. the corresponding author upon reasonable request.
In addition, we used an Internet survey owing to the
COVID-19 pandemic. The reliability and validity of Declarations
the survey results may have been affected by partici-
Ethics approval and consent to participate
pants’ responses. Our study included college students All procedures involving human subjects will be approved by the Ethics
from Heilongjiang Province, and the overall sample Committee of Beijing Rehabilitation Hospital of Capital Medical University
size was large and representative. Therefore, a nation- (No.2020bkky LW010). We confirmed that all experiments and methods were
performed in accordance with relevant guidelines and regulations. The study
wide investigation should be conducted in the future. obtained the consent of all participants and signed an informed consent form
prior to the investigation.
Conclusions
Consent for publication
More than half the students that were part of the survey Not applicable.
had academic burnout. Several factors affect academic
burnout. Implementing an effective wellness program Competing interests
The authors declare that they have no competing interests.
may be sufficient to reduce student burnout. We rec-
ommend that all students undergo an annual long-term
burnout assessment to determine the effectiveness of the Received: 13 October 2022 Accepted: 3 May 2023
wellness program and modify it accordingly.

Abbreviation References
MBI-GS The Maslach Burnout Inventory General Survey 1. Freudenberger HJ. Staff burnout. J Soc Issues. 1974;30(1):159–65.
2. Jackson SE, Maslach C: Burnout in health professions: A social psychologi-
cal analysis. 1982.
Supplementary Information 3. Pines A, Kafry D: Tedium in College. 1980, 1(1):1.
The online version contains supplementary material available at https://​doi.​ 4. Meier ST, Schmeck RR. The burned-out college student: A descriptive
org/​10.​1186/​s12909-​023-​04316-y. profile. J Coll Stud Pers. 1985;26(1):63–9.
5. Schaufeli WB, Martinez IM, Pinto AM, Salanova M, Bakker AB. Burnout and
Additional file 1. The result of pairwise comparisons among different engagement in university students: A cross-national study. J Cross Cult
demographic variables in emotional exhaustion dimension. Psychol. 2002;33(5):464–81.
6. Yanghuizhen: A study on the factors influencing academic burnout and
Additional file 2. The result of pairwise comparisons among different
computer learning effectiveness of information management students.
demographic variables in cynicism dimension.
National Central University; 1998.
Additional file 3. The result of pairwise comparisons among different 7. Mar O, Co JAO, Assun CCAOH, Harju-Luukkainen H, Lin S, Sit P, Cheung
demographic variables in reduced personal accomplishment dimension. K, Maloa B, Ilic ISC, Smith TJ, Campos JA. Predictors of academic efficacy
Liu et al. BMC Medical Education (2023) 23:317 Page 13 of 13

and dropout intention in university students: Can engagement suppress 30. Liu H, Yansane AI, Zhang Y, Fu H, Hong N, Kalenderian E. Burnout and
burnout? PLoS ONE. 2020;15(10):e239816. study engagement among medical students at Sun Yat-sen University,
8. Al-Alawi M, Al-Sinawi H, Al-Qubtan A, Al-Lawati J, Al-Habsi A, Al-Shuraiqi China: A cross-sectional study. Medicine. 2018;97(15):e326.
M, Al-Adawi S, Panchatcharam SM. Prevalence and determinants of burn- 31. Rees CS, Heritage B, Osseiran-Moisson R, Chamberlain D, Cusack L, Ander-
out syndrome and depression among medical students at Sultan Qaboos son J, Terry V, Rogers C, Hemsworth D, Cross W, et al. Can we predict
University: a cross-sectional analytical study from Oman. Arch Environ burnout among student nurses? An exploration of the ICWR-1 model of
Occup Health. 2019;74(3):130–9. individual psychological resilience. Front Psychol. 2016;7:1072.
9. Wickramasinghe ND, Dissanayake DS, Abeywardena GS. Prevalence 32. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-
and correlates of burnout among collegiate cycle students in Sri resources model of burnout. J Appl Psychol. 2001;86(3):499–512.
