Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions

Nutrition Strategies for Reducing Risk of Burnout Among Physicians and Health Care Professionals

Under typical circumstances, up to half of physicians, 31% of nurses who provide direct patient care, and 37% of nurses working in nursing homes experience burnout, and these rates are likely exacerbated following the Coronavirus disease 2019 pandemic. Diet is a mediating and modifiable factor with regard to burnout risk. Chronic stress, such as the stress experienced by individuals suffering from burnout, has been shown to influence the amounts and types of foods individuals eat, contributing both to excessive eating and undereating and the development of chronic diseases. Dietary strategies to mitigate burnout for physicians and health care professionals should be developed based on existing evidence related to nutrition and mental health, incorporate effective behavior change theory, and include systems-level change to promote healthy eating among health care professionals. Evidence supports the application of the Mediterranean diet, cognitive behavioral theory, and mindful eating interventions. Policy and systems approaches should support the availability of healthy foods at employer-sponsored events and eating outlets, worksite wellness, and nutrition education in medical training curriculum.

Wellness Services: A Need Assessment Survey for Post Graduate Medical Education Trainees at Aga Khan University Hospital, Pakistan

OBJECTIVE

The study aimed to assess the need of mental wellbeing services for post graduate medical (PGME) trainees working at the Aga Khan University Hospital in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted among all PGME trainees working at Aga Khan University Hospital in Karachi, Pakistan. The study questionnaire was developed by the team of investigators. The data collection was done through online survey from April 2019 to May 2019 and it was analyzed using descriptive and inferential analyses.

RESULTS

Out of total 623 PGME trainees, 334 trainees completed the online survey (response rate of 53.61%). A total of 292 participants (87.4%) perceived a need for mental health services. The major stressors identified were increase work hours (77.8%), excessive workload (75.1%), and difficulty balancing between work and personal life (72.8%). The perceived obstacles of utilizing mental services included lack of protected time (69.8%), fear of consequences (36.8%), lack of confidentiality (36.5%), and stigma (32.9%). The study participants indicated various suggestions to reduce their stressors such as separate relaxation space in hospital (91.3%), appreciation gestures like encouraging emails (65%), mentoring programs (43.4%), and regular surveys about resident needs (39.8%).

CONCLUSION

It is evident that innovative strategies to address trainees' mental health needs, looking at limitations of developing countries like Pakistan with large population and limited resources, need to be explored.

Burnout and resilience among Canadian palliative care physicians

Background

Physicians experience high rates of burnout, which may negatively impact patient care. Palliative care is an emotionally demanding specialty with high burnout rates reported in previous studies from other countries. We aimed to estimate the prevalence of burnout and degree of resilience among Canadian palliative care physicians and examine their associations with demographic and workplace factors in a national survey.

Methods

Physician members of the Canadian Society of Palliative Care Physicians and Société Québécoise des Médecins de Soins Palliatifs were invited to participate in an electronic survey about their demographic and practice arrangements and complete the Maslach Burnout Inventory for Medical Professionals (MBI-HSS (MP)), and Connor-Davidson Resilience Scale (CD-RISC). The association of categorical demographic and practice variables was examined in relation to burnout status, as defined by MBI-HSS (MP) score. In addition to bivariable analyses, a multivariable logistic regression analysis, reporting odds ratios (OR), was conducted. Mean CD-RISC score differences were examined in multivariable linear regression analysis.

Results

One hundred sixty five members (29%) completed the survey. On the MBI-HSS (MP), 36.4% of respondents reported high emotional exhaustion (EE), 15.1% reported high depersonalization (DP), and 7.9% reported low personal accomplishment (PA). Overall, 38.2% of respondents reported a high degree of burnout, based on having high EE or high DP. Median CD-RISC resilience score was 74, which falls in the 25th percentile of normative population. Age over 60 (OR = 0.05; CI, 0.01–0.38), compared to age ≤ 40, was independently associated with lower burnout. Mean CD-RISC resilience scores were lower in association with the presence of high burnout than when burnout was low (67.5 ± 11.8 vs 77.4 ± 11.2, respectively, p < 0.0001). Increased mean CD-RISC score differences (higher resilience) of 7.77 (95% CI, 1.97–13.57), 5.54 (CI, 0.81–10.28), and 8.26 (CI, 1.96–14.57) occurred in association with age > 60 as compared to ≤40, a predominantly palliative care focussed practice, and > 60 h worked per week as compared to ≤40 h worked, respectively.

Conclusions

One in three Canadian palliative care physicians demonstrate a high degree of burnout. Burnout prevention may benefit from increasing resilience skills on an individual level while also implementing systematic workplace interventions across organizational levels.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-020-00677-z.

Burnout in university faculty: An interaction between subjective sleep quality and the OXTR rs2268498 polymorphism

BACKGROUND

Job burnout is a stress-related syndrome influenced by both genetic and environmental factors. Poor sleep quality acting as a stressor may lead to job burnout. The oxytocin receptor gene (OXTR) related to stress reactivity may also exert an effect on job burnout. We aimed to explore the effect of sleep quality, a functional OXTR rs2268498 polymorphism, and their interaction on job burnout in the Chinese population, which has not been explored yet.

METHODS

A preliminary study was performed using a cross-sectional design. The Pittsburgh Sleep Quality Index (PSQI) and the Malash Burnout Inventory (MBI) were measured from 575 healthy subjects. The OXTR rs2468498 polymorphism was genotyped in 376 subjects.

RESULTS

There were significant main effects of sleep quality (p<0.05), but not of the OXTR rs2468498 genotype on burnout. Interestingly, the interaction between sleep quality and the rs2468498 genotype was significant (p<0.05). In the poor sleep group, the C allele (C/C and T/C) carriers showed higher Emotional Exhaustion level than T homozygotes, while in the good sleep group, the C allele carrier showed a lower Emotional Exhaustion level.

LIMITATIONS

This study covered subjects from only one university and the sample size for genotyping was relatively small. As we analyzed only the OXTR rs2268498 polymorphism, this study could not reveal the effects of the cerebrospinal oxytocin concentration and the haplotypes.

