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PubMed2005

[The validity of the depersonalisation-derealisation scale of the narcissism--inventory].

The German Narcissism-Inventory contains a 6-item scale for the assessment of depersonalization (DP) and derealization (DR). The validity of this scale (NI-DRP) was examined in comparison to the German version of the Dissociative Experiences Scale (FDS) and the Cambridge Depersonalization Scale (CDS). The sample consists of 144 psychotherapy patients, of whom showed on the basis of a structured clinical interview n = 51 none, n = 45 mild, n = 28 moderate and n = 20 severe DP-DR. The areas under the curve and the rate of misclassification did not differ for NI-DRP and the scales of the FDS. The CDS showed the lowest rate of misclassifications.

Adult↗
PubMed1984

Burnout and self-actualization in public school teachers.

Public school teachers (N = 211) in six northwestern Ohio school districts completed the Maslach Burnout Inventory (MBI), Shostrom's Personal Orientation Inventory (POI), and a brief, biographic questionnaire. The responses to the MBI produced the three factors previously named by Maslach as Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Each of the three scales correlated with the summed POI score (r = -.28, -.22, and .35, respectively) and produced high to moderate levels of internal consistency (alphas of .92, .85, and .88, respectively). Teachers with more students tended to produce higher scores on the Depersonalization scale.

Burnout, Professional↗
PubMed1993

Factors associated with burnout of physical therapists in Massachusetts rehabilitation hospitals.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the factors associated with burnout in physical therapists at rehabilitation hospitals. Burnout is a serious concern because it can lead to psychosomatic complaints, work-associated withdrawal behaviors, and a decreased quality of care. SUBJECTS: Full-time, nonadministrative, nonsupervisory, staff physical therapists working in inpatient settings in rehabilitation hospitals in Massachusetts were surveyed. METHODS: The survey included demographic data, the Maslach Burnout Inventory (MBI), and questions designed to address attributes of the work environment and individual personalities. The MBI scores were calculated according to instructions provided by publishers to determine the degree of burnout experienced by this group. Questions involving personality and work environment were submitted to factor analyses. Multivariate analyses were done to determine the factors related to burnout. RESULTS: Forty-six percent of the respondents scored high on the emotional exhaustion subscale of the MBI, 20% scored high on the depersonalization subscale, and 60% scored low on the personal accomplishment subscale. As a whole, the sample demonstrated moderate burnout. Three factors emerged from the factor analysis. The factors communication/connectedness, achievement, and time constraints accounted for 69% of the variability in emotional exhaustion and 73% of the variability in depersonalization and personal accomplishment. Burnout was not significantly associated with the therapists' number of years of practice, number of years on the job, or number of patients seen daily. CONCLUSION AND DISCUSSION: Recognition of factors contributing to burnout may prove to be instrumental in the prevention of burnout in physical therapists and the problems that arise from it.

Adult↗
PubMed2005

Burnout contagion among intensive care nurses.

AIM: This paper reports a study investigating whether burnout is contagious. BACKGROUND: Burnout has been recognized as a problem in intensive care units for a long time. Previous research has focused primarily on its organizational antecedents, such as excessive workload or high patient care demands, time pressure and intensive use of sophisticated technology. The present study took a totally different perspective by hypothesizing that--in intensive care units--burnout is communicated from one nurse to another. METHODS: A questionnaire on work and well-being was completed by 1849 intensive care unit nurses working in one of 80 intensive care units in 12 different European countries in 1994. The results are being reported now because they formed part of a larger study that was only finally analysed recently. The questionnaire was translated from English to the language of each of these countries, and then back-translated to English. Respondents indicated the prevalence of burnout among their colleagues, and completed scales to assess working conditions and job burnout. RESULTS: Analysis of variance indicated that the between-unit variance on a measure of perceived burnout complaints among colleagues was statistically significant and substantially larger than the within-unit variance. This implies that there is considerable agreement (consensus) within intensive care units regarding the prevalence of burnout. In addition, the results of multilevel analyses showed that burnout complaints among colleagues in intensive care units made a statistically significant and unique contribution to explaining variance in individual nurses' and whole units' experiences of burnout, i.e. emotional exhaustion, depersonalization and reduced personal accomplishment. Moreover, for both emotional exhaustion and depersonalization, perceived burnout complaints among colleagues was the most important predictor of burnout at the individual and unit levels, even after controlling for the impact of well-known organizational stressors as conceptualized in the demand-control model. CONCLUSION: Burnout is contagious: it may cross over from one nurse to another.

Adult↗
PubMed2006

Gender differences in psychiatric symptoms related to suicidal ideation in Japanese patients with depression.

