Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons

When Low Leisure-Time Physical Activity Meets Unsatisfied Psychological Needs: Insights From a Stress-Buffer Perspective

Background: Few studies have tested whether the stress-buffering effects of leisure-time physical activity (LTPA) depend on other resources, such as the satisfaction of basic psychological needs. Therefore, the present study examines the interaction between perceived stress, LTPA and psychological need satisfaction (PNS) on occupational burnout symptoms in a sample of Swiss workers.

Methods: The sample consisted of 306 employees (48% women; M_age = 42.9 years, SD = 14.1). Perceived stress was assessed with the Perceived Stress Scale, LTPA with the International Physical Activity Questionnaire, PNS (autonomy, relatedness, and competence) with the Need Satisfaction Scale, and occupational burnout symptoms with the Shirom-Melamed Burnout Measure. A hierarchical regression analysis and single slopes tests were performed to examine two- and three-way interactions.

Results: Stress was positively correlated with burnout, and negatively correlated with LTPA and PNS levels. LTPA was positively associated with PNS, and negatively correlated with burnout. A negative association existed between PNS and burnout. In the hierarchical regression analysis, all main effects, two- and three-way interactions were significant. People who engaged in more LTPA reported fewer burnout symptoms, if they reported high stress. However, the potential of LTPA to buffer stress was particularly evident in participants who reported low PNS.

Conclusion: If adult workers are exposed to elevated stress, they are particularly likely to show increased burnout levels if they report low LTPA in combination with low PNS, specifically a lack of autonomy, competence and relatedness.

Combating toxic workplace environment

Purpose

Across the globe, every organization is striving to enhance the productivity and growth rate, but the prosperity and success of an organization is determined by the type of work environment in which it operates. To address this apprehension, this paper aims to determine the effect of toxic workplace environment on job stress that can badly affect the job productivity of an employee.

Design/methodology/approach

As an independent variable, toxic workplace environment was used as a complete spectrum consisting multiple dimensions named as workplace ostracism, workplace incivility, workplace harassment and workplace bullying. Job stress was used as a mediating variable between the spectrum of toxic workplace environment and job productivity. In this regard, self-administered close-ended questionnaire was used to collect the data from 267 employees of the health sector (HS) of Lahore region in Pakistan. For analysis purpose, we used confirmatory factor analysis to ensure the convergent and discriminant validity of the factors. AMOS 22 was used to check the direct and indirect effect of selected variables. Hayes mediation approach was used to check the mediating role of job stress between four dimensions of toxic workplace environment and job productivity.

Findings

The output demonstrated that the dimensions of toxic workplace environment have a negative significant relationship with job productivity, while job stress was proved as a statistical significant mediator between dimensions of toxic workplace environment and job productivity. Finally, we conclude that organizations need to combat/cleanse the roots of toxic workplace environment to ensure their prosperity and success.

Originality/value

This study aims to determine the effect of toxic workplace environment on job stress that can badly affect the job productivity of an employee. An empirical study in the context of the HS of Pakistan. This study, which is based on HS, has never been reported before in literature.

Psychometric properties of the Shirom-Melamed Burnout Measure (SMBM) among adolescents: results from three cross-sectional studies

BACKGROUND

Burnout has long been understood as work-related physical, emotional, and cognitive exhaustion. However, burnout symptoms can also be found among younger people, including school-aged adolescents. While the Shirom-Melamed Burnout Measure (SMBM) is a widely applied instrument, its psychometric properties have not yet been investigated in adolescent populations. We therefore examined the psychometric properties of the SMBM in three independent samples of adolescents.

METHODS

In total, 249 high school students, 144 vocational students, and 257 adolescent elite athletes completed the SMBM, along with questionnaires related to perceived stress, depressive symptoms, and life satisfaction. Descriptive statistics, gender differences, and internal consistency, convergent/discriminant validity, and factorial validity (including measurement invariance across genders) were examined in each sample.

RESULTS

The SMBM had adequate internal consistency. Confirmatory factor analyses showed that both a first- and second-order model achieve good model fit. Moreover, evidence for sufficient convergent and discriminant validity was found. Finally, in two of the three samples, female adolescents reported higher SMBM scores.

CONCLUSIONS

The SMBM has been widely used in international burnout research. However, this is the first study providing empirical evidence that the SMBM has acceptable psychometric properties and satisfactory convergent/discriminant and factorial validity among young people. The SMBM is a concise and economic tool to assess self-rated symptoms of burnout, and presents a valuable alternative to existing school burnout inventories. In particular, the SMBM can facilitate the investigation of the transition of young people from school to working life.

The relation between social capital and burnout: a longitudinal study

OBJECTIVES

Although social capital approach has showed its merits in predicting well-being and health in the working environment, studies examining the relation between social capital and burnout are scarce and limited to cross-sectional studies in the health care sector. This study aims to explore the longitudinal relationship between workplace social capital and burnout in a Belgian company in the energy sector. An additional aim was to assess whether the relation between workplace social capital and the dimensions of burnout was independent of job characteristics, i.e., the level of decision-making autonomy and task variety, and demographical variables.

METHODS

Analyses are conducted on the questionnaire data of 473 workers who participated at the two waves (2013 and 2014) of a longitudinal study.

RESULTS

The results showed a negative relation between social capital and distance and a positive relation between social capital and competence, after 1-year follow-up and after adjustments for baseline levels of the respective burnout dimension. In contrast with the literature, no relation between social capital and emotional exhaustion was found after adjustment for baseline level of emotional exhaustion. After additional adjustments were made for the job characteristics 'decision-making autonomy' and 'task variety', the relation between social capital and competence disappeared.

CONCLUSIONS

This study delivered evidence for the lagged relation between social capital and distance, even after controlling for demographical and job characteristics. Therefore, the findings suggest that organizations should pay attention to strategies enhancing social interaction, enabling to increase the levels of support, reciprocity, sharing and trust, in the prevention of burnout.

