Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors

Role of Institutional Support for Evidence-Based Psychotherapy in Satisfaction and Burnout Among Veterans Affairs Therapists

OBJECTIVE

Burnout is widespread among psychotherapists and leads to negative mental and other health outcomes, absenteeism, and turnover. Job resources, including institutional support for evidence-based practices, can buffer against burnout and may improve satisfaction among therapists. The Veterans Health Administration (VHA) is the nation's largest integrated health system and employs 23,000 therapists, including psychologists, social workers, and counselors. The authors assessed associations between perceived institutional support for evidence-based treatment and satisfaction and burnout among VHA therapists.

METHODS

This analysis used data from the VHA's national 2018 Mental Health Provider Survey. Responding therapists (N=5,341) answered questions about the quality of mental health care and job satisfaction. Multilevel logistic regression models were used to predict burnout and satisfaction. The authors tested availability of evidence-based treatment and measurement-based care (MBC) as predictors; analyses were adjusted for therapist workload, demographic characteristics, and potential clustering by facility.

RESULTS

VHA therapists had less burnout and more job satisfaction when they perceived receiving institutional support for evidence-based psychotherapy (EBP) and MBC, irrespective of whether the analyses were adjusted for workload. Less difficulty in scheduling EBP was significantly associated with decreased likelihood of burnout (OR=0.83, p<0.001) and increased satisfaction (OR=1.09, p=0.008). Less difficulty ending psychotherapy was significantly associated with decreased likelihood of burnout (OR=0.89, p=0.002) and increased satisfaction (OR=1.12, p=0.004).

CONCLUSIONS

Support for evidence-based practices, including EBP and MBC, was closely linked to VHA therapists' satisfaction and burnout. Expanding support for therapists to provide evidence-based treatment may benefit therapists, patients, and the health care system.

Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review

The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.

Exploring burnout among psychiatric trainees at a South African university

Background

The mental health of doctors is increasingly topical, internationally and locally. Of importance is the phenomenon of burnout, a far-reaching repercussion of chronic work-related stress. Psychiatrists are more vulnerable to stress, burnout and suicide in comparison with other medical specialities. There is a void in published research relating to South African psychiatric trainees.

Aim

The study aimed to investigate burnout and associated factors among psychiatric registrars at a South African university.

Setting

Department of Psychiatry at the University of the Witwatersrand.

Methods

This was a cross-sectional study via an anonymous self-administered questionnaire. The questionnaire comprised three sections: demographics; the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and questions relating to contributing factors, protective factors and consequences of burnout. The MBI-HSS is recognised as the leading measure of burnout, consisting of three subscales: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA).

Results

The questionnaire was completed by 33 out of 55 psychiatric registrars (60.0% response rate). Data from 31 registrars were used in the analyses, as two registrars did not provide informed consent. Among participants, EE was the most commonly affected, followed by DP and lastly PA. The majority (67.8% or n = 21) had scores in the high category for any one of the three subscales (EE/DP/PA). Significant factors associated with burnout included poor work and non-professional life balance (p = 0.017), utilising annual leave days for work-related tasks (p < 0.001), irregular holidays (p = 0.003) and financial debt (p = 0.026). A possible protective factor was an amicable relationship with fellow psychiatric registrars.

Conclusion

There is evidence of some degree of burnout in more than two-thirds of participants. Associated factors lie largely at an organisational level, and while optimising individual resilience is important, systemic support plays a key role.

Interrelation between defensive mechanisms and coping strategies in psychiatry trainees in Romania: a multicenter study

BACKGROUND

The challenges faced by professionals when working in the field of psychiatry require the development of adequate defensive and coping mechanisms. This study aimed to explore both coping strategies and defense mechanisms and their relationship in psychiatry trainees in Romania.

METHODS

A cross-sectional study was conducted to determine and evaluate both defensive and coping mechanisms of Romanian psychiatry trainees. Defensive Style Questionnaire-60 and COPE scale were applied to psychiatry trainees from five training centers in Romania. By applying structural equation modeling, models that presumed the existence of relationships between coping strategies and defensive mechanisms were analyzed.

