Burnout Clinical Subtypes Questionnaire (BCSQ-36): reliability and validity study in Latvia.

The study aimed to test the validity of the burnout subtypes hierarchic model operationalized by the 'Burnout Clinical Subtypes Questionnaire' (BCSQ-36) and its applicability in other cultures. To that aim psychometric properties, factorial and convergent validity regarding the Maslach Burnout Inventory - General Survey (MBI-GS), and correlation with demographic factors were reviewed. A voluntary internet-based approach was used on a multi-occupational sample of adult Latvians (n = 394). The results of the internal consistency of the Latvian version of the BCSQ-36 exceeded .89 for all three subtypes. The CFA was used to test a hierarchical factorial model, and the analysis revealed an acceptable fit of the model to the data. Correlation analysis showed results as expected, similarly to the original sample - Underchallenged and Worn-out subtypes correlated with all MBI-GS scales, while Frenetic subtype did not correlate with the MBI-GS Cynicism scale. Besides, demographic data showed some correlation only on the subscale level. Overall research results provide support of the validity of the burnout subtypes hierarchical model and applicability in another culture.

Psychische Erkrankungen im Arbeitskontext ­ eine Verortung im Versorgungssystem.

Work and mental health are closely interrelated. Sick leave rates due to mental illness have constantly been rising for years. Thus, not only companies but also the society as a whole have become more and more aware of the relevance of this topic.At first, various work stress models are outlined in this article. This is followed by an overview of how to classify work-related mental disorders in the ICD and DSM systems. Burnout is explained with regard to terminology, origin and adequate use in clinical practice. Furthermore, the ILO (International Labour Organization) classification of work-related mental disorders is presented. Possible intervention models for the prevention and therapy of work-related mental health problems are discussed. In addition, the most essential components of work-related psychotherapy are pointed out. Finally, corresponding guidelines are put into an international context.

Discriminating low-, medium- and high-burnout nurses: Role of organisational and patient-related factors.

AIM: To discriminate low/medium/high burnout in nurses by work and patient-related indicators and explore what factors characterize these categories best. METHODS: Cross-sectional, online survey with a representative sample of nurses. Measures assessed burnout, intragroup conflict, job insecurity, overt aggression and impact of patient aggression on nurses. RESULTS: Top nurse managers experienced more burnout than middle managers or staff, middle managers also reported greater burnout than staff. Those who had never suffered aggression experienced greater burnout but less intragroup conflict and job insecurity. Staff differed on job insecurity from top and midlevel managers. The first discriminant function differentiated high burnout from medium and low; this function was characterized by exhaustion, aggression and intragroup conflict. The second function differentiated medium burnout from others; job insecurity, years worked, over aggression and overtime dominated this function. CONCLUSIONS: Burnout affects managers and staff differently; top managers may be more susceptible to burnout than reported before. Low, medium and high burnout groups require tailored interventions because of their different characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: In the future, burnout assessment should focus on both organisational and care related factors. Determining levels of burnout will guide managers to improve the right aspects of practice and work environment.

Maslach Burnout Inventory and a Self-Defined, Single-Item Burnout Measure Produce Different Clinician and Staff Burnout Estimates.

