Crisis Line Operators Under Fire: What Lebanon’s 2024 War Revealed About Burnout on the Front Lines of Suicide Prevention

When war engulfed Lebanon in late 2024, the country’s national suicide prevention lifeline became something more than a mental health service: it was a psychological front line. While sirens sounded and displacement swept across communities, a small team of trained operators kept answering calls from people in acute distress, many of them contemplating ending their lives. A new study published in BMC Psychiatry has now provided one of the first systematic looks at what that sustained exposure did to the operators themselves, and the findings carry a message that reaches far beyond one small country.

The research, led by Dina Farran of Embrace, the organization that runs Lebanon’s National Lifeline, together with colleagues from the Lebanese Ministry of Public Health’s National Mental Health Programme, Vrije Universiteit Amsterdam, and other institutions, examined burnout among the hotline’s operators during the conflict period spanning September 2024 until the ceasefire. Burnout is not a vague feeling of tiredness; in occupational health research it is measured along three distinct dimensions captured by the Maslach Burnout Inventory-Human Services Survey: emotional exhaustion, the depletion of emotional resources; depersonalization, the development of detached, cynical responses toward the people one serves; and personal accomplishment, the sense of competence and meaningful achievement in one’s work, which tends to erode as burnout deepens.

The study design was a cross-sectional online survey conducted in February 2025, after the ceasefire had taken hold but while memories of the crisis period were fresh. All 96 operators who had been trained and remained active throughout the conflict were invited to participate, and 51 completed the survey, a response rate of 53.1 percent. That sample size is modest, and the authors are candid that the findings are exploratory, but the setting is extraordinarily rare: a national crisis line operating continuously while its country is under active bombardment, staffed largely by people who were themselves living through the same war as the callers they served.

The headline numbers are, in one sense, reassuring. Only nine of the 51 participants, or 17.6 percent, met criteria for burnout. Across the three dimensions, operators reported moderate levels of emotional exhaustion and moderate depersonalization, while their sense of personal accomplishment remained relatively preserved. For a workforce answering distress calls during airstrikes and mass displacement, that profile suggests a degree of resilience that the researchers attribute in part to the structures wrapped around the role. Yet moderate is not negligible, and the study’s real value lies in what predicted who fared worse and who fared better.

One individual-level factor stood out in the adjusted logistic regression models: concurrent employment. Operators who held an additional job alongside their Lifeline role showed higher emotional exhaustion. In Lebanon’s protracted economic crisis, where salaries in many sectors have collapsed, moonlighting is often a necessity rather than a choice, and the finding hints at a structural vulnerability. A crisis line operator who spends the day at another job and the night absorbing other people’s despair has little capacity left for recovery, and the exhaustion dimension of burnout is precisely the one most tightly linked to workload and insufficient recovery time.

More striking, the protective factors were overwhelmingly organizational and relational rather than personal. Satisfaction with the role itself, perceived organizational support, access to supervision, clear communication within the service, and opportunities for professional development were all associated with more favourable burnout indicators. In other words, the operators who weathered the war best were not necessarily those with unusual personal fortitude; they were those embedded in a system that supported them, communicated clearly, and invested in their growth. This aligns with a broad body of occupational health psychology research showing that organizational resources, often described under the umbrella of job demands-resources theory, buffer the strain of emotionally demanding work more reliably than individual coping strategies alone.

Supervision deserves particular attention. In crisis line practice, supervision is not a luxury; it is the mechanism through which operators process the emotional residue of difficult calls, receive feedback on their technique, and rehearse responses to situations they may face again. During the 2024 conflict, Lebanese operators were handling calls from people who were displaced, bereaved, or suicidal while rockets fell, and the study suggests that having a structured space to decompress and reflect was linked to better outcomes on the burnout measures. Perceived organizational support, the belief that the institution values one’s contribution and cares about one’s wellbeing, has repeatedly been shown in the literature to attenuate the link between job demands and exhaustion, and this study extends that evidence into the extreme context of armed conflict.

The authors were careful with their statistics. Because burnout was relatively uncommon in the sample, they ran sensitivity analyses using alternative burnout classifications and Firth penalized logistic regression, a technique designed to produce more stable estimates when outcome events are sparse and conventional maximum-likelihood models risk biased or inflated coefficients. The overall pattern of findings held up reasonably well, though some associations shifted depending on how burnout was operationally defined, a reminder that in small cross-sectional studies the details of measurement matter. The cross-sectional design itself imposes a further limit: the survey captured a single moment in time, so it cannot establish whether organizational support caused lower burnout or whether less burned-out operators simply perceived their organization more positively.

Even with those caveats, the implications for hotline practice are concrete. The study points to supervision, organizational support, communication processes, professional development opportunities, and operational flexibility as levers that crisis services can actually pull, particularly in low-resource and conflict-affected settings where the mental health workforce is thin and turnover would be catastrophic. Lebanon’s National Lifeline, launched under the National Mental Health Programme, has become a model for suicide prevention infrastructure in the region, and its operators’ experience during the war offers a template: protect the workforce with the same seriousness that the workforce protects the public. The authors call for longitudinal and intervention studies to test these associations directly, which would mean following hotline staff over time and evaluating whether strengthening supervision and support genuinely reduces burnout rather than merely correlating with it.

The broader resonance of the study lies in its timing and its setting. Suicide rates and psychological distress typically surge during armed conflict and humanitarian emergencies, which means crisis lines are often busiest exactly when their operators are most personally endangered and most personally distressed. The Lebanese findings suggest that the answer to that paradox is not to recruit tougher people but to build tougher systems: services that treat operator wellbeing as a core operational parameter rather than an afterthought. As conflicts and climate disasters multiply the demand for remote psychological crisis support worldwide, the quiet data from a Beirut hotline in February 2025 may prove to be a blueprint for keeping the people who answer the phone from burning out themselves.

Subject of Research: Burnout among suicide prevention hotline operators during the 2024 war in Lebanon

Article Title: Burnout indicators among operators of Lebanon’s national suicide prevention lifeline during the 2024 war: organizational correlates and implications for hotline practice

Article References: Farran, D., Haj, M. E., Chiha, G., Fouani, R. E., Ramia, J. A., Noun, P., Zeinoun, L., Atoui, M., & El Chammay, R. (2026). Burnout indicators among operators of Lebanon’s national suicide prevention lifeline during the 2024 war: organizational correlates and implications for hotline practice. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08591-z

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08591-z

Keywords: burnout, suicide prevention, crisis hotline, Lebanon, armed conflict, occupational health, mental health workforce, emotional exhaustion, organizational support, supervision, Maslach Burnout Inventory, BMC Psychiatry