RESULTS

Superior defense mechanisms and task-oriented coping strategies were the commonly used approaches by psychiatry trainees. Furthermore, significantly consistent correlations (ranging from 0.2 to 0.5) between adaptive defense mechanisms and coping strategies focused on the problem or emotion were shown. Similarly, avoidant coping strategies correlated with non-adaptive defense mechanisms (correlations between 0.3 and 0.5). Our model presented good fit indices (X 2(34) = 64.324, p < 0.001; GFI = 0.93; root mean square error = 0.08). Moreover, the results indicated a weak association between the two types of adaptive processes (r = 0.07, p < 0.001).

CONCLUSION

Psychiatry trainees present a profile based on two independent groups of adaptation processes, namely, adaptive defenses and problem-oriented coping scales and non-adaptive defenses and avoidant coping scales.

Providing healthcare through “value shops”: impact on professional fulfilment for physicians and nurses

Purpose

The purpose of this paper is to empirically explore and demonstrate the ability of healthcare professionals to attain professional fulfilment when providing healthcare inspired by “value shops”.

Design/methodology/approach

A qualitative case study incorporating interviews and observations was conducted.

Findings

The empirical data suggest that the professional fulfilment of both physicians and nurses is facilitated when care is organized through “value shops”. Both groups of professionals state that they are able to return to their “professional core”.

Originality/value

The beneficial outcomes of organizing healthcare inspired by the “value shop” have previously been explored in terms of efficiency and quality. However, the professional fulfilment of healthcare professionals when providing such care has not been explicitly addressed. Professional fulfilment is vital in order to safeguard high-quality care, as well as healthcare professionals' involvement and engagement in implementing quality improvements. This paper highlights the fact that care provision inspired by the “value shop” may facilitate professional fulfilment, which further strengthens the potential positive outcomes of the “value shop” when utilized in a healthcare setting.

Measuring Burnout Among Psychiatric Residents Using the Oldenburg Burnout Inventory (OLBI) Instrument

Burnout is prevalent among mental health providers and is significantly associated with the employee, consumer, and organizational costs. Nowadays, burnout prevalence is increasing and can challenge the residents' professional development, place patients at risk, and have a significant influence on a variety of personal costs. Considering its importance, this research attempted to measure the burnout experienced by Romanian psychiatric residents while also correlating demographic characteristics and work situations. A cross-sectional study was conducted on 116 Romanian psychiatric residents. Our questionnaire contained socio-demographic information and burnout assessment, which was performed using the Oldenburg Burnout Inventory (OLBI). The burnout scores were classified as high burnout (22.4% of the respondents), moderate burnout (51,7% of the respondents), and low burnout (25.9% of the respondents). As such, all psychiatric residents who suffered from high levels of burnout were satisfied with their salary and their work but dissatisfied with the resources available for attending patients. From all physicians who might experience burnout, psychiatrists are most likely to search for help. The fact that the majority of psychiatric residents in our study were satisfied with their salary and their work, but dissatisfied with the available resources for attending patients might be a result of the Romanian policy of increasing incomes for medical personnel. In conclusion, adding stress management training to the medical education curriculum could help the residents to deal more effectively with the training strain, develop personal techniques for helping themselves to improve their professional path, and potentially prevent upcoming physician burnout.

Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships

This study explores the nature of clinical therapeutic relationships between mental health treatment providers and high-need clients with serious mental illness who had recently discontinued treatment. Semi-structured qualitative interviews of 56 clients with serious mental illness who had recently discontinued care and 25 mental health treatment providers were completed. Both clients with serious mental illness and treatment providers emphasized the importance of client-focused goal setting, time and availability of treatment providers, a caring approach, and trust and honesty in the relationship. However, clients with serious mental illness placed greater emphasis on goals involving tangible services, a notable area of discord between the two groups. Individuals with serious mental illness and treatment providers agreed regarding several key elements to a positive clinical relationship. Further attention to client goals related to tangible services may serve to improve relationships between treatment providers and high-need clients with serious mental illness.

The mental health of nurses in the UK

The recruitment and retention crisis in UK nursing puts many reforms outlined in recent health policies at risk. Increasing bureaucratisation of health care, unattractive working conditions, poor pay and the emotionally exhausting nature of the work are associated with high rates of burnout and workplace violence. Some nurses prefer agency work, some leave because they cannot reconcile a caring role with working in the NHS. It seems that health care has become emotionally distant and the profession's longstanding attachment to caring through interpersonal relationships has been overridden by a high-technology, fast-track system of care management. To retain the principles and ethos of nursing at the centre of health developments, attention must be given to the micro-environments in which nurses work.

