Part-time versus full-time work: an empirical evidence-based case of nurses in Spain

Purpose

– The purpose of this paper is to examine the reasons given by nurses for working part-time; compare the work experiences, satisfactions, and psychological well-being of nursing staff working full-time vs part-time; and identify possible antecedents and sources of leverage to encourage part-time nurses to work full-time.

Design/methodology/approach

– An online survey was developed, pre-tested and validated, and sent to the regional associations of nurses in Spain for distribution to their members. Data collection involved a cross-sectional design. A total of 2,094 valid questionnaires were completed online. The majority of responding nurses were located in Catalunya and Gipuzkoa. Respondents were given 15 reasons and asked to indicate the extent to which each played a role in their decision to work part-time. Job context and job content scales bearing multi items reliable measures were also employed. All scales met the criteria of reliability.

Findings

– Nurses working full-time included more males, were older, had longer nursing experience (both job and unit tenure), reported higher levels of both job resources (autonomy, self-development opportunities), higher levels of positive work attitudes (job involvement, affective commitment, work engagement), more medication use, and a higher intention to quit. Full-time and part-time nursing staff were similar on marital status, levels of social support (supervisor, co-worker, spouse, and family), self-reported absenteeism, levels of burnout, levels of psychological well-being (psychosomatic symptoms, self-reported health), and potential accident propensity. Some of the more concrete results include: first, reasons for working part-time were varied with some being voluntary (going to school) and others involuntary (poor health). Second, different clusters of individuals likely exist (e.g. students, caretakers, transitioning to retirement or other career options). Third, part-time nursing staff tended to report a more negative workplace (less autonomy, fewer opportunities for self-development) and less favorable work attitudes (less engagement, job involvement, and affective commitment) than their full-time counterparts.

Research limitations/implications

– First, all data were collected using self-report questionnaires, raising the possibility of response set tendencies. Second, all data were collected at one point in time, making it difficult to determine cause-effect relationships. Third, although the sample was very large, it was not possible to determine its representativeness or a response rate given the data collection procedure employed. Fourth, the large sample size resulted in relatively small mean differences reaching levels of statistical significance. Fifth, many of the nurse and work/organizational outcomes were themselves significantly correlated inflating the number of statistically significant relationships reported. Finally, it is not clear to what extent the findings apply to Spain only.

Practical implications

– Health care organizations interested in encouraging and supporting part-time nursing staff to consider working full-time may have some sources of leverage. Part-time nursing staff indicated generally lower levels of commitment involvement and engagement compared to their full-time colleagues. Part-time nursing staff in this study reported lower levels of job resources, such as autonomy and self-development opportunities. Increasing nursing staff input into decision making, increasing levels of nursing staff empowerment, increasing supervisory development that in supporting and respecting the nursing staff contributions, reducing levels of workplace incivility, and improving nursing work team functioning would make the work experiences of part-time nursing staff more meaningful and satisfying. In addition, offering more flexible work schedules and tackling the stereotype associated with working only part-time would also address factors associated with working part-time. A more long-term strategy would involve enhancing both the psychological and physical health of nursing staff through the introduction of a corporate wellness initiative. Increasing the work ability of nursing staff by improving their psychological and physical well-being addresses a common factor in the part-time work decision.

Social implications

– There is a call in the paper for Spanish authorities to consider implementing the “Magnet hospital program” which is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses in attracting them to work on a full-time basis. The process of Magnet recognition involves implementing 14 evidence-based standards.

Originality/value

– Experts claim that the part-time phenomenon is a growing trend and is there to stay. The authors still do not know sufficiently about the HR implications for having a large workforce of part-time employees. In this paper, a tentative attempt was made to better understand this phenomenon, especially when there is a shortage of qualified nurses in the health sector. Several promising research directions follow from this investigation. First, nurses working part-time need to be polled to identify factors that would encourage and support them should they desire to change to full-time work. Second, the authors learn more about the relatively low levels of involvement, commitment, and engagement of part-time nurses, a phenomenon that most organizations wish to minimize.