CONCLUSIONS

Our findings suggest that the OXTR polymorphism modulates the influence of subjective sleep quality on burnout. We conclude that the C allele of the OXTR rs2468498 polymorphism plays a susceptible role in job burnout.

Burnout syndrome and metabolic syndrome: a cross-sectional population-based study

In the population of Primary Health Care Nursing (PHC) professionals, the association between Burnout Syndrome (BS) and Metabolic Syndrome (MS) has not been investigated. The objective was to evaluate the association between BS and MS among PHC Nursing Professionals. A cross-sectional, multicenter, population-based study was conducted in the state of Bahia, Brazil, with 1,125 professionals. The prevalence of BS and MS corresponded to 18.3% and 24.4%, respectively. The prevalence in women of BS was 16.4% and of MS 23.7%, in men 31.6% for BS and 29.4% for MS. Men with BS are 3.23 times more likely to develop MS, and women 1.48 times more. BS was associated between men and women and exhibited a good discriminatory predictive power.

Facing a blind alley - Experiences of stress-related exhaustion: a qualitative study

INTRODUCTION

Mental illness is a major concern in many countries. In Sweden, stress-related mental illness is currently the most frequent reason for sick leave.

OBJECTIVE

This study aimed to explore patients' experiences of stress-related exhaustion.

DESIGN

A qualitative study with interview data analysed using a phenomenological hermeneutic method.

SETTING

Participants were selected from public primary healthcare centres in a larger city in western Sweden.

PARTICIPANTS

Seven women and five men on sick leave from work due to stress-related exhaustion were included in the study.

FINDINGS

Stress-related exhaustion was experienced as a loss of access to oneself and one's context and feelings of being trapped and lost in life. The condition had a significant impact on personal identity, raised existential issues and was interpreted as facing a blind alley. Participants described a mistaken direction in life, being forced to stop, change direction and act differently.

CONCLUSION

Stress-related exhaustion is a challenging, life-changing existential experience that involves a crisis with an opportunity for new insights. Careful consideration of patients' narratives together with the expertise of healthcare professionals can be combined to improve health and optimise recovery based on individual's situation.

Oncology Residency-a Burning Issue, Results of a Questionnaire-Based Survey on Psychological Well-being of Oncology Residents

Residency, in particular oncology residency, is a challenging time with extensive academic demands, long working hours, and uncertainty about the future. Our study aimed to evaluate the prevalence and factors associated with burnout, anxiety and depression among oncology residents at a tertiary cancer centre. An anonymised questionnaire-based study was conducted among medical, surgical, paediatric and radiation oncology resident doctors at a tertiary cancer centre in April 2019. We used Copenhagen Burnout Index (CBI) to assess burnout (which includes personal, work-related and patient-related burnout), Patient Health Questionnaire (PHQ9) for depression and Generalised Anxiety Disorder (GAD7) for anxiety. The questionnaire was served to 201 residents. The overall response rate was 70.6%. High personal, work-related and patient-related burnout was identified in 71.1%, 67.6% and 23.2% of the respondents respectively. Medical oncology residents had the highest rate of personal and work-related burnout (95% and 85%) while head and neck oncology residents had the highest rate of patient-related burnout (33.3%). 27.5% of participants were found to have high levels of anxiety on the GAD7 while 14.8% of participants were detected to have a high score on the PHQ9 for depression. High personal burnout and work-related burnout were associated with both high anxiety and depression scores (p < 0.05). There is a high prevalence of burnout, depression and anxiety among oncology residents. With an expected rise in cancer burden in the next decade, psychological issues in caregivers can be expected to increase. Further studies will be needed to determine interventions to reduce psychological distress.

The Effect of Inquiry-Based Stress Reduction on Teacher Burnout: A Controlled Trial

Burnout is a well-known phenomenon with significant social, biological and economic costs. In particular, teacher burnout is associated with unfavorable mental health outcomes and economic costs due to reduced hours and teacher turnover. This study investigated the effect of an Inquiry-Based Stress Reduction (IBSR) cognitive-reframing program on teacher burnout using a quasi-experimental design. Fifty-three teachers participated in a prospective intervention with a passive control group. The intervention group completed a 12-week IBSR program with 4.5 h of weekly engagement. Relative to control, teachers in the intervention group showed greater improvements in emotional exhaustion (18.8 ± 5.2 to 15.9 ± 5.7 vs. 16.0 ± 4.8 to 17.4 ± 4.8; p = 0.01) and personal accomplishment (21.8 ± 5.0 to 24.6 ± 4.3 vs. 21.9 ± 4.5 to 22.8 ± 4.3; p = 0.04). Significant correlations were found between change in emotional exhaustion and negative affect (positive correlation; r = 0.32; p = 0.034) and between personal accomplishment and perceived stress (negative correlation; r = −0.451; p = 0.002). This study demonstrates the potential of IBSR to improve teacher well-being. Future randomized studies are needed to evaluate the causality of IBSR in reducing burnout among teachers and other high-stress workplaces.

Burnout, but not job strain, is associated with irritable bowel syndrome in working adults

OBJECTIVE

Although stress is an important component of irritable bowel syndrome (IBS) pathophysiology, the possibility that work-related stress is implicated in the pathophysiology of IBS has not been widely studied. This study aimed to examine whether job strain (a combination of high job demands and low control at work) and/or burnout, the outcome of a gradual depletion of energetic resources resulting from chronic exposure to work-related stress, are associated with IBS.

METHODS

Fifty-five patients fulfilling the Rome III criteria for IBS and 214 matched healthy controls (HC) participated in this cross-sectional study. All participants completed a job strain measure, the Shirom - Melamed Burnout Measure (SMBM), and dietary and health questionnaires.

RESULTS

There was no significant difference in the prevalence of job strain between IBS patients and HC (25.5% vs. 23.0%, respectively). Job strain was not associated with increased IBS prevalence (adjusted OR = 1.99, 95% CI: 0.54-7.33). In contrast, the mean burnout score in the IBS group was significantly higher than in HC (2.9 ± 1.1 vs. 2.1 ± 0.8, p < .001). Burnout was associated with a 2.41-fold elevated prevalence of IBS (95% CI: 1.16-5.02), after adjusting for potential confounding variables including job strain. Moreover, the odds of having IBS increased in patients with a high burnout level (adjusted OR = 3.3, 95% CI:1.09-10.03).

