Burnout in nursing staff: a clinical syndrome rather than a psychological reaction?

Life events in schizoaffective disorder: A systematic review

BACKGROUND

Life events play a central role in the development of psychiatric disorders and impact course and outcome. We present a systematic review of the literature on the relationship of life events with the onset and long-term course of schizoaffective disorder.

METHODS

MEDLINE was searched with the combination of the key words: 'life events' plus 'schizoaffective'. The PRISMA method was followed in the review process.

RESULTS

From the identified 66 papers only 12 were considered to be of relevance to the current study and 6 more papers were identified by inspecting the reference lists of the identified papers.

LIMITATIONS

There are very few studies focusing on the role of life events in schizoaffective disorder indicating insufficient data concerning the relationship of life events with onset and long-term course of schizoaffective disorder. Reported effects are not generic but concern specific events like the loss of mother, and females seem to be more vulnerable. Patients with schizoaffective disorder manifest high rates of PTSD.

CONCLUSION

The literature on life events with the development and course of schizoaffective disorder is limited and precludes solid conclusions.

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.

Burnout in internal medicine physicians: Differences between residents and specialists

BACKGROUND

Burnout poses a substantial problem for physicians' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents.

METHODS

A cross-sectional study using an anonymous mailed survey was used. Some 103 specialists and 143 residents participated in the study. Burnout was measured using the Maslach Burnout Inventory. Subjective work characteristics included perceived job demands in terms of time pressure, mental effort and emotional labor. Workload was assessed in terms of average number of hours worked per week.

RESULTS

Emotional exhaustion in medical specialists was only predicted by perceived job demands [odds ratio 3.7 (CI 1.7-7.9), P<0.001]. Emotional exhaustion in medical residents was only predicted by emotional labor [odds ratio 1.9 (CI 1.2-3.0), P=0.003]. Depersonalization among medical specialists was only predicted by emotional labor [odds ratio 2.7 (CI 1.1-6.7), P=0.032], while depersonalization among medical residents was only predicted by number of hours worked per week [odds ratio 1.1 (CI 1.1-1.2), P=0.007].

DISCUSSION

Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment.

The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study

BACKGROUND

Depression and burnout are common health problems in working populations today. They appear to be interrelated, and the need for their differential diagnosis has been highlighted in many reviews. We analysed the overlap of job-related burnout and depressive disorders, i.e., major depressive disorder, dysthymia, and minor depressive disorder.

METHODS

We used the population-based 'Health 2000 Study' in Finland. Our nationally representative sample comprised 3276 employees aged 30-64 years. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Diagnoses of depressive disorders were based on the Composite International Diagnostic Interview.

RESULTS

Burnout and depressive disorders were clearly related. The risk of depressive disorders, especially major depressive disorder (12-month prevalence), was greater when burnout was severe. Half of the participants with severe burnout had some depressive disorder. Those with a current major depressive episode suffered from serious burnout more often than those who had suffered a major depressive episode earlier.

LIMITATIONS

This study was cross-sectional.

CONCLUSIONS

The concepts of burnout and depression complement each other and cover partly overlapping phenomena. Depressive disorders are related to job-related burnout, particularly when it is severe. A current major depressive episode is likely to be associated with the experience of burnout. When encountering working patients, it is recommended to assess both the occurrence of burnout and of depressive disorders.

The relationship between job stress, burnout and clinical depression

The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.

Burnout versus depression and sense of coherence: study of Greek nursing staff

We assessed the relationships between burn out, depression and sense of coherence (SOC) using the Maslach Burnout Inventory, Beck's depression inventory and Antonovsky's SOC questionnaire in a large sample of 17 male and 62 female Greek nurses. Analysis showed that SOC in nursing staff was correlated with burnout (BO) and depression, while the latter was correlated to a lesser degree with BO. The relationship of BO with depression seems to be the result of the relationship between depression and SOC. Thus, we could hypothesize that the degree of SOC renders persons either vulnerable or resistant to both depression and BO, though further studies are warranted. In the hospital setting, the intervention by specialized personnel in order to assist nursing staff with BO may be an appealing option. Further, prevention programs aimed at helping individuals prone to BO could also be envisaged.

Burnout in psychiatric nursing

INTRODUCTION

Burnout in nursing is of both individual and organizational concern with ramifications for well-being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short-coming which this paper attempts to redress.

METHOD

A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable.

FINDINGS

The respondents reported average, low and average levels of emotional exhaustion, depersonalization and personal accomplishment, respectively. The study sample had significantly lower scores on emotional exhaustion and depersonalization than normative data but also significantly lower levels of personal accomplishment than a normative group of physicians and nurses. Only 2.0% of the study sample could be categorized as having high burnout overall (i.e. high emotional exhaustion, high depersonalization, low personal accomplishment) and they differed significantly from the rest only in terms of males being over-represented. Hierarchical regression analysis revealed that selected explanatory variables accounted for 41.9% of emotional exhaustion, 16.4% of depersonalization and 25.6% of personal accomplishment in the study sample.

IMPLICATIONS

The paper discusses the implications of the findings in terms of a comprehensive approach to intervention aimed at minimizing the risk of burnout in psychiatric nurses. Such an approach will involve interventions at the organizational and individual level.

Relation between immune variables and burnout in a sample of physicians

OBJECTIVES

To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables.

METHODS

Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures.

RESULTS

With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables.

CONCLUSIONS

In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.

Burnout in nursing staff: is there a relationship between depression and burnout?

OBJECTIVE

There is evidence that burnout may be a clinical entity with pathological stress reaction features related to the inability in finding pleasure from work. The purpose of this study was to investigate the relationship between burnout and depression.

METHODS

The study took place in the general hospital AHEPA of Thessaloniki. All members of the nursing staff (in total 368 subjects) took part. The protocol was self-reported and anonymous, in order to obtain as valid data as possible and included the Maslach Burnout Inventory (MBI) to assess the level of burnout, the Eysenck Personality Questionnaire (EPQ) to assess personality traits, and the Zung Self-Rating Depression Scale to assess depressive symptomatology.

RESULTS

The analysis revealed a weak but significant relationship between burnout and depression.

CONCLUSIONS

Depression is a pervasive disorder that affects almost every aspect of the patient's life. On the contrary, burnout is, by definition, a syndrome restricted to the patient's professional environment. However, it seems that there may be two distinct types of burnout syndromes, of which the one comprising the majority of nurses has little or no common features with depression. The second type consists of individuals with a predisposition to develop burnout. The latter is characterized by more severe symptomatology, phenotypic similarity to depression and presumably common etiological mechanisms.