Burnout
Burnout prevention: A review of intervention programs

https://doi.org/10.1016/j.pec.2009.04.008Get rights and content

Abstract

Objective

To evaluate the effectiveness of intervention programs at the workplace or elsewhere aimed at preventing burnout, a leading cause of work related mental health impairment.

Methods

A systematic search of burnout intervention studies was conducted in the databases Medline, PsycINFO and PSYNDEX from 1995 to 2007. Data was also extracted from papers found through a hand search.

Results

A total of 25 primary intervention studies were reviewed. Seventeen (68%) were person-directed interventions, 2 (8%) were organization-directed and 6 (24%) were a combination of both interventions types. Eighty percent of all programs led to a reduction in burnout. Person-directed interventions reduced burnout in the short term (6 months or less), while a combination of both person- and organization-directed interventions had longer lasting positive effects (12 months and over). In all cases, positive intervention effects diminished in the course of time.

Conclusion

Intervention programs against burnout are beneficial and can be enhanced with refresher courses. Better implemented programs including both person- and organization-directed measures should be offered and evaluated.

Practice implications

A combination of both intervention types should be further investigated, optimized and practiced. Institutions should recognize the need for and make burnout intervention programs available to employees.

Introduction

Burnout is a work related mental health impairment comprising three dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. Emotional exhaustion is the state of being depleted of one's emotional resources, depersonalisation refers to a negative, cynical and detached approach to people under ones care and reduced personal accomplishment refers to a sense of low self-efficacy and negative feelings towards one's self.

The presence of these three components alongside one another differentiates burnout from stress and other psychological conditions with which it shares similar symptoms like depression, fatigue, anxiety or lack of motivation. Burnout further differs from stress in that its victims have experienced prolonged symptoms. Burnout results from stress that comes about through the social relationship between a helper and a help recipient, usually found in asymmetrical professional relationships, whereby the victim is the “giver” and the client(s) the “receiver”. This is usually the case with professionals like physicians, nurses, teachers or social workers [1]. For example an estimated 22% of physicians in the USA, 27% of physicians in Great Britain [2] and 20% of physicians in Germany suffer burnout [3]. Similarly, about 30% of teachers are affected [4], [5] and some studies report up to 40% [6]. However, burnout can manifest in any person and the number of individuals suffering burnout are continuously on the rise [7].

An imbalance between job demands and job skills, a lack of job control, effort reward imbalance (discrepancy which exists between resources, expectations and job reality) and prolonged work stress, are some of the leading risk factors for the development of burnout or other work related mental health impairment [8], [9]. Some consequences of burnout are absenteeism, sick leave job turnover as well as physical health impediments [10], [11], [12]. The health report of one German employee insurance company Deutsche Angestellten-Krankenkasse (DAK) for 2005 for instance, showed a continuous increase in the rate of sick leave days for the diagnosis group psychological sickness among members. Cases of illness and the total number of days off work due to mental health problems increased approximately by 70% between 1997 and 2004, while total sick leave increased by 5% in the same period [13].

Poor work related mental health is associated with enormous economic costs. The European Agency for Safety and Health at Work estimated that the annual economic cost of work related stress disorders in the EU was about 20 billion Euros (about USD 25 billion) in 2002. Similar losses have been estimated for other western countries [14], [15], [16]. A favourable psychological working environment is therefore in the interest of both employers and employees. This has not only been recognized by health promotion policy makers as a means of reducing health inequalities today, but also is being practiced by certain institutions with different degrees of success.

Intervention programs for preventing burnout can either be person-directed (individual/groups), organization-directed or a combination of both person- and organization-directed aspects. Person-directed interventions programs are usually cognitive behavioural measures aimed at enhancing job competence and personal coping skills, social support or different kinds of relaxation exercises. Organization-directed interventions on the other hand are usually changes in work procedures like task restructuring, work evaluation and supervision aimed at decreasing job demand, increasing job control or the level of participation in decision making. These measures empower individuals and reduce their experience of stressors. In the absence of effective burnout prevention, employees are likely to suffer poor work related mental health where risk factors prevail.