Burnout and its Influencing Factors among Primary Health Care Providers in the North East of Iran

Introduction

Burnout is a popular research topics in service providing jobs, including the health care field. This study aimed at assessing the level of job burnout and to consider the important antecedents which might be related to job burnout among primary health care providers in Iran.

Methods

The participants in this applied cross-sectional study which was conducted in 2013 were 548 primary health care providers who were randomly selected from among those working in Shahroud, Sabzevar, Neishabour, Bojnord (provinces located in the north east of Iran). Maslach Burnout Inventory (MBI) was administered to the participants and the collected data were analyzed using SPSS through chi-square test and ordinal logistic regression model.

Results

The burnout mean score among the participants was 54.1 ± 27.2 and the mean scores of burnout components i.e., emotional exhaustion, depersonalization and personal accomplishment were 15.5 ± 13.6, 3.7 ± 5.4 and 35.5 ± 13.5 respectively. In terms of levels of burnout, 64.2% of the participants showed low levels (n = 352), 18.4% average levels (n = 101) and 17.3% high levels (n = 95). A significant relationship was observed between burnout, job resources and interest in job (p ≤ 0.05). However, no significant relationship was observed between burnout and the place (university) of working, age, satisfaction with income, experience, gender, level of education, marital status, housing status, having a second job and place of residence (p ≥0.05).

Conclusion

Lack of personal accomplishment was highly prevalent among the participating primary health care providers. Lack of career advancement and job transfer opportunities may play a role in the burnout of primary health care providers. Therefore, paying attention to this aspect may help to reduce burnout and even increase job engagement.

Happiness amongst Israel Defense Force (IDF) Mental Health Officers (MHO's)

BACKGROUND

Positive psychology is the scientific study of positive experiences and positive individual traits. Happy people have a better quality of life and other benefits, including better health. The Mental Health Department of the IDF employs a large cadre of Mental Health Officers (MHO's). The rate of burnout among MHO's is considered to be high. Career satisfaction has received attention recently with publications dealing with the growing discontent of healthcare system workers. High MHO's satisfaction is likely to result in good outcomes with patients. Continued state of dissatisfaction, may result in health problems. In this study we tried to assess levels of happiness and its correlates among MHO's.

METHODS

Survey among MHO's. Participants answered a questionnaire including the Satisfaction with Life Scale (SLS);personal details: sex, age, marital status, number of children, family income, state of healthand military details:seniority as MHO, rank, administrative executive or clinical position, unit type, army service placement.

RESULTS

In the period of the survey100 MHO's completed the questionnaire. Amongst them were 14 psychiatrists, 25 psychologists and 60 social workers. Mean age 37.37 ± 7.12 years, mean years in army service 7.83 ± 6.47. 44% of the MHO's were Captains, 44% Majors, 3% Lieutenant Colonels and 8% citizens working for the I.D.F. The SLS score was analyzed in order to identify correlations to demographic and clinical variables and Pearson coefficient correlations were calculated. The mean total SLS score was 24.29 ± 5.22. The only statistically significant association with SLS score was family income (p = 0.0109).

CONCLUSIONS

MHO's reported similar levels of happiness as the mean score found in an Israeli national survey and slightly higher level of happiness compared to Israeli physicians. Family income was found to be associated to the level of happiness. Army rank and unit type were not associated with higher satisfaction with life.

Organizational Wellbeing among Workers in Mental Health Services: A Pilot Study

INTRODUCTION

Organizational wellbeing in mental health services influences the outcomes of users and their families. Workers should be motivated, have a positive morale and be able to recognize values and the deep meaning of their work. This survey aims to examine the organizational wellbeing of the services provided by the Department of Mental Health (DSM) in Lanusei (Italy) and the correlations between job satisfaction and the psychosomatic health of its workers.

MATERIALS AND METHODOLOGY

Descriptive-correlational study on a population of 43 mental health workers. Organizational wellbeing, as well as workers' job satisfaction and psychosomatic health, were measured using the "Multidimensional Organizational Health Questionnaire" (MOHQ). It is a self-report questionnaire able to examine 14 dimensions of organizational wellbeing, 14 indicators about individual discomfort, 12 indicators about individual wellbeing, 8 psychosomatic symptoms related to job distress.

