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EEG power modifications in panic disorder during a temporolimbic activation task: relationships with temporal lobe clinical symptomatology.

Computerized EEG activity derived from the temporal lobes was investigated in normal subjects and panic disorder patients with and without depersonalization and/or derealization, in a resting condition and during an odor stimulation task. Panic patients without depersonalization or derealization showed an increase of fast and a decrease of slow activities independent of odor stimulation. Panic patients with depersonalization and/or derealization showed an increase of slow activity and bilateral lack of responsiveness in the fast alpha frequency band during odor stimulation. Findings suggest there are different EEG patterns in the temporal regions of the two different groups of panic patients during rest and activating conditions.

Adult↗

Effective leadership in salient groups: revisiting leader-member exchange theory from the perspective of the social identity theory of leadership.

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high-than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.

Adult↗

Optimism and coping as moderators of the relationship between chronic stress and burnout.

Using a model based on Lazarus (1999) and previous research, specific relationships were predicted between the antecedent conditions of chronic stress, personal moderation factors of optimism/pessimism, and coping on the one hand, and the affective outcome of burnout on the other. Participants were 82 information service workers whose jobs required them to evaluate and remediate computer programming problems in anticipation of the Y2K deadline. Multiple regression analysis indicated that Optimism, Pessimism, Control Coping, and Escape Coping all moderated chronic stress for Emotional Exhaustion and Depersonalization, but not for Personal Accomplishment. Lower Optimism, higher Pessimism, lower Control Coping, and higher Escape Coping all related to increased workers' Depersonalization under conditions of higher chronic stress due to the approaching Y2K deadline. Lower Optimism and higher Pessimism were also related to higher Emotional Exhaustion under conditions of higher chronic stress due to the Y2K deadline. Beyond moderation effects, all moderator variables showed main effects with Emotional Exhaustion, Depersonalization, and Personal Accomplishment in the predicted directions. Suggestions are given for incorporating results into stress relief efforts in organizations.

Adaptation, Psychological↗

Burnout and self-reported patient care in an internal medicine residency program.

BACKGROUND: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. OBJECTIVE: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. DESIGN: Cross-sectional study using an anonymous, mailed survey. SETTING: University-based residency program in Seattle, Washington. PARTICIPANTS: 115 internal medicine residents. MEASUREMENTS: Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made...errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. RESULTS: Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout--but not sex, depression, or at-risk alcohol use--was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). CONCLUSION: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.

Attitude of Health Personnel↗

A test of Leiter's process model of burnout.

This study among Dutch nurses (N = 156) tested Leiter's 1993 process model of burnout. The LISREL results of this study partially support Leiter's model. It appeared that emotional exhaustion was primarily related with the demand variable work overload while depersonalization was, to a lesser degree, associated with the resource variable coworker support. Personal accomplishment was significantly related with coping and emotional exhaustion was associated with depersonalization. However, Leiter's model did not fit to the data in all respects. Modifications indices provided by LISREL 8 suggested to relax the relationship between: (1) coping and depersonalization and (2) social support and emotional exhaustion. Because these relationships were supported by both theory and existing empirical evidence, they were successively added to the model. Eventually, the model improved considerably and all selected criteria were met. Several relationships in the final model, however, were nonsignificant (e.g., the relationship between personal accomplishment and autonomy and participation, respectively).

Adaptation, Psychological↗

Are orthopedic surgeons prone to burnout?

