Psychological Reporfr,2002,90,309-314. O Psychological Reports 2002
BURNOUT SYNDROME IN THE HELPING PROFESSIONS ' SARA CERV A1
PIER CIORGIO GABASSl
Departmetzt of Prycbology
PATRIZIA ROZBOWShT
Departmen! of Political Scietzces Deparfmenl of Hurnatz Sciences U t ~ i v e r sof i ~ Trierte
ARIANNA SEiMERARO
DAN0 GREGORI
I/alTbr SpA, Biomedical and Scientt$c Technologies
Departtnent of Ecotzomics and Sfati.ifics University of Trieste
Summary.-Burnout can be d e f i e d as a long-term reaction to occupational stress which involves, particularly, the helping professions. The main aim of this study was the assessment of burnout in a sample of professional and voluntary health care workers and comparison of the two samples on scores from the Maslach Burnout Invencory. Analysis suggests a significant ddference in mean scores for Emotional Exhaustion of volunteers vs professional workers. Some evidence has supported the hypothesis of a fourth dimension, called Behavioral Exhaustion, in the burnout syndrome.
Burnout can be considered a reaction to occupational stress. Initially Freudenberger (1974) defined burnout as a state of emotional exhaustion based on interactions with other people. The syndrome is most common among people whose work involves intensive interactions (Jackson, Schwab, & Schuler, 1986). Maslach and Jackson (1981) identified three dimensions, a part~cularaspect of emotional exhaustion, depersonalization, and reduced personal accomplishment. They devised a measure of 22 items, the Maslach Burnout Lnventory. The testee rates each item on a 7-point scale for the frequency with which feehgs are experienced. Anchors are 0 for no experience of the f e e h g described, and 6 indicates frequent experience. The inventory assesses stress in the work setting (Belcastro, Gold, & Hays, 1983). The items are distributed across the three dimensions with 9 on Emotional Exhaustion or the fatigue related to excess work, 5 items on Depersonalization describe hostility toward service users, and 8 items on Reduced Personal Accomplishment concern competence and success in the profession. Originally, external v&dation of the Maslach Burnout Inventory was reflected in the correlation of inventory scores with independent external judgment. Discriminant vahdity was estimated by other measures such as depression, unhappiness, etc. The internal consistency of each subscale was estimated with the Cronbach coefficient alpha (Maslach &Jackson, 1981). Address enquiries to Prof. Pier Giorgio Gabassi, Dipartimento di Psicologia, Universitl de 11 itudi di Trieste, Via S. Anas~asio12, 34131 Trieste, Italy or e-mail (
[email protected].
P. G: GABASSI, ET X.
Researchers (Maslach & Pines, 1977; Jackson & Maslach, 1982) have conducted studies considering different aspects of the work situation (work load, work state, time spent near people, problems' difficulties, work conflicts, etc.). Another job characteristic which could be relevant to burnout is job motivation. One may infer that highly motivated subjeccs or those who hke their work are more advantaged than people who work every day in a place in which they do not feel gratified. A job situation that fulfills ambitions may help workers face their problems at work. The present intent was to verify whether burnout varies for voluntary and professional workers. If volunteers have different job motivations than professionals, say, in perceiving their work as a "vocation," whereas the professional group considers their work mainly as a source of earning, a different state of mind may characterize the two groups' interactions with service users.
Sample The sample included 50 health care workers, 25 of whom were volunteers, and 25 professionals. The latter belonged to the Association "La Nostra Farniglia," a private religious association which provides professional assistance to physically and mentally dl children 5 to 18 years of age. The sample ranged in age from 22 to 44 years, and their work experience, measured by the time belonging to the Association, was from 24 to 240 months (cf. Table 1). The volunteers belonged to the Association "La Ginestra," a voluntary association which organizes several activities (excursions, walks, etc.) for persons with less serious disabhties. Ages in this group ranged from 18 to 68 years and work experience from 3 to 96 months; cf. Table 1. TABLE 1 MEANA N D RANGEO F AGEAND WORKEXPERIENCE IN T w o GROUPS (11s=25)
Measure
1M Age, y r. Work Experience, rno.