CONCLUSION

Burnout, but not job strain, is associated with the prevalence of IBS in working adults.

Enhancing Engagement through Job Resources: The Moderating Role of Affective Commitment

Research has shown that affective commitment, one of three components of organizational commitment defined by Meyer and Allen (1991), can act as a moderator in relationships between job stressors and worker´s psychological tension. However, due to the scarcity of studies that investigate the moderating effect of this commitment component on relationships between positive variables, the purpose of this study is to examine the moderating role of affective commitment in the relationship between autonomy, peer support, supervisory support and perceived organizational support (POS), as job resources, on engagement. In this sense, we analyzed the data provided by a sample of Portuguese employees (N = 554), from an organization belonging to the consultancy sector. Firstly, we aimed to examine the direct effects of those job resources on engagement, and, then, examine the impact of affective commitment as a moderator on these relationships. The results partially support the hypotheses formulated. Indeed, there was a positive relationship between the job resources studied - work autonomy, peer support, supervisory support and POS - and engagement. Furthermore, according to our hypothesis, the interaction established between affective commitment and autonomy, significantly exacerbates the positive effect of this job resource on workers well-being, that is, on their engagement (b = .08, p < .05). However, contrary to our hypothesis, the affective commitment does not moderate the relationship between the other job resources and engagement. This study contributes to a deepest knowledge about the potentialities of affective commitment, reinforcing the importance of consider it as a contextual resource.

Burnout syndrome among psychiatrists in Egyptian mental health hospital

Background

Burnout is a special type of work-related stress—a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity (Lancet 388:2272-2281, 2016).

Burnout is a syndrome of state of emotional exhaustion, depersonalization, and feelings of low personal accomplishment (Maslach C and Jackson S, Maslach burnout inventory manual, 1986).

Burnout syndrome leads to severe problems. It may cause psychosomatic problems, family and marital conflicts, and substance misuse and also may result in complications such as late coming and early leaving of employees, quitting, having frequent medical reports, and the lack of productive and constructive ideas and criticism in the occupational settings (Sayil et al, Kriz Dergisi, Cilt 5, Say 1:2 ss.71-77, 1997).

So, we aimed to estimate the rate of occurrence of burnout among a sample of psychiatrists in one of the governmental psychiatric hospitals in Egypt.

Results

Result shows that 56.2% of study sample were males and 43.8% were females. Their mean age was 32 ± 6, and 57.5% were married and 42.5% were single. Mean score of emotional exhaustion was 28.25 ± 10.45 (high). Mean score of depersonalization was 8.5 ± 6.1 (moderate). Mean score of personal accomplishment was 31.78 ± 8.5 (low)

Conclusion

Burnout rate among psychiatrists of Al-Abbassia Hospital is higher than in western countries. Marriage and sleeping in home have protective effects. There is a significant association between high number of working hours per week and quality of the relationship with seniors and burnout.

Combining Associations Between Emotional Intelligence, Work Motivation, and Organizational Justice With Counterproductive Work Behavior: A Profile Analysis via Multidimensional Scaling (PAMS) Approach

The need for better incorporation of the construct emotional intelligence (EI) into counterproductive work behavior (CWB) research may be achieved via a unified conceptual framework. Accordingly, the purpose of this paper is to use the Profile Analysis via Multidimensional Scaling (PAMS) approach, and a conceptual framework that unifies motivational process with antecedents and outcomes, to assess differences in EI concerning a variety of constructs: organizational justice, CWB, emotional exhaustion, job satisfaction, and intrinsic motivation. Employing established scales within a framework unifying CWB, intrinsic motivation, EI, organizational justice, and outcome constructs, two EI-based profiles displayed associations with CWB based on responses from 3,293 employees. Both the first core profile, high overall justice and low emotional intelligence, and the second core profile, high emotional intelligence and low work motivation, displayed associations with interpersonal deviance and organizational deviance, as well as emotional exhaustion and job satisfaction. The results are discussed with respect to possible underlying theory and an overarching unified motivation framework that incorporates goal choice, intrinsic motivation, antecedents, and outcomes. We also provide directions for future research and implications for managers in the workplace based on heuristic conceptual frameworks that combine multiple motivational perspectives into a unified model.

Social Stigma during COVID-19 and its Impact on HCWs Outcomes

The COVID-19 emergency has significantly transformed the working environment and job demands. Providing care was emotionally difficult for healthcare workers. Uncertainty, stigmatisation, and potentially exposing their families to infection were prominent themes for healthcare workers (HCWs) during the crisis, which first broke out in China at the end of 2019, and then in Italy in early 2020. This study examined the effects of stigma, job demands, and self-esteem, and the consequences of working as a “frontline care provider” with patients infected with the coronavirus (COVID-19). A correlational design study involved 260 healthcare workers (HCWs) working in a large hospital in southern Italy. The following questionnaires were administered: (1) the Job Content Questionnaire (JCQ), for assessing psychological and physical demands; (2) the Professional Quality of Life Scale (ProQOL) to measure the quality individuals feel in relation to their work as “frontline care providers”, through three dimensions: compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS); (3) the Rosenberg Self-Esteem Scale, for evaluating individual self-esteem; (4) a self-administered multiple-choice questionnaire developed by See et al. about attitudes of discrimination, acceptance, and fear towards HCWs exposed to COVID-19. The findings suggest that stigma has a high impact on workers’ outcomes. Stigma may influence worker compliance and can guide management communication strategies relating to pandemic risk for HCWs.

Physician Well-Being

Burnout is a work-related condition. Although stress may be a part of emergency medicine, excessive levels of chronic stress can lead to maladaptive behaviors and burnout. Burnout can lead to decreased physician longevity and performance and poorer patient outcomes. The first step is recognizing burnout in providers. Efforts can then be made to identify modifiable or unnecessary sources of stress to help reduce chronic stress and burnout. Solutions should be found to eliminate or ameliorate individual-level and system-level sources of stress.

Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain

Background

To investigate the development of pain intensity and pressure pain thresholds during and 24 h after a light dynamic physical load among patients with chronic neck-shoulder pain.

Methods

Twenty-six patients with chronic neck-shoulder pain and 12 healthy controls were included. The participants arm-cycled on an ergometer. Effort was rated with the Borg Rating of Perceived Exertion scale (RPE), and pain intensity with an numeric rating scale (NRS). Pressure pain thresholds were measured by an algometer. Participants started a pain diary 1 week before the physical exercise and continued until 1 week after. Pain intensity was assessed before, during and the following two evenings after arm-cycling. Pressure pain thresholds were assessed before, 15 min after, 105 min after and 24 h after.

Results

The chronic pain group showed increased pain intensity during, and the following two evenings after the arm cycling, and decreased pain thresholds immediately after the arm cycling involving painful regions. In the patient group there were no impact on pain thresholds in the neck the following day.

Conclusions

Patients with chronic neck-shoulder pain reported increased pain intensity during and in the evenings after a light dynamic load involving painful regions. In addition, they showed decreased pain thresholds close to the exercise, indicating mechanical hyperalgesia.

The Measurement of Orthopaedic Surgeon Burnout Using a Validated Wearable Device

Purpose

The purpose of this study was (1) to determine the prevalence of burnout in orthopaedic surgeons and (2) to determine whether there is an association or correlation between subject-specific variables (age, attending physician, resident, postgraduate year level, gender, number of calls, total hours worked, and total hours of sleep) and burnout.

Methods

Surgeons were prospectively enrolled and provided with a validated wearable device. Subject-specific variables were recorded. Participants completed the Maslach Burnout Inventory and Patient-Reported Outcomes Measurement Information System (PROMIS-29) weekly. Burnout and burnout risk were defined. Multivariate analysis and bivariate correlations were used to determine the association and correlation between subject-specific variables and burnout. Residents were compared to attending surgeons.

Results

Of the 26 enrolled subjects, 21 (15 males, 6 females; mean age 37.2 ± 10.9) completed the 4-week study. Residents worked significantly more hours per week than attending surgeons (68.5 ± 15.2 versus 49.9 ± 7.5, P = 0.009). Of the orthopaedic surgeons, 6 (28.6%) experienced burnout, and 7 (33.3%) orthopaedic surgeons were at risk for burnout. There was no significant difference in burnout rates between residents and attending surgeons (P > 0.05). The number of overnight calls was significantly correlated with increased burnout (r = 0.435, P = 0.049). Female gender was significantly associated (P = 0.041) and correlated (r = 0.558, P = 0.009) with burnout. There was no significant association with burnout between the number of hours worked and hours of sleep.

Conclusions

The rate of burnout was less than 50% among orthopaedic surgeons. The number of overnight calls and female gender are significantly correlated with increased burnout. There was no significant correlation between hours worked and hours of sleep in surgeon burnout.

Clinical Relevance

Burnout is an increasingly common problem among orthopaedic surgeons, and it can have significant negative effects on surgeons' health and patients' outcomes. Identifying the predictors of burnout would allow surgeons to address these risk factors and reduce burnout.

Chronic diseases, age and gender: examining the contribution to burnout symptoms in a sample of 2075 Canadian workers

PURPOSE

This cross-sectional study aims to evaluate the role of chronic diseases, and their interactions with age and gender, on the emotional exhaustion component of the burnout syndrome.

METHODS

Data came from the Salveo Study conducted in 2009-2012. It contained a random sample of 2075 Canadian workers employed in 63 workplaces. Multilevel regression models were estimated. Main effects of chronic diseases were first evaluated, and then age-chronic diseases interactions were tested. Analyses were performed on the total sample and stratified by gender. All analyses were adjusted for work conditions decision latitude, physical and psychological demands, work hours, social support and rewards.

RESULTS

Mental and behavioural disorders, diseases of the nervous system, the musculoskeletal system and connective tissue, and genitourinary system are associated with a higher level of burnout symptoms. Associations with mental and behavioural disorders, and diseases of the nervous system are stronger for men than women. Age increases the association of behavioural disorders, diseases of the nervous system, and genitourinary system and burnout. Age may moderate the association of nervous and genitourinary systems diseases with burnout in women.

CONCLUSION

Workplaces must be more proactive to better recognise the role of chronic diseases on burnout and to implement preventive measures. The development of interventions towards specific risk groups is needed.

Long-term follow-up of residual symptoms in patients treated for stress-related exhaustion

Background

Many patients with stress-related exhaustion seem to struggle with long-term recovery. The primary aim of this study was to explore residual symptoms and perceived recovery in patients previously treated for stress-related exhaustion, 7 years after seeking care.

Methods

A total of 217 former patients (74% women) previously treated for exhaustion disorder were asked to participate in follow-ups 2, 3, 5, and 7 years post treatment. Symptoms of depression, and anxiety were measured with questionnaires. Remaining symptoms of extreme fatigue, sleep disturbances, problems with concentration, problems with memory and reduced stress tolerance, were rated with single item questions. A subgroup of patients (n = 163) participated in a clinical assessment to confirm residual stress-related exhaustion not caused by other diseases.

Results

Almost half of the patients previously treated for stress-related exhaustion perceive fatigue 7 years after initially seeking care, and as many as 73% reported decreased stress tolerance. The clinical assessment confirmed that a third of the patients were clinically judged as still suffering from stress-related exhaustion. Male and female patients showed similar patterns regarding residual symptoms.

Conclusions

One third of patients with exhaustion disorder are clinically judged to have exhaustion, 7 years after seeking care. Further studies are needed to elucidate the reason for such a long-term recovery and ultimately to identify methods for prevention.

Patients' Experiences of a Stress-Management Programme in Primary Care

Introduction

Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Purpose

To describe participant´s experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Methods

In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41–57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.

Results

The analysis resulted in the theme “Process of change for a sustainable everyday living”. The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants’ identification with the others in the group.

Conclusion

The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.