OBJECTIVE: Burnout syndrome (BOS) is a state of physical, and emotional or mental exhaustion, depersonalization, and low personal accomplishment. Health care givers are most prone to suffer from BOS. There are no studies to date on BOS among trained orthopedic, and trauma surgeons. The objective of this study, was to assess the prevalence of BOS among the orthopedic surgeons in the Eastern province of Saudi Arabia. METHODS: This study was conducted among the orthopedic surgeons of the Eastern province of Saudi Arabia between September 2003 and October 2004. One hundred and two questionnaires of the Maslach Burnout Inventory (MBI) were sent to the qualified orthopedic surgeons with a self-addressed stamped envelope, from the Department of Orthopedic Surgery, King Fahd Hospital of the University, Al-Khobar. Three factors of MBI, which were assessed, were emotional exhaustion, depersonalization, and personal accomplishment. The data were entered in the database, and analyzed using Statistical Package for Social Science. RESULTS: Sixty-nine (67.6%) of the orthopedic surgeons completed the questionnaire. The average age was 45.72 +/- 6.82 (33-57) years. Thirty-five (50.7%) were found to be in a state of emotional exhaustion, 59.4% depersonalized, and 17% had low state of personal accomplishment. Doctors working in the government hospitals fared better than those in the private sector. CONCLUSION: Burnout syndrome is common among orthopedic surgeons working in the Eastern province Saudi Arabia. It is emphasized that awareness of the problem should be highlighted; programs need to be put in place to reduce the prevalence of burnout syndrome.

Adult↗

[Hierarchical regression analysis for relationship between job stress and job burnout in Shanghai employees].

OBJECTIVE: To identify related factors of job burnout in Shanghai employees. METHODS: Four hundred fifty-six employees in Shanghai were investigated in this study. Self-administered questionnaires were used to assess job burnout and job stress, based on Maslach Burnout Inventory and the Job Demand-Control model as well as Effort-Reward Imbalance Model. Hierarchical linear regression was employed to analyze the relationship of job burnout to personal characteristics and job stress. RESULTS: The indexes of three dimensions of job burnout were emotional exhaustion 19.70 +/- 8.92, depersonalization 11.95 +/- 4.45 and reduced personal accomplishment 28.10 +/- 10.08. Job stress was found to be affected differently in three dimensions of job burnout. Job demand, effort and over-commitment had positive impact on emotional exhaustion. Job control had a negative association with emotional exhaustion. There were significant relationship between depersonalization and age, sex and education of employees. Job control, reward and over-commitment affected the index of depersonalization. Education level and social support increased personal accomplishment index. CONCLUSION: It is necessary to reduce job stress and care about personal characteristics in preventing job burnout.

Adult↗

Are Texas dentists burned out?

Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do "people work" of some kind. Health care providers, including dentists, are at high risk for burnout because their occupation often requires intense interaction with fearful, demanding patients on a daily basis. The purpose of this study was to assess the prevalence of burnout among Texas dentists using a standardized measurement device, the Maslach Burnout Inventory (MBI). Dentists attending the 1989 Texas Dental Association Annual Session were surveyed using the MBI. The respondents' results were analyzed and compared to each other as well as to the norms of medicine and to society (human service workers nationwide). Among the Texas sample, male dentists scored significantly higher for emotional exhaustion and depersonalization than did female dentists. When compared to the norms of medical workers, Texas dentists scored higher burnout in the depersonalization subscale, but lower burnout for personal accomplishment. The Texas sample again scored lower for burnout in the personal accomplishment subscale when compared to societal norms. At no time did the Texas sample fall into the high range of experienced burnout as defined by the survey instrument. Texas dentists did not appear "burned out" as a group and actually demonstrated an increased sense of personal accomplishment in their profession.

Adult↗

Professional depression, 'burnout' and personality in longstay nursing.

Conceptualizations of 'burnout' vary between authors. Some descriptions of burnout show strong similarities to depression in the work setting, or 'professional depression' as described by Oswin [Children Living in Long Stay Hospitals, 1978. Heinemann, London]. This study supported such a similarity, and demonstrated a considerable extent of depressed mood amongst nursing staff in longstay settings, which was particularly significant amongst male staff. A number of distinct 'burnout' responses were evident amongst staff including not only 'professional depression' and depersonalization but also the avoidance of problems and decisions. Ambiguity about supervisors' expectations and success in meeting such expectations were associated with increased scores on each of these variables. Personality appeared to be related to staff's responses. Staff prone to direct hostility inwards on themselves were more likely to show an avoidance of problems and decisions. Those staff prone to direct hostility outwards were more likely to report an awareness of depersonalization toward others. Both these processes may in different ways affect patient care and relationships with other professionals.

