| Hacia una definición breve del síndrome de burnout por subtipos: desarrollo del ¨Cuestionario de Burnout Clínico por Subtipos¨ (BCSQ-12). |
Towards a brief definition of burnout: syndrome by subtypes: Development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12).
Montero-Marin J, Skapinakis P, Araya R, Gili M, Garcia-Campayo J.
Health Qual Life Outcomes. 2011 Sep 20;9(1):74.
Abstract
ABSTRACT: BACKGROUND: Burnout has traditionally been described by means of the dimensions of exhaustion, cynicism and lack of eficacy from the "Maslach Burnout Inventory-General Survey" (MBI-GS). The "Burnout Clinical Subtype Questionnaire" (BCSQ-12), comprising the dimensions of overload, lack of development and neglect, is proposed as a brief means of identifying the different ways this disorder is manifested. The aim of the study is to test the construct and criterial validity of the BCSQ-12. METHOD: A cross-sectional design was used on a multi-occupational sample of randomly selected university employees (n=826). An exploratory factor analysis (EFA) was performed on half of the sample using the maximum likelihood (ML) method with varimax orthogonal rotation, while confirmatory factor analysis (CFA) was performed on the other half by means of the ML method. ROC curve analysis was performed in order to assess the discriminatory capacity of BCSQ-12 when compared to MBI-GS. Cut-off points were proposed for the BCSQ-12 that optimized sensitivity and specificity. Multivariate binary logistic regression models were used to estimate effect size as an odds ratio (OR) adjusted for sociodemographic and occupational variables. Contrasts for sex and occupation were made using Mann-Whitney U and Kruskall-Wallis tests on the dimensions of both models. RESULTS: EFA offered a solution containing 3 factors with eigenvalues >1, explaining 73.22% of variance. CFA presented the following indices: chi2=112.04 (p<0.001), chi2/gl=2.44, GFI=0.958, AGFI=0.929, RMSEA=0.059, SRMR=0.057, NFI=0.958, NNFI=0.963, IFI=0.975, CFI=0.974. The area under the ROC curve for 'overload' with respect to the 'exhaustion' was =0.75 (95% CI=0.71-0.79); it was =0.80 (95% CI=0.76-0.86) for 'lack of development' with respect to 'cynicism' and =0.74 (95% CI=0.70-0.78) for 'neglect' with respect to 'inefficacy'. The presence of 'overload' increased the likelihood of suffering from 'exhaustion' (OR=5.25; 95% IC=3.62-7.60); 'lack of development' increased the likelihood from 'cynicism' (OR=6.77; 95% CI=4.79-9.57); 'neglect' increased the likelihood from 'inefficacy' (OR=5.21; 95% CI=3.57-7.60). No differences were found with regard to sex, but there were differences depending on occupation. CONCLUSIONS: Our results support the validity of the definition of burnout proposed in the BSCQ-12 through the brief differentiation of clinical subtypes.
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| Elevada incidencia de burnout en los directivos académicos de anestesiología: ¿Deberíamos tener mejor cuidado de nuestros líderes? |
High incidence of burnout in academic chairpersons of anesthesiology: should we be taking better care of our leaders?
De Oliveira GS Jr, Ahmad S, Stock MC, Harter RL, Almeida MD, Fitzgerald PC, McCarthy RJ.
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Anesthesiology. 2011 Jan;114(1):181-93.
Abstract
BACKGROUND: Burnout is a work-related psychologic syndrome characterized by emotional exhaustion, low personal accomplishment, and depersonalization. METHODS: By using an instrument that included the MBI-HHS Burnout Inventory, we surveyed academic anesthesiology chairpersons in the United States. Current level of job satisfaction compared with 1 and 5 yr before the survey, likelihood of stepping down as chair in the next 2 yr, and a high risk of burnout were the primary outcomes. RESULTS: Of the 117 chairs surveyed, 102 (87%) responded. Nine surveys had insufficient responses for assessment of burnout. Of 93 chairs, 32 (34%) reported high current job satisfaction, which represented a significant decline compared with that reported for 1 yr (P = 0.009) and 5 yr (P = 0.001) before the survey. Of 93 chairs, 26 (28%) reported extreme likelihood of stepping down as a chair in 1-2 yr. There was no association of age (P = 0.16), sex (P = 0.82), or self-reported effectiveness (P = 0.63) with anticipated likelihood of stepping down, but there was a negative association between the modified efficacy scale scoρrgr; = -0.303, P = 0.003) and likelihood of stepping down. Of 93 chairs, 26 (28%) met the criteria for high burnout and an additional 29 (31%) met the criteria for moderately high burnout. Decreased current job satisfaction and low self-reported spousal/significant other support were independent predictors of high burnout risk. CONCLUSION: Fifty-one percent of academic anesthesiology chairs exhibit a high incidence/risk of burnout. Age, sex, time as a chair, hours worked, and perceived effectiveness were not associated with high burnout; however, low job satisfaction and reduced self-reported spousal/significant other support significantly increased the risk.http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2011&issue=01000&article=00038&type=abstract
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| Riesgo de burnout en médicos perioperatorios: una encuesta y revisión de la literatura |
Risk of burnout in perioperative clinicians: a survey study and literature review.