RESULTS

31 workers (72%) participated in the survey. Regarding the organizational wellbeing of DSM, the general profile mean±sd was 2.66±0.28 (values from 1 to 4: 1=never, 4=often). Job satisfaction was negatively correlated with headaches and concentration difficulties (R=-.584, p=0.001), nervousness, restlessness, anxiety (R=-.571, p=0.001), sense of excessive fatigue (R=-.634, p=0.000) and sense of depression (R=-.558, p=0.001) reported by workers.

CONCLUSIONS

Data denoted an overall healthy state of the DSM. There were significant correlations between workers' job satisfaction and their psychosomatic health. The recognition and restitution about the weakness and strengths of the services could be useful to point out some organizational development perspectives.

Burnout in Veterans Health Administration mental health providers in posttraumatic stress clinics

The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload, and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his or her job. Findings suggest that providers in VHA specialty PTSD-care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout.

The experience of working on a locked acute psychiatric ward

This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health-care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context.

Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors

AIMS AND OBJECTIVES

The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories.

BACKGROUND

Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy.

DESIGN

A cross-sectional survey research was conducted with self-report questionnaires.

METHODS

The Maslach Burnout Inventory-General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study.

RESULTS

The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment.

CONCLUSIONS

Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk.

RELEVANCE TO CLINICAL PRACTICE

Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction.

Nationwide survey of work environment, work-life balance and burnout among psychiatrists in Japan

BACKGROUND

Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan.

AIMS

The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan.

METHOD

We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used.

RESULTS

Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation.

CONCLUSIONS

A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

Compassion fatigue and burnout amongst clinicians: a medical exploratory study

BACKGROUND

Compassion fatigue is a broad term comprising of two components - burnout and secondary traumatic stress. The current study is aimed at identifying 'burnout' and 'compassion fatigue' among clinicians involved in care of individuals suffering from medical illness.

MATERIALS AND METHODS

A total of 60 clinicians were included in the study. A semi-structured questionnaire was administered to gather information related to personal, professional, anthropometric, and metabolic profile of the study participants. Professional Quality of Life Scale (ProQoL Version V) was used to assess burnout, compassion satisfaction and secondary traumatic stress. Analysis was carried out using the SPSS version 19.0.

RESULTS

The mean age of clinicians was 46.68±11.06 (range 26-67 years). Burnout score was significantly higher in those involved in diabetology practice. Similarly, compassion satisfaction score was greater among those with greater years of practice as well as among those in private practice. Clinicians who reported a poor working condition, as opposed to good, had more burnout and less compassion satisfaction.

CONCLUSION

The current study suggests that it is important to find out ways of decreasing burnout and compassion fatigue among clinicians.

Stresses experienced by psychiatrists and their role in burnout: a national follow-up study

BACKGROUND

Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion.

METHODS

A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents.

RESULTS

Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work; working long hours; an aggressive administrative environment; and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries.

CONCLUSIONS

Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously.

A self-referral preventive intervention for burnout among Norwegian nurses: one-year follow-up study

OBJECTIVE

Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.

METHODS

Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).

RESULTS

Mean level of emotional exhaustion (one dimension of burnout, scale 1-5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t=5.3, p<0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p<0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (beta -0.53 (SE 0.13), p<0.001) or by getting a period of sick leave (beta -0.28 (SE 0.12), p<0.05) after the intervention.

CONCLUSIONS

A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.

PRACTICE IMPLICATIONS

Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.

Burnout among care staff for older adults with dementia

People working in the helping professions have been found to be vulnerable to the development of burnout and research has suggested a relationship between dementia care and burnout. Literature suggests that the development of burnout may be linked to a number of factors, including lack of reciprocity, low self-efficacy and organizational factors. The study explored burnout in staff for older people with dementia and examined the roles of reciprocity, self-efficacy and organizational factors and aimed to identify which of these variables was the greatest predictor of burnout. Sixty—one members of staff in continuing care homes for people with dementia completed self-report questionnaires. Self-efficacy was found to be the greatest predictor of burnout. Findings from the study also emphasized the connections of reciprocity, occupational commitment, demographic factors and self-efficacy with burnout. The clinical implications of the study, methodological considerations and recommendations for future research are discussed.

