Occupational stress and job burnout in mental health.

Professionals who care for long-term and seriously ill patients frequently experience distressing emotional situations and profound suffering. These emotions can include the need to ‘rescue’ patients, a sense of failure and frustration when the illness progresses, feelings of powerlessness against the illness and its associated losses, grief, fear of becoming ill oneself and a desire to remain emotionally distant from and avoid patients to escape from these feelings. Although they are common in everyday clinical practice, such emotions often affect the quality of medical care that physicians provide and their well-being (Meier et al., 2001). Individuals who work in the mental health field have been identified as a high-risk group for occupational stress (Leary & Brown, 1995; Nolan et al., 1995) and burnout (Leiter & Harvie, 1996; Prosser et al., 1996; Thomsen et al., 1999). Burnout should be distinguished conceptually from occupational stress, which is a generic term that refers to temporary adaptation at work, accompanied by mental and physical symptoms. In contrast, burnout is considered to be the final stage in a breakdown during adaptation and therefore results from prolonged occupational stress. Moreover, burnout includes the development of dysfunctional attitudes and behaviours towards the recipients of one’s care or services and towards one’s job and organisation. Burnout is a critical issue for mental health-care delivery, because it can lead to decreased work performance and, ultimately, poorer treatment outcomes (Priebe et al., 2004). Mental health services throughout Europe are facing severe financial shortages and consequent shortfalls in the number of sector-employed professionals. The situation is particularly exigent in European countries with a national health service, such as the UK (Sainsbury Centre for Mental Health, 2001) and Italy (Lasalvia et al., 2007). Thus, workers’ feelings of job disaffection and burnout can thin a mental health service workforce. Historically, burnout has been considered more of a personal problem than an organisational one (Maslach & Leiter, 1997). Studies that explored determinants of burnout in mental health settings generally focused on individual socio-demographic factors (Fagin et al., 1996; Edwards et al., 2000), individual occupational characteristics (Prosser et al., 1999; Kilfedder et al., 2001; Evans et al., 2006) and predisposing personality traits (Naisberg-Fennig et al., 1991; Deary et al., 1996a). Yet, recent research has expanded the theoretical burnout framework to include perceived organisational sources of stress. Maslach & Leiter (1997) proposed that burnout develops as a result of mismatches between professionals and their job contexts in several worklife areas (i.e. workload, control, rewards, community, fairness and values). Specifically, a discrepancy is perceived when the process of establishing a psychological ‘contract’ with one’s job leaves critical issues unresolved or when changes in working relationships feel unacceptable to the worker. Accordingly, Leiter & Maslach (2000) proposed the ‘Mediation Model’, which postulates that the greater the degree of workerjob mismatch, the greater the likelihood of burnout. The Mediation Model can be used in research and applied intervention, because it focuses on the relationship between burnout and contextual work sources (Leiter & Maslach, 2004). Thus, burnout is viewed as an individual syndrome that develops in a work context, where perceived organisational factors have greater influence than personal factors (Maslach & Leiter, 2008). A recent, large-scale survey that examined Italian mental health staff (Lasalvia et al., 2009), adopting the framework of Leiter & Maslach’s Mediation Model found that perceived organisational factors were the only significant predictors of the three dimensions of burnout (emotional exhaustion, cynicism and professional efficacy). Moreover, specific predictors accounted for each dimension, with no significant professional category effects. With regard to strength of association, high workload was most predictive of exhaustion; poor rewards and few perceived positive service changes were the best predictors of disengagement from work; and lack of participation in decision-making was most predictive of reduced professional efficacy. These findings are consistent with the ‘Job Demand-Resources’ (JD-R) * Address for correspondence: Dr Antonio Lasalvia, Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico ‘G.B. Rossi’, Piazzale L.A. Scuro 10, 37134 Verona, Italy. (Email: [email protected]) Epidemiology and Psychiatric Sciences (2011), 20, 279–285. © Cambridge University Press 2011 doi:10.1017/S2045796011000576 PRESENTATION OF THE EDITORIALS, DECEMBER 2011