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PubMed2006

Efavirenz and chronic neuropsychiatric symptoms: a cross-sectional case control study.

OBJECTIVE: The aim of the study was to investigate symptoms of long-term central nervous system (CNS) toxicity in HIV-positive patients treated with efavirenz (EFV). METHODS: We carried out a single-centre, cross-sectional case-control study comparing patients treated with EFV for at least 6 months with a matched control group. Self-administered, standardized questionnaires including the Depression, Anxiety and Stress Scales (DASS), the Cognitive Failures Questionnaire (CFQ) and a questionnaire on unusual dreams, insomnia, fatigue, dizziness, depersonalization and derealization were administered. RESULTS: Data for 32 matched pairs were analysed. Significantly higher total stress scores (P=0.008) were found in the EFV group. Of the patients in this group, 19% also reported severe to extremely severe levels of stress (P=0.014), indicating increased difficulty in relaxing, and being more irritable, impatient, agitated and easily upset. Nineteen per cent of patients treated with EFV also reported severe levels of anxiety (P=0.059) as assessed with the DASS scale. This patient group also reported a higher rate of unusual dreams (P=0.049). No significant differences between groups were found for measures of cognitive impairments, fatigue, dizziness, derealization or depersonalization. CONCLUSION: EFV-treated patients reported higher levels of severe stress and anxiety as well as a higher rate of unusual dreams than patients not treated with EFV. These differences may be an expression of persisting CNS side effects in patients who remain on EFV for a prolonged period.

Adult↗
PubMed1997

Dissociation in epilepsy and conversion nonepileptic seizures.

PURPOSE: We examined the dimensionality of the item content of the Dissociative Experiences Scale (DES) in relation to the clinical diagnosis of conversion nonepileptic seizures (C-NES) versus complex partial epilepsy (CPE). METHODS: The DES was administered to a sex- and age-matched sample of 132 patients with C-NES and 169 with CPE and was factor analyzed with principal components analysis (PCA) with varimax rotation. RESULTS: The mean total DES score was 15.1 in the C-NES group and 12.7 in the CPE group (p = 0.079). The factors obtained by PCA differentiated the CPE and C-NES groups more strongly than did the total DES score. The factor accounting for the most variance, interpreted as "depersonalization-derealization," was significantly greater in C-NES than CPE (p = 0.005). An "absorption-imaginative involvement" factor, which included some of the clinical features of posttraumatic stress disorder was elevated only in subjects reporting histories of childhood abuse (p = 0.001) regardless of the diagnosis of CPE or C-NES. An "amnestic" factor appearing to represent memory problems related to neurologic impairment showed a trend toward elevation in CPE (p = 0.056) and may have confounded the CPE versus C-NES distinction using total DES scores. CONCLUSIONS: The DES has separate underlying dimensions that appear to relate distinctively to depersonalization and derealization, childhood trauma, and neurologic impairment. The heterogeneous item content of the DES is a potential confound that should be appreciated when this instrument is used to study dissociation in neuropsychiatric populations.

Adult↗
PubMed2005

[Burnout syndrome among health workers in pediatrics].

BACKGROUND: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious problems in occupational behavior. OBJECTIVE: In the present study we assessed the prevalence of burnout syndrome in pediatric healthcare workers. DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHODS: In November 2002, the Maslach Burnout Inventory was given to 127 staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b) depersonalization, and c) personal achievement. RESULTS: The questionnaire was completed by 93 staff members (73.2 % of the whole sample; 83 % women and 17 % men). The mean age was 38.6 +/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine percent were pediatricians, 50.5 % were nurses and 20.5 % were nurse assistants. A total of 20.8 % had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales were applied, the results showed that 67.7 % of respondents presented a low level of personal achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the depersonalization scale. CONCLUSIONS: BS is present in a significant percentage of hospital workers attending pediatric patients. In our sample, the most notable component of BS was the lack of personal achievement. This finding alerted us to the eventual presence of negative attitudes toward self and professional activity, as well as to the loss of interest in pediatric care, low productivity and diminished self-esteem. We believe that specific strategies should be implemented to attenuate the factors influencing the development of BS in pediatric health staff.