Exploring the causes, symptoms and health consequences of joint and inverse states of work engagement and burnout

Purpose

– The purpose of this research is to explore the relationship between the positive and negative psychological states of work (i.e. engagement and burnout, respectively) and their effects on an individual’s mental and physical health. This study analyzes their separate and joint manifestations. In total, 2,094 nurses were segmented into quadrants that represent a 50/50 median split on both engagement and burnout. The four resulting quadrants were then examined in a series of analyses including logistic regression and ANOVA.

Design/methodology/approach

– This is a cross-sectional study based on a very large survey (> 2,000 people) in Spain. Data were collected from nurses in collaboration with the official nurses corporations in half a dozen provinces in Spain. Data were analyzed in stages which included zero-item correlations and ANOVA to determine their independence and suitability for predicting states of engagement and burnout. This was followed by a series of binary logistic regression analyses.

Findings

– The findings suggested that engagement and burnout were generally inversely related (67 per cent of the sample) which is the conventional wisdom in this regard, but 33 per cent of the sample manifested concurrently at either extreme. Burnout was chiefly driven by work demands, as both quadrants of low burnout had lower demands and both quadrants of high burnout had higher demands. Engagement was primarily driven by resources and affinity. Social support acted independently (perhaps as a moderator) by aligning with states of burnout. Worker health was primarily driven by burnout, wherein both states of low burnout exhibited better health and both states of high burnout exhibited poorer health.

Originality/value

– Much of the current research on this topic considers engagement and burnout to be linear dimensions and focuses on building structural models of the precise relationships between variables. That approach is to be encouraged, but there is also a need to jointly deconstruct dimensions and relationships in a tactile manner that can inform future structural models. The secondary benefit of this approach is that these findings can be submitted directly to managers to provide an easily understood approach for assessments and interventions.

Crossover of exhaustion between dentists and dental nurses

The aim of this study was to investigate the conditions under which job-related exhaustion may transmit (cross over) from dentists to dental nurses and vice versa. We conducted a cross-sectional survey study among 470 Finnish dentist-dental nurse dyads and used moderated structural equation modelling analyses. We found no support for the direct crossover of exhaustion from one work partner to the other. Instead, we found that exhaustion transferred from dentists to dental nurses only when collaboration was frequent and dental nurses perceived the collaboration as friendly or consisting of mutual feedback. In contrast, dentists were not affected by dental nurses' exhaustion. These results indicate that exhaustion can be contagious in work dyads and may be fuelled by positive and frequent interpersonal relationships when the partner who is higher in the hierarchy has high (versus low) levels of exhaustion. Thus, interpersonal and hierarchical relationships among work partners may play an important role in the crossover process. Limitations and implications are mentioned.

Influence of employees' attachment styles on their life satisfaction as mediated by job satisfaction and burnout

The aim of this study was to obtain better insight into the associations between attachment styles and employees' life satisfaction. This was achieved by examining the mediating roles of burnout and job satisfaction. Three hundred and thirty-nine employees, from a convenience community sample, participated in the current study. Results of the mediation model indicated that the associations between avoidance and life satisfaction were mediated by burnout and job satisfaction. However, the associations between attachment anxiety and life satisfaction were mediated by burnout but not by job satisfaction. Theoretical and practical implications for organizations and for attachment theory at work are discussed.

Burnout, vigour, big five personality traits and social support in a sample of police officers

Orientation: Burnout occurs as a result of prolonged job stress, which is a phenomenon prevalent amongst police officers in South Africa. Whilst some suffer from burnout, others elude the pathological effects of burnout and execute their duties vigorously under the same circumstances.Research purpose: The purpose of the study was to obtain an understanding of a police officer’s need to reduce the effects of prolonged stressors and to utilise personal and social sources to mitigate the effects of negative stressors.Motivation for the study: Burnout causes negative health consequences for police officers. Those who are affected reflect withdrawal behaviour through operational disruption or lower productivity in the work context. Research design, approach and method: The research has a non-experimental design in the quantitative tradition with a cross-sectional data-collection method. The availability sample (N = 505) included participants from different demographic backgrounds. A survey was used to measure all constructs at a single point in time.Main findings: Neuroticism and a lack of family support predicted burnout whilst conscientiousness and emotional stability predicted vigour. This was followed by significant other, which predicted physical strength, friend support which predicted emotional energy and family support which predicted cognitive liveliness.Practical/managerial implications: The study provides markers for selection purposes and calls on police management to be aware of the value of social support in the prevention of burnout whilst encouraging supervisor support in operational designs.Contribution/value-add: The study adds to the body of knowledge on the role of personality and social support in burnout and vigour in police officers.

