Objective: To propose and test psychometric models establishing direct, cross-lagged, and reciprocal longitudinal relationships between burnout, depression, and anxiety among occupational physicians during the COVID-19 pandemic. Methods: This one-year prospective cohort study used repeated online questionnaires at three time points (2020-2022). A convenience sample of occupational physicians was recruited through professional networks and scientific associations. Data collection included a sociodemographic questionnaire, the Stanford Professional Fulfillment Index (PFI), and the Depression, Anxiety, and Stress Scale (DASS-21). Path analysis using Reciprocal Cross-Lagged Panel Models (RCLPM) assessed dynamic, bidirectional relationships among psychological variables over time, controlling for age, sex, and years of practice. Three models were specified, each centered on burnout, anxiety, or depression, to determine the best fit to the data. Results: Of 540 participants, 124 completed all waves; 435 participated in wave 1, 220 in wave 2, and 265 in wave 3. Most participants were women, with similar age and experience across waves. Burnout declined from T1 to T2 and remained stable at T3. Depression and anxiety scores consistently decreased. All models revealed significant reciprocal cross-lagged effects, with feedback loops indicating mutual reinforcement. Anxiety emerged as particularly influential over time. Model fit indices confirmed model robustness, and stability indices suggested psychological stabilization over time. Conclusion: Burnout, depression, and anxiety are reciprocally interrelated and evolve dynamically among occupational physicians. Burnout appears central in these interactions. Findings highlight the need for integrated strategies addressing both individual and organizational contributors to mental distress, especially during crisis contexts such as the COVID-19 pandemic.

The authors have declared no competing interest.

This study was funded by CGP Brasil.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Human Research Ethics Committee of Sao Camilo University Center (Opinion 4,077,484/2020), with registration on the Brazil Platform (CAAE 31400620.0.0000.0062), gave ethical approval for this work

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All data produced in the present study are available upon reasonable request to the authors