Influence of perceived organisational factors on job burnout: survey of community mental health staff

BACKGROUND

Staff burnout is a critical issue for mental healthcare delivery, as it can lead to decreased work performance and, ultimately, to poorer treatment outcomes.

AIMS

To explore the relative weight of job-related characteristics and perceived organisational factors in predicting burnout in staff working in community-based psychiatric services.

METHOD

A representative sample of 2000 mental health staff working in the Veneto region, Italy, participated. Burnout and perceived organisational factors were assessed by using the Organizational Checkup Survey.

RESULTS

Overall, high levels of job distress affected nearly two-thirds of the psychiatric staff and one in five staff members suffered from burnout. Psychiatrists and social workers reported the highest levels of burnout, and support workers and psychologists, the lowest. Burnout was mostly predicted by a higher frequency of face-to-face interaction with users, longer tenure in mental healthcare, weak work group cohesion and perceived unfairness.

CONCLUSIONS

Improving the workplace atmosphere within psychiatric services should be one of the most important targets in staff burnout prevention strategies. The potential benefits of such programmes may, in turn, have a favourable impact on patient outcomes.

Prevalence of burnout among Swiss cancer clinicians, paediatricians and general practitioners: who are most at risk?

GOALS OF WORK

Increasing economical and administrative constraints and changes in health-care systems constitute a risk for burnout, especially for cancer physicians. However, little is known about differences across medical specialties and the importance of work characteristics.

METHODS

A postal questionnaire addressing burnout, psychiatric morbidity, sociodemographics and work characteristics was administered to 180 cancer physicians, 184 paediatricians and 197 general practitioners in Switzerland.

RESULTS

A total of 371 (66%) physicians participated in the survey. Overall, one third of the respondents expressed signs indicative of psychiatric morbidity and of burnout, including high levels of emotional exhaustion (33%) and depersonalisation/cynicism (28%) and a reduced feeling of personal accomplishment (20%). Workload (>50 h/week), lack of continuing education (<6 h/month) and working in a public institution were significantly associated with an increased risk of burnout. After adjustment for these characteristics, general practitioners had a higher risk for emotional exhaustion (OR: 2.0, 95% CI: 1.1 to 3.6) and depersonalisation (OR: 2.7, 95% CI: 1.4 to 5.3).

CONCLUSION

In this Swiss sample, cancer clinicians had a significant lower risk of burnout, despite a more important workload. Among possible explanations, involvement in research and teaching activities and access to continuing education may have protected them.

Interventions in relation to occupational burnout: the population-based health 2000 study

OBJECTIVE

To study participation in occupational and individual-focused interventions in relation to burnout.

METHODS

We used data from a questionnaire, structured interview, national register of psychopharmacological prescriptions, and the Composite International Diagnostic Interview in a nationally representative Finnish sample of 3276 employees (30 to 64 years).

RESULTS

When compared with employees free of burnout, the odds ratio of severe burnout for participation in occupational interventions was 0.41 (95% confidence interval [CI] = 0.26 to 0.65) and in individual-focused interventions 5.36 (95% CI = 3.14 to 9.17). Antidepressant prescriptions were 2.53 (95% CI = 1.04 to 6.15) times more common among those with severe burnout than among those without burnout after adjustment for depressive and anxiety disorders.

CONCLUSIONS

Employees with burnout were less often targets of occupational interventions but participated more in individual-focused interventions when compared with other employees. The use of antidepressants among employees with severe burnout was not fully explained by coexisting depressive or anxiety disorders.