The bifactor model of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS)--an alternative measurement model of burnout

The purpose of the present study was to examine the construct validity of the Hungarian language version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A sample of 653 healthcare professionals (420 physicians and 233 nurses and nursing assistants) completed the MBI-HSS. A series of confirmatory factor analyses showed that a hierarchical bifactor model including a global burnout factor and three specific factors of emotional exhaustion, depersonalization and reduced personal accomplishment had the closest fit to the data, compared with an alternative second-order three-factor hierarchical model as well as to non-hierarchical one-factor, two-factor, three-factor, four-factor and five-factor models. However, only the global burnout factor and the specific personal accomplishment factor explained a considerable unique proportion of variance in observed scores. Our study confirms the validity of the MBI-HSS and suggests an alternative structural model, which may contribute to further understanding of the burnout construct.

The 9-item Bergen Burnout Inventory: factorial validity across organizations and measurements of longitudinal data

The present study tested the factorial validity of the 9-item Bergen Burnout Inventory (BBI-9). The BBI-9 is comprised of three core dimensions: (1) exhaustion at work; (2) cynicism toward the meaning of work; and (3) sense of inadequacy at work. The study further investigated whether the three-factor structure of the BBI-9 remains the same across different organizations (group invariance) and measurement time points (time invariance). The factorial group invariance was tested using a cross-sectional design with data pertaining to managers (n=742), and employees working in a bank (n=162), an engineering office (n=236), a public sector organization divided into three service areas: administration (n=102), education and culture (n=581), and social affairs and health (n=1,505). Factorial time invariance was tested using longitudinal data pertaining to managers, with three measurements over a four-year follow-up period. The confirmatory factor analysis revealed that the three-factor structure of the BBI-9 was invariant across cross-sectional samples. The factorial invariance was also supported across measurement times. To conclude, the factorial structure of the BBI-9 was found to remain the same regardless of the sample properties and measurement times.

The Morning Morality Effect

Are people more moral in the morning than in the afternoon? We propose that the normal, unremarkable experiences associated with everyday living can deplete one’s capacity to resist moral temptations. In a series of four experiments, both undergraduate students and a sample of U.S. adults engaged in less unethical behavior (e.g., less lying and cheating) on tasks performed in the morning than on the same tasks performed in the afternoon. This morning morality effect was mediated by decreases in moral awareness and self-control in the afternoon. Furthermore, the effect of time of day on unethical behavior was found to be stronger for people with a lower propensity to morally disengage. These findings highlight a simple yet pervasive factor (i.e., the time of day) that has important implications for moral behavior.

