Wednesday June 29 2011
Burnout causes exhaustion and cynicism, researchers say
The risk of feeling run-down and “burnt out” is increased when you work more than 40 hours a week, reports the Daily Mail. The Daily Telegraph adds that simply “having a boring job can leave you just as vulnerable to experiencing ‘burnout’”.
The news is based on Spanish research into "occupational burnout": the concept that workers can develop feelings of exhaustion and cynicism, leading to inefficiency. It looked at different types of burnout, including underchallenged workers feeling bored and lacking any kind of personal development in their jobs.
The researchers questioned more than 400 university workers and found that individuals working more than 40 hours a week and working part-time were at greater risk of “frenetic” burnout: feeling involved in their work but with too much to do in the time available. Administration and service personnel were at a higher risk of “underchallenged” burnout than teaching and research staff, as were men compared to women. Employees with more than sixteen years service were at the highest risk of “worn-out” burnout, where a person feels a lack of control or acknowledgement for their work.
Although this research has found associations between a variety of factors and the risk of different burnouts, there are several limitations to this study. For example, it looked at university employees, who are likely to have different roles and working times compared to workers in other sectors. Overall, the research may inform us more about working at the university in question rather than workplaces as a whole.
Where did the story come from?
The study was carried out by researchers from the University of Zaragoza and from other research institutes in Spain. The funding source for this study is not reported. The study was published in the peer-reviewed medical journal, BMC Psychiatry.
This study was generally reported well by the media, although not all reports made it clear that the research only found associations between work habits and burnout. Finding that two factors are associated does not necessarily mean that they have a cause-and-effect relationship.
Different newspapers chose to concentrate on different results: The Daily Telegraph reported that “boring jobs lead to burnout”, while the Daily Mirror, Daily Mail and Metro all had headlines describing the increased risk of burnout with working 40 hours or more each week. The papers also state that the risk of burnout is “six times higher” with working 40 hours or more each week, which could be taken to suggest one cause of burnout.
What kind of research was this?
This was a cross-sectional study carried out on randomly selected employees of the University of Zaragoza in Spain. It was concerned with “burnout”, a type of work-related psychological stress and fatigue that has been the subject of research for more than 35 years. Although there is no single, agreed definition of burnout there is a general consensus among researchers that it is characterised by exhaustion, adoption of a cynical attitude towards work and a loss of efficiency.
In this study, burnout has been classified into three different subtypes: “frenetic”, “underchallenged” and “worn out”. “Frenetic” burnout occurs in subjects who are involved and ambitious, but who overload themselves. “Underchallenged” burnout occurs when subjects are indifferent and bored. “Worn-out” burnout refers to a feeling of lack of control and acknowledgement.
The researchers asked the recruits to complete a questionnaire which collected data on a variety of sociodemographic and occupational factors and assessed burnout. The researchers then used this data to examine the association between different sociodemographic and occupational factors and the different subtypes of burnout syndrome.
This was a cross-sectional study, which means that the data was examined only at a single point in time rather than following participants over time. As it was cross-sectional, it can only show association between burnout and the examined factors, and cannot show causation, or which among several factors occurred first.
What did the research involve?
The study sampled 1,600 employees of the University of Zaragoza, with a proportional number of employees drawn from each different class of occupation (classified as teaching and research, administration and service or trainees). An email was sent to the selected participants, explaining the aims of the research and including a link to a questionnaire.
Using the questionnaire, the researchers collected information on a variety of sociodemographic and occupational characteristics, including:
- whether or not the subject was in a stable relationship
- level of education
- number of hours worked per week
- length of service
- monthly income
- contract duration (permanent or temporary)
- contract type (part-time or full-time)
The participants were then asked to complete the “Burnout Clinical Subtype Questionnaire”. In this validated questionnaire, the participants had to indicate the degree to which they agreed or disagreed with statements such as “I have a strong need for important achievements in my work” and “When things at work don’t turn out as well as they should, I stop trying”. Responses were given on a seven-point scale, with higher scores indicating a greater degree of burnout. Scores relating to different sets of statements allowed the researchers to define the extent to which participants represented each burnout subtype.