Recent figures show that more than 30,000 people suicide each year in Japan, and that many of them are considered to suffer from depression. In addition, the suicide rate among Japanese women has been shown to be higher than in other countries. However, it is not clear whether the psychiatric symptoms leading to suicide differ by gender. The authors examined gender differences in psychiatric symptoms related to suicidal ideation (SI) in Japanese patients with depression. Study subjects were 199 new patients (66 men and 133 women) who were diagnosed with a major depressive disorder. SI and psychiatric symptoms were assessed by several psychological tests using questionnaires. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) with an adjustment for all relevant factors simultaneously. The stepwise method was also used for selecting variables. In univariate analysis, several psychosocial factors such as self-reproach, derealization, depressive moods, depersonalization, and anxiety traits were statistically significantly associated with SI in both men and women. However, multivariate analysis using the stepwise method distinguished gender differences. Low social/family support and depersonalization were statistically significantly associated with SI in men, while depressive moods and an anxiety state were significantly associated with SI in women. The relation between derealization and SI was statistically significant in women but not significant in men.

Adult↗
PubMed1975

The psychopathology of anancastic endogenous depression.

From a sample of 1,005 patients admitted to the Psychiatric Hospital in Aarhus for the first time during the period 1950-1959 and diagnosed as suffering from manic-depressive psychosis or endogenous depression (affective psychoses), a subsample of 104 manic-depressive patients with anancastic symptoms in the history was selected. The 104 probands were individually matched with 104 non-anancastic probands with affective psychoses. The study was designed as a follow-up study, and the patients who were still living were seen personally. In the search for factors which could be used to distinguish affective psychoses with anancastic symptoms from affective psychoses without these traits, the incidence of a number of psychopathological features was evaluated based on the case histories and the information given by the patients at the follow-up. There was no difference as far as atypical, schizophrenia-like symptoms were concerned between the anancastic probands and the controls. Manic and hypomanic features were more frequent among the controls, corresponding to a greater number of bipolar psychoses among them. At the same time, the controls showed a significant preponderance of decidedly psychotic symptoms such as disturbances of consciousness, delusions and delusion-like ideas and hallucinations. Furthermore, retardation was more frequent among the controls. There was no difference in the suicidal behaviour of the two groups. Symptoms which were more often met among the anancastic depressives were: anxiety, agitation, diurnal variation of mood and early awakening. Seasonal variation in symptomatology was also more frequent among the anancastic probands. The same held true for depersonalization. The anancastic probands showed a significant preponderance of anancastic premorbid personality features. A positive correlation was found between the number of anancastic personality features and the following symptoms: agitation, anxiety, diurnal fluctuation, seasonal variation, hypochondriacal attitude and depersonalization. On the other hand, objective retardation or flight of ideas showed a significant negative correlation. The pattern of the anancastic symptoms was rather uniform; aggressive obsessions, mostly in the form of suicidal and homicidal obsessions, were present in more than two thirds of the cases. The anancastic depressions were often less severe than non-anancastic depressions in that the latter were more often complicated by decidedly psychotic symptoms. It is possible to interpret the symptomatology of anancastic depressions as a pathoplastic influence of the anancastic personality, but it cannot be excluded that some of the symptoms like anxiety and agitation are linked to the presence of anancastic symptoms as such.

Adult↗
PubMed1999

Professional burnout among Dutch dentists.

UNLABELLED: Professional burnout, a long-term consequence of occupational stress, is considered to be a factor that explains a substantial proportion of incapacity for work. Burnout is defined as emotional exhaustion, depersonalization, and diminished personal accomplishment. AIMS: To investigate levels of burnout among Dutch practising dentists, to compare dentists' scores with norm scores, and to determine the percentage of dentists "at risk". METHODS: The instrument used was the Dutch version of the Maslach Burnout Inventory (MBI-NL), a 20-item modified version of the original MBI. A highly representative group of Dutch dentists participated (n = 709, 75% response rate). RESULTS: Mean levels (and standard deviations) of burnout were: emotional exhaustion 13.7 (8.6); depersonalization 5.9 (3.9); personal accomplishment 30.8 (5.9). Dentists had more favourable means compared with standard scores, although in the 95th percentile dentists showed more emotional exhaustion than standards indicate. While no overall sex differences were found, male middle-aged dentists tended to show more burnout. Of the working Dutch dentists, 21% had a certain risk, 13% had high overall levels of burnout, and 2.5% were highly burned out. CONCLUSION: It is concluded that Dutch dentists have relatively favourable mean levels of burnout, but those who are exhausted are extremely exhausted. The male dentist in his forties appears to be most vulnerable to burnout.