Hyperventilation and exhaustion syndrome

Chronic stress is among the most common diagnoses in Sweden, most commonly in the form of exhaustion syndrome (ICD-10 classification - F43.8). The majority of patients with this syndrome also have disturbed breathing (hyperventilation). The aim of this study was to investigate the association between hyperventilation and exhaustion syndrome. Thirty patients with exhaustion syndrome and 14 healthy subjects were evaluated with the Nijmegen Symptom Questionnaire (NQ). The participants completed questionnaires about exhaustion, mental state, sleep disturbance, pain and quality of life. The evaluation was repeated 4 weeks later, after half of the patients and healthy subjects had engaged in a therapy method called 'Grounding', a physical exercise inspired by African dance. The patients reported significantly higher levels of hyperventilation as compared to the healthy subjects. All patients' average score on NQ was 26.57 ± 10.98, while that of the healthy subjects was 15.14 ± 7.89 (t = -3.48, df = 42, p < 0.001). The NQ scores correlated strongly with two measures of exhaustion (Karolinska Exhaustion Scale KES r = 0.772, p < 0.01; Shirom Melamed Burnout Measure SMBM r = 0.565, p < 0.01), mental status [Hospital Anxiety and Depression Score (HADS) depression r = 0.414, p < 0.01; HADS anxiety r = 0.627, p < 0.01], sleep disturbances (r = -0.514, p < 0.01), pain (r = -.370, p < 0.05) and poor well-being (Medical Outcomes Survey Short Form 36 questionnaire- SR Health r = -0.529, p < 0.05). In the logistic regression analysis, the variance in the scores from NQ were explained to a high degree (R(2) = 0.752) by scores in KES and HADS. The brief Grounding training contributed to a near significant reduction in hyperventilation (F = 2.521, p < 0.124) and to significant reductions in exhaustion scores and scores of depression and anxiety. The conclusion is that hyperventilation is common in exhaustion syndrome patients and that it can be reduced by systematic physical therapy such as Grounding.

Cognitive impairment in patients with stress-related exhaustion

Patients who seek medical care for stress-related mental health problems frequently report cognitive impairments as the most pronounced symptom. The purpose of the present study was to compare cognitive function in patients with stress-related exhaustion with that in healthy controls, using a comprehensive battery of cognitive tests. We also explored whether neuropsychological findings were related to severity of illness measured using the Shirom-Melamed burnout questionnaire and hospital anxiety and depression scale. Thirty-three patients (15 males) and 37 healthy controls (11 males), mean age 46 years [standard deviation (SD) 3.9] and 47 years (SD 4.3), respectively, were included in the final analysis. Five cognitive domains were assessed: (1) speed, attention and working memory, (2) learning and episodic memory, (3) executive functions, (4) visuospatial functions and (5) language. The most pronounced difference between patients and controls was seen on executive function, when tested with a multidimensional test, including aspects of speed, control and working memory. The patients also performed poorer on Digit span, measuring attention span and working memory as well as on learning and episodic memory, when measured as delayed recall and the difference between immediate and delayed recall. Delayed recall was the only test that was significantly related to severity of burnout symptoms among the patients. This could reflect poor cognitive sustainability in the patients with the highest burnout scores, as this particular test was the last one performed during the test session. This study clearly shows that cognitive impairment should be considered when evaluating and treating patients who seek medical care for stress-related exhaustion.

Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population

Allostatic load (AL) has been shown to be a useful marker of physiological strain during chronic stress and burnout in non-clinical working populations. The usability of the AL index for a clinical population with severe stress-related exhaustion was tested in this study. Thirteen biomarkers assembled as an AL index were analysed using blood samples from 90 patients with stress-related exhaustion (43 men and 47 women, age 31-61 years) and 90 healthy controls (46 men and 44 women, age 25-56 years). The AL scores did not differ between patients and controls. For men, some indication of higher cardiovascular risk was seen in the patient group: male patients had higher body mass index and waist-hip ratio and a poorer blood lipid status than male controls. We found lower plasma glucose concentrations in both female and male patients than those in controls. The male patients also showed increased fasting serum insulin concentrations. Further analysis using homeostasis model assessment for insulin resistance and β-cell function showed indications of insulin resistance in the patient group, particularly in the males, and an increased insulin secretion in both male and female patients. In conclusion, AL index does not seem to capture plausible physiological strain in patients diagnosed with stress-related exhaustion. The finding of lower plasma glucose concentrations, probably due to higher insulin secretion, in patients with severe stress-related exhaustion, needs to be further investigated, including mechanisms and the clinical relevance.

Psychometric properties of the 'Spanish burnout inventory' among employees working with people with intellectual disability

BACKGROUND

Burnout has been recognised as an important stress-related problem for employees working with people with intellectual disability. Researchers have been troubled by some of the psychometric limitations of the questionnaires developed to evaluate burnout. This study was designed to assess the psychometric properties of the Spanish Burnout Inventory.