The Dresden Burnout Study: Protocol of a prospective cohort study for the bio-psychological investigation of burnout

OBJECTIVES

The Dresden Burnout Study (DBS) is a 12-year longitudinal cohort study that aims to provide a description of the burnout syndrome on the basis of time and symptom criteria with a special focus on the search for biomarkers. Biological and psychosocial approaches are applied to examine the long-term course and consequences of burnout within a population-based German-speaking sample aged 18 to 68 years.

METHODS

Demographics and psychosocial data are generated by online assessments, including demographics and questionnaires on burnout, burnout-related constructs, work-environment, and health-related factors. The lab-based biomarker assessment includes endocrine, physiological, immunological, and epigenetic markers obtained from blood and hair samples. In addition, heart rate variability is also measured repeatedly. Within the first 2 years, the DBS collected psychosocial data from over 7,600 participants with biological data obtained from more than 800 individuals. During the following 10 years, detailed assessments of biomarkers and psychosocial factors will be collected in annual study waves.

RESULTS

Results will be generated during the following decade.

CONCLUSION

The findings of the DBS are expected to pave the road for an in-depth biopsychosocial characterization of burnout and to give insight into the long-term course and potential mental and physical health consequences of the burnout syndrome.

Consequences of parental burnout: Its specific effect on child neglect and violence

Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. It encompasses three dimensions: an overwhelming exhaustion related to one's parental role, an emotional distancing from one's children and a sense of ineffectiveness in one's parental role. This study aims to facilitate further identification of the consequences of parental burnout for the parents themselves, their spouses and their child(ren). In a sample of 1551 parents, we examined the relationship between parental burnout and seven possible consequences: escapism and suicidal thoughts, addictions, sleep disorders, marital conflicts, a partner estrangement mindset, and neglect and violence towards one's child(ren). We examined (1) to what extent parental and job burnout related to each of these possible consequences and (2) whether parental burnout is specifically related to neglectful and violent behaviour towards one's child(ren). The results suggest that parental burnout has a statistically similar effect to job burnout on addictions and sleep problems, a stronger effect on couples' conflicts and partner estrangement mindset and a specific effect on child-related outcomes (neglect and violence) and escape and suicidal ideation. These results emphasize the importance of accurately diagnosing this syndrome.

More than a feeling: A unified view of stress measurement for population science

Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement.

Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies

Burnout is a syndrome that results from chronic stress at work, with several consequences to workers' well-being and health. This systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies. The PubMed, Science Direct, PsycInfo, SciELO, LILACS and Web of Science databases were searched without language or date restrictions. The Transparent Reporting of Systematic Reviews and Meta-Analyses guidelines were followed. Prospective studies that analyzed burnout as the exposure condition were included. Among the 993 articles initially identified, 61 fulfilled the inclusion criteria, and 36 were analyzed because they met three criteria that must be followed in prospective studies. Burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. The psychological effects were insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders and psychological ill-health symptoms. Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were identified as professional outcomes. Conflicting findings were observed. In conclusion, several prospective and high-quality studies showed physical, psychological and occupational consequences of job burnout. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.

Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes

BACKGROUND

Environmental and lifestyle changes, in addition to the ageing of populations, are generally believed to account for the rapid global increase in type 2 diabetes prevalence and incidence in recent decades.

DISCUSSION

In this review, we present a comprehensive overview of factors contributing to diabetes risk, including aspects of diet quality and quantity, little physical activity, increased monitor viewing time or sitting in general, exposure to noise or fine dust, short or disturbed sleep, smoking, stress and depression, and a low socioeconomic status. In general, these factors promote an increase in body mass index. Since loss of β-cell function is the ultimate cause of developing overt type 2 diabetes, environmental and lifestyle changes must have resulted in a higher risk of β-cell damage in those at genetic risk. Multiple mechanistic pathways may come into play.

CONCLUSIONS

Strategies of diabetes prevention should aim at promoting a 'diabetes-protective lifestyle' whilst simultaneously enhancing the resistance of the human organism to pro-diabetic environmental and lifestyle factors. More research on diabetes-protective mechanisms seems warranted.

Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes

BACKGROUND

Environmental and lifestyle changes, in addition to the ageing of populations, are generally believed to account for the rapid global increase in type 2 diabetes prevalence and incidence in recent decades.

DISCUSSION

In this review, we present a comprehensive overview of factors contributing to diabetes risk, including aspects of diet quality and quantity, little physical activity, increased monitor viewing time or sitting in general, exposure to noise or fine dust, short or disturbed sleep, smoking, stress and depression, and a low socioeconomic status. In general, these factors promote an increase in body mass index. Since loss of β-cell function is the ultimate cause of developing overt type 2 diabetes, environmental and lifestyle changes must have resulted in a higher risk of β-cell damage in those at genetic risk. Multiple mechanistic pathways may come into play.

CONCLUSIONS

Strategies of diabetes prevention should aim at promoting a 'diabetes-protective lifestyle' whilst simultaneously enhancing the resistance of the human organism to pro-diabetic environmental and lifestyle factors. More research on diabetes-protective mechanisms seems warranted.

Biometrics and Policing: A Protocol for Multichannel Sensor Data Collection and Exploratory Analysis of Contextualized Psychophysiological Response During Law Enforcement Operations

Background

Stress experienced by law enforcement officers is often extreme and is in many ways unique among professions. Although past research on officer stress is informative, it is limited, and most studies measure stress using self-report questionnaires or observational studies that have limited generalizability. We know of no research studies that have attempted to track direct physiological stress responses in high fidelity, especially within an operational police setting. The outcome of this project will have an impact on both practitioners and policing researchers. To do so, we will establish a capacity to obtain complex, multisensor data; process complex datasets; and establish the methods needed to conduct idiopathic clinical trials on behavioral interventions in similar contexts.