Adult↗
PubMed1994

Factors contributing to the development of burnout in oncology nursing.

The purpose of this study was to determine whether oncology nurses experience higher levels of burnout compared to nurses working in general hospitals, and to further identify the personal and environmental factors that contribute to the development of emotional exhaustion, depersonalization and lack of personal accomplishment. Seven tools, measuring a selected set of demographic, psychological and occupational variables, were administered to 217 female nurses who worked in oncological hospitals and 226 nurses who worked in general hospitals in the area of Athens. Measures used in the study included the Maslach Burnout Inventory, the Hardiness Scale, the Ways of Coping Scale, the Life Style Scale, the Type A Behaviour Scale, a Job Stress Questionnaire and a General Information Questionnaire. No statistically significant difference was revealed in the degree of burnout experienced by nurses in oncology and those in general hospitals. Multiple linear regression analysis suggested that personality characteristics seem to predict a greater percentage of the variability of the burnout experienced than occupational and demographic variables. A sense of personal control over the things that happen in life and in the work environment was found to protect nurses from emotional exhaustion, depersonalization and lack of personal accomplishment.

Adult↗
PubMedDate not supplied

[Psychiatric side effects of non-steroidal anti-inflammatory agents].

The nonsteroidal anti-inflammatory drugs (NSAIDs) are often used all over the world. Their psychiatric side-effects are rarely known. We report a case of indomethacin related depersonalization and have done a review of literature. We wanted to show the NSAIDs's side-effects. These are non specific, they can be either affective disorders, depersonalization states, hallucinations, or paranoid psychosis (which seems to be the most frequent). The symptomatology is easily suppressed, as soon as NSAIDs are stopped and/or psychotherapeutic symptomatic treatment is started. Different explanations are proposed: prostaglandin inhibition for the NSAIDs in general, indolic molecular structure (which looks like serotonin) for the indomethacin in particular which is the NSAID the most find in these side effects. There is several studies about the role of prostaglandin in psychiatry above all about schizophrenia. Some therapeutic essays were realized with prostaglandins precursors. The rest of the nosology is less studied.

Adult↗
PubMed2003

Extending our understanding of burnout: test of an integrated model in nonservice occupations.

C. L. Cordes and T. M. Dougherty (1993) provided a conceptual framework of job burnout in nonservice organizations. This study sought to determine the "fit" of that theoretical model within nonservice occupations. LISREL VIII was used to test this model on 165 participants, and the overall model fit the data well. Supervisory support moderated the relationships between the role conflict, role ambiguity, and quantitative role overload stressors and emotional exhaustion and between emotional exhaustion and depersonalization. Unexpectedly, role conflict, role ambiguity, and quantitative role overload had a positive impact on emotional exhaustion when supervisory support was high. As expected, participation had a negative association with depersonalization. Employees experiencing emotional exhaustion were more likely to feel nervous or tense at work.

Achievement↗
PubMedDate not supplied

[Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale].

INTRODUCTION: The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. METHODS: This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). RESULTS: 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). CONCLUSION: The Spanish version of the CDS has good reliability and validity, similar to the original instrument.

Adolescent↗
PubMed1990

[The psychopathological structure of paroxysmal psychoautonomic disturbances and its importance for the differential diagnosis and prognosis of different forms of neuroses and depressions].

The psychopathological structure of vegetative paroxysms was studied in different patterns of neuroses (120 cases), endogenous depressions and organic CNS lesions (160 cases). Four types of paroxysms were distinguished depending on the predominance of the definite register of disorders: (1) simple vegetative paroxysms (crises) with the predominance of the vegetative manifestations proper, characteristic for organic CNS lesions and somatogenic; (2) vegetoaffective paroxysms including the vegetative manifestations proper and psychopathological manifestations closely related to the patients' personality and the influence of external factors, characteristic for neurotic disorders; (3) affective-vegetative paroxysms (raptoid conditions) as a unified psychosomatic complex including the protopathic affect of fear, impairment of the general feeling and vegetative functional abnormalities characteristic for MDP and schizophrenia; (4) depersonalization raptuses based on the deranged self-consciousness in the form of different types of depersonalization characteristic primarily for schizophrenia.

Autonomic Nervous System Diseases↗
PubMed1994

Burnout and career-choice regret among family practice physicians in early practice.