Adult↗
PubMed2005

[Professional burnout in dentists and stomatologists of the Galician Health Service].

AIM: To analyse the degree of professional burnout in primary care dentists of the Galician Health Service (GHS). DESIGN: Descriptive, cross-sectional study. SETTING: Dental care units of the GHS primary care network. SUBJECTS: All primary care dentists of the new primary care model of the GHS (N=79). Response rate: 50% (N=35). MEASUREMENTS: Anonymous self-applied questionnaire: the Maslach Burnout Inventory, that evaluates emotional exhaustion, depersonalization, and personal achievements; a social and personal questionnaire. Student's t test, ANOVA, 2 or Fisher's exact test were used. MAIN RESULTS: Mean age: 46.58+/-9.47; sex: 74.3% males; temporary job: 82.9%; years in the GHS: 15.25+/-8.34. High values were detected in: emotional exhaustion 54.3%; depersonalization 55.6%; personal achievements 6.9%. No statistically significant differences were identified in terms of age, sex, marital status, type of contract, rural vs urban areas, number of patients treated, or years in the GHS, apart from the "personal achievements" subscale, that was rated, significantly higher (P=.046) by those who had shorter experience at for the GHS. CONCLUSION: GHS dentists show a degree of professional burnout close to the one described for family doctors at the Spanish National Health System.

Adult↗
PubMedDate not supplied

Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians.

BACKGROUND: Burnout and psychological stress symptoms represent a major problem among health care professionals. The aim of this study was to investigate the prevalence of and the relationship between psychiatric morbidity and burnout among a convenience sample of Italian primary care physicians (GPs) and hospital physicians (HPs). METHOD: The sample consisted of 328 physicians (182 GPs and 146 HPs) who completed the 12-item version of the General Health Questionnaire and the Maslach Burnout Inventory (MBI). RESULTS: The global prevalence of psychiatric morbidity was 22.3% (20.3% among GPs and 24.6% among HPs). Symptoms of emotional exhaustion were reported by 27.5% of the participants (GPs: 32.4%; HPs: 21.2%), depersonalization by 25.6% (GPs: 27.4%; HPs: 22.6%) and low personal accomplishment by 12.8% (GPs: 13.1%; HPs: 12.3%). No significant difference was found between the two groups, except higher levels of emotional exhaustion among GPs. Female GPs reported lower scores on MBI depersonalization and female HPs lower scores MBI personal accomplishment than male GPs and HPs, respectively. CONCLUSIONS: The study underscores the significant problem of stress among physicians and indicates the need for supporting health professionals in order to improve their psychological well-being and, possibly, the quality of their relationship with the patients.

Adult↗
PubMed1997

The neural substrates of religious experience.

Religious experience is brain-based, like all human experience. Clues to the neural substrates of religious-numinous experience may be gleaned from temporolimbic epilepsy, near-death experiences, and hallucinogen ingestion. These brain disorders and conditions may produce depersonalization, derealization, ecstasy, a sense of timelessness and spacelessness, and other experiences that foster religious-numinous interpretation. Religious delusions are an important subtype of delusional experience in schizophrenia, and mood-congruent religious delusions are a feature of mania and depression. The authors suggest a limbic marker hypothesis for religious-mystical experience. The temporolimbic system tags certain encounters with external or internal stimuli as depersonalized, derealized, crucially important, harmonious, and/or joyous, prompting comprehension of these experiences within a religious framework.

Epilepsy↗
PubMed1986

Role structure and burnout in the field of human services.

This article discusses a study that investigated burnout as a function of aspects of role structure for people working in the field of human services. The subjects, the staff of a residential rehabilitation and mental health center, completed a six-team questionnaire, the Maslach Burnout Inventory, and the Least Preferred Coworker Scale. The relationships of accuracy, concentration of social support network, mutual references, and motivational hierarchy were analyzed in three multiple regressions with emotional exhaustion, personal accomplishment, and depersonalization. Emotional exhaustion was found to have occurred less often when a person's social support network within the setting was not concentrated solely within the formal work subgroup, personal accomplishment was enhanced by an ambiguous role structure, and depersonalization was found to be related primarily to a person's values toward personal relationships and work and to be more prevalent among those with concentrated networks and ambiguously structured roles.