Adult↗

Dietetic technicians report low to moderate levels of burnout.

This study identified and described the status of burnout experienced by dietetic technicians (DTRs) in various settings. A questionnaire was sent to a random sample of 300 members from the American Dietetic Association's (ADA's) Dietetic Technician in Practice practice group. The Maslach Burnout Inventory-Human Services Survey was used to measure burnout. On the emotional exhaustion subscale, the respondents reported a mean score of 20.6 (high level of burnout >27), 5.3 on the depersonalization subscale (high level of burnout >14), and 38.6 on the personal accomplishment subscale (high level of burnout <30). These results suggest that the DTRs as a group perceive themselves to be moderately emotionally exhausted, to have a low level of depersonalization, and to have a high level of personal accomplishment. Further analysis also suggests that DTRs in nontraditional settings experience more personal accomplishment than those in traditional healthcare and foodservice settings.

Adult↗

A national study of burnout among American transplant surgeons.

This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values.

Burnout, Professional↗

Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy.

Since Cullen coined the term "neurosis" in the 18th century, medical investigators have searched the neural substrates of conditions we now classify as anxiety disorders. Harper and Roth in 1962 hypothesized that the temporal lobes might represent one such substrate for phobic-anxious patients with depersonalization-derealization (DD); the association between the presumed temporal lobe feature and phobic anxiety was so compelling that Roth (in 1959) described the condition as "phobic-anxiety-depersonalization" syndrome. Introduced into our current nosology as panic disorder-agoraphobia (PDA), this seemingly neuropsychiatric condition is nonetheless distinct from complex partial epilepsy (CPE), from which it is conventionally differentiated through clinical and anamnestic evaluation. Yet increasingly there are clinical-and laboratory-hints of certain overlap between manifestations of the two disorders, hitherto based largely on evaluation of psychosensorial phenomena in PDA or affective phenomena in CPE. We located only one systematic study that monitored 24-hour electroencephalogram (EEG) abnormalities in PDA. Finally, recent epidemiologic data suggest a significantly greater than chance association between PDA and a history of seizures. To further explore these intriguing links, the present study directly compared a group of 91 PDA outpatients with a group of 41 CPE outpatients with respect to DD and other psychosensorial symptoms. The broad similarities discovered between psychosensorial and related phenomena provide further support for the hypothesis that there may be a common neurophysiological substrate linking CPE phenomena with PDA.

Adolescent↗

Management of stress and prevention of burnout in emergency physicians.

We conducted a study to measure participating practitioners' burnout levels and to identify coping methods used by these physicians to manage stress. A cross-sectional study was done with a sample of 77 physicians employed in emergency departments in 24 private, public, and university-affiliated teaching hospitals in the greater Los Angeles area. Data revealed that 60% of the physicians reported medium to high emotional exhaustion and 78% medium to high depersonalization, while 84% reported medium to high levels of personal achievement. Physicians who reported high levels of job satisfaction and personal accomplishment use a balanced number of short- and long-term coping methods in dealing with stress. Further studies should be undertaken to facilitate in-depth analysis of the characteristics of those emergency physicians who report low levels of emotional exhaustion and depersonalization as well as high levels of personal achievement to identify factors that lead to the successful practice of emergency medicine.

Achievement↗

Antecedents and consequences of work-home interference among medical residents.