OBJECTIVE: Burnout and career-choice regret among physicians in early practice may contribute to physician impairment and attrition as well as patient dissatisfaction. METHOD: Fifty residency-trained family physicians in early practice completed the Maslach Burnout Inventory and a questionnaire on career-choice, demographics, and practice characteristics. RESULTS: The sample showed moderate burnout related to emotional exhaustion and depersonalization of patients but low burnout related to lack of personal accomplishment. Although only 52% reported that they would definitely choose a medical career again, 70% reported that they would definitely choose the specialty of family practice again. At the 0.01 level of significance, those who worked more hours were more emotionally exhausted, and those with children and those with more children under the age of 5 reported less depersonalization. CONCLUSIONS: This sample of physicians in early practice reported slightly less burnout and less specialty-choice regret than a comparable sample of family practice residents, suggesting possible attenuation of burnout with the transition from training to practice. Nonetheless, the importance of overwhelming time demands as a precipitant of exhaustion and potential physician impairment is noted.

Burnout, Professional↗
PubMedDate not supplied

Burnout and internal medicine resident work-hour restrictions.

BACKGROUND: Burnout is very common in internal medicine residents. Effective July 2003, all residents were restricted to work less than an average of 80 hours per week and no more than 30 hours of continuous duty for patient care and educational obligations. We evaluated rates of burnout in internal medicine residents before and after the implementation of the new work-hour restriction. METHODS: University of Colorado Health Science Center internal medicine residents were surveyed in May 2003 and May 2004. The survey contained the Maslach Burnout Inventory, organized into 3 subscales (ie, emotional exhaustion, depersonalization, and personal accomplishment); the Primary Care Evaluation of Mental Disorders depression screen; and self-reported quality of care and education. RESULTS: The response rate was 87% (121 of 139 residents) and 74% (106 of 143 residents) in 2003 and 2004, respectively. Self-reported hours worked decreased from a mean of 74.6 to 67.1 (P = .003). In 2004, 13% fewer residents experienced high emotional exhaustion (42% vs 29%; P = .03). There was a trend toward fewer residents with high depersonalization (61% vs 55%; P = .13) and fewer residents with a positive depression screen (51% vs 41%; P = .11). Personal accomplishment did not change. The assessment of self-reported quality of care did not significantly change from 2003 to 2004. Residents reported attending fewer educational conferences per month (18.99 vs 15.56; P = .01). Overall residency satisfaction decreased 6 mm on a 100-mm visual analogue score (P = .02). CONCLUSIONS: Burnout continues to be a major problem. Reducing hours may be the first step to reduce burnout but may also affect education and quality of care.

Adult↗
PubMed2006

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.

CONTEXT: Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations. OBJECTIVE: To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months. MAIN OUTCOME MEASURES: Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures. RESULTS: Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively). CONCLUSIONS: Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.

Adult↗
PubMed1991

Nurse burnout: work related and demographic factors as culprits.

This study was an examination of the combined ability of perceived work environment, demographic, and work-related variables to predict burnout among 314 nurses at a large metropolitan hospital. The three dimensions of burnout measured were emotional exhaustion, depersonalization, and personal accomplishment. High work pressure and low work involvement and supervisor support predicted emotional exhaustion. Task orientation, work pressure, work involvement, and age predicted both depersonalization and personal accomplishment. Burnout among nurses on each of the three work shifts also was examined. Results are discussed from the perspective of how to decrease or to prevent burnout among nurses.

Adult↗
PubMedDate not supplied

Burnout, depression, life and job satisfaction among Canadian emergency physicians.

Our goal was to determine the level of burnout, depression, life and job satisfaction of Canadian emergency physicians. Six instruments were administered: the emotional exhaustion, depersonalization, and personal accomplishment intensity subscales of the Maslach Burnout Inventory (MBI); the Centre for Epidemiologic Research Self-Report Depression Scale (CES-D); the Satisfaction With Life Scale (SWLS); and the Emergency Physician Job Satisfaction Measurement Instrument (EPJS). Forty-six percent of the sample fell within the medium to high level of emotional exhaustion, 93% within the medium to high range for depersonalization, and 79% within the medium to low range for personal accomplishment. Sixty-one percent were satisfied with their lives, and 75.5% were satisfied with their jobs. Multiple regression analysis showed that increased age, being a department head, and increased weeks of holiday per year were positive contributors to EPJS scores (P < 0.05). Involvement in medical education, increased clinical hours worked per year, and region of residence-Quebec were negative contributors to EPJS scores (P < 0.05). Involvement in medical education is a significant factor among physicians experiencing depressive symptomatology. Time away from clinical practice is important to job satisfaction and emotional well-being.

Adult↗
PubMed2006

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.

Journal Article↗