Exploring the Influence of Self-Efficacy, School Context and Self-Esteem on Job Burnout of Iranian Muslim Teachers: A Path Model Approach

This study tested the influence of self-efficacy, school context and self-esteem on job burnout of Iranian Muslim teachers. Job burnout was taken to be composed of three components: emotional exhaustion, depersonalization and personal accomplishment. A sample of 212 secondary school teachers completed a packet of scales that measure self-efficacy, school context, self-esteem and job burnout. The relationships between the variables were examined via path analysis. Path analysis showed self-efficacy to have a significant direct negative effect on depersonalization (β = - 0.25, p < 0.01) and reduced personal accomplishment (β = - 0.31, p < 0.01). School context had a significant direct effect on emotional exhaustion (β = - 0.36, p < 0.01), depersonalization (β = - 0.23, p < 0.01) and reduced personal accomplishment (β = - 0.17, p < 0.01). Self-esteem had a significant direct effect on emotional exhaustion (β = - 0.36, p < 0.01), depersonalization (β = - 0.15, p < 0.01) and reduced personal accomplishment (β = - 0.26, p < 0.01). The proposed model explained 47% of total variance of "emotional exhaustion," 28% of "depersonalization" and 54% of "reduced personal accomplishment."

Work Addiction, Obsessive-Compulsive Personality Disorder, Burn-Out, and Global Burden of Disease: Implications from the ICD-11

Occupational stress and high workload are being increasingly recognized as significant contributors to the diseases and disorders constituting major components of the global burden of disease. A more detailed definition of burn-out was recently included by the World Health Organization (WHO) in the eleventh revision of the International Classification of Diseases (ICD-11) which reflects a growing acknowledgment of the role of professional work in mental health. One of the symptoms of obsessive-compulsive personality disorder/anankastic personality disorder (OCPD/APD) is an undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships. This compulsive overworking is closely related to the concept of work addiction, and OCPD/APD was suggested to be its major risk factor. OCPD/APD is the most prevalent personality disorder and one that appears to produce the highest direct and indirect medical costs. At the same time, it is vastly understudied. In recent years, it has been repeatedly emphasized that it requires consistent conceptualization and clarification of its overlapping with similar conditions. Even though the limited existing studies suggest its strong relationship with burn-out and depression among employed individuals, there has been no systematic effort to investigate its role in the consequences of occupational stress and high workload. This paper identifies several substantial gaps in the current understanding of the relationships between work addiction, OCPD/APD, burn-out, and the global burden of disease within the context of the WHO's plan of developing evidence-based guidelines on mental wellbeing in the workplace.

Sleep Quality as a Mediator in the Relationship Between Perceived Stress and Job Burnout Among Chinese Nurses: A Structural Equation Modeling Analysis

Background: Job burnout has become an increasing prevailing phenomenon among nurses in both developed and developing countries. There is a paucity of research exploring the relationship between perceived stress (i.e., the level of one's perception or appraisal of stress rather than objective stressful events) and job burnout and no existing literature examining the mediating role of sleep quality in the relationship between these two constructs. The objective of the study was to examine if sleep quality mediates the relationship between perceived stress and job burnout. Methods: Cross-sectional data were collected from a total of 1,013 nurses working in six public tertiary hospitals in China. The self-administered questionnaire included demographic information, the Maslach Burnout Inventory-General Scale, the Pittsburgh Sleep Quality Index and the Perceived Stress Scale. Hierarchical multiple regression (HMR) analyses were performed to examine the contribution of each covariate to the prediction of job burnout. Structural equation modeling (SEM) was employed to test whether the proposed relationships between variables involved existed. Results: Both perceived stress and poor sleep quality exhibited strong positive associations with job burnout among Chinese nurses. The SEM analysis confirmed the direct pathway from perceived stress to burnout and the indirect pathway mediated by sleep quality. The direct effect of perceived stress on job burnout was found to be statistically significant and positive (β = 0.69, p < 0.05). There existed statistically significant effects of sleep quality on both perceived stress (β = 0.48) and job burnout (β = 0.29). The path coefficients of perceived stress on job burnout were significantly reduced (β = 0.56) when sleep quality was modeled as a mediator. The bias-corrected and accelerated bootstrap test revealed that sleep quality had a significant mediating effect on the relationship between perceived stress and job burnout (a ^* b = 0.139, BCa 95%, CI: 0.110~0.174). Conclusion: Perceived stress might exert significant effects on burnout both directly and indirectly through the mediating role of sleep quality. Efforts to reduce burnout among nurses in clinical settings may benefit from interventions for coping with perceived stress and practices for promoting healthy sleep.

Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic

OBJECTIVE

The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic.

METHODS

This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657).

RESULTS

Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest.

CONCLUSIONS

NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.

Burnout Syndrome Among Hospital Healthcare Workers During the COVID-19 Pandemic and Civil War: A Cross-Sectional Study

Objective: We aimed to determine the prevalence of burnout among hospital healthcare workers in Libya during the coronavirus disease (COVID-19) pandemic and civil war. Methods: A cross-sectional study was conducted from April 18 to May 2, 2020 among Libyan healthcare workers. Data on participant characteristics were collected with a specifically designed questionnaire. Burnout was assessed with the abbreviated Maslach Burnout Inventory (aMBI) comprising three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with each sub-scale score range from 0 to 18. For EE and DP, scores of 10 to 18 were regarded as "moderate to severe burnout." PA was scored inversely, where a score ≤ 10 indicated severe burnout. Results: The study yielded a sample size of 532 participants. Of these, 357 (67.1%) reported emotional exhaustion (EE Score ≥ 10), 252 (47.4%) reported depersonalization (DP score ≥ 10), and 121 (22.7%) reported a lower sense of personal accomplishment (PA score ≤ 10). Verbal abuse was experienced by 304 participants (57.1%) and physical abuse in 93 (17.5). Gender was associated with high emotional exhaustion and high depersonalization. Being 35 years or older was associated with high depersonalization. Professional specialty was significantly associated with high emotional exhaustion and depersonalization. Fear of COVID-19 infection was associated with high emotional exhaustion and high depersonalization. Conclusion: The rising prevalence of mental disorders and inadequate availability of health services facilities during the COVID-19 pandemic and civil war demonstrated the need for healthcare policies to address the well-being of healthcare workers to decrease the risk of loss, suicide, and medical negligence.