Objective

The objective of this pilot study is to demonstrate the practicality and utility of wrist-worn biometric sensor-based research in a law enforcement agency.

Methods

We will use nonprobability convenience-based sampling to recruit 2-3 participants from the police department in Durham, North Carolina, USA.

Results

Data collection was conducted in 2016. We will analyze data in early 2017 and disseminate our results via peer reviewed publications in late 2017.

Conclusions

We developed the Biometrics & Policing Demonstration project to provide a proof of concept on collecting biometric data in a law enforcement setting. This effort will enable us to (1) address the regulatory approvals needed to collect data, including human participant considerations, (2) demonstrate the ability to use biometric tracking technology in a policing setting, (3) link biometric data to law enforcement data, and (4) explore project results for law enforcement policy and training.

Reliability of Actigraphy and Subjective Sleep Measurements in Adults: The Design of Sleep Assessments

STUDY OBJECTIVES

The aim of the study was to investigate how many nights of measurement are needed for a reliable measure of sleep in a working population including adult women and men.

METHODS

In all, 54 individuals participated in the study. Sleep was assessed for 7 consecutive nights using actigraphy as an objective measure, and the Karolinska sleep diary for a subjective measure of quality. Using intra-class correlation and the Spearman-Brown formula, calculations of how many nights of measurements were required for a reliable measure were performed. Differences in reliability according to whether or not weekend measurements were included were investigated. Further, the correlation between objectively (actigraphy) measured sleep and subjectively measured sleep quality was studied over the different days of the week.

RESULTS/CONCLUSIONS

The results concerning actigraphy sleep measures suggest that data from at least 2 nights are to be recommended when assessing sleep percent and at least 5 nights when assessing sleep efficiency. For actigraphy-measured total sleep time, more than 7 nights are needed. At least 6 nights of measurements are required for a reliable measure of self-reported sleep. Fewer nights (days) are required if measurements include only week nights. Overall, there was a low correlation between the investigated actigraphy sleep parameters and subjective sleep quality, suggesting that the two methods of measurement capture different dimensions of sleep.

Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey

BACKGROUND AND OBJECTIVES

Excessive and prolonged work-related stress has always been a cause for burnout among healthcare professionals. This has led to emotional, mental, and physical exhaustion. This survey was conducted to assess the burnout among medical practitioners using the abbreviated Maslach Burnout Inventory (aMBI) and Burnout Clinical Subtype Questionnaire (BCSQ-12) scales.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 482 registered medical practitioners across India. A questionnaire consisting of 25 socio-demographic and occupational questions related to aMBI and BCSQ-12 scales was used to assess the burnout. The distribution of responses for each variable was examined using frequencies and percentages among the subgroups to find out the burnout levels of various components of the scales.

RESULTS

High burnout levels were uniformly recorded for the entire population. For the aMBI, 45.02% (n = 217) and 65.98% (n = 318) of the participants scored high on the emotional exhaustion and depersonalization scales, respectively, whereas 87.14% (n = 420) scored low on the personal accomplishment scale and 62.86% (n = 303) and 11.41% (n = 55) had medium and low scores on the satisfaction with the medical practice scale. The BCSQ-12 scale showed the mean values of 15.89, 11.56, and 10.28 on a scale of 28 for overload, lack of development, and neglect subtypes, respectively, whereas, satisfaction with the financial compensation item showed a mean value of 3.79 on a scale of seven. All these values indicate high levels of burnout.

CONCLUSION

The results suggest high levels of burnout in all domains of aMBI and BCSQ-12 scales in all the occupational and socio-demographic groups of medical practitioners and warrant immediate actions to address this issue.

Work Characteristics as Predictors of Correctional Supervisors' Health Outcomes

OBJECTIVE

This study examined associations among health behaviors, psychosocial work factors, and health status.

METHODS

Correctional supervisors (n = 157) completed a survey that assessed interpersonal and organizational views on health. Chi-square and logistic regressions were used to examine relationships among variables.

RESULTS

Respondents had a higher prevalence of obesity and comorbidities compared with the general US adult population. Burnout was significantly associated with nutrition, physical activity, sleep duration, sleep quality, diabetes, and anxiety/depression. Job meaning, job satisfaction, and workplace social support may predict health behaviors and outcomes.

CONCLUSIONS

Correctional supervisors are understudied and have poor overall health status. Improving health behaviors of middle-management employees may have a beneficial effect on the health of the entire workforce. This paper demonstrates the importance of psychosocial work factors that may contribute to health behaviors and outcomes.

Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout

BACKGROUND

Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions.

QUESTIONS/PURPOSES

We asked: (1) For surgeons treating musculoskeletal conditions, what risk factors are associated with worse job dissatisfaction? (2) What risk factors are associated with burnout symptoms?

METHODS

Two hundred ten (52% of all active members of the Science of Variation Group [SOVG]) surgeons who treat musculoskeletal conditions (94% orthopaedic surgeons and 6% trauma surgeons; in Europe, general trauma surgeons do most of the fracture surgery) completed the Global Job Satisfaction instrument, Shirom-Malamed Burnout Measure, and provided practice and surgeon characteristics. Most surgeons were male (193 surgeons, 92%) and most were academically employed (186 surgeons, 89%). Factors independently associated with job satisfaction and burnout were identified with multivariable analysis.

RESULTS

Greater symptoms of burnout (β, -7.13; standard error [SE], 0.75; 95% CI, -8.60 to -5.66; p < 0.001; adjusted R(2), 0.33) was the only factor independently associated with lower job satisfaction. Having children (β, -0.45; SE, 0.0.21; 95% CI, -0.85 to -0.043; p = 0.030; adjusted R(2), 0.046) was the only factor independently associated with fewer symptoms of burnout.