Haemato-oncology and burnout: an Italian survey

This cross-sectional survey aimed to evaluate the prevalence of burnout and estimated psychiatric disorders among haemato-oncology healthcare professionals in Italy. The aspects of work that respondents perceive as stressful and satisfying have also been examined. The assessments were made using the Maslach Burnout Inventory (MBI), General Health Questionnaire and a study-specific questionnaire. Logistic regression models were applied to show associations between different sources of work-related stress and burnout. Three hundred and eighty-seven out of 440 (87.95%) returned their questionnaires. The scores on MBI subscales indicate a high level of emotional exhaustion in 32.2% of the physicians and 31.9% of the nurses; a high level of Depersonalisation in 29.8 and 23.6%, respectively; and a low level of personal accomplishment in 12.4 and 15.3% respectively. The estimated prevalence of psychiatric disorders was 36.4% in physicians and 28.8% in nurses. Statistical analysis confirmed age, sex, personal dissatisfaction, physical tiredness and working with demanding patients to be associated with burnout. In conclusion, haemato-oncology healthcare professionals report a level of burnout and estimated psychiatric morbidity comparable to other oncological areas. Knowledge of the mechanisms of burnout and preventing and dealing with them is therefore a fundamental requirement for the improvement of quality in health services and job satisfaction.

Schizoidia in schizophrenia spectrum and personality disorders: role of dissociation

Dissociation was one of the roots of the nosopoetic construct "schizophrenia", and a link seems to exist between psychotic and dissociative phenomena. We explored the relationship between dissociation and schizoidia as defined by the Dissociative Experiences Scale (DES) total score and the schizoidia subscale of the Munich Personality Test (MPT), respectively. The study comprised 43 outpatients diagnosed with schizophrenia spectrum disorders in remission, 47 outpatients with personality disorders and 42 non-patients. Besides the DES and the MPT, all participants also completed parts of the Symptom Checklist (SCL-90-R) and theTrauma Questionnaire (TQ). In the final multivariable logistic model, a set of five variables was identified as the strongest contributors to the occurrence of schizoida. The model included TQ broken home, MPT neuroticism, schizophrenia spectrum and personality disorder diagnoses, and SCL aggressivity; it did not include any dissociation variable. The purported relationship between dissociation and schizoidia could not be confirmed; the existence of schizophrenia-inherent dissociation appears questionable.

What makes psychiatry such a stressful profession? A qualitative study

OBJECTIVE

We aimed to elucidate causative and protective factors associated with burnout in New Zealand psychiatrists, to identify signs and symptoms of the burnout syndrome, and to identify any difference in the perspectives of psychiatrists who scored high versus low on the emotional exhaustion (EE) subscale of the Maslach Burnout Inventory (MBI).

METHOD

Twelve participants were randomly selected, six from each group of psychiatrists (high versus low EE). A face-to-face interview based on a semi-structured questionnaire was carried out with each participant. The interviews were recorded and transcribed verbatim. The transcriptions were manually analysed by two independent reviewers using a grounded theory approach for qualitative analysis.

RESULTS

Major features of burnout were changes in appearance, behaviour and mood. Causes of burnout identified were external, internal and interpersonal factors, and changing work environment. Protective factors associated with burnout included supportive relationships, extracurricular activities, variety in one's work, a positive attitude towards one's work and high job satisfaction.

CONCLUSIONS

A preliminary profile of the burnout syndrome was established and has a potential role in the prevention of burnout in psychiatrists. Causative factors associated with burnout were identified and supported previous findings. Novel factors protective against burnout were suggested and require further investigation. No differences were apparent between the two subgroups of psychiatrists (high versus low EE).

Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms

The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

Burnout and job satisfaction in New Zealand psychiatrists: a national study

OBJECTIVES

To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population.

METHOD

In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures.

RESULTS

The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.

CONCLUSIONS

This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.

Burnout in psychiatrists: an etiological model

OBJECTIVE

This article reviews burnout in psychiatrists. A model of burnout is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout. Lastly, recommendations are made for future research.

METHODS

We conducted a selective literature review to expand on two recent systematic reviews to examine the etiology, prevalence, and consequences of burnout in psychiatrists. We distinguish the effects of burnout, depression, and work-related stress.

RESULTS

An etiological model for the development of burnout in psychiatrists is described here in terms of an interaction between the predisposing, precipitating, and perpetuating factors.

CONCLUSIONS

Research is needed on the long-term effects of work-place stress on psychiatrists, to identify possible protective factors, and to utilize this information to inform the design of interventions that protect or mitigate the effects of work-place stress on psychiatrists.

Psychiatrists in New Zealand: are they burning out, satisfied at work and, in any case, who cares?

OBJECTIVE

To explore possible contributing or mitigating factors for burnout in New Zealand psychiatrists as well as future research directions in this area.

METHOD

A selective review of the literature pertaining to burnout and reports regarding New Zealand's medical workforce.