Burnout, Professional↗
PubMed1995

Test-retest reliability of a psychometric instrument designed to measure physical therapy students' burnout.

The purpose of this study was to assess the reproducibility of scores on an instrument designed to measure physical therapy students' burnout. Physical therapy students (28 juniors and 28 seniors) completed an adapted educator's version of the Maslach Burnout Inventory on two occasions within a week interval. At each testing session, a separate score was obtained for each student for the three (emotional exhaustion, depersonalization, and personal accomplishment) subscales of the instrument. These scores, analyzed with a two-factor repeated-measures analysis of variance, indicated a significant difference in the personal accomplishment score between the junior and senior students during the two time frames. Scheffé post hoc tests showed that the junior students reported higher personal accomplishment affect at both testing sessions than the senior students. Both junior and senior students reported higher personal accomplishment at retest than at baseline testing. A test-retest reliability coefficient of .850 was obtained for the Depersonalization subscale; .907 and .715 were obtained for the Emotional Exhaustion and Personal Accomplishment subscales, respectively.

Adult↗
PubMed1997

Depression and Burnout in Hospital Health Care Professionals.

A cross-sectional study was conducted on a random sample of 1,200 health care professionals in Marseille, France, in order to assess the prevalences of depression and burnout, and to compare these two entities. Depression was assessed by the Center for Epidemiologic Studies-Depression scale (CES-D), and burnout by the Maslach Burnout Inventory (MBI). Burnout is a syndrome of emotional exhaustion, depersonalization towards patients, and reduced sense of personal accomplishment. Some psychiatrists consider burnout to be a clinical form of depression. The prevalences of depression and burnout were very close: 17.1% and 15.7% among the women, 19.4% and 22% among the men, but 6.5% of the women and 9.4% of the men were both depressive and burned-out. A correlation was found between the CES-D and the subscales Emotional Exhaustion and Depersonalization of the MBI. Multivariate analysis and logistic regression models showed that many demographic and subjective variables influenced depression and burnout in different ways.

Journal Article↗
PubMed2005

Can skill-development training alleviate burnout in hospital social workers?.

Staff development programs, which focus on imparting and improving intervention skills, are acknowledged as an efficient way to reduce burnout, but few studies have examined this effect. The aim of the present study was to detect any difference in the level of social worker's burnout before and after attending two different skill-development groups, namely group-intervention skills for more experienced social workers and general hospital social-work skills for less experienced. Twenty-five hospital social workers participated in the study. The three dimensions of burnout, namely emotional exhaustion, depersonalization, and personal accomplishment, changed between the pre-training and post-training measures: personal accomplishment rose by 12.39% and depersonalization fell by 29.75%. The difference was significant for the two dimensions in both groups. Emotional exhaustion significantly declined in the hospital social-work skills group only, and revealed a group-time effect. The level of peer support rose in the hospital-skills group and was positively related to a lowering of emotional exhaustion. This was an exploratory study, with a rather small sample, and the results are preliminary, but they show a promising possibility of burnout reduction among professional workers. Further research on the effect of skill development training on reducing burnout is needed.

Adaptation, Psychological↗
PubMed2002

Henri Tajfel's 'cognitive aspects of prejudice' and the psychology of bigotry.