Hyman SA, Michaels DR, Berry JM, Schildcrout JS, Mercaldo ND, Weinger MB.
Department of Anesthesiology, Veterans Affairs Medical Center-Nashville, Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee 37205, USA. steve.hyman@vanderbilt.edu
Anesthesiology. 2011 Jan;114(1):194-204.
Abstract
BACKGROUND: Burnout can lead to health and psychologic problems and is apparently increasing in physicians and nurses. Previous studies have not evaluated all healthcare workers within a single work unit. This study evaluates the risk of burnout in all medical personnel in one perioperative unit. METHODS: We developed an online survey that included demographics, a modified version of the Maslach Burnout Inventory-Human Services Survey, and the Social Support and Personal Coping Survey. Survey constructs (e.g., depersonalization and health) and a global score were calculated. Larger construct and global values were associated with higher risk of burnout. These were separately regressed on role, age, and sex. The global score was then regressed on each of the survey constructs. RESULTS: Of the 145 responses, 46.2% were physicians (22.8% residents), 43.4% were nurses or nurse anesthetists, and 10.3% were other personnel. After adjusting for sex and age, residents scored higher than other physicians on the following (expected change [95% confidence interval]): global score (1.12 [0.43-1.82]), emotional exhaustion (1.54 [0.44-2.60]), and depersonalization (1.09 [0.23-1.95]). Compared with nonphysicians, residents were 1 U or more higher on these items (P < 0.05 in all cases). Residents had higher health (1.49 [0.48-2.50]) and workload (1.23 [0.07-2.40]) values compared with physicians. Better health, personal support, and work satisfaction scores were related to decreased global scores (P < 0.05). CONCLUSIONS: Physicians (particularly residents) had the largest global burnout scores, implying increased risk of burnout. Improving overall health, increasing personal support, and improving work satisfaction may decrease burnout among perioperative team membershttp://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2011&issue=01000&article=00039&type=abstract |
| Diagnóstico diferencial del síndrome de burnout |
Differential diagnostic of the burnout syndrome.
Korczak D, Huber B, Kister C.
GP-Forschungsgruppe, Institut für Grundlagen- und Programmforschung, Munich, Germany.
GMS Health Technol Assess. 2010 Jul 5;6:Doc09.
Abstract
INTRODUCTION : There is no consistent definition of burnout. It is neither a defined diagnosis in ICD-10 nor in DSM-IV. Yet it is diagnosed by office-based doctors and clinicians. Mainly due to reimbursement reasons, diagnoses like depression are used instead of burnout diagnoses. Therefore burnout has a very high individual, social and economic impact. OBJECTIVES : How is burnout diagnosed? Which criteria are relevant? How valid and reliable are the used tools?What kind of disorders in case of burnout are relevant for a differential diagnosis?What is the economic effect of a differential diagnosis for burnout?Are there any negative effects of persons with burnout on patients or clients?Can stigmatization of burnout-patients or -clients be observed? METHODS : Based on a systematic literature research in 36 databases, studies in English or German language, published since 2004, concerning medical and differential diagnoses, economic impact and ethical aspects of burnout, are included and evaluated. RESULTS : 852 studies are identified. After considering the inclusion and exclusion criteria and after reviewing the full texts, 25 medical and one ethical study are included. No economic study met the criteria. The key result of this report is that so far no standardized, general and international valid procedure exists to obtain a burnout diagnosis. At present, it is up to the physician's discretion to diagnose burnout. The overall problem is to measure a phenomenon that is not exactly defined. The current available burnout measurements capture a three dimensional burnout construct. But the cutoff points do not conform to the standards of scientifically valid test construction. It is important to distinguish burnout from depression, alexithymia, feeling unwell and the concept of prolonged exhaustion. An intermittent relation of the constructs is possible. Furthermore, burnout goes along with various ailments like sleep disturbance. Through a derogation of work performance it can have also negative effects on significant others (for example patients). There is no evidence for stigmatization of persons with burnout. DISCUSSION : The evidence of the majority of the studies is predominantly low. Most of the studies are descriptive and explorative. Self-assessment tools are mainly used, overall the Maslach Burnout Inventory (MBI). Objective data like medical parameters, health status, sick notes or judgements by third persons are extremely seldomly included in the studies. The sample construction is coincidental in the majority of cases, response rates are often low. Almost no longitudinal studies are available. There are insufficient results on the stability and the duration of related symptoms. The ambiguity of the burnout diagnosis is regularly neglected in the studies. CONCLUSIONS : The authors conclude, that (1) further research, particularly high-quality studies are needed, to broaden the understanding of the burnout syndrome. Equally (2) a definition of the burnout syndrome has to be found which goes beyond the published understanding of burnout and is based on common scientific consent. Furthermore, there is a need (3) for finding a standardized, international accepted and valid procedure for the differentiated diagnostics of burnout and for (4) developing a third party assessment tool for the diagnosis of burnout. Finally, (5) the economic effects and implication of burnout diagnostics on the economy, the health insurances and the patients have to be analysed.http://www.egms.de/static/pdf/journals/hta/2010-6/hta000087.pdf
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