RESULTS

Possible factors contributing to burnout in New Zealand psychiatrists include rapid changes in the country's health system, the challenge of recruiting and retaining psychiatrists, poor distribution of staff and funds and difficulties in psychiatric training. Potential protective factors against burnout include lifestyle factors, long experience in psychiatry, proposed long lengths of career in New Zealand and potentially positive changes in the health system. Research challenges include subject recruitment, the lack of exploration of personal protective factors and completing longitudinal studies.

CONCLUSIONS

Given the current state of knowledge, it would be difficult to accurately know whether New Zealand psychiatrists were burnt out or satisfied with their work. Carefully designed studies would help to clarify this issue.

Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey

BACKGROUND

There is a growing interest in the psychosocial work environment of health care staff since they are at high risk for burnout, role conflict and job dissatisfaction. Burnout, as a type of prolonged response to chronic job-related stressors, has a special significance in health care where staff experience both psychological-emotional and physical stress. Burnout and the other negative aspects of the job of health care staff have major behavioural and health implications.

OBJECTIVES

The present study investigated the interrelationships among burnout, role conflict and job satisfaction in a sample of Hungarian health care staff. The study also investigated how these indicators of psychosocial work climate influence respondents' frequency of psychosomatic symptoms.

DESIGN

A questionnaire survey (anonymous questionnaires) has been carried out to detect these interrelationships.

SETTINGS

Two major hospitals in Szeged, Hungary.

PARTICIPANTS

Questionnaires were distributed to 450 health care staff among whom 55.7% were registered nurses. All together, 201 questionnaires were returned and analyzed, giving a response rate of 44.6%.

METHODS

Questionnaire contained items on work and health-related information (i.e., burnout, job satisfaction, role conflict, and psychosomatic symptoms) and on some basic sociodemographics. Beyond descriptive statistics, correlation and multiple regression analyses were computed.

RESULTS

Findings show that emotional exhaustion and depersonalization scores were higher, while scores on personal accomplishment was lower as compared to Canadian, Norwegian or US samples. Burnout, particularly emotional exhaustion (p<.001), was found to be strongly related to job dissatisfaction. Schooling was inversely related to satisfaction with the job (p<.05). While job satisfaction was a negative predictor of each type of burnout subscale (p<.001), role conflict was a factor contributing positively to emotional exhaustion (p<.001) and depersonalization scores (p<.001).

CONCLUSIONS

The study results underline the importance of the role of psychosocial work environment and the interrelationships among burnout, role conflict, job satisfaction and psychosomatic health among Hungarian health care staff.

Las trabajadoras de la salud: vida, trabajo y trastornos mentales

Se estudió la relación entre condiciones de vida, trabajo y trastornos mentales en trabajadoras de la salud del Instituto Mexicano del Seguro Social (IMSS). La población se integró por médicas, enfermeras, personal de laboratorio y asistentes médicas (n = 170). La información principal se obtuvo de una encuesta, validada en población trabajadora mexicana. Se encontró que los trastornos mentales están relacionados con todos los ámbitos de la vida de las mujeres. En relación con el ámbito doméstico, se muestra que las mujeres con mayor morbilidad mental son: las que son madres; las que tienen un mayor número de hijos; aquéllas que no cuentan con ayuda para el trabajo doméstico; y las que tienen pareja. En relación con el trabajo asalariado, la morbilidad mental se encontró asociada con la duración de la jornada, el ausentismo y la falta de contenido del trabajo. El desarrollo de habilidades, la satisfacción y la creatividad fueron aspectos "protectores" o preventivos de trastornos mentales y de fatiga. Los principales riesgos y exigencias que actuaron como causantes de estrés fueron: el calor, el ruido, el esfuerzo físico, las posiciones forzadas y el trabajo intenso y repetitivo.

Stress, burnout, coping and stress management in psychiatrists: findings from a systematic review

BACKGROUND

Research into stress among psychiatrists has attempted to identify stressors, which can lead to physical illness and psychological distress.

AIMS

The aim of the study was systematically to review the current evidence for the effectiveness of stress management interventions for those working in the psychiatric profession.

METHOD

A systematic review of the current literature was conducted into stress and stress management within the profession of psychiatry.