METHOD

The sample consisted of 697 Spanish employees working in intellectual disability services. The instrument is composed of 20 items distributed in four dimensions: Enthusiasm towards the job, Psychological exhaustion, Indolence and Guilt. The psychometric properties were examined through the following analyses: confirmatory factor analysis and reliability. To assess the factorial validity of the Spanish Burnout Inventory, four alternative models were tested.

RESULTS

The four-factor model obtained an adequate data fit for the sample. The four sub-scales exhibited high reliability, with Cronbach alphas exceeding the critical value of 0.70.

CONCLUSIONS

This study provides evidence showing the adequate psychometric properties of an alternative burnout measure that could facilitate the diagnosis of individuals with burnout. It recommends taking feelings of guilt into consideration in interventions designed to improve staff burnout.

Burnout and vigor as predictors of the incidence of hyperlipidemia among healthy employees

We examined the effects of burnout and vigor on the incidence of hyperlipidemia. Based on the bivariate theoretical approach to negative and positive affects and on past studies on the prediction of blood lipids by burnout and vigor, we expected increases from Time 1 (T1) to Time 2 (T2) in burnout levels to be associated with an increase in the risk for hyperlipidemia and T1-T2 increases in vigor levels to be associated with a decrease in the risk of hyperlipidemia. Our sample consisted of 3,337 healthy employees (2,214 men and 1,123 women) who were followed up for about 27 months on average. Burnout and vigor were assessed by well-validated multiple-item instruments. We used logistic regressions and controlled for variables associated with blood lipids as well as with vigor and burnout. We cross-validated all self-reported hyperlipidemia by their T2 lipids levels. As expected, we found that T1-T2 increases in vigor levels were associated with a decreased risk of hyperlipidemia. However, the T1-T2 change in burnout levels was marginally significant (p = .06) in predicting hyperlipidemia. We consider our finding that vigor and burnout are independently associated with the risk of hyperlipidemia as providing support for the bivariate approach to affective states. In addition, our major finding suggests a possible mechanism via which vigor influences physical health outcomes.

The relationship between value incongruence and individual and organizational well-being outcomes: an exploratory study among Catalan nurses

AIMS

To report a correlational study of the relations of value incongruence to the individual and organizational well-being variables of self-rated health, turnover intention, and accident propensity, as mediated by burnout.

BACKGROUND

Previous literature found that value incongruence may lessen individual and organizational well-being through the psychological mechanism of burnout. Empirical investigation is needed to validate these claims.

DESIGN

A cross-sectional between-cases correlational design was used.

METHODS

A survey was conducted in one of the largest university hospitals in a large metropolitan city in Spain in the spring of 2009, using a cross-sectional design. A total of 234 nurses participated in the study. Stepwise regression was used to test the direct and mediation relationships.

RESULTS

Hypotheses were confirmed for certain axes of values and outcome variables. In particular, Economical and Ethical value incongruence were found to be correlated with burnout. Economical, Ethical, and Emotional value incongruence were found to be correlated with turnover intention. Ethical and Emotional value incongruence were found to be correlated with accident propensity. Burnout partially mediated the relationship between Economical and Ethical value incongruence and turnover intention and fully mediated the relationship between Ethical value incongruence and accident propensity.

CONCLUSION

The purported mediation of burnout on the relationship between value incongruence and individual and organizational well-being outcomes is valid on certain axes of values and outcome variables. This calls for caution when discussing value incongruence in organizations. Instead of advocating broad organizational culture congruence, we should target specific axes of values.