This paper pays tribute to Tajfel's classic article 'Cognitive aspects of prejudice' and re-examines its central arguments. Tajfel's paper is important for outlining a social cognitive approach to the study of prejudice and also for refuting of what Tajfel called the 'blood-and-guts' approach. Taking Tajfel's proposition that social psychology is not value-free, the current paper examines the moral and political view of 'Cognitive aspects' and also the gaps in its approach to the study of prejudice. It is suggested that this cognitive approach has difficulty in accounting for extreme bigotry, at least without recourse to the motivational themes that the approach seeks to exclude. In particular, there would be limitations in applying this approach in order to understand the Holocaust. Indeed, Tajfel did not attempt to do so, for reasons that are discussed. Tajfel's Social Identity Theory (SIT) has similar limitations. The paper also examines Tajfel's use of the term 'depersonalization', which he described as a 'milder' form of dehumanization of out-groups. Later social identity theorists have tended to use 'depersonalization' differently, shifting their attention to in-groups. Their perspective moves away from understanding the topic of prejudice in the way that can be found in Tajfel's 'Cognitive aspects of prejudice'. Finally, the present paper suggests how extreme prejudice might be studied without returning to the motivational 'blood-and-guts' approach that Tajfel so cogently criticized.

Cognition↗
PubMed2004

Stress and coping among orthopaedic surgery residents and faculty.

BACKGROUND: Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. METHODS: Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. RESULTS: The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p < 0.0003), an average level of depersonalization (p < 0.0001), and a high level of personal achievement (p < 0.0001). Only two of twenty-five faculty members (compared with seven of twenty-one residents) scored over 4 points on the General Health Questionnaire-12, indicating significant symptomatology (p < 0.01). The majority of subjects reported that a partner or spouse showed nondistressed levels of marital adjustment and satisfaction. All residents and nine of the twenty-five faculty members had mentors but judged the resource to be minimally beneficial. Resident burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. CONCLUSIONS: In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity. Furthermore, with regard to our second goal; our data revealed a number of risk factors for resident decompensation, most notably, increased workload, high debt levels, and discord with superiors. In addition, our research revealed that the current support interventions by the residency program, including mentoring and facilitation of spousal adjustment, are viewed as being of little help.

Adaptation, Psychological↗
PubMed2002

Confirmatory factor analysis and job burnout correlates of the Health Professions Stress Inventory.

Previous research in 1994 by Gupchup and Wolfgang identified four factors from Wolfgang's Health Professions Stress Inventory (1988) that were common among a sample of practicing pharmacists. The factors were labeled Professional Recognition. Patient Care Responsibilities, Job Conflicts, and Professional Uncertainty, respectively. We used confirmatory factor analysis to assess whether this factor structure was generalizable to nurses. To examine concurrent validity, we correlated the factors with Maslach and Jackson's three dimensions of job burnout, i.e., Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Data were collected through a questionnaire survey of a random sample of 9,380 nurses from across 43 public hospitals in Hong Kong, from which 2,267 (24.2%) responded. Analysis indicated statistically acceptable goodness of fit indices for the four-factor solution. Except for the factor Patient Care Responsibilities. all other factors had moderate correlations between .44 and .53 with Emotional Exhaustion and Depersonalization. Correlations between the factors of Stress Inventory and Personal Accomplishment were small but significant, ranging from -.25 to .13. Areas for further improving the psychometric properties of the inventory are discussed.

Adult↗
PubMed2006

Relationships among burnout, job involvement, and organizational citizenship behavior.

R. Cropanzano, D. E. Rupp, and Z. S. Byrne (2003) found that emotional exhaustion (i.e., 1 dimension of burnout) negatively affects organizational citizenship behavior (OCB). The authors extended this research by investigating relationships among 3 dimensions of burnout (emotional exhaustion, depersonalization, and diminished personal accomplishment) and OCB. They also affirmed the mediating effect of job involvement on these relationships. Data were collected from 296 paired samples of service employees and their supervisors from 12 hotels and restaurants in Taiwan. Findings demonstrated that emotional exhaustion and diminished personal accomplishment were related negatively to OCB, whereas depersonalization had no independent effect on OCB. Job involvement mediated the relationships among emotional exhaustion, diminished personal accomplishment, and OCB.

Adult↗
PubMed1993

A longitudinal study of the relationships between overload, social support, and burnout among nursing educators.

