Mental health, burnout and job satisfaction among professionals in sheltered living in Flanders. A pilot study

Job Satisfaction and Cortisol Awakening Response in Teachers Scoring high and low on Burnout

The burnout syndrome is an important psychosocial risk in the job context, especially in professions with a strong social interaction, as in the case of teaching. High levels of burnout have been related to negative psychological indicators and hormonal alterations. This study compares job satisfaction and the cortisol awakening response (CAR) in teachers scoring high (HB) and low (LB) on burnout. HB teachers showed lower job satisfaction and no significant differences in the CAR when compared with the LB group. The results of the study suggest a general dissatisfaction with work along with a different functioning of the hypothalamo-pituitary-adrenocortical axis in HB teachers. Although non significantly, they showed a lower magnitude of the CAR than LB teachers. When considering the whole sample, emotional exhaustion and depersonalization correlated negatively and personal accomplishment positively with each subscale of the job satisfaction questionnaire whereas cortisol levels or CAR did not correlate significantly with both burnout subscales and job satisfaction. These results should be taken into account when working to prevent burnout in teachers, as the modified parameters could be considered indicators of the onset or development of the syndrome.

The relationship of case managers' expressed emotion to clients' outcomes

BACKGROUND

Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients.

METHODS

The present study assessed 42 case managers serving clients with schizophrenia spectrum disorder regarding their EE for specific clients enrolled in a larger study examining the reliability and validity of two alliance measures. Case managers and clients were personally interviewed at baseline, 3, 6, 6 plus 2 weeks, and 9 months post-client entry into case management. The EE measure was inserted into the 6 months plus 2 week case manager interview. Generalized Estimating Equation analysis was employed to examine predicted outcomes of EE.

RESULTS

High EE was found to be related to client attitudes toward medication compliance and social contact.

CONCLUSIONS

Family psychoeducation interventions, an evidence-based practice, have been demonstrated to be effective in reducing relapse of relatives with serious mental illness. Given the clinical evidence that EE is modifiable, it is expected that such educational training for non-familial caregivers will have the same potential as for family caregivers. Providers dealing with challenging clients may also need support and skills to better handle difficult situations, especially direct support providers like case managers who are not clinically trained.

Staff working with people who have intellectual disabilities within secure hospitals: expressed emotion and its relationship to burnout, stress and coping

Studies involving professional carers of people with mental health problems have investigated the relationship between burnout, job satisfaction, the coping strategies employed by carers, and expressed emotion (EE). We undertook a similar study involving carers of adults with intellectual disabilities detained within a secure hospital. Twenty-seven nursing staff completed a Five Minute Speech Sample regarding a keyworked client. EE was coded, and measures of coping strategies, burnout, attitudes to psychiatric treatment and job satisfaction were administered. Sixty-three percent of the sample were coded as having high EE. These subjects reported significantly higher levels of depersonalization and lower levels of personal accomplishment. They used coping strategies more frequently: specifically they reported trying to reorganize their work and to seek support from others. The results are discussed in light of the findings of previous studies. It is noted that the study was not causal and the sample size was small.

Measuring expressed emotion: an evaluation of the shortcuts

The construct of expressed emotion (EE) is a highly reliable and valid predictor of poor clinical outcomes in patients with major psychopathology. Patients are at early risk for relapse if they live with family members who are classified as high in EE. Conventionally, EE is assessed with the Camberwell Family Interview (CFI), a semistructured interview that is conducted with the patient's key relatives. Unfortunately, training in the CFI is difficult to obtain. The CFI is also time-consuming to administer and labor intensive to rate. In this article, the authors discuss alternative ways of assessing EE. They also evaluate the predictive validity of these measures and make recommendations for researchers and clinicians interested in using these assessments.

A study of emotional attitude of psychiatric nurses: reliability and validity of the Nurse Attitude Scale

In psychiatric nursing, the exchange of feelings among nurses and patients is vital. However, expressed emotion (EE) studies that have been performed in family studies of schizophrenia indicate that a high EE score can predict the relapse of schizophrenic patients. In the case of long-term inpatients at a psychiatric hospital in Japan, the emotional attitude of nurses towards patients is anticipated to have some effect on the course of the illness. In the present study, we revised part of the phrasing of the Japanese version of the Family Attitude Scale, and renamed it the Nurse Attitude Scale (NAS). We tested 189 nurses with this scale, and examined reliability and validity. In a factor analysis of the NAS, three factors were extracted, which we termed criticism, hostility, and positive remarks. These factors are the same as items for assessment on the Camberwell Family Interview, a method of EE assessment. Cronbach's alpha for individual subscales was 0.848 for criticism, 0.845 for hostility, and 0.685 for positive remarks. With regard to test-retest reliability, there were significant correlations with values of 0.65 for criticism, 0.77 for hostility, and 0.44 for positive remarks. In addition, there was a significant correlation between the NAS and Pines' Burnout scores. These facts, thus suggested that the NAS represents an approximation of the EE of psychiatric nurses. In addition, these findings indicated that the state of burnout in psychiatric nurses resulted in a critical attitude towards patients.