CONCLUSIONS

Among an active research group of largely academic surgeons treating musculoskeletal conditions, most are satisfied with their job. Efforts to limit burnout and job satisfaction by optimizing engagement in and deriving meaning from the work are effective in other settings and merit attention among surgeons.

LEVEL OF EVIDENCE

Level II, prognostic study.

Diabetes Risk Assessment of the UC Irvine Campus Population

Type 2 diabetes (T2D), historically affecting primarily older individuals, now affects younger people. Few studies have analyzed diabetes risk factors among younger individuals, including college students. We investigated risk in that overlooked population. A 2-part diabetes risk assessment survey was administered to University of California Irvine (UCI) students, faculty, and staff for 2 months. Part I, including 26 questions, assessed participants' nutrition, physical activity, and stress management behaviors. Part II assessed risk according to American Diabetes Association (ADA) Risk Assessment's 8 demographic and lifestyle questions producing a risk score. Scores and behavioral factors analyzed risk on individual and community levels. Recruitment included emails and flyers promoting the UCI Electronic Educational Environment survey link. According to the ADA Risk Assessment scores of the 915 respondents, only 4% are at high risk of developing T2D. Although these scores indicate a small population at risk, our survey revealed a high prevalence of individuals practicing multiple unhealthy lifestyle behaviors associated with diabetes. These multiple behaviors may lead to high percentages of college students developing T2D, despite current low ADA risk status. We conclude the ADA Risk Assessment is geared toward an older demographic and may reflect short-term risk rather than longer-term risks.

Job Burnout, Work Engagement and Self-reported Treatment for Health Conditions in South Africa

The purpose of the study being reported here was to investigate the relationship of job burnout and work engagement with self-reported received treatment for health conditions (cardiovascular condition, high cholesterol, depression, diabetes, hypertension and irritable bowel syndrome), while controlling for age, gender, smoking and alcohol use. The sample comprised 7895 employees from a broad range of economic sectors in the South African working population. A cross-sectional survey design was used for the study. Structural equation modelling methods were implemented with a weighted least squares approach. The results showed that job burnout had a positive relationship with self-reported received treatment for depression, diabetes, hypertension and irritable bowel syndrome. Work engagement did not have any significant negative or positive relationships with the treatment for these health conditions. The results of this study make stakeholders aware of the relationship between job burnout, work engagement and self-reported treatment for health conditions. Evidence for increased reporting of treatment for ill-health conditions due to burnout was found. Therefore, attempts should be made to manage job burnout to prevent ill-health outcomes.

Influence of clerks' personality on their burnout in the clinical workplace: a longitudinal observation

BACKGROUND

The clinical training of medical students in clerkship is crucial to their future practice in healthcare services. This study investigates burnout during a 2-year clerkship training period as well as the role of personality traits on burnout during training.

METHODS

Ninety-four clerks at a tertiary medical centre who provided at least 10 responses to a routine survey on clinical rotation were included in this study, which spanned September 2013 to April 2015. Web-based, validated, structured, self-administered questionnaires were used to evaluate the clerks' personalities at the beginning of the first clerkship year, and regular surveys were conducted to evaluate their burnout at each clinical specialty rotation throughout the 2-year clerkship period. Overall, 2230 responses were analysed, and linear mixed-effects models were used to examine the repeated measures of the clerks.

RESULTS

Our findings revealed that medical student burnout scores were lower in the second year than they were in the first year of clerkships. Using the Big Five personality factors, all of the propensities, namely extroversion, agreeableness, consciousness, emotional stability, and openness were related to different extents of burnout reduction in the first clerkship year (P < .05). However, only emotional stability and openness were related to clerks' reduced burnout in the second clerkship year. Furthermore, being female, older, and with accompanied living were more closely related to lower burnout compared with being male, younger, and living alone throughout the clerkship period.

CONCLUSIONS

The students in the first-year clerkship, particularly those with higher burnout levels, had tendencies in the Big Five personality characteristics, exhibiting higher levels of introversion, antagonism, lack of direction, neuroticism, and not open to new experiences. The students in the second-year clerkship who do not exhibit a high propensity for emotional stability and openness should be of particular concern. The findings can serve as a reference for clinical teachers and mentors to effectively prevent and reduce the burnout of medical students during clerkship training at clinical workplaces.

Poor structural social support is associated with an increased risk of Type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study

AIMS

Several psychosocial factors have been shown to increase the risk of Type 2 diabetes mellitus. This study investigated the association between structural social support and incidence of Type 2 diabetes mellitus in men and women.

METHODS

Data were derived from three population-based MONICA/KORA surveys conducted in 1984-1995 in the Augsburg region (southern Germany) and followed up by 2009. The study population comprised 8952 participants (4669 men/4283 women) aged 30-74 years without diabetes at baseline. Structural social support was assessed using the Social Network Index. Sex-specific hazard ratios were estimated from Cox proportional hazard models.

RESULTS

Within follow-up, 904 incident Type 2 diabetes mellitus cases (558 men, 346 women) were observed. Crude incidence rates for Type 2 diabetes mellitus per 10 000 person-years were substantially higher in poor compared with good structural social support (men: 94 vs. 69, women: 58 vs. 43). After adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, hypertension, dyslipidaemia, BMI, education, sleep complaints and depressed mood, risk of Type 2 diabetes mellitus for participants with poor compared with good structural social support was 1.31 [95% confidence interval (CI) = 1.11-1.55] in men and 1.10 (95% CI = 0.88-1.37) in women. Stratified analyses revealed a hazard ratio of 1.50 (95% CI = 1.23-1.83) in men with a low level of education and 0.87 (95% CI = 0.62-1.22) in men with a high level of education (P for interaction: 0.0082).