30 18
Volunteers Lower Upper QuarriIe Quarule 27 18
33 24
M 30 120
Professionals Lower Upper Quarule Quart~le 23 72
47 120
Statistical Methods
Burnout was assessed on the validated Italian version of the Maslach Burnout Inventory (Sirigatti, Stefanile, & Menoni, 1988). The scoring method was partially modified: the subjects answered on the original 0 to 6 scale, but the scores were reweighted using -3 (which corresponds to 0) to + 3 (which corresponds to 6). The median value and the quartiles of the re-
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DIMENSIONS OF BURNOUT AT WORK
sponses of the two groups were calculated for each item. Lntercorrelations of responses on the frequency scale were submitted to principal components factor analysis with varimax rotation. According to the Kaiser criterion, the first four factors of 22 were selected as significant. Then, interpretation of the components was based on rotated factor loadings. Reliabdity on Maslach original scales and new subscales was computed as well as the Cronbach alpha. To examine the ddferences in scores on subscales for the volunteer and professional groups we estimated a h e a r regression model separately for each dimension (the Anderson-Rubin rotation, used to derive latent variables, produces nearly uncorrelated covariates), which has the form: Ci = Poi + P l j S + 3 Age + ti Work
where C represents the expected value of the dimension j ( i = 1, . . . , 4), S is a dummy variable with the value of O for the professional group and of 1 for the volunteer group. Significance was set at an alpha level of 05. Age and work are two continuous variables indicating, respectively, age m years and work experience in months. The hypothesis tested was based on PI = 0, as a test for the equahty of the mean scores on each dmension. The model was adjusted by age and work experience (y, Age and ti Work), treating both as potential confounding factors.
RESULTS Four factors were selected as significant, with a cumulative variance of .57 captured by the model, cf. Table 2 . To choose the right interpretation of TABLE 2 E X P ~ N EAND D CUMULAT~VE VARIANCE IN FACTORIAL MODEL Component Standard Deviation Variance Proportion Cumulative Variance
Factor
I
I1
111
Iv
2.49 .28 .28
1.61 .I1 .40
1.39 08
1.34 .08 .57
-I8
the four components the rotated factor loadings of each item (Table 3) were analyzed. The first component was called Emotional Exhaustion and coincides with Maslach's first dimension. The second component was called Personal Accomplishment and coincides with Maslach's second dimension. The third and the fourth dimensions can be considered parts of the last dimension of Maslach's subscale of Depersonalization and were defined Behavioral Exhaustion and Depersonalization. Tables 4 and 5 summarize the results of the estimated model. For the three Maslach dimensions, the higher PI value in the first dimension (-6.73;
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P. G. GABASSI, ET AL. TABLE 3 ROTATEDFACTORLOADINGS Item
Factor
I1
1
IV
I11
p = .0004) seems to indicate that volunteers present a mean score on emotional exhaustion lower than that of professionals. On the other Maslach dimensions, scores show that mean ratings of Personal Accomplishment and Depersonalization are similar and not s~gn~ficantly different (1.90 and -.5). TABLE 4 MODELSFOR O N C I N A MASLACH L SCALESAND CRONBACH ALPHA Dimension Emotional Exhausdon
a .90
Po p, Y
Personal Accomplishment
.59
5 Po PI
Y Depersonalization
.61
Po PI
Y
5
Estimate
SE
t
P
-
4.39 1.77 .12 .03 2.90 1.17
-1.24 -3.81 .74 -1.85 3.71 -1.63 .98 1.93 -6.44 - .66 .09
ns ,0004 ns ns ,0006 ns ns ns .OOOO ns ns ns
5.46 6.73 .09 .06 10.76 1.90 - .08 - .04 -12.57 -.52 .01 .01