BACKGROUND: Clinicians and healthcare staff report high levels of burnout. Two common burnout assessments are the Maslach Burnout Inventory (MBI) and a single-item, self-defined burnout measure. Relatively little is known about how the measures compare. OBJECTIVE: To identify the sensitivity, specificity, and concurrent validity of the self-defined burnout measure compared to the more established MBI measure. DESIGN: Cross-sectional survey (November 2016-January 2017). PARTICIPANTS: Four hundred forty-four primary care clinicians and 606 staff from three San Francisco Aarea healthcare systems. MAIN MEASURES: The MBI measure, calculated from a high score on either the emotional exhaustion or cynicism subscale, and a single-item measure of self-defined burnout. Concurrent validity was assessed using a validated, 7-item team culture scale as reported by Willard-Grace et al. (J Am Board Fam Med 27(2):229-38, 2014) and a standard question about workplace atmosphere as reported by Rassolian et al. (JAMA Intern Med 177(7):1036-8, 2017) and Linzer et al. (Ann Intern Med 151(1):28-36, 2009). KEY RESULTS: Similar to other nationally representative burnout estimates, 52% of clinicians (95% CI: 47-57%) and 46% of staff (95% CI: 42-50%) reported high MBI emotional exhaustion or high MBI cynicism. In contrast, 29% of clinicians (95% CI: 25-33%) and 31% of staff (95% CI: 28-35%) reported "definitely burning out" or more severe symptoms on the self-defined burnout measure. The self-defined measure's sensitivity to correctly identify MBI-assessed burnout was 50.4% for clinicians and 58.6% for staff; specificity was 94.7% for clinicians and 92.3% for staff. Area under the receiver operator curve was 0.82 for clinicians and 0.81 for staff. Team culture and atmosphere were significantly associated with both self-defined burnout and the MBI, confirming concurrent validity. CONCLUSIONS: Point estimates of burnout notably differ between the self-defined and MBI measures. Compared to the MBI, the self-defined burnout measure misses half of high-burnout clinicians and more than 40% of high-burnout staff. The self-defined burnout measure has a low response burden, is free to administer, and yields similar associations across two burnout predictors from prior studies. However, the self-defined burnout and MBI measures are not interchangeable.

[Is burnout a syndrome or an occupational disease? Instructions for occupational physicians]. / Il burnout è una sindrome o una malattia professionale? Istruzioni per i medici del lavoro.

Since Herbert Freudenberger described Burnout Syndrome (BOS) in 1974, thousands of scientific papers have been published on this syndrome and this trend does not seem to diminish. After being internationally known as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in helping professions, its construct has been criticized, questioned, and subjected to profound modifications. To date, however, in Italy and in many other Countries it is not possible to diagnose this syndrome, because World Health Organization, in its last ICD-10, did not indicate any clinical criteria to diagnose it. Unfortunately, not even in the recent DSM- 5 by American Psychiatric Association, contrary to what was expected, BOS found room as a specific psychiatric disorder. As a consequence, framing this syndrome from a medical-legal point of view is still widely debated from scholars.

Causes of discomfort in the academic workplace and their associations with the different burnout types: a mixed-methodology study.

BACKGROUND: Burnout is the result of prolonged workplace exposure to chronic stress factors and may present itself in one of the following subtypes: "frenetic", "under-challenged" and "worn-out". The aims of the present study were to identify the causes of workplace discomfort that affect employees in large organizations and to determine the predictive power of these causes with regard to the burnout subtypes. METHOD: We employed a qualitative and quantitative analysis (QQA), using a cross-sectional design with an online survey administered to a randomly selected sample of University workers (n = 409). To determine the causes of discomfort, we raised the following open question: "What aspects of your work generate discomfort for you?". The responses were subjected to content analysis and categorized by three independent referees. The concordance between the responses was estimated with the kappa coefficient (k). Subtype classification was assessed according to the "Burnout Clinical Subtype Questionnaire" (BCSQ-36). The degree of association between the motives for the complaint and the burnout profiles was evaluated using adjusted odds ratio (OR), which was based on multivariate logistic regression models. RESULTS: The causes of discomfort included: physical environment (setting aspects, material conditions, journey/access), organization (schedules, structure, functions, interpersonal relations) and individual conditions (workload, powerlessness, rewards, negligence). The concordance index between the referees was k = 0.80. Employees who were upset with the hierarchical structure were more likely to be classified as frenetic (OR = 4.32; 95% CI = 1.43-13.06; p = 0.010); those who complained of routine duties were more likely to be classified as under-challenged (OR = 5.33; 95% CI = 1.84-15.40; p = 0.002); those whose discomfort was caused by structure control systems were more likely to be classified as worn-out (OR = 6.13; 95% CI = 1.57-23.91; p = 0.009). CONCLUSIONS: The causes of discomfort among the different burnout subtypes are primarily attributable to the organization itself, in response to the structure and functions. The associations observed between the different subtypes and motives for complaint are consistent with the clinical profile-based syndrome definition, which suggests that interventions should be case-specific.

