Innov Clin Neurosci. 2026;23(1–3):5–9.

Dear Editor:

We thank Sah and Kumbhalwar for their careful reading of our article, “Burnout and Ethical Awareness in Mental Health Professionals: A Correlational Study,”1 and for their constructive engagement with its findings. Their letter raises important methodological and interpretive points that extend scholarly discussion on burnout and ethical awareness within low-resource mental health contexts such as Pakistan.

Regarding sampling, we acknowledge the limitations inherent in purposive nonprobability methods, particularly with respect to generalizability. This approach was intentionally adopted to recruit mental health professionals with a minimum of 2 years of clinical experience in Lahore, Pakistan, where probability-based sampling is often constrained by fragmented service delivery systems and limited institutional access.2 Within these contextual constraints, this approach allowed for focused examination of an under-researched professional group. We agree that future studies incorporating multilevel or hierarchical analytic techniques would be well-positioned to account for institution-level effects and enhance generalizability across broader and nonurban clinical settings.

The authors also appropriately highlighted the potential influence of professional seniority and role autonomy when interpreting the inverse association between ethical awareness and burnout. Our sample included professionals from multiple disciplines, including psychiatrists, psychologists, couples and family therapists, and counselors. Age was examined as a correlational variable and demonstrated a consistent protective association with overall burnout and its dimensions (r=−0.22 to –0.19; P<0.001), consistent with prior evidence linking greater professional experience with reduced burnout risk.3 While ANOVA post-hoc analyses did not indicate statistically significant differences across professional roles, we concur that future research using larger, multisite samples and role-stratified multivariate analyses would more precisely clarify the contribution of professional position, autonomy, and decision-making latitude.

With respect to sector-based differences, we agree with the authors’ cautious interpretation of the small effect size observed between public and private sector professionals. Although exhaustion levels were significantly higher among those working in the public sector, the modest magnitude of this difference underscores the importance of nuanced interpretation. Rather than supporting binary policy interpretations, this finding highlights the need for context-sensitive interventions that address systemic stressors such as high caseloads, limited resources, and infrastructural constraints, which are particularly salient within public healthcare settings in Pakistan. In this context, ethics-informed training initiatives and complementary assessment tools, for example, instruments designed to capture ethical dilemma–related distress,4 may represent one potential component of broader organizational strategies aimed at mitigating professional burnout.

We appreciate the authors’ thoughtful critique and their recommendations for future research directions. Longitudinal designs, role-stratified analyses, and multilevel modeling would substantially advance understanding of the dynamic interplay between ethical awareness, professional context, and burnout. Importantly, within its stated methodological limits, the present study contributes initial empirical evidence linking ethical awareness with lower burnout across multiple domains among mental health professionals in Pakistan, an area in which systematic data remain limited.

We thank the authors for their valuable contribution to this scholarly exchange and welcome continued dialogue on strategies to promote the wellbeing and sustainability of the mental health workforce.

With regards,

Muqadas Fatima, MS, and Uzma Ilyas, PhD

Ms. Fatima is Lecturer at the National University of Modern Languages, Lahore, Pakistan. Dr. Ilyas is Senior Lecturer at Forman Christian College University, Lahore, Pakistan.

Funding/financial disclosures. The authors have no relevant conflicts of interest. No funding was received for the preparation of this letter.

Correspondence. Muqadas Fatima, MS

References

  1. Fatima M, Ilyas U. Burnout and ethical awareness in mental health professionals: a correlational study. Innov Clin Neurosci. 2025;22(7–9):24–27.
  2. Dayani K, Zia M, Qureshi O, et al. Evaluating Pakistan’s mental healthcare system using World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst. 2024;18(1):32.
  3. Sofology M, Efstratopoulou M, Dunn T. Predicting burnout syndrome in Greek mental health professionals. J Soc Serv Res. 2019;45(1):142–149.
  4. Fatima M, Ilyas U. Development of Ethical Dilemma Distress Scale for Mental Health Practitioners (EDDS-MHP). Pak J Psychol Res. 2024;39(3):613–637.