CONCLUSIONS

Poor structural social support is associated with Type 2 diabetes mellitus in men. This association is independent of risk factors at baseline and is particularly pronounced in men with a low level of education.

Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians

INTRODUCTION

Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices.

METHODS

In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed.

RESULTS

We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care.

CONCLUSION

A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.

Underlying spirituality and mental health: the role of burnout

OBJECTIVE

This study investigated the effects of burnout on the relationship between spirituality and mental health among healthcare workers in Hong Kong.

METHODS

Using a cross-sectional design, 312 healthcare workers (mean age=38.6, SD=9.9; 77.7% females) in a mental rehabilitation institution completed a self-administered questionnaire on anxiety, depression, burnout, and daily spiritual experiences. Multivariate regressions were used to test the effects of burnout on the relationships between daily spiritual experiences and anxiety and depression.

RESULTS

After adjusting for age, education level, marital status, and staff ranking, higher levels of daily spiritual experience were associated with lower levels of burnout (β=-0.22, p<0.01), depression (β=-0.68, p<0.01), and anxiety (β=-0.05, p<0.01). Burnout was found to have a significant partial mediating effect on the relationship between daily spiritual experiences and depression (z=-2.99, p<0.01), accounting for 37.8% of the variation in depression. Burnout also completely mediated the relationship between daily spiritual experiences and anxiety (z=-3.06, p<0.01), accounting for 73.9% of the variation in anxiety.

CONCLUSIONS

The results suggested that the association between spirituality and mental health is influenced by the level of burnout, thereby supporting the role of burnout as a potential mediator. Moreover, day-to-day spiritual practice was found to be potentially protective against burnout and mental health problems. Future interventions could incorporate spirituality training to reduce burnout so as to improve the well-being of healthcare workers.

Low Levels of Dehydroepiandrosterone Sulfate in Younger Burnout Patients

Objective

Dehydroepiandrosterone sulphate (DHEA-s) is an anabolic protective hormone of importance for maintenance of health. DHEA-s levels peak in young adults and decline thereafter with age. DHEA-s has previously been shown to be lower in individuals reporting prolonged stress. This study investigates DHEA-s levels in patients with clinical burnout, a disorder caused by long-term psychosocial stress.

Methods

122 patients (51% men) and 47 controls (51% men) in the age 25–54 years were included in the study. DHEA-s levels were compared between patients and controls in the whole sample and within each of the three 10-year-interval age groups.

Results

In the youngest age group (25–34 years), DHEA-s levels were on average 25% lower in the patients (p = 0.006). The differences in DHEA-s levels between patients and controls were more pronounced among female than male participants (on average 32% and 13% lower, respectively). There were no differences in DHEA-s levels between patients and controls in the age group 35–44 years (p = 0.927) or 45–54 years (p = 0.897) or when analyzing all age groups together (p = 0.187).

Conclusion

The study indicates that levels of the health promoting “youth” hormone DHEA-s are low in younger burnout patients. The fact that younger adults have much higher DHEA-s levels and more pronounced inter-subject variability in DHEA-s levels than older individuals might explain why burnout status differentiates patients from controls only among the youngest patients included in this study.

Indication of attenuated DHEA-s response during acute psychosocial stress in patients with clinical burnout

OBJECTIVE

Dehydroepiandrosterone sulphate (DHEA-s) is an anabolic protective hormone. We have previously reported that DHEA-s production capacity is attenuated in stressed individuals. The aim of the present study was to investigate the DHEA-s response during acute psychosocial stress in patients with clinical burnout.

METHODS

Seventeen patients with clinical burnout were compared to 13 non-chronically stressed healthy controls, aged 31-50 years (mean age 41 years, SD 6 years), as they underwent the Trier Social Stress Test (TSST). All patients fulfilled diagnostic criteria for stress-related exhaustion disorder, which is a criteria-based diagnosis that has been used in Sweden since 2005 to define patients seeking health-care for clinical burnout. Blood samples were collected before, directly after the stress test, and after 30 min of recovery. DHEA-s levels were measured and delta values (peak levels minus baseline levels) plus area under the curve with respect to increase (AUCI) were calculated.

RESULTS

The patients had 43% smaller AUCI DHEA-s (p=0.041) during the stress test. The delta DHEA-s was 34% lower in the patients, however, this difference was not statistically significant (p=0.054).

CONCLUSION

The study indicates that DHEA-s production capacity during acute stress may be attenuated in patients with clinical burnout. Reduced DHEA-s production may constitute one of the links between stress, burnout and the associated adverse health.

Work overload, burnout, and psychological ill-health symptoms: a three-wave mediation model of the employee health impairment process

BACKGROUND AND OBJECTIVES

The study reported here investigated the causal relationships in the health impairment process of employee well-being, and the mediating role of burnout in the relationship between work overload and psychological ill-health symptoms, over time. The research is deemed important due to the need for longitudinal evidence of the health impairment process of employee well-being over three waves of data.

DESIGN

A quantitative survey design was followed. Participants constituted a longitudinal sample of 370 participants, at three time points, after attrition.

METHODS

Descriptive statistics and structural equation modeling methods were implemented.

RESULTS

Work overload at time one predicted burnout at time two, and burnout at time two predicted psychological ill-health symptoms at time three. Indirect effects were found between work overload time one and psychological ill-health symptoms time three via burnout time two, and also between burnout time one and psychological ill-health symptoms time three, via burnout time two.

CONCLUSIONS

The results provided supportive evidence for an "indirect-only" mediation effect, for burnout's causal mediation mechanism in the health impairment process between work overload and psychological ill-health symptoms.

