Burnout Subtypes and Absence of Self-Compassion in Primary Healthcare Professionals: A Cross-Sectional Study.

BACKGROUND: Primary healthcare professionals report high levels of distress and burnout. A new model of burnout has been developed to differentiate three clinical subtypes: 'frenetic', 'underchallenged' and 'worn-out'. The aim of this study was to confirm the validity and reliability of the burnout subtype model in Spanish primary healthcare professionals, and to assess the explanatory power of the self-compassion construct as a possible protective factor. METHOD: The study employed a cross-sectional design. A sample of n = 440 Spanish primary healthcare professionals (214 general practitioners, 184 nurses, 42 medical residents) completed the Burnout Clinical Subtype Questionnaire (BCSQ-36), the Maslach Burnout Inventory General Survey (MBI-GS), the Self-Compassion Scale (SCS), the Utrecht Work Engagement Scale (UWES) and the Positive and Negative Affect Schedule (PANAS). The factor structure of the BCSQ-36 was estimated using confirmatory factor analysis (CFA) by the unweighted least squares method from polychoric correlations. Internal consistency (R) was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the BCSQ-36 and the other constructs were analysed using Spearman's r and multiple linear regression models. RESULTS: The structure of the BCSQ-36 fit the data well, with adequate CFA indices for all the burnout subtypes. Reliability was adequate for all the scales and sub-scales (R≥0.75). Self-judgement was the self-compassion factor that explained the frenetic subtype (Beta = 0.36; p<0.001); isolation explained the underchallenged (Beta = 0.16; p = 0.010); and over-identification the worn-out (Beta = 0.25; p = 0.001). Other significant associations were observed between the different burnout subtypes and the dimensions of the MBI-GS, UWES and PANAS. CONCLUSIONS: The typological definition of burnout through the BCSQ-36 showed good structure and appropriate internal consistence in Spanish primary healthcare professionals. The negative self-compassion dimensions seem to play a relevant role in explaining the burnout profiles in this population, and they should be considered when designing specific treatments and interventions tailored to the specific vulnerability of each subtype.

Perceived stress latent factors and the burnout subtypes: a structural model in dental students.

BACKGROUND: Students of health-professions suffer high levels of stress and burnout. The aim of the present study was to evaluate the relationship between perceived stress latent factors ('tenseness' and 'frustration') and the features ('overload', 'lack of development' and 'neglect') of the three burnout subtypes ('frenetic', 'under-challenged' and 'worn-out', respectively), in a sample of Spanish dental students. METHODS: The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the 'Perceived Stress Questionnaire' and the 'Burnout Clinical Subtype Questionnaire Student Survey'. The associations among variables were observed by means of structural equation modelling using the unweighted least squares method from polychoric correlations. RESULTS: Strong associations among perceived stress factors and the burnout characteristics were observed, although a distinct pattern of relations was observed for each burnout subtype. The 'overload' was moderately and positively associated with both 'tenseness' (0.45), and 'frustration' (0.38) dimensions of perceived stress; the 'lack of development' was positively associated with the 'frustration' dimension (0.72), but negatively associated with 'tenseness' (-0.69); the 'neglect' showed a weaker positive associated with 'frustration' (0.41), and a small negative association with 'tenseness' (-0.20). The model was a very good fit to the data (GFI  =  0.96; RSMR  =  0.07; AGFI = 0.96; NFI = 0.95; RFI = 0.95). CONCLUSIONS: The stress factors of 'frustration' and 'tenseness' seems to be related in a distinct way to the burnout subtypes in Spanish dental students. This finding suggests that intervention programs specifically tailored to these subtypes may be a promising future direction.

Coping with stress and types of burnout: explanatory power of different coping strategies.

BACKGROUND: Burnout occurs when professionals use ineffective coping strategies to try to protect themselves from work-related stress. The dimensions of 'overload', 'lack of development' and 'neglect', belonging to the 'frenetic', 'under-challenged' and 'worn-out' subtypes, respectively, comprise a brief typological definition of burnout. The aim of the present study was to estimate the explanatory power of the different coping strategies on the development of burnout subtypes. METHODS: This was a cross-sectional survey with a random sample of university employees, stratified by occupation (n = 429). Multivariate linear regression models were constructed between the 'Burnout Clinical Subtypes Questionnaire', with its three dimensions -overload, lack of development and neglect- as dependent variables, and the 'Coping Orientation for Problem Experiences', with its fifteen dimensions, as independent variables. Adjusted multiple determination coefficients and beta coefficients were calculated to evaluate and compare the explanatory capacity of the different coping strategies. RESULTS: The 'Coping Orientation for Problem Experiences' subscales together explained 15% of the 'overload' (p<0.001), 9% of the 'lack of development' (p<0.001), and 21% of the 'neglect' (p<0.001). 'Overload' was mainly explained by 'venting of emotions' (Beta = 0.34; p<0.001); 'lack of development' by 'cognitive avoidance' (Beta = 0.21; p<0.001); and 'neglect' by 'behavioural disengagement' (Beta = 0.40; p<0.001). Other interesting associations were observed. CONCLUSIONS: These findings further our understanding of the way in which the effectiveness of interventions for burnout may be improved, by influencing new treatments and preventive programmes using features of the strategies for handling stress in the workplace.