The major purpose of this study was to examine the causal relationships between role overload, social support, and burnout among nursing educators over a period of time. Eighty-four nursing educators from eight campuses of a state university system completed a questionnaire twice, within a two-year interval. Data analyses consistently revealed the following: 1) Emotional exhaustion correlated significantly and positively with a demanding job, time pressure, and feelings of job inadequacy; 2) Burnout (i.e., emotional exhaustion, depersonalization of students, and a sense of decreased accomplishment) correlated significantly and negatively with social support from one's chairperson and peers. Predictor variables from the initial data set were regressed on the burnout data of two years later. The variable--job demands--was the strongest predictor of emotional exhaustion. Chairperson support was the strongest predictor of both depersonalization toward students and a person's sense of accomplishment two years later. The reported chronic exhaustion among educators in this study should be of concern. An awareness of the role of social support and overload as associated with burnout can help educators develop policies to assure peak performance on the job.

Achievement↗
PubMed1990

Role overload, social support, and burnout among nursing educators.

The purpose of this study was to examine the relationships between role overload, social support, and burnout among nursing educators. Ninety percent (N = 141) of nursing educators from eight campuses of the California State University system completed a four-part questionnaire. Later, in-depth interviews were conducted with 30 nursing educators and five chairpersons. The findings indicated that a demanding job correlated, significantly and positively with almost all aspects of burnout (emotional exhaustion, depersonalization of students, and decreased sense of accomplishment). The degree of support from one's chairperson and peers correlated significantly and negatively with almost all aspects of burnout. The findings from the interviews verified these relationships. In the hierarchical regression analyses, a demanding job was the most important predictor of emotional exhaustion. Lack of peer support was the most important predictor of depersonalization towards students. Chairperson support was the most important predictor of a person's sense of accomplishment. Social support did not serve as a buffer against the negative effects of overload on burnout. It was concluded that attempts to alleviate burnout must directly address the extent of overload or the lack of support. Any attempt to mitigate the overload-burnout relationship by merely amplifying the amount of support is not likely to be effective.

Burnout, Professional↗
PubMedDate not supplied

Burnout in occupational therapists and physical therapists working in head injury rehabilitation.

OBJECTIVES: Burnout has been linked to job retention in occupational therapy, physical therapy, and other health professions. Professional development activities are often suggested to reduce burnout, but little empirical evidence supports this contention. This study explored the prevalence of burnout among occupational and physical therapists working in head injury rehabilitation and evaluated the relationship between burnout and professional development activities. METHOD: Forty therapists working full-time in head injury rehabilitation were surveyed. Correlations between subscale scores of the Maslach Burnout Inventory (i.e., Emotional Exhaustion, Depersonalization, and Personal Accomplishment) and responses to a survey of professional development activities are reported. RESULTS: Professional development activities are most strongly associated with feelings of personal accomplishment. Emotional exhaustion was relatively high among these therapists, but few feelings of depersonalization were evident. CONCLUSIONS: Professional development activities in the workplace may augment feelings of personal accomplishment and minimize burnout as an issue in job retention. Strategies to effectively identify and manage therapists' feelings of emotional exhaustion require further study.

Adult↗
PubMed1987

Perceived levels of burnout of Veterans Administration therapeutic recreation personnel.

This study investigated the relationship between work-related variables and perceived levels of burnout of therapeutic recreation personnel who work with long-term psychiatric patients in Veterans Administration hospitals. Subjects completed a three-part instrument composed of a demographic questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. Of the 511 subjects surveyed, 287 (56%) responded with usable questionnaires. The demographic, job- and profession-related variables were found to be significantly related to burnout. The eta values were somewhat low. The WES variables accounted for 20.9% of the variance in the burnout measures. The WES variables accounted for 20.9% of the variance in the burnout measures. The most salient relationships emerged between the emotional exhaustion and the depersonalization subscales and clarity, supervisor support, involvement, work pressure, autonomy, innovation, peer cohesion, task orientation and physical comfort. In comparison with other groups of human service professionals, therapeutic recreation personnel experienced low levels of emotional exhaustion, moderate levels of depersonalization, and somewhat lower levels of personal accomplishment.

Burnout, Professional↗