Burnout-depression overlap: a review

Whether burnout is a form of depression or a distinct phenomenon is an object of controversy. The aim of the present article was to provide an up-to-date review of the literature dedicated to the question of burnout-depression overlap. A systematic literature search was carried out in PubMed, PsycINFO, and IngentaConnect. A total of 92 studies were identified as informing the issue of burnout-depression overlap. The current state of the art suggests that the distinction between burnout and depression is conceptually fragile. It is notably unclear how the state of burnout (i.e., the end stage of the burnout process) is conceived to differ from clinical depression. Empirically, evidence for the distinctiveness of the burnout phenomenon has been inconsistent, with the most recent studies casting doubt on that distinctiveness. The absence of consensual diagnostic criteria for burnout and burnout research's insufficient consideration of the heterogeneity of depressive disorders constitute major obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the seminal, field-dominating definition of burnout is questioned. It is suggested that systematic clinical observation should be given a central place in future research on burnout-depression overlap.

Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Burnout and Hypocortisolism - A Matter of Severity? A Study on ACTH and Cortisol Responses to Acute Psychosocial Stress

BACKGROUND

Common consequences of long-term psychosocial stress are fatigue and burnout. It has been suggested that burnout could be associated with hypocortisolism, thus, inability to produce sufficient amounts of cortisol. This study aimed to investigate whether patients with clinical burnout exhibit aberrant ACTH and cortisol responses under acute psychosocial stress compared with healthy individuals.

METHODS

Nineteen patients (9 men and 10 women) and 37 healthy subjects (20 men and 17 women), underwent the Trier Social Stress Test. Blood samples and saliva samples were collected before, after, and during the stress test for measurements of plasma ACTH, serum cortisol, and salivary cortisol. Several statistical analyses were conducted to compare the responses between patients and controls. In addition, in order to investigate the possibility that burnout patients with more severe symptoms would respond differently, sub-groups of patients reporting higher and lower burnout scores were compared.

RESULTS

In both patients and healthy controls, we observed elevated levels of ACTH and cortisol after exposure to the stressor. There were no differences in responses of ACTH, serum cortisol, or salivary cortisol between patients and controls. Patients reporting higher burnout scores had lower salivary cortisol responses than controls, indicating that patients with more severe burnout symptoms may be suffering from hypocortisolism. In addition, patients with more severe burnout symptoms tended to have smaller ACTH responses than the other patients. However, there was no corresponding difference in serum cortisol.

CONCLUSION

This study indicates that hypocortisolism is not present in a clinical burnout patient group as a whole but may be present in the patients with more severe burnout symptoms.

Job strain as a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study

OBJECTIVE

To examine whether job strain is associated with an increased risk of subsequent Type 2 diabetes mellitus (T2DM) development in a population-based study of men and women.

METHODS

Data were derived from the prospective MONICA/KORA Augsburg study. We investigated 5337 working participants aged 29 to 66 years without diabetes at one of the three baseline surveys. Job strain was measured by the Karasek job content questionnaire. High job strain was defined by the quadrant approach, where high job demands combined with low job control were classified as high job strain. Continuous job strain (quotient of job demands divided by job control) was additionally analyzed as sensitivity analysis. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazards models with adjustment for age, sex, survey, socioeconomic and life-style variables, parental history of diabetes, and body mass index.

RESULTS

During a median follow-up of 12.7 years, 291 incident cases of T2DM were observed. The participants with high job strain at baseline had a 45% higher fully adjusted risk to develop T2DM than did those with low job strain (HR = 1.45 [95% confidence interval = 1.00-2.10], p = .048). On the continuous scale, more severe job strain in the magnitude of 1 standard deviation corresponded to a 12% increased fully adjusted T2DM risk (HR = 1.12 [95% confidence interval = 1.00-1.25], p = .045).

CONCLUSIONS

Men and women who experience high job strain are at higher risk for developing T2DM independently of traditional risk factors. Preventive strategies to combat the globally increasing T2DM epidemic should take into consideration the adverse effects of high strain in the work environment.

Work stress is associated with diabetes and prediabetes: cross-sectional results from the MIPH Industrial Cohort Studies

BACKGROUND

Diabetes is rapidly rising globally, and the relation of psychosocial stress in workplace to diabetes and prediabetes is not well investigated.

PURPOSE

The aim of the study was to examine the association of work stress with diabetes and prediabetes in a sample of German industrial workers.

METHOD

In this cross-sectional survey of an occupational cohort (n = 2,674, 77 % male), work stress was measured by the Effort-Reward Imbalance (ERI) Questionnaire. Diabetic status, i.e., diabetes and prediabetes, were diagnosed by glycated hemoglobin A1c criterion or fasting plasma glucose criterion supplemented by self-reports.

RESULTS

The overall prevalence rates of diabetes and prediabetes were 3.5 and 42.2 %, respectively. Using ordinal logistic regression with adjustment for potential confounding factors, high ERI at work was associated with diabetes-related ordinal variable (odds ratio [OR], 1.27; 95 % confidence interval [95 % CI], 1.02-1.58) and prediabetes-related ordinal variable (OR, 1.26; 95 % CI, 1.01-1.58) in men, whereas the associations in women were somewhat less pronounced and did not reach statistical significance.

CONCLUSION

The findings indicate that work stress in terms of ERI is associated with diabetes and prediabetes in German industrial male workers. If supported by prospective evidence, results point to a new approach towards primary prevention of diabetes.

Burnout is associated with elevated prolactin levels in men but not in women

OBJECTIVE

Prolactin levels have been shown to be increased by different types of psychosocial stress. Since burnout is a consequence of long-term psychosocial stress, prolactin levels might also be affected in burnout. The aim of this study was to investigate whether there are differences in prolactin levels between individuals who report burnout and others.

METHOD

Morning fasting serum prolactin levels were compared between individuals who reported burnout (24 men and 25 women) and individuals who reported no burnout (25 men and 13 women). Women were tested in the follicular phase of the menstrual cycle. Men and women were analysed separately.