.08
.02 1.95 .79 .05 .01
33
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DIMENSIONS OF BURNOUT AT WORK
Considering the four current dimensions, the only significant differl ences are evident for the first and the fourth dimensions i ~ m i t i o n a Exhaustion and Depersonalization) which present values of PI of -1.58 and -38 with p = .0004 and p = .03. This suggests that, also on these mean ratings, the volunteers scored lower than professionals. TABLE 5 MODELS FORFOURDIMENSIONS DERIVED I N PWENTANALYSIS AND CRONBACH ALPHA
Dimension
Q
Emotional Exhauscjon
.89
Po
Personal Accomplishment
.68
Po PI
Estimate
SE
t
P
1.24
1.10
1.12
ns
Y Behavioral Exhaustion
.48
5 Po PI Y
5 Depersonalization
.44
Po
PI Y
E Drscuss~o~ The initial hypothesis seems to be confirmed since the comparison of the mean scores for the two groups shows them to be M e r e n t for the volunteers and professionals. Moreover, the estimated model confirms this finding, as the-following analysis of the parameters shows. The only difference between median scores of volunteers and . significant professionals was on the first Maslach dimension on which volunteers had lower median ratings of exhaustion than professionals. For the second dimension, Personal Accomplishment, the volunteers scored lower; professionals had higher ratings on Reduced Personal Accomplishment. The structure of the Maslach Burnout Lnventory, based on our samples' responses, supports other studies which have suggested the presence of two subscales (Garden, 1987). The third Maslach dimension was split into two subscales of Behavioral Exhaustion and Depersonahzation. In other words, responses from this sample suggest two subscales, not subdimensions of Depersonalization and Behavioral Exhaustion, because the former presents those items for Depersonalization in the original Maslach factor structure. Analyzing PI values of the third and the fourth dimensions of Behav-
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P. G. GABASSI, ET AL.
ioral Exhaustion and Depersonahzation, volunteers seemed less emotionally exhausted than the professionals; they were less cynical and established better relationships with service users. In the present study the small sample and the small number of covariates, which may potentially influence people's ability to interact, limit generalization. There are some indications consistent with literature that Maslach burnout may not apply to people with nonstandard motivation, such as the volunteers in our research. The new subscale may permit more sensitive and precise rnodehg as research continues with larger and more varied samples. REFERENCES BELCASTRO. l? A.. GOLD,R. S., &HAYS,L. C. (1983) Maslach Burnout Inventory: h c t o r structures for samples of teachers. Psychological Reports, 53, 364366. FREUDENBERGER, H. (1974) Staff burnout. Joztr~zaioJSocial I ~ ~ u e30, s , 159-165. GARDEN.A. M. (1987) Depersonalization: a valid dimension oC burnout? Hztmo17 Rela1ior7s. 40, 545-560. JACKSON, S. E., & MASLACH,C. (1982) After-effects of job related stress: families as victims. ]otrrrlal of Occzrpalional Behauiozrr, 3, 63-77. JACKSON. 5. E.. SCHWAB. R. L., &SCHULER.R. S. (1986) Toward an understanding of [he burnout phenomenon. Joztrnal o/Appiied Psychology, 7 1 , 630-610. ~ ~ A S L AC., C H&JACKSON, , S. E. (1981) Masloch Bztr~zoufIrzuerztory marztiaf. Palo Alto, CA: Consulting Psychologists Press. MASUCH,C., & P I N E S A. , (1977) T h e burnout syndrome in the day care setting. Child Care Quarterly, 6, 100-113. S I R I C A ~S.,I , STEFANILE. C., & MENONI,E. (I9SSI Per un adattamento italiano del Maslach Burnout Inventory (MBI). BolleflLzo dl P~iiofogiaApplicata, 187/188, 33-39.
Accepled December 26, 2001