People who take part in stress intervention programs usually experience less stress symptoms than those who do not [17]. We therefore expect that intervention programs against burnout will reduce symptoms and positively influence risk factors for poor work related mental health. For person-directed interventions we hypothesise a short term reduction in burnout. Secondly, we hypothesise that organization-directed interventions will result in longer lasting positive effects on burnout and worksite mental health than person-directed interventions, since they address major risk factors like work overload and effort reward imbalance. Thirdly, we hypothesise that a combination of both person- and organization-directed interventions will lead to better results on burnout and worksite mental health than either person- or organization-directed interventions independently.

The aim of this review is to analyze the effectiveness of different intervention programs in reducing burnout.

The objectives of this literature review are:

  • 1.

    To evaluate the effectiveness of person-and organization-directed intervention programs intended to prevent burnout in any target group and

  • 2.

    to compare the effectiveness of these different intervention types in reducing burnout.

Section snippets

Literature search

This review is based on a systematic search of burnout intervention studies in the electronic databases Medline, PsycINFO and PSYNDEX. The search was conducted in two phases: Literature search I was carried out at the end of March 2006 and covered the period from January 1995 to March 2006. Literature search II, conducted in January 2008, covered the period from April 2006 to December 2007. Languages were limited to English and German for both search phases and the search strategy was based on

Search results

The systematic literature search I and II resulted in a total of 535 publications. Based on their titles, 258 relevant abstracts were selected and read while 277 were excluded. Twenty of these met the inclusion criteria and their full texts were further analyzed. The hand search resulted in 5 additional studies. Thus, a total of total 25 studies made up the basis of this review.

Twelve of the 25 selected studies (48%) were conducted in the Netherlands and constituted the majority. Four (16%)

Discussion

Preventing and reducing work related burnout is of great importance not only with regard to the quality of life of those affected or endangered, but also for preventing the economic losses which come about as a result of absenteeism and job turnover.

The intervention programs analyzed in this review were generally helpful in reducing burnout or any of its core components. About 80% of all studies led to positive effects on burnout, while in about 20% there were either no positive effects or

References (49)

  • A.B. Baker et al.

    Using the job demands–resources model to predict burnout and performance

    Hum Resource Manage

    (2004)
  • W.B. Schaufeli et al.

    Burnout: an overview of 25 years of research and theorizing

  • S. Toppinen-Tanner et al.

    Burnout as a predictor of medically certified sick-leave absence and their diagnosed causes

    J Behav Med

    (2005)
  • M.J.H. Huibers et al.

    Fatigue, burnout, chronic fatigue syndrome among employees on sick leave: do attributions make the difference?

    Occup Environ Med

    (2000)
  • V. Chikani et al.

    Work characteristics predict cardiovascular disease risk factors and health functioning in rural women: the Wisconsin Rural Women's Health Study

    J Rural Health

    (2005)
  • R. Nübling et al.

    Zur psychotherapeutischen und psychosozialen Versorgung psychisch kranker Kinder und Jugendlicher in Baden-Württemberg

    Psychother J

    (2006)
  • American Institute of Stress; 2002, http://www.stress.org/job.htm...
  • European Agency for Safety and Health at Work, http://osha.europa.eu/en/topics/stress...
  • A.D. Lamontagne et al.

    A systematic review of the job–stress intervention evaluation literature 1990–2005

    Int J Occup Environ Health

    (2007)
  • C. Van de Voorde et al.

    Search for evidence and critical appraisal: health services research Brussels, Belgian Health Care Knowledge Centre (KCE)

    Process Notes

    (2007)
  • M. Pålsson et al.

    Burnout empathy and sense of coherence among Swedish District Nurses before and after systematic clinical supervision

    Scand J Caring Sci

    (1996)
  • D. Van Dierendonck et al.

    The Evaluation of an Individual burnout intervention program: the role of inequity and social support

    J Appl Psychol

    (1998)
  • H.C. Ossebaard

    Stress reduction by technology? An experimental study into the effects of brainmachines on burnout and state anxiety

    Appl Psychophysiol Biofeedback

    (2000)
  • M.M. Rowe

    Skills training in the long-term management of stress and occupational burnout

    Curr Psychol

    (2000)
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