[Fatigue syndromes--an overview of terminology, definitions and classificatory concepts]. / Erschöpfungssyndrome--Eine Diskussion verschiedener Begriffe, Definitionsansätze und klassifikatorischer Konzepte.

This article aims at giving a general view of fatigue syndromes, their description, and their differentiation. The syndromes neurasthenia, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and burnout are discussed. First, the historical background of fatigue classification is shortly reviewed. Each syndrome is introduced in terms of definition and classification as well as differentiation from each other. The article discusses the differentiation of the syndromes from each other as well as differentiation of CFS/ME and burnout from depression. We conclude that it is difficult to differentiate criteria due to insufficient empirical evidence. More research is needed concerning integration of the diagnoses in classification systems as well as differentiation between syndromes. High comorbidity of depression with CFS and Burnout can be shown, but diagnoses also comprise distinct symptoms.

[Understanding the term burnout in psychiatry and psychotherapy]. / Verständnis des Begriffs Burnout in Psychiatrie und Psychotherapie.

BACKGROUND: Currently there is much debate about the concept of burnout and its use as a diagnostic entity. The aim of the present survey was to present the view of mental health professionals towards the concept of burnout. METHODS: A total of 300 mental health professionals were surveyed using a structured questionnaire. RESULTS: The majority of participants see burnout as a state of exhaustion which constitutes a risk factor for later developing a mental disorder. Participants reported that from their point of view typical triggers for burnout exist while symptoms overlap to a great extent with depression. Psychotherapy as well as interventions at the workplace are regarded as promising interventions; however, in the clinical routine only a minority of participants actually contacted the patients' workplace. In the participants workplace settings most Burnout-Patients suffered from a diagnosis defined in ICD 10 but judged themselves to be suffering from burnout. DISCUSSION: Burnout-Patients in mental health settings differ from the picture currently drawn in the media, probably because Burnout-Patients reach the mental health sector only after already having developed a manifest psychiatric disorder.

Burnout in nurses working in Portuguese palliative care teams: a mixed methods study.

Repeat contact with suffering, dying, and death is considered to be a risk factor for burnout among health professionals, particularly nurses working in palliative care. A mixed methods study was conducted to identify burnout levels, risk and protective factors, prevention strategies, and the emotional impact of working in palliative care among nurses in Portugal. A quantitative questionnaire was completed by nursing members of nine different palliative care teams and was supported by interviews and observation. Although the participants were exposed to risk factors, such as work overload, disorganisation, difficult relationships within the team and with patients' relatives, they showed a low risk of burnout. These results appear to be related both to the protective factors identified-namely the ethic of care in the relationship the nurses establish with patients, families, and within their teams-and to the preventive strategies they actively adopt for burnout prevention. The positive aspects of the nurses' roles help them to build a positive view of their work, which also promotes their own personal and professional development.

Sociodemographic and occupational risk factors associated with the development of different burnout types: the cross-sectional University of Zaragoza study.

BACKGROUND: Three different burnout types have been described: The "frenetic" type describes involved and ambitious subjects who sacrifice their health and personal lives for their jobs; the "underchallenged" type describes indifferent and bored workers who fail to find personal development in their jobs, and the "worn-out" in type describes neglectful subjects who feel they have little control over results and whose efforts go unacknowledged. The study aimed to describe the possible associations between burnout types and general sociodemographic and occupational characteristics. METHODS: A cross-sectional study was carried out on a multi-occupational sample of randomly selected university employees (n = 409). The presence of burnout types was assessed by means of the "Burnout Clinical Subtype Questionnaire (BCSQ-36)", and the degree of association between variables was assessed using an adjusted odds ratio (OR) obtained from multivariate logistic regression models. RESULTS: Individuals working more than 40 hours per week presented with the greatest risk for "frenetic" burnout compared to those working fewer than 35 hours (adjusted OR = 5.69; 95% CI = 2.52-12.82; p < 0.001). Administration and service personnel presented the greatest risk of "underchallenged" burnout compared to teaching and research staff (adjusted OR = 2.85; 95% CI = 1.16-7.01; p = 0.023). Employees with more than sixteen years of service in the organisation presented the greatest risk of "worn-out" burnout compared to those with less than four years of service (adjusted OR = 4.56; 95% CI = 1.47-14.16; p = 0.009). CONCLUSIONS: This study is the first to our knowledge that suggests the existence of associations between the different burnout subtypes (classified according to the degree of dedication to work) and the different sociodemographic and occupational characteristics that are congruent with the definition of each of the subtypes. These results are consistent with the clinical profile definitions of burnout syndrome. In addition, they assist the recognition of distinct profiles and reinforce the idea of differential characterisation of the syndrome for more effective treatment.

