• Atir Khan, Kevin Rh Teoh, Saiful Islam, and Juliet Hassard.
• Diabetes Centre, Glangwili Hospital, Hywel Dda University Health Board, Carmarthen, UK.
• BMJ Open. 2018 Jul 23; 8 (7): e018720.

ObjectivesThe objectives of this study are twofold. First, to examine the direct effect of psychosocial work characteristics (as measured by job autonomy and work-related pressure) in relation to self-reported psychological morbidity symptoms and early retirement intentions among a sample of hospital consultants in the National Health Service (NHS). Second, to investigate burnout as mediating variable (ie, indirect effect) of these postulated associations.DesignA cross-sectional observational study.Participants593 NHS consultants (male=63.1%) from hospitals in England, Scotland and Wales.MeasuresSelf-reported online questionnaires on work-related pressure and job autonomy (Job Demands-Resources Questionnaire); emotional exhaustion and depersonalisation (Maslach Burnout Inventory); depressive and anxiety symptoms (State Trait Personality Inventory) and a single-item on early retirement intention.ResultsThis study observed high prevalence rates across all adverse health measures: emotional exhaustion (38.7%), depersonalisation (20.7%), anxiety symptoms (43.1%) and depressive symptoms (36.1%). Multiple linear regressions examined the postulated direct and indirect effects. Job autonomy had significant negative direct effects on the frequency of NHS consultants' anxiety and depressive symptoms, and their intention to retire early. Both emotional exhaustion and depersonalisation mediated the relationships that work-related pressure (full mediation) and job autonomy (partial mediation) had with self-reported symptoms of psychological morbidities. Only emotional exhaustion mediated the relationships where early retirement intention was the outcome. In terms of sociodemographic factors, age and years' experience predicted both burnout dimensions and psychological morbidity.ConclusionsThis is the first study to observe job autonomy to be associated with the number of self-reported psychological morbidity symptoms and early retirement intentions in a sample of NHS consultants. Burnout dimensions mediated these relationships, indicating that interventions need to focus on enhancing working conditions and addressing burnout among NHS consultants before more severe symptoms of psychological morbidity are reported. This study has implications for NHS policy makers and senior leadership.© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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