The researchers then performed a number of analyses of their survey data, grouping the participants in various ways in order to draw associations between results and personal factors. For example, they were divided into three groups based on age:
There is no previously established score for defining burnout in the “Burnout Clinical Subtype Questionnaire”, so the researchers performed analyses comparing high-score groups against low-score groups. They designated the participants with the top 25% highest scores to be the "high-score group".
What were the basic results?
The final sample consisted of 409 participants (a response rate of 25.6%), with participation rates varying across different occupation types.
The number of hours worked each week and contract type was associated with “frenetic” burnout – the type seen in subjects who are involved and ambitious, but who overload themselves. Participants working more than 40 hours a week were more likely to have a high score than those working fewer than 35 hours a week (adjusted odds ratio 5.69; 95% confidence interval 2.52-12.82).
In addition, the number of hours worked each week correlated with the risk of burnout, with more hours associated with a greater risk. In an analysis of part-time vs. full-time workers, part-timers were more likely to have a high score, indicating greater burnout symptoms (adjusted odds ratio 3.30; 95% confidence interval 1.12-9.47). While this association was statistically significant, only 25 part-time workers were featured in this particular analysis. Although these participants only worked at the university part-time the researchers say that it is likely that they worked several jobs, which may have increased their risk of burnout.
Being male and working in administration and service were associated with “underchallenged” burnout – the subtype involving feeling indifferent and bored. Administration and service personnel of both genders were more likely to have a high score than teaching and research staff (adjusted odds ratio 2.85; 95% confidence interval 1.16-7.01). Overall, male participants were more likely to have a high score than women (adjusted odds ratio 2.16; 95% confidence interval 1.13-3.55).
Increased length of service was associated with the “worn-out” burnout type. Participants in the group who had been working for 4-16 years were more likely to have a high score (adjusted odds ratio 3.44; 95% confidence interval 1.34-8.86), as were those who had been working for more than 16 years (adjusted odds ratio 4.56; 95% confidence interval 1.47-14.16). As the length of service increased, likelihood of a high score also increased. Being in a stable relationship, having children and being educated reduced the risk of this type of burnout. Participants not in a stable relationship were more likely to have a high score (adjusted odds ratio 1.91; 95% confidence interval 1.05-3.45), as were those without children (adjusted odds ratio 1.90, 95% confidence interval 1.09-3.31). Having a university education decreased the likelihood of a high score when compared to being educated up to secondary level (adjusted odds ratio 0.48, 95% confidence interval 0.24-0.96).
How did the researchers interpret the results?
The researchers conclude that their results “support the idea of a differential characterisation of burnout syndrome by providing specific associations with a number of sociodemographic and occupational factors”.
The researchers have identified associations between the different burnout subtypes and different sociodemographic and occupational variables. However, there are several issues that need consideration when interpreting the results.
Principally, there are issues relating to the selection and recruitment of participants, which may have influenced the results. Recruitment was conducted using an email explaining that the purpose of the research was to study the presence of burnout in the workplace, which may have unduly influenced the responses the participants gave when they later completed the study’s online questionnaire (which similarly had the word “burnout” in the title).
Also, there was only a 25.6% response rate, and an uneven response between each occupational groups. The authors say these values are comparable to other studies using similar data collection procedures, but it is possible that those who responded to the invitation were different in some way from those who did not respond. For example, worker satisfaction levels might have influenced the decision to complete the questionnaire, leading to a disproportionate number of happy or unhappy workers responding.
Other points to consider include:
- All the participants worked at the same Spanish university, which is likely to differ in its workings compared to many other workplaces. For example, a university will centre many of its working practices around term and holiday seasons, which is not typical of many other jobs.
- The study looked at a single workplace, and may represent the workings of that institution rather that other workplaces.
- As the authors point out, the fact that the data was all self-reported also means that it could be influenced by the need to give socially desirable responses.
- The researchers do not describe the factors that were adjusted for in their analysis. Burnout is unlikely to be attributable to a single cause, and it is not possible to say if other, unmeasured factors may have been influencing the relationship.
- Importantly, the main problem with this study is that it was a cross-sectional study and therefore by design did not follow people up over time. It cannot show causation, only an association.