RESULTS

Men who reported burnout exhibited significantly higher (34%) serum prolactin levels compared to men who reported no burnout. The prolactin levels in women who reported burnout were not different from the levels in the women who reported no burnout before or after adjusting for estradiol levels.

CONCLUSIONS

This study indicates that prolactin levels are higher in men with burnout than men without burnout but not affected in women with burnout. Why no association was seen in women needs to be further explored.

Behavioral contributions to the pathogenesis of type 2 diabetes

Behavioral contributions to the pathogenesis of prediabetes and Type 2 diabetes (T2D) include lifestyle behaviors including dietary intake, exercise, sedentariness, sleep, and stress. The purpose of this paper is to review evidence for the metabolic pathways by which the behavior is linked to T2D. Evidence for interventions, which change each of the lifestyle behaviors, is discussed. The article will close with a brief discussion on how new technologies may provide opportunities to better understand relationships between moment-to-moment fluctuations in behaviors and diabetes pathogenesis, as well as provide opportunities to personalize and adapt interventions to achieve successful behavior change and maintenance of that change. Especially promising are new technologies, which assist in tracking lifestyle behaviors along with clinical and metabolic outcomes.

Occupational burnout and severe injuries: an eight-year prospective cohort study among Finnish forest industry workers

OBJECTIVES

Burnout is a psychological consequence of prolonged work stress. Studies have shown that it is related to physical and mental disorders. The safety outcomes of burnout have been studied to a lesser extent and only in the work context. This study explored the effect of burnout on future severe injuries regardless of their context.

METHODS

A total of 10,062 forest industry employees (77% men, 63% manual workers) without previous injuries participated in 1996 or 2000 in the "Still Working" study examining the work-related antecedents of health and mortality. Burnout was assessed using the Maslach Burnout Inventory-General Survey. Injuries leading to death or hospitalization were regarded as severe. We extracted such injuries from independent national registers. The relationship between burnout and new injuries was analyzed using Cox proportional regression. The analyses were adjusted for age, sex, marital status, and occupational status.

RESULTS

There were 788 new injuries over eight years. Injuries were more common among male and manual workers. After adjustments, each one-unit increase in the burnout score was related to a 9% increase in the risk of injury (95% confidence interval: 1.2-1.17). Experiencing symptoms at least monthly was related to a 1.18-fold adjusted injury risk (95% CI: 1.2-1.36). Of the subscales of burnout, exhaustion and cynicism but not lack of professional efficacy predicted injuries after adjustments.

CONCLUSIONS

In addition to mental and physical disorders, burnout predicts severe injuries. Developing work conditions and optimizing workload may enhance safety and decrease health expenses related to all injuries.

Cardiorespiratory fitness protects against stress-related symptoms of burnout and depression

OBJECTIVE

To examine how cardiorespiratory fitness and self-perceived stress are associated with burnout and depression. To determine if any relationship between stress and burnout/depression is mitigated among participants with high fitness levels.

METHODS

197 participants (51% men, mean age=39.2 years) took part in the study. The Åstrand bicycle test was used to assess cardorespiratory fitness. Burnout was measured with the Shirom-Melamed Burnout Questionnaire (SMBQ), depressive symptoms with the Hospital Anxiety and Depression Scale (HAD-D). A gender-matched stratified sample was used to ensure that participants with varying stress levels were equally represented.

RESULTS

Participants with moderate and high fitness reported fewer symptoms of burnout and depression than participants with low fitness. Individuals with high stress who also had moderate or high fitness levels reported lower scores on the SMBQ Tension subscale and the HAD-D than individuals with high stress, but low fitness levels.

CONCLUSION

Better cardiovascular fitness seems to be associated with decreased symptoms of burnout and a better capacity to cope with stress.

PRACTICAL IMPLICATIONS

Promoting and measuring cardiorespiratory fitness can motivate employees to adopt a more physically active lifestyle and thus strengthen their ability to cope with stress exposure and stress-related disorders.

Psychosocial stress predicts abnormal glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

BACKGROUND

The evidence supporting a relationship between stress and diabetes has been inconsistent.

PURPOSE

This study examined the effects of stress on abnormal glucose metabolism, using a population-based sample of 3,759, with normoglycemia at baseline, from the Australian Diabetes, Obesity and Lifestyle study.

METHODS

Perceived stress and stressful life events were measured at baseline, with health behavior and anthropometric information also collected. Oral glucose tolerance tests were undertaken at baseline and 5-year follow-up. The primary outcome was the development of abnormal glucose metabolism (impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes), according to WHO 1999 criteria.

RESULTS

Perceived stress predicted incident abnormal glucose metabolism in women but not men, after multivariate adjustment. Life events showed an inconsistent relationship with abnormal glucose metabolism.

CONCLUSIONS

Perceived stress predicted abnormal glucose metabolism in women. Healthcare professionals should consider psychosocial adversity when assessing risk factor profiles for the development of diabetes.

Burnout and quality of life among Spanish healthcare personnel

The purpose of this study was to analyse the relationship between perceived quality of life and levels of burnout among healthcare personnel. A sample of 1095 participants (nurses, physicians, nursing assistants and orderlies) from five hospitals in the province of Girona (Spain) were studied (78% women, mean age=36.6 years, SD=8.8) using the 36-item short-form health questionnaire (SF-36) and the Maslach Burnout Inventory. The results showed that health-related quality of life reported by this sample of healthcare personnel was lower than the reference population values, especially in those SF-36 dimensions that comprise the mental component. In comparing the dimensions of the SF-36 by profession, we found that physicians had better perceived health in the dimensions of the physical component than nurses and other professionals (P< 0.01). No statistical differences were observed between profession and the dimensions of the mental component (P>0.05). Moreover, perceived health was worse among those that reported a high level on any of the components of burnout. These results should be taken account when designing a burnout prevention programme in the workplace.