Cyber incivility @ work: the new age of interpersonal deviance

The current study was designed to extend the interpersonal deviance literature into the online domain by examining the incidence and impact of supervisor cyber incivility and neuroticism on employee outcomes at work. Conservation of Resources (COR) theory was used as the guiding framework because cyber incivility is thought to deplete energetic resources in much the same way that other stressors do, ultimately leading to negative outcomes like burnout. Results indicate that supervisor cyber incivility is positively related to burnout, absenteeism, and turnover intentions. Support was also found for the role of neuroticism as a moderator of the relationship between supervisor cyber incivility and outcomes. In general, the relations between cyber incivility and outcomes were stronger for those individuals reporting higher levels of neuroticism. Results are discussed in terms of COR theory, and possible mechanisms for the role of neuroticism in the stressor-strain relationship are discussed. The current study highlights the importance of understanding workplace online behavior and its impact on employee health and organizational well-being. Future research directions examining online interpersonal deviance are suggested.

Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ)

Background

Burnout is a mental condition defined as a result of continuous and long-term stress exposure, particularly related to psychosocial factors at work. This paper seeks to examine the psychometric properties of the Shirom-Melamed Burnout Questionnaire (SMBQ) for validation of use in a clinical setting.

Methods

Data from both a clinical (319) and general population (319) samples of health care and social insurance workers were included in the study. Data were analysed using both classical and modern test theory approaches, including Confirmatory Factor Analysis (CFA) and Rasch analysis.

Results

Of the 638 people recruited into the study 416 (65%) persons were working full or part time. Data from the SMBQ failed a CFA, and initially failed to satisfy Rasch model expectations. After the removal of 4 of the original items measuring tension, and accommodating local dependency in the data, model expectations were met. As such, the total score from the revised scale is a sufficient statistic for ascertaining burnout and an interval scale transformation is available. The scale as a whole was perfectly targeted to the joint sample. A cut point of 4.4 for severe burnout was chosen at the intersection of the distributions of the clinical and general population.

Conclusion

A revised 18 item version of the SMBQ satisfies modern measurement standards. Using its cut point it offers the opportunity to identify potential clinical cases of burnout.

The role of psychosocial factors in the course of pain--a 1-year follow-up study among women living in Sweden

The understanding of the associations between psychosocial factors and persistent pain and their impact on the course of pain among women is crucial to identify risk populations and prevent long-term pain from developing. The aim of the study was to investigate the course of pain among women and the psychosocial factors associated with it. The study was a 1-year follow-up (FU) among 2,300 women in the general population of Sweden. Sociodemographic and psychosocial factors were analyzed in relation to the course of pain, assessed as the presence of pain during the last 3 months at baseline (BL) and at FU. Thirty-three percent of the women with no pain at BL and 77% of those with pain at BL reported pain at FU. Compared to the pain-free women, those who developed pain at FU reported lower social support and physical quality of life (QoL) and worse mental health. Women with sustained pain were older and reported worse mental health, lack of social support, and lower levels of QoL compared to those who recovered from pain. In the multiple logistic regression analyses, only post-traumatic stress symptoms were associated with the development of pain at FU. Number of pain locations and pain duration at BL and physical QoL were associated with sustained pain. Moreover, social support was identified as a protective factor against sustained pain. Pain is persistent or recurrent in a general female population. The results indicate that psychosocial factors do not work as primary predictors in the course of pain and might be better understood through indirect processes by limiting the individual's resources for handling pain in a functional manner.

Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?

PURPOSE

The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD + MD and to determine which variables are associated with sick leave.

METHOD

A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees' health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions.

RESULTS

Forty-four per cent of the employees had MSD, 22% had MD and 34% had a MSD + MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD + MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R²).

CONCLUSIONS

Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.

Psychosocial working conditions and exhaustion in a working population sample of Swedish middle-aged men and women

BACKGROUND

Exhaustion is a concept of interest for both occupational health research and stress-disease theory research. The aim of the present study was to explore associations between chronic stressors, in terms of psychosocial working conditions, and exhaustion in a Swedish middle-aged population sample.

METHODS

A vocationally active population sample of the Malmö Shoulder and Neck Study cohort, comprising 2555 men and 2466 women between 45 and 64 years of age, was used. Psychosocial working conditions, assessed by means of the demand-control-support model, were measured longitudinally with a 1-year interval. Exhaustion was assessed by the SF-36 vitality scale and measured at follow-up, yielding a cross-sectional study design.