RESULTS

Twenty-three international studies were included in the psychiatry section of the review. Psychiatrists report a range of stressors in their work, including stress associated with their work and personal stresses. One personal stress, which psychiatrists find very difficult to cope with is patient suicide. Coping strategies include support from colleagues and outside interests. No studies evaluated the use of stress-management interventions for psychiatrists.

CONCLUSIONS

Psychiatry is a stressful profession. Psychiatrists identified several stressors in their professional and personal lives.

Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future

OBJECTIVE

To examine the levels of satisfaction and stress of Australian psychiatrists.

METHOD

A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire.

RESULTS

The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas.

CONCLUSION

Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind.

Personnel reductions and structural changes in health care: work-life experiences of medical secretaries

OBJECTIVE

To explore the experiential aspects of 'psychosocial stressors and motivators' for medical secretaries, following a period of personnel reductions and structural changes in Swedish health care. The focus was to understand and describe work-life experiences for this specific group of women and how they managed in what can be presumed to be a more demanding work situation.

METHOD

A descriptive qualitative study with repeated in-depth interviews of six medical secretaries (mean age: 45 years) in a large hospital in Sweden. The first interview took place in the autumn of 1997 (in connection with the last round of the 20% staff redundancies), 1998 and 2000. Thematic content analysis from audiotaped and transcribed interviews was used to obtain understanding.

RESULTS

The study provided three main themes from the women's perceived stressors, motivators and coping options. The descriptions of their stressors provided the metaphor, 'energy thieves' with three underlying subthemes: 'too much work,' 'lack of recognition' and 'the dilemma of health, family and finances.' Experienced motivators, labeled as 'energy givers' had two subthemes: 'professional pride' and 'the comprehensive whole.' The women's descriptions about managing increasing demands were thematized as altering between 'being submissive and taking actions' with three subthemes: 'unequal communication,' 'resigned and passive reactions' versus 'cautious and solution-oriented coping.' Expressions concerned mainly 'energy thieves,' inclusively worries about 'lacking energy' (intrinsic stressor), combined with passive and cautious coping behavior. However, the descriptions became somewhat more varied and balanced with enriching and solution oriented factors in the follow-up interviews.

CONCLUSIONS

There is an evident contrast between a demanding reality of work, described by medical secretaries in this study, and their expressed desire to have a more reasonable work environment that allowed them to be able to complete their work. They also wanted to be heard regarding their requests about work options and decent salaries. This study demonstrates the importance of making feelings of inferiority and injustice visible as well as to support professional pride and more assertive coping behavior. This is also valid for the need to enhance equal/congruent communication between interdependent workers. The study has implications for managers and health workers supporting and empowering women, providing administrative service in a clinical health care context. The subthemes being identified within the metaphor 'energy thieves,' in relation to resigned/passive reactions and cautious coping styles, could be used in stress prevention, while the understanding of 'energy givers' and the support of active and solution-oriented coping conducts could be used in health promotion work.

Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians

BACKGROUND

Burnout and psychological stress symptoms represent a major problem among health care professionals. The aim of this study was to investigate the prevalence of and the relationship between psychiatric morbidity and burnout among a convenience sample of Italian primary care physicians (GPs) and hospital physicians (HPs).

METHOD

The sample consisted of 328 physicians (182 GPs and 146 HPs) who completed the 12-item version of the General Health Questionnaire and the Maslach Burnout Inventory (MBI).

RESULTS

The global prevalence of psychiatric morbidity was 22.3% (20.3% among GPs and 24.6% among HPs). Symptoms of emotional exhaustion were reported by 27.5% of the participants (GPs: 32.4%; HPs: 21.2%), depersonalization by 25.6% (GPs: 27.4%; HPs: 22.6%) and low personal accomplishment by 12.8% (GPs: 13.1%; HPs: 12.3%). No significant difference was found between the two groups, except higher levels of emotional exhaustion among GPs. Female GPs reported lower scores on MBI depersonalization and female HPs lower scores MBI personal accomplishment than male GPs and HPs, respectively.

CONCLUSIONS

The study underscores the significant problem of stress among physicians and indicates the need for supporting health professionals in order to improve their psychological well-being and, possibly, the quality of their relationship with the patients.

Psychosomatic medicine: emerging trends and perspectives

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.