A cross-sectional field study is reported in which a comprehensive model of work-home interference (WHI) was developed and tested among 166 medical residents of an academic hospital in the Netherlands. It was hypothesized that WHI functions as a critical mediating pathway in the relationship between work and home characteristics on the one hand, and work-related and general psychological health indicators on the other. The results revealed that one home characteristic and three work characteristics put pressure on the interface between the work and home life, that is, (1) having a spouse who works overtime frequently, (2) an unfavorable worktime schedule, (3) a high quantitative workload and (4) a problematic dependency on the superior. The results further showed that WHI was positively associated with emotional exhaustion and depersonalization (i.e. work-related health indicators), as well as with psychosomatic health complaints and sleep deprivation (i.e. general health indicators). More importantly, the results strongly supported our basic hypothesis that WHI mediates the impact of some work and home characteristics on psychological health indicators. This seems to be particularly true for the general health indicators: none of the home and work characteristics just mentioned, had a direct impact on these general indicators, independent of WHI. With respect to the work-related health indicators, particularly depersonalization, the mediating role of WHI was also strong, though less consistent. The theoretical and practical implications of the findings are discussed.

Adult↗

Gender differences in burnout among Dutch dentists.

OBJECTIVES: Differences between the sexes in the manifestation of burnout have been reported for different occupational groups. Although some gender-specific explanations for this finding have been forwarded, there is a paucity of studies in which the relation with other work-related gender differences is examined. The objective of this study was to analyze gender differences in burnout among dentists and to identify possible concomitant factors. METHODS: Male (n = 411) and female (n = 81) Dutch dentists filled out the Dutch version of the Maslach Burnout Inventory (MBI) together with several health and work-related questionnaires. RESULTS: Results showed male dentists to report a higher score on the depersonalization dimension of the MBI than did female dentists. No gender differences were found on the other dimensions (i.e. emotional exhaustion and personal accomplishment). Moreover, no gender-related differences in experienced work-stress or health-related aspects were found. It was found, however, that male dentists put in working hours and see more patients per week when compared to female dentists. Also, a difference in mean age was found. Our main finding was that the difference in depersonalization disappears when controlling for working hours and age. CONCLUSIONS: Gender differences in burnout among dentists do exist. However, our results indicate that underlying factors, such as working hours, have a profound effect on these differences. These results can have direct practical consequences, for instance, in distinguishing between groups concerning the way burnout scores should be interpreted.

Achievement↗

When self-categorization makes sense: the role of meaningful social categorization in minority and majority members' self-perception.

The authors examined the joint influence of meaningful social categorization and relative in-group size on the depersonalization of self-perception. Meaningfulness of social categorization was varied following the fit principle, introduced by self-categorization theory. In Experiment 1, the authors predicted and found that minority members show more depersonalized self-perception than majority members if, and only if, the meaningfulness of the underlying in-group-out-group categorization is high as opposed to low. Experiment 2 further substantiated that a meaningful social categorization affects only minority members' self-perception. Finally, the conceptual relationship between fit, meaning, and identity is discussed.

Adult↗

Nurse teacher stress in Northern Ireland.

Occupational stress among a 60% sample of all nurse tutors in Northern Ireland was investigated by means of the General Health Questionnaire (GHQ), Maslach Burnout Inventory and a stress questionnaire. Seventy per cent of tutors judged themselves to be worse or much worse than usual on 45% of GHQ items. Significant levels of moderate and high burnout were discovered on the sub-scales of emotional exhaustion and depersonalization, with an almost unanimous (95%) report of high burnout arising out of feelings of lack of personal accomplishment. Male nurse tutors reported more frequent and more intense signs of burnout than their female counterparts at a statistically significant level of difference in emotional exhaustion (P = 0.028 and P = 0.003 respectively) and in depersonalization (P < 0.003 and P = 0.007 respectively). The work stressor most commonly identified by tutors (72%) was that of experiencing too little time to perform their duties to their satisfaction. The most common request for help to alleviate workplace stress (61%) was for more support and appreciation from their seniors.

Adult↗

Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses' stress and occupational commitment.

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.

Achievement↗