Sliding Sheet Use in Nursing Practice: An Intervention Study

Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck ( p < .001); arms, shoulders, hands ( p = .041); and lower back ( p < .001), with an increase in job satisfaction ( p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.

Lagged versus concurrent changes between burnout and depression symptoms and unique contributions from job demands and job resources

Burnout and depression pose significant threats to emotional and occupational functioning; however, questions exist over how these 2 conditions are associated with each other over time, and how these are related to underlying job stressors. The job demands-resources model provides a useful framework for understanding how job demands and job resources may lead to burnout, but questions remain about their distinct association with depression symptoms. The current study examined these questions in a sample of 402 nursing workers. The Exhaustion subscale of the Oldenburg Burnout Inventory, the Patient Health Questionnaire-9 depression assessment, and items reflecting job demands and job resources from the Copenhagen Psychosocial Questionnaire were assessed at baseline; additionally, Oldenburg Burnout Inventory Exhaustion and Patient Health Questionnaire-9 depression were assessed over 12 monthly follow-ups. Linear mixed models assessed longitudinal bidirectional associations between burnout and depression in both concurrent and lagged models. Longitudinal models found bidirectional relationships between burnout and depression symptoms over time, with relatively stronger associations for concurrent models relative to lagged models. Job demands and job resources each predicted unique variance in burnout and depression symptoms over time. Results provide evidence that burnout and depression symptoms change in the same direction, in tandem, rather than one condition having a distinctly stronger temporal association over the other. Results also indicate that both job demands and job resources are associated with depression symptoms independent from their association with burnout symptoms. Our results highlight the importance of considering burnout symptoms, depression symptoms, and job stressors concurrently in evaluating worker mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rejuvenating The Concept Of Work Alienation Through Job Demands-Resources Model And Examining Its Relationship With Emotional Exhaustion And Explorative And Exploitative Learning

PURPOSE

The purpose of the present study was twofold. First, this study examined the relationships of work alienation with explorative learning and exploitative learning. Second, the study tested the role of emotional exhaustion as a mediator of the relationships of work alienation with explorative learning and exploitative learning. Job Demands-Resources model was used as the underlying theoretical foundation to establish these relationships.

METHODS

Two-source time-lagged data were collected from 225 middle-level managers and their 222 immediate supervisors in 87 Pakistani firms spanning different industries. Structural equation modeling and bootstrapping were used to test the hypothesized relationships,.

RESULTS

The study revealed that work alienation is negatively related to both explorative learning and exploitative learning. Moreover, the study also established emotional exhaustion as a mechanism underlying the relationships work alienation with explorative learning and exploitative learning by showing that work alienation enhances emotional exhaustion, which, in turn, negatively influences both explorative learning and exploitative learning.

CONCLUSION

By conceptualizing and providing empirical evidence of the negative relationships of work alienation with explorative learning and exploitative learning, both directly and via emotional exhaustion, the study signified some of the important but largely ignored dynamics of the employment relationship within the current regime of organizational structures. The findings suggest that the managers' sensed estrangement from work and work context need to be addressed, as it can exhaust them emotionally and hinder their search and acquisition of new knowledge and competencies.

Mediating effects of hair cortisol on the mutual association of job burnout and insomnia: A retrospective exploratory study

BACKGROUNDS

The present study was designed to clarify the mutual association of job burnout and insomnia and to detect the mediating effects of hair cortisol on that association.

METHODS

In all, 68 female employees were recruited for the study from one secondary and one tertiary hospital between October 2018 and November 2018 in Beijing. Participants completed a questionnaire for the collection of demographic data and standardized measures for burnout and insomnia. Hair sample collection and anthropometric measurements were performed at the same time.

RESULTS

Median hair cortisol concentration (HCC) was 5.89 ng/g hair (interquartile range = 2.20-10.74). And ages are between 22 and 51 years old (32.50 ± 6.13), among which 22 were below 30 years, 20 were between 30 and 35 years, and 26 were over 35 years. A majority of Pearson's coefficients were significant, with the exception of that for the correlation between personal accomplishment and HCC or depersonalization. Significant mutual correlations were shown between burnout dimensions and insomnia directly. HCC acted as a mediator in the pathway from emotional exhaustion, depersonalization to insomnia; and no significant mediating effect of HCC in the pathway from insomnia to burnout was found.

CONCLUSIONS

Job burnout may directly or indirectly (through chronically elevated cortisol) increase insomnia risk, whereas insomnia probably promotes burnout. Prospective studies involving different body systems and a larger sample size should be performed to further identify the mechanisms underlying the associations between burnout and insomnia among the working population.

An Empirical Study Comparing Unobtrusive Physiological Sensors for Stress Detection in Computer Work

Several unobtrusive sensors have been tested in studies to capture physiological reactions to stress in workplace settings. Lab studies tend to focus on assessing sensors during a specific computer task, while in situ studies tend to offer a generalized view of sensors' efficacy for workplace stress monitoring, without discriminating different tasks. Given the variation in workplace computer activities, this study investigates the efficacy of unobtrusive sensors for stress measurement across a variety of tasks. We present a comparison of five physiological measurements obtained in a lab experiment, where participants completed six different computer tasks, while we measured their stress levels using a chest-band (ECG, respiration), a wristband (PPG and EDA), and an emerging thermal imaging method (perinasal perspiration). We found that thermal imaging can detect increased stress for most participants across all tasks, while wrist and chest sensors were less generalizable across tasks and participants. We summarize the costs and benefits of each sensor stream, and show how some computer use scenarios present usability and reliability challenges for stress monitoring with certain physiological sensors. We provide recommendations for researchers and system builders for measuring stress with physiological sensors during workplace computer use.

Promoting work engagement in the hotel sector: review and analysis

Purpose

Using the job demands-resources (JD-R) model as a theoretical framework, the purpose of this study is to identify antecedents of work engagement in the hotel sector through an integrative literature review of existing empirical studies.