RESULTS

Exhaustion was twice as common in women as in men. High psychological job demands, low job control and low job support were independently associated with exhaustion in both men and women. These associations remained after controlling for a variety of potential confounders and mediators, including socio-demographic factors, lifestyle factors, musculoskeletal pain, disease, other work-related factors (including physical workload) and non-work-related factors. High demands in combination with low control (job strain), and job strain combined with low job support (iso-strain), increased the risk for exhaustion.

CONCLUSION

Psychosocial working conditions seem to contribute to exhaustion in middle-aged men and women. Future research should include exploration of exhaustion as a possible mediator between work stress and disease, as well as exploration of other chronic stressors, including non-work-related stressors, regarding their effects on exhaustion in men and women.

Construção e validação fatorial da Escala de Caracterização do Burnout (ECB)

Este artigo descreve o desenvolvimento da Escala de Caracterização do Burnout (ECB). No primeiro estudo, 375 trabalhadores de enfermagem e do ensino responderam a primeira versão da ECB com 77 itens. Análises fatoriais revelaram os fatores Exaustão Emocional (Alfa = 0,94); Desumanização (Alfa = 0,88), Realização Pessoal (Alfa = 0,76) e Decepção no Trabalho (Alfa = 0,80). No segundo estudo, 787 membros da Policia Civil responderam a segunda versão da ECB com 46 itens. Os resultados de novas análises fatoriais evidenciaram os mesmos três fatores do estudo 1: Exaustão Emocional (Alfa = 0,93); Desumanização (Alfa = 0,84) e Decepção no Trabalho (Alfa = 0,90). Os itens do fator Realização Pessoal, observado no estudo 1, foram incorporados ao fator Decepção no Trabalho. A versão final da ECB apresentou 35 itens. O fator Exaustão Emocional evidenciou a maior consistência interna. Os níveis de consistência interna dos outros dois fatores superaram índices apresentados por outras medidas de burnout.

Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors

BACKGROUND

Doctors have long been exposed to situations that can induce psychological distress. Long hours, little acknowledgement, poor sleep and high-stress work environments all contribute to making doctors prone to psychological distress and burnout, which have been much studied in younger doctors, but less so in older doctors. Little is known about whether there are differences in psychological distress among different age groups of doctors.

METHODS

Doctors (n = 158) were recruited from in and around the St George Hospital, a major teaching hospital in Sydney, Australia. Participants completed a self-report questionnaire, comprising the Maslach Burnout Inventory (MBI), and Kessler 10 Psychological Distress Scale. Demographic details were collected. A subsample (n = 51) completed a semi-structured interview about issues related to burnout. These data were subjected to qualitative analysis.

RESULTS

Older doctors and doctors with more years of experience had significantly lower scores on MBI subscales of Depersonalization and Emotional exhaustion, and K-10 measured psychological distress. Aspects of working conditions such as being in private practice were associated with increased scores on MBI subscales of Personal accomplishment, and lower scores on MBI subscales of Emotional exhaustion and Depersonalization, and K-10 measured psychological distress. Older doctors more frequently worked in private practice. These quantitative findings were supported by the qualitative data that suggested that older doctors perceived that they experienced less psychological distress compared with earlier in their careers, which they attributed to the development of protective defences in their relationship with patients and the liberation afforded by accumulation of experience and changed work conditions.

CONCLUSIONS

Findings from this study suggest that older, more experienced doctors report lower psychological distress and burnout than younger doctors which the older doctors attributed to lessons learned over their years of training and practice. It may be of considerable value to find ways to more efficiently pass on these lessons to younger doctors to aid them in dealing with this challenging profession. By soliciting older doctors to aid in this transfer of knowledge, this approach may also have the added benefit of assisting older doctors in transitioning from an active clinical practice to a role of mentoring the new physician cohort.

On the nature of burnout-insomnia relationships: a prospective study of employed adults

OBJECTIVE

This prospective study was designed to test the hypothesis that burnout and insomnia predict each other's incidence and intensification across time. Burnout is conceptualized as representing individuals' unique affective response to their exposure to chronic stressors.