A newer and broader definition of burnout: validation of the "Burnout Clinical Subtype Questionnaire (BCSQ-36)".

BACKGROUND: Burnout syndrome has been clinically characterised by a series of three subtypes: frenetic, underchallenged, and worn-out, with reference to coping strategies for stress and frustration at work with different degrees of dedication. The aims of the study are to present an operating definition of these subtypes in order to assess their reliability and convergent validity with respect to a standard burnout criterion and to examine differences with regard to sex and the temporary nature of work contracts. METHOD: An exploratory factor analysis was performed by the main component method on a range of items devised by experts. The sample was composed of 409 employees of the University of Zaragoza, Spain. The reliability of the scales was assessed with Cronbach's alpha, convergent validity in relation to the Maslach Burnout Inventory with Pearson's r, and differences with Student's t-test and the Mann-Whitney U test. RESULTS: The factorial validity and reliability of the scales were good. The subtypes presented relations of differing degrees with the criterion dimensions, which were greater when dedication to work was lower. The frenetic profile presented fewer relations with the criterion dimensions while the worn-out profile presented relations of the greatest magnitude. Sex was not influential in establishing differences. However, the temporary nature of work contracts was found to have an effect: temporary employees exhibited higher scores in the frenetic profile (p < 0.001), while permanent employees did so in the underchallenged (p = 0.018) and worn-out (p < 0.001) profiles. CONCLUSIONS: The classical Maslach description of burnout does not include the frenetic profile; therefore, these patients are not recognised. The developed questionnaire may be a useful tool for the design and appraisal of specific preventive and treatment approaches based on the type of burnout experienced.

Sociodemographic and occupational aspects associated with burnout in military nursing workers.

OBJECTIVES: to analyze association between burnout and sociodemographic and occupational features of military nursing workers. METHODS: a cross-sectional study, developed in five military hospitals of the Army of Rio Grande do Sul State, among 167 workers from military nursing from December 2015 to May 2016. Sociodemographic and occupational questionnaires and the Maslach Burnout Inventory were applied. For the analysis, it was used descriptive statistics, Chi-Square Test and Poisson Regression. RESULTS: the majority of participants were female; temporary military personnel, nursing technicians, with a median age of 34 years old. Burnout was related to the variables: Military Health Organization, time of practice in military nursing and accomplishment of leisure activities. CONCLUSIONS: burnout assessment may contribute to the Brazilian Army Command in organizing plans for prevention and handling of occupational diseases in military nursing, improving quality of life at work.

A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment.

BACKGROUND: Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity. PURPOSE: This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals. METHODS: A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index-Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data. RESULTS: On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (ß = 0.608, p < .001) and depersonalization (ß = 2.439, p < .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (ß = -0.250, p < .001), depersonalization (ß = -1.587, p < .001), and personal accomplishment (ß = 4.126, p < .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (ß = 0.111, p < .01; ß = 0.583, p < .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p > .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.

Analysis of nurses' job burnout and coping strategies in hemodialysis centers.