Design/methodology/approach

A total of 38 quantitative studies published between 2001 and 2017 were reviewed, and a summary of the antecedents of work engagement was compiled based on the JD-R model.

Findings

Support from the organization, supervisors and coworkers were the most frequently discussed predictors of work engagement. Compared with previous studies in other sectors, the findings show unique antecedents of work engagement in the hotel sector, such as internal branding, organizational justice and organizational features (e.g., organizational size/history/level) as job resources; behavioral intentions and polychronicity as personal resources; and customer emotions and sexual harassment as job demands.

Practical implications

This study is relevant considering the discourse in the hotel sector on delegating human resource responsibilities to frontline managers. Hotel managers should establish and maintain a work environment where coworkers and supervisors provide support as the environment is found to be a key factor that promotes work engagement.

Originality/value

The significance of the study is that it provides an overview of studies on work engagement in the hotel sector and insights on how hotel service practices affect employees and work engagement by highlighting the antecedents of work engagement from previous empirical studies.

Psychometric Properties and Convergent Validity of the Shirom-Melamed Burnout Measure in Two German-Speaking Samples of Adult Workers and Police Officers

Burnout is considered an occupation-related psychological syndrome consisting of emotional, physical, and cognitive exhaustion. To assess dimensions of burnout, the Shirom-Melamed Burnout Measure (SMBM) is widely used, but its validity and reliability have rarely been examined in adult samples. The aim of this study is to examine the psychometric properties of the German version of the SMBM in two independent samples of adults. In total, 311 adult workers and 201 police officers completed the SMBM, and questionnaires related to perceived stress and mental well-being. Descriptive statistics, internal consistency, convergent validity, and factorial validity were assessed for both samples, separately for male and female participants. The German SMBM had adequate psychometric properties and sufficient convergent validity. In confirmatory factor analyses, we found a good fit for both the first- and second-order model. Furthermore, measurement invariance across gender was observed in both samples. Although the SMBM is a popular instrument among burnout researchers, this study demonstrates for the first time that the SMBM can be considered a valid and reliable tool to assess burnout symptoms in both male and female adults and across different professional groups. Furthermore, with its 14 items, the SMBM is a succinct and economic self-assessment tool for symptoms of burnout.

Is it all about Depression? Determinants of Burnout among Employees Referred for Inpatient Treatment of Job-Related Stress Disorders

Objectives: There is an ongoing debate as to whether job burnout and depression are overlapping concepts or differ from each other, although this has not been scrutinized in inpatients. To further elucidate the robustness of this relationship, we used three different measurements of depression. We further examined the influence of psychological distress, perceived stress and sleep quality in the link between depressive symptoms and burnout. Methods: We investigated 723 consecutive inpatients, aged 23 to 82 years, 51.2 % women, referred to a hospital specialized in the treatment of job stress-related disorders. Patients completed the Maslach Burnout Inventory, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Results: We found significant correlations between burnout total scores as well as subscales (emotional exhaustion, depersonalization, lack of accomplishment) and depressive symptoms, virtually independent of the applied depression measure. The shared variance ranged between 1.1 % and 19.4 %. Greater levels of burnout were directly associated with cognitiveaffective symptoms and, although to a lesser extent, also with somatic-affective symptoms of depression. In the multivariable analysis, significantly more total burnout symptoms were revealed in more depressed and younger patients, in men than women, and in employees with greater levels of psychological distress and perceived stress, respectively. Conclusions: The findings suggest that although burnout and depression do not represent the same psychopathology, there is considerable overlap between the two constructs; the extent of this overlap may vary depending upon the applied depression measure.

Evidências científicas sobre a associação entre burnout e síndrome metabólica: revisão integrativa

Resumo Objetivo Avaliar as evidências científicas disponíveis na literatura sobre a associação entre Síndrome de Burnout e Síndrome Metabólica. Métodos Revisão integrativa da literatura, com buscas nas bases de dados do Cumulative Index to Nursing and Allied Health Literature, National Library of Medicine National Institutes of Health, Web of Science, Scopus, Cochrane Library, Latin American and Caribbean Center on Health Sciences Information, Scientific Eletronic Library Online e Springer Link. Os artigos selecionados foram analisados de acordo com a Agency for Healthcare Research and Quality. Resultados A maioria (80%) dos 5 artigos que atenderam aos critérios de seleção estava na língua inglesa e indexada nas bases de dados Web of Science e Scopus. Dentre os trabalhos, 80% tinham médicos como autores principais. O continente asiático (Israel, Japão e China) concentrou a maior parte de produção. Não ocorreu predominância de desenho de estudo. A área financeira correspondeu a 60% do público pesquisado. Conclusão As evidências disponíveis na literatura são incipientes, apenas 20% dos artigos elegíveis apresentou associação entre as síndromes estudadas e os demais, indicam associação entre Burnout e componentes da SM separadamente.

Metabolic Syndrome Among Primary Health Care Nursing Professionals: A Cross-Sectional Population-Based Study

This research aims at evaluating prevalence and factors associated with metabolic syndrome (MS) in primary health care (PHC) nursing professionals. A multicenter, population-based and cross-sectional study was conducted in a team-tested sample of 1125 PHC nurses in the state of Bahia, Brazil. Sociodemographic, labor, lifestyle and human biology variables were investigated by mean of anamnesis. MS was evaluated according to the criteria of the first Brazilian Guideline for Metabolic Syndrome, which fully adopts the criteria of the National Cholesterol Education Program's Adult Treatment Panel III. MS-associated factors were tested by using robust Poisson Regression. The prevalence of MS found was 24.4%; low High Density Lipoprotein (HDL) cholesterol was the most prevalent component of the syndrome. In the multivariate analysis, physical inactivity (PR = 1.25, 95% CI = 1.02-1.53), alcohol use (PR = 1.84, 95% CI = 1.22-2.77), acanthosis nigricans (PR = 3.23, 95% CI = 2.65-3.92), burnout syndrome (PR = 1.45, 95% CI = 1.17-1.81), (PR = 1.37, 95% CI = 1.12-1.69), working as a nursing technician (PR = 1.43, 95% CI = 1.14-1.80), were associated to MS. It was found that the prevalence of MS was high, which evidences the need for interventions in the PHC environment, improvement of working conditions, monitoring of worker safety and health, diet programs and physical activity.