Lanka: a school-based cross-sectional study. Child Adol Psych Men.
2018;12(1):1–11.
10. Ezeudu FO, Nwoji IHN, Dave-Ugwu PO, Abaeme DO, Ikegbunna NR, Publisher’s Note
Agugu CV, Muoneke MN, Alabi AO, Nwefuru BC. Intervention for burnout Springer Nature remains neutral with regard to jurisdictional claims in pub-
among chemistry education undergraduates in Nigeria. J Int Med Res. lished maps and institutional affiliations.
2020;48(1):1219667384.
11. Chunming WM, Harrison R, MacIntyre R, Travaglia J, Balasooriya C. Burn-
out in medical students: a systematic review of experiences in Chinese
medical schools. BMC Med Educ. 2017;17(1):1–11.
12. Lin S, Huang Y. Life stress and academic burnout. Act Learn High Educ.
2014;15(1):77–90.
13. Hu Q, Schaufeli WB. The factorial validity of the Maslach burnout inven-
tory–student survey in China. Psychol Rep. 2009;105(2):394–408.
14. Vizoso C, Arias-Gund I N O, Rodr I Guez C: Exploring coping and optimism
as predictors of academic burnout and performance among university
students. EDUC PSYCHOL-UK 2019, 39(6):768-783
15. Ye Y, Huang X, Liu Y: Social support and academic burnout among uni-
versity students: a moderated mediation model. PSYCHOL RES BEHAV MA
2021, 14(Mar 18):335.
16. Luo Y, Zhang H, Chen G: The impact of family environment on academic
burnout of middle school students: The moderating role of self-control.
CHILD YOUTH SERV REV 2020, 119(issue C):105482.
17. Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, burnout
and coping strategies in preclinical medical students. N Am J Med Sci.
2016;8(2):75.
18. Robinson GE: Stresses on women physicians: consequences and coping
techniques.|.*17*17.: Wiley Online Library; 2003:180–189.
19. Santen SA, Holt DB, Kemp JD, Hemphill RR. Burnout in medical stu-
dents: examining the prevalence and associated factors. South Med J.
2010;103(8):758–63.
20. Chang E, Eddins-Folensbee F, Coverdale J. Survey of the prevalence of
burnout, stress, depression, and the use of supports by medical students
at one school. Acad Psychiatr. 2012;36(3):177–82.
21. Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA,
Shanafelt TD. A Multicenter Study of Burnout, Depression, and Quality of
Life in Minority and Nonminority US Medical Students. Mayo Clin Proc.
2006;81(11):1435–42.
22. Isaksson Ro KE, Tyssen R, Hoffart A, Sexton H, Aasland OG, Gude T. A
three-year cohort study of the relationships between coping, job stress
and burnout after a counselling intervention for help-seeking physicians.
BMC Public Health. 2010;10(1):1–13.
23. Fu Ss I. N U Bling M, Hasselhorn H, Schwappach D, Rieger MA: Working
conditions and work-family conflict in German hospital physicians: psy-
chosocial and organisational predictors and consequences. BMC Public
Health. 2008;8(1):1–17.
24. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Durning
S, Moutier C, Szydlo DW, Novotny PJ, et al. Burnout and suicidal ideation
among US medical students. Ann Intern Med. 2008;149(5):334–41.
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25. Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric
morbidity in new medical graduates. Med J Aust. 2004;181(7):357–60.
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associated with burnout in Korean medical students. Psychiat Invest. • thorough peer review by experienced researchers in your field
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27. Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical
• support for research data, including large and complex data types
students. Med Educ Online. 2014;19(1):25209.
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man J, Federico B, Richter M, Kunst AE, Lorant V. Academic well-being and • maximum visibility for your research: over 100M website views per year
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Chinese college students: mediating effects of the dimensions of learn- Learn more biomedcentral.com/submissions
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