In recent years, nursing has come to be considered a high-risk and high-pressure profession, given the fast-paced working environment and constant need to handle emergencies, especially for nurses working in hemodialysis centers. Nearly every day, nurses are confronted with life and death situations and are required to provide skilled, high quality care for their patients, in fast-paced and demanding environments. Thus, nurses are susceptible to both psychological stress and other mental health problems, making them more vulnerable to burnout when compared against other healthcare professions.An anonymous online questionnaire was completed by a group of participating nurses, using the web-based survey platform WeChat. Registered nurses working in hemodialysis centers were randomly selected from 5 comprehensive tertiary level hospitals in Sichuan Province, China. The data collection instrument comprised two parts: demographic data and a nurse burnout questionnaire-the Maslach Burnout Inventory. Overall, 70 nurses were invited to participate, with 65 returning completed questionnaires, giving a response rate of 92.9%. In this survey, the burnout level was set at28.15 ±â€Š12.39 for emotional exhaustion (EE), 10.23 ±â€Š5.47 for depersonalization (DP), and 37.19 ±â€Š8.31 for personal accomplishment (PA)-EE and DP levels are found to be high at the level of burnout.Job burnout was found to exist widely among the nurses of hemodialysis centers, which may then result in adverse effects on their physical and mental health. Active interventions can significantly reduce job burnout and also help maintain the stability of nursing workforce levels.

Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.

BACKGROUND: Burnout has negative effects on work performance and patient care. The current standard for burnout assessment is the Maslach Burnout Inventory (MBI), a well-validated instrument consisting of 22 items answered on a 7-point Likert scale. However, the length of the MBI can limit its utility in physician surveys. OBJECTIVE: To evaluate the performance of two questions relative to the full MBI for measuring burnout. DESIGN AND PARTICIPANTS: Cross-sectional data from 2,248 medical students, 333 internal medicine residents, 465 internal medicine faculty, and 7,905 practicing surgeons. MEASUREMENTS AND MAIN RESULTS: The single questions with the highest factor loading on the emotional exhaustion (EE) ("I feel burned out from my work") and depersonalization (DP) ("I have become more callous toward people since I took this job") domains of burnout were evaluated in four large samples of medical students, internal medicine residents, internal medicine faculty, and practicing surgeons. Spearman correlations between the single EE question and the full EE domain score minus that question ranged from 0.76-0.83. Spearman correlations between the single DP question and the full DP domain score minus that question ranged from 0.61-0.72. Responses to the single item measures of emotional exhaustion and depersonalization stratified risk of high burnout in the relevant domain on the full MBI, with consistent patterns across the four sampled groups. CONCLUSIONS: Single item measures of emotional exhaustion and depersonalization provide meaningful information on burnout in medical professionals.

Individual and contextual covariates of burnout: a cross-sectional nationwide study of French teachers.

BACKGROUND: Limited information on the covariates of burnout syndrome in French teachers is available. The aim of this study was to evaluate the relative contributions of individual and contextual factors on the three burnout dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. METHODS: The source data come from an epidemiological postal survey on physical and mental health conducted in 2005 among 20,099 education workers (in activity or retired) selected at random from the health plan records of the national education system. The response rate was 52.4%. Teachers in activity currently giving classes to students who participated in the survey (n = 3,940) were invited to complete a self-administered questionnaire including the Maslach Burnout Inventory. 2,558 teachers provided complete data (64.9%). Variables associated with high emotional exhaustion (highest quartile of score), high depersonalization (highest quartile), and reduced personal accomplishment (lowest quartile) were evaluated using multivariate logistic regression. Studied variables referred to demographic characteristics, socio-professional environment, job dissatisfaction, experienced difficulties at work, and teaching motivations. RESULTS: Different variables were associated with each burnout dimension. Female teachers were more susceptible to high emotional exhaustion and reduced personal accomplishment, whereas male teachers were more susceptible to high depersonalization. Elementary school teachers were more susceptible to high emotional exhaustion, but less susceptible to high depersonalization and reduced personal accomplishment than their higher school level counterparts. Experienced difficulties with pupils were associated with all three dimensions. A socio-economically underprivileged school neighbourhood was also related to high emotional exhaustion and high depersonalization. CONCLUSION: Programs to enhance teaching environment might be an interesting approach to try to prevent burnout. It would be useful to take the different dimensions into account in planning the intervention.

Burnout 3.0.

Although burnout has long been discussed and recognized in nurses, the fact that it is now classified in the World Health Organization's International Classification of Diseases brings it back into the forefront. Dismissal of burnout as a generational construct or a lack of resilience carries significant risks for individuals, organizations, and the clients they serve. Purpose-driven work actually may exacerbate the rise of burnout. [J Contin Educ Nurs. 2019;50(8):345-346.].