METHOD

Apparently healthy respondents (1356) completed questionnaires during periodic health examinations undergone at two time points T(1) and T(2), about 18 months apart. Burnout was assessed by the Shirom-Melamed Burnout Measure, while insomnia was assessed by the Brief Athens Insomnia Scale. Depressive symptomatology, neuroticism, body mass index, age, gender, follow-up duration, and T(1) levels of the criterion were controlled.

RESULTS

Burnout and insomnia were found to be only moderately associated at T(1). However, logistic regression results indicated that burnout significantly predicted the development of new cases of insomnia at 18-month follow-up [odds ratio (OR)=1.93; 95% confidence interval (95% CI)=1.45-2.58], even after adjusting for depression and other potent confounders. Likewise, insomnia significantly predicted the onset of new cases of burnout at 18-month follow-up (OR=1.64; 95% CI=1.30-2.08). Hierarchical regression results indicted that T(1) burnout significantly predicted an increase in T(2) insomnia (beta=.05, P<.05), and that T(1) insomnia significantly predicted an increase in T(2) burnout (beta=.07, P<.05).

DISCUSSION

The results indicate that burnout and insomnia recursively predict each other's development and intensification over time, thus suggesting that either might be a risk factor for the other across time. Possible mechanisms of link between burnout and insomnia, as well as the clinical implications of the findings, were suggested.

Insomnia and sleep quality among primary care physicians with low and high burnout levels

OBJECTIVE

The aim of this study was to assess insomnia and sleep quality in primary care physicians with low and high burnout scores.

METHODS

A representative sample of 240 physicians was drawn from 70 medical centers in Madrid, Spain. Based on quartile splits of the overall index of the Shirom-Melamed Burnout Questionnaire, 55 participants were allocated to a low-burnout group, and 58 were included in a high-burnout group. The questionnaire also included sociodemographic data, insomnia symptomatology, and the Pittsburgh Sleep Quality Index.

RESULTS

Of the total sample, 18.8% met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for insomnia diagnoses. More individuals with high burnout scores (21.1%) than individuals with low burnout scores (6.9%) fulfilled these criteria. Results of multivariate logistic regression analyses showed that burnout was the only variable related to insomnia diagnoses (odds ratio=7.56; 95% confidence interval=2.38-14.02). Furthermore, the results of multivariate analysis of covariance, after adjustments for sociodemographic variables, indicated that subjects from the high-burnout group scored significantly higher than subjects from the low-burnout group on the global sleep quality index and its components, indicating significantly greater disturbed sleep for the former.

CONCLUSION

The results of the present study provide support for a clear relationship between burnout and disturbed sleep, as shown by the high prevalence of insomnia and poor sleep quality among physicians with high levels of burnout.

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

OBJECTIVE

This prospective study was designed to test the extent to which the onset of type 2 diabetes in apparently healthy individuals was predicted by burnout, a unique affective response to combined exposure to chronic stressors.

METHODS

The study participants were 677 employed men and women who were followed up for 3 to 5 years (mean = 3.6 years) for the onset of diagnosed type 2 diabetes. Burnout was assessed by the Shirom-Melamed Burnout Measure with its three subscales: emotional exhaustion, physical fatigue, and cognitive weariness.

RESULTS

The burnout symptoms were remarkably consistent over the follow-up period irrespective of changes in place of work and in employment status. During the follow-up period, 17 workers developed type 2 diabetes. Logistic regression results indicated that burnout was associated with a 1.84-fold increased risk of diabetes (95% confidence interval [CI] = 1.19-2.85) even after adjusting for age, sex, body mass index, smoking, alcohol use, leisure time physical activity, initial job category, and follow-up duration. In a subsample of 507 workers, the relative risk of diabetes was found to be much higher after additional control for blood pressure levels (odds ratio = 4.32, 95% CI = 1.75-10.67), available only for this subsample.

CONCLUSIONS

These findings suggest that chronic burnout might be a risk factor for the onset of type 2 diabetes in apparently healthy individuals.