The Impact of Sleep and Circadian Disorders on Physician Burnout

Nearly 50% of physicians report symptoms of clinical burnout. Occupational factors and personal health play substantial roles in physician burnout. The role of sleep in physician burnout is not well understood. Burnout is at epidemic levels in health care, with research suggesting nearly one in two physicians experience clinical burnout as defined according to the Maslach Burnout Index. Sleep deprivation, burnout, and clinician health are intricately intertwined. The relation between sleep deprivation and burnout is not only suggested in hypothetical models but also confirmed in observational studies of workers of all types. Models describing the relation between burnout and sleep suggest as potential causative mechanisms of sleep disturbances the following: (1) a chronic depletion of energy stores; or (2) activation of the hypothalamic-pituitary-adrenal axis and increasing levels of bodily stress. Sleep deprivation and burnout are widespread in health-care workers, affecting not only nurses but also medical students, physicians-in-training, and practicing physicians. Although sleep deprivation is associated with clinical burnout, direct studies showing that sleep extension can improve burnout recovery are lacking. Early detection and early intervention to improve both sleep deprivation and burnout are warranted in health-care professionals. Interventions should be directed not only at individuals but also at the entire health system. This review highlights the latest developments and emerging concepts concerning the role of sleep and circadian disorders in physician burnout.

Association of sleep quality with job burnout among Chinese coal mine staff: a propensity score weighting analysis

This study examines the association of sleep quality with job burnout among Chinese coal mine staff. 3832 subjects were selected from a coal mine group located in Shanxi Province in China. Job burnout was evaluated by the Maslach Burnout Inventory-General Survey and sleep quality was acquired with a self-reported questionnaire. We used the inverse probability of treatment weighting with propensity score to mimic the randomization and to minimize bias in estimations. Sensitivity analysis was conducted to test the robustness of our findings. We identified that good sleep quality was significantly associated with lower risk of job burnout (OR: 0.70; 95%CI, 0.60 to 0.82, p = 6.02e-06), with 0.21 decrease in the score of exhaustion (95%CI,-0.29 to -0.12, p = 5.00e-06), and with 0.13 decrease in the score of cynicism (95%CI,-0.21 to -0.04, p = 3.73e-03). Sensitivity analysis demonstrated that the results were robust to the choice of estimation models, as well as unmeasured confounding. Stratification analysis demonstrated that the associations of sleep quality with job burnout were largely heterogeneous for male and female workers. This study implicated that good sleep quality benefits the workers in relief of job burnout. Further research may be warranted in support of a definite causal relationship and intervention strategy.

Burnout and Metabolic Syndrome in Female Nurses: An Observational Study

Nurses are at risk of having burnout due to workload and job stress-studies have reported that chronic stress is associated with metabolic syndrome. This study aimed to assess the association between burnout and metabolic syndrome in a sample of female nurses. Data were collected from a cross-sectional study from 2016 to 2018 in a tertiary hospital in Mexico City. All nurses that work in the hospital were invited to participate. Information pertaining to sociodemographic (age, education level), work (labor seniority, service area, shift work), anthropometric (weight, waist circumference, blood pressure) and biochemical (glucose, serum lipids) variables were collected. Burnout was assessed using the Maslach Burnout Inventory test, and metabolic syndrome was defined according to the International Diabetes Federation criteria. A total of 168 nurses participated with a median age of 44 years. The prevalence of burnout and metabolic syndrome was 19.6% and 38.7%, respectively. There was no association between burnout and metabolic syndrome (p = 0.373). However, associations of emotional exhaustion (aOR: 14.95; 95% CI: 1.5-148.7), personal accomplishment (aOR: 0.13; 95% CI: 0.01-0.99), and night shift (aOR: 12.39; 95% CI: 1.02-150.5) with increased waist circumference were found. Strategies are needed to prevent burnout and metabolic syndrome in nurses, especially in those who work at night shift.

Integrating Self-Determination and Job Demands-Resources Theory in Predicting Mental Health Provider Burnout

Limited progress has been made in reducing burnout in mental health professionals. Accordingly, we identified factors that might protect against burnout and could be productive focal areas for future interventions. Guided by self-determination theory, we examined whether supervisor autonomy support, self-efficacy, and staff cohesion predict provider burnout. 358 staff from 13 agencies completed surveys. Higher levels of supervisor autonomy support, self-efficacy, and staff cohesion were predictive of lower burnout, even after accounting for job demands. Although administrators may be limited in their ability to reduce job demands, our findings suggest that increasing core job resources may be a viable alternative.

Concurrent and lagged effects of psychosocial job stressors on symptoms of burnout

Purpose

Burnout is a mental condition described as being a result of long-term stressors commonly related to psychosocial factors at work. The aim of the present study was to investigate longitudinal relationships between job demands, decision authority, effort and reward, and symptoms of burnout, as well as the joint effects of job demands and decision authority, and of effort and reward.

Methods

The data came from a four-wave longitudinal cohort study of Swedish health care workers. Longitudinal associations were analysed using mixed effects regression models with random intercept.

Results

The concurrent analysis showed that demand and decision authority, as well as effort and reward, were associated with symptoms of burnout over time. Evidence of the lagged effects of workplace factors on burnout symptoms was limited to reward. No clear effect modification was found.

Conclusion

An increase in unfavourable working conditions implied increasing scores on the burnout measure over time. The concurrent effects of job demands, decision authority, effort and reward on symptoms of burnout were seen. The evidence of lagged effects was limited to the low-reward condition. Regularly monitoring these work environment conditions at workplaces can help identify risk situations for burnout and thus be useful in the prevention of work-related mental illness. Lastly, a new approach to defining the risk groups was proposed, which is consistent across different populations and time points.

Electronic supplementary material

The online version of this article (10.1007/s00420-019-01437-0) contains supplementary material, which is available to authorized users.

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI_asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI_asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

Can mindfulness in health care professionals improve patient care? An integrative review and proposed model

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.