Reassessment of the psychometric characteristics and factor structure of the 'Perceived Stress Questionnaire' (PSQ): analysis in a sample of dental students.

BACKGROUND: The training to become a dentist can create psychological distress. The present study evaluates the structure of the 'Perceived Stress Questionnaire' (PSQ), its internal consistency model and interrelatedness with burnout, anxiety, depression and resilience among dental students. METHODS: The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the PSQ, the 'Goldberg Anxiety and Depression Scale' (GADS), 'Connor-Davidson Resilience Scale' (10-item CD-RISC) and 'Maslach Burnout Inventory-Student Survey' (MBI-SS). The structure was estimated using Parallel Analysis from polychoric correlations. Unweighted Least Squares was the method for factor extraction, using the Item Response Theory to evaluate the discriminative power of items. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variable. The relationships between the PSQ and the other constructs were analysed using Spearman's coefficient. RESULTS: The results showed a PSQ structure through two sub-factors ('frustration' and 'tenseness') with regard to one general factor ('perceived stress'). Items that did not satisfy discriminative capacity were rejected. The model fit were acceptable (GFI = 0.98; RSMR = 0.06; AGFI = 0.98; NFI = 0.98; RFI = 0.98). All the factors showed adequate internal consistency as measured by the congeneric model (≥0.91). High and significant associations were observed between perceived stress and burnout, anxiety, depression and resilience. CONCLUSIONS: The PSQ showed a hierarchical bi-factor structure among Spanish dental students. Using the questionnaire as a uni-dimensional scale may be useful in perceived stress level discrimination, while the sub-factors could help us to refine perceived stress analysis and improve therapeutic processes.

Construct validity of a figure rating scale for Brazilian adolescents.

BACKGROUND: Figure rating scales were developed as a tool to determine body dissatisfaction in women, men, and children. However, it lacks in the literature the validation of the scale for body silhouettes previously adapted. We aimed to obtain evidence for construct validity of a figure rating scale for Brazilian adolescents. METHODS: The study was carried out with adolescent students attending three public schools in an urban region of the municipality of Florianopolis in the State of Santa Catarina (SC). The sample comprised 232 10-19-year-old students, 106 of whom are boys and 126 girls, from the 5th "series" (i.e. year) of Primary School to the 3rd year of Secondary School. Data-gathering involved the application of an instrument containing 8 body figure drawings representing a range of children's and adolescents' body shapes, ranging from very slim (contour 1) to obese (contour 8). Weights and heights were also collected, and body mass index (BMI) was calculated later. BMI was analyzed as a continuous variable, using z-scores, and as a dichotomous categorical variable, representing a diagnosis of nutritional status (normal and overweight including obesity). RESULTS: Results showed that both males and females with larger BMI z-scores chose larger body contours. Girls with higher BMI z-scores also show higher values of body image dissatisfaction. CONCLUSION: We provided the first evidence of validity for a figure rating scale for Brazilian adolescents.

Desarrollo de estándares para la educación y formación en medicina familiar y comunitaria – contribuciones de la WONCA IberoAmérica (CIMF) / Development of standards for education and training in family and community medidcine – contributions by WONCA IberoAmerica (CIMF)

El Grupo de Trabajo de Educación de la WONCA (GTE) está desarrollando un conjunto de estándares globales para la educación en medicina de familia y comunitaria / medicina general (MF) con el objetivo de elaborar patrones internacionales de enseñanza de la MF para todos los niveles de educación: pregrado en medicina, formación de postgrado en MF y desarrollo profesional continuo para los médicos de familia. En este momento del proceso de los modelos, las contribuciones de las regiones mundiales de WONCA son importantes, por eso, el objetivo principal de ese relato es presentar los modelos validados y elaborados por la WONCA Iberoamérica (CIMF). Para que sean globales y efectivos, los estándares deben reflejar las realidades regionales, en ese sentido, las contribuciones de CIMF pueden reforzar y fortalecer esta iniciativa fundamental del Grupo de Trabajo de Educación de WONCA y su consecuente implementación en todo el mundo(AU)

The WONCA Education Working Party (WEP) is developing a set of standards for medical student education, postgraduate training in family medicine / general practice and continuing professional development for family doctors. At this point the contributions by WONCA world regions are very important, and for this reason the main objective of this report is to present the standards developed by the Iberoamerican WONCA Region (CIMF). To be comprehensive and effective, standards should reflect regional realities and so the contributions from CIMF may reinforce and strengthen the key initiative of WEP and the implementation of the standards throughout the world(AU)