The effects of exercise program on burnout and metabolic syndrome components in banking and insurance workers

To explore the effectiveness of exercise program for banking and insurance workers and clarify the association between exercise, burnout, and metabolic syndrome components. In the process of the study, a practicable worksite exercise program was developed for bank and insurance enterprises. A three-month (12-wk) exercise course was conducted, and its benefits evaluated. Levels of burnout and metabolic syndrome components were analyzed after exercise intervention. After intervention, the indicators of burnout and metabolic syndrome components were significantly improved in both low and high intensity groups, and the improvement were expressed in reduction of waist circumference, systolic blood pressure, person burnout and work-related burnout. A dose-response of burnouts and metabolic syndrome components with exercise intensity are shown (p<0.05). Metabolic syndrome components were independently associated with burnout and exercise intensity in the crude model. After adjustment for potential confounders, waist circumference and systolic blood pressure differences showed significant associations with exercise intensity (p<0.05). This study demonstrated an effective approach to worksite exercise intervention and exercise intensity played an important role to alleviate damage between burnouts and metabolic syndrome components.

Aerobic exercise training and burnout: a pilot study with male participants suffering from burnout

Background

Occupational burnout is associated with severe negative health effects. While stress management programs proved to have a positive influence on the well-being of patients suffering from burnout, it remains unclear whether aerobic exercise alleviates burnout severity and other parameters related to occupational burnout. Therefore, the main purpose of this study was to pilot-test the potential outcomes of a 12-week exercise training to generate hypotheses for future larger scale studies.

Methods

The sample consisted of 12 male participants scoring high on the MBI emotional exhaustion and depersonalization subscales. The training program took place in a private fitness center with a 17.5 kcal/kg minimum requirement of weekly energy expenditure.

Results

The key findings are that increased exercise reduced overall perceived stress as well as symptoms of burnout and depression. The magnitude of the effects was large, revealing changes of substantial practical relevance. Additionally, profiles of mood states improved considerably after single exercise sessions with a marked shift towards an iceberg profile.

Conclusion

Among burnout patients, the findings provide preliminary evidence that exercise has the potential to reduce stress and prevent the development of a deeper depression. This has important health implications given that burnout is considered an antecedent of depressive disorders.

Trial registration

ClinicalTrials.gov Identifier: ISRNCT01575743

Perceived stress symptoms in midlife predict disability in old age: a 28-year prospective cohort study

BACKGROUND

Stress has damaging effects on individual's health. However, information about the long-term consequences of mental stress is scarce.

METHODS

This 28-year prospective cohort study examined on the associations between midlife stress and old age disability among 2,994 Finnish municipal professionals aged 44-58 years at baseline. Self-reported stress symptoms were assessed at baseline in 1981 and 4 years later in 1985 and perceived disability in 2009. For the baseline data, principal component analysis was used for differentiation into stress symptom profiles. The regression coefficient estimates for self-care disability (activities of daily living) and instrumental activities of daily living disability were estimated using left-censored regression. The odds ratios for mobility limitation were estimated using logistic regression.

RESULTS

Four midlife stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. We saw a clear gradient of increasing disability severity in old age for increasing intensity of midlife stress symptoms. In comparison with the participants with no stress symptoms, the extensively adjusted left-censored and logistic regression models showed that in old age, disability scores were almost 2-4 units higher and risk for mobility limitation was 2-3 times higher for those with constant stress symptoms in midlife.

CONCLUSIONS

Among occupationally active 44- to 58-year-old men and women, perceived stress symptoms in midlife correlated with disability 28 years later. Stress symptoms may be the first signs of decompensation of individual functioning relative to environmental demands, which may later manifest in disabilities.

Investigating the reversed causality of engagement and burnout in job demands-resources theory

Orientation: Reversed causality is an area that has not commanded major attention within the South African context, specifically pertaining to engagement, burnout and job demands resources. Therefore, this necessitated an investigation to elucidate the potential effects.Research purpose: To investigate the reversed causal hypotheses of burnout and engagement in job demands-resources theory over time.Motivation for the study: Organisations and researchers should be made aware of the effects that burnout and engagement could have over time on resources and demands.Research design, approach and method: A longitudinal design was employed. The availability sample (n = 593) included participants from different demographic backgrounds. A survey was used to measure all constructs at both points in time. Structural equation modelling techniques were implemented with a categorical estimator to investigate the proposed hypotheses.Main findings: Burnout was found to have a significant negative longitudinal relationship with colleague support and supervisor support, whilst the negative relationship with supervisor support over time was more prominent. Engagement showed only one significant but small, negative relationship with supervisor support over time. All other relationships were statistically non-significant.Practical/managerial implications: This study makes organisations aware of the relationship between burnout and relationships at work over time. Proactive measures to promote relationships at work, specifically supervisor support, should be considered in addition to combatting burnout itself and promoting engagement.Contribution/value-add: This study provides insights and information on reversed causality, namely, the effects that engagement and burnout can have over time.

Quality of clinical supervision and counselor emotional exhaustion: the potential mediating roles of organizational and occupational commitment

Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships.

Workplace bullying influences women's engagement in the workforce

Workplace bullying creates hostile work environments, affects mental and physical health, and has social, economic, and career implications. Over 70% of targets of workplace bullying become unemployed either by losing their jobs or by leaving voluntarily. In a grounded theory study, we explored how experiencing workplace bullying and its health consequences affected 40 Canadian women. Further, I examined whether women stayed at or left workplaces after being bullied, how they left, and the influences on whether they stayed or left. Implications of this study are that bullied women and the organizations for which they work need to be assisted to manage this experience more effectively.