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Psychosocial work factors and burnout: a study of a working general population and patients at a stress rehabilitation clinic
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background The psychosocial work environment affects our health (e.g., sick leave and mortality rates). Research on psychosocial work factors and burnout has focused on specific workplaces or occupations and rarely evaluated in the general population or used longitudinal designs. In Sweden, the diagnosis of exhaustion disorder (closely related to burnout) is a common cause for sick leave. The effects of psychosocial work environments on the process of returning to work has not been studied in this specific patient group. The overall aims of this thesis were to (1) assess the level of burnout in a working general population and investigate the importance of psychosocial work factors and sex on burnout, and (2) study reduction of sick leave and experiences of returning to work in burnout patients, with special attention towards psychosocial work factors.

Methods An occupationally active subset (n=1000) of the 2004 Northern Sweden MONICA survey was used in a cross-sectional study. A five-year follow-up of this population was also performed (n=626). Level of burnout was measured using the Shirom Melamed Burnout Questionnaire (SMBQ). Burnout patients were studied for the second thesis aim. A cohort of 117 patients from the REST project was investigated using a baseline questionnaire and sick leave data at two-year follow-up. Grounded Theory was used for an in-depth interview and analysis of 12 employed patients.

Results Cross-sectional results from the working general population showed that women have higher levels of burnout than men. In both sexes, work demands, work control, and job insecurity were associated with burnout levels. Among women, education, socioeconomic position, work object, and working hours were also important. Work factors in combination with situational life factors explained about half the difference in burnout level between women and men. Longitudinal results show that burnout levels decrease with age in both sexes, although the changes occur at an earlier age for men. A constant job strain, increased job insecurity, and a worsened economic situation are related to an increase in burnout level. When studying risk factor accumulation, each additional risk factor exposure increases the burnout level.

In burnout patients, low work control and use of covert coping towards supervisors and workmates predicts unchanged sick leave levels after a twoyear period. Borderline significance was found between work overcommitment and reduced sick leave. Both personal resources and external support are described as important factors when regaining the ability to work. Perceived validation, insights into the situation and adaptive coping skills increase the chance of regaining the ability to work. External support, particularly from the workplace, is also important.

Conclusion There are links between psychosocial work factors and burnout levels in a working general population and sick leave levels in burnout patients. Socioeconomic position and working conditions are important for the level of burnout among working women. In the working population, age differences occur between the sexes; women reduce their burnout levels later in life than men. In the burnout patient population, coping patterns and control at work predict sick leave levels after two years. Both internal resources and external support are important when burnout patients describe the process of regaining the ability to work. The workplace and the work environment are important in preventing working people from becoming burned out and in easeing return to work after sick leave. A person’s coping pattern is also important in reduction of sick leave.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1439
Keyword [en]
Burnout, exhaustion disorder, psychosocial work factors, coping, social support, demands, control, job strain, job insecurity, sick leave, return to work, working population, epidemiology, grounded theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-47623ISBN: 978-91-7459-269-6 (print)OAI: oai:DiVA.org:umu-47623DiVA: diva2:443911
Public defence
2011-10-21, Hörsal Betula, Byggnad 6M, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-09-30 Created: 2011-09-26 Last updated: 2012-11-07Bibliographically approved
List of papers
1. Burnout, working conditions and gender: results from the northern Sweden MONICA Study
Open this publication in new window or tab >>Burnout, working conditions and gender: results from the northern Sweden MONICA Study
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2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 326Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sick-leave because of mental and behavioural disorders has increased considerably in Sweden since the late nineties, and especially in women. The aim of this study was to assess the level of burnout in the general working population in northern Sweden and analyse it's relation to working conditions and gender.

METHODS: In this cross-sectional study the survey from the MONICA-study (Monitoring of Trends and Determinants in Cardiovascular Disease) in northern Sweden 2004 was used. A burnout instrument, the Shirom Melamed Burnout Questionnaire (SMBQ), was incorporated in the original survey which was sent to a random sample of 2500 individuals with a response rate of 76%. After including only actively working people, aged 25-64 years, our study population consisted of 1000 participants (497 women and 503 men). ANOVA and multiple linear regression models were used.

RESULTS: The prevalence of a high level of burnout (SMBQ >4.0) was 13%. Women had a higher level of burnout than men with the most pronounced difference in the age group 35-44 years. In both sexes the level of burnout decreased with age. Demand and control at work, and job insecurity were related to burnout. In women the level of education, socioeconomic position, work object, and working varying hours were of importance. Interaction effects were found between sex and work object, and sex and working hours. In a multiple regression analysis almost half of the gender difference could be explained by work related and life situational factors.

CONCLUSIONS: Working life conditions contributed to the level of burnout in this actively working sample from the general population in northern Sweden. Especially in women, socioeconomic position was associated with burnout. The high level of burnout in women compared to men was partly explained by more unfavourable working conditions and life situational factors. Efforts to level out gender differences in burnout should probably focus on improving both working and socioeconomic conditions for women.

Keyword
social support; mental-health; occupational burnout; disability pension; job strain; population; predictor; women; associations; exhaustion
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-35231 (URN)10.1186/1471-2458-10-326 (DOI)000279909900004 ()20534136 (PubMedID)
Available from: 2010-08-10 Created: 2010-08-10 Last updated: 2017-12-12Bibliographically approved
2. Work situation and self-perceived economic situation as predictors of change in burnout: a prospective population based cohort study
Open this publication in new window or tab >>Work situation and self-perceived economic situation as predictors of change in burnout: a prospective population based cohort study
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(English)In: Article in journal (Other academic) Submitted
Keyword
burnout, psychosocial, Sweden, working population
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-47693 (URN)
Available from: 2011-09-27 Created: 2011-09-27 Last updated: 2015-04-29Bibliographically approved
3. Work related factors and sick leave after rehabilitation in burnout patients: experiences from the REST-project
Open this publication in new window or tab >>Work related factors and sick leave after rehabilitation in burnout patients: experiences from the REST-project
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2011 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 1, 23-30 p.Article in journal (Refereed) Published
Abstract [en]

Introduction The aim of this study was to investigate the impact of psychosocial working conditions and coping strategies at work on change in sick leave level for patients on long-term sick leave due to burnout.

Methods A cohort sample of patients (n = 117) on long-term sick leave due to burnout was analyzed. The patients answered a questionnaire at baseline and sick leave information was collected from the Swedish Social Insurance Agency at baseline and at follow-up 2 years later. Two groups were formed depending on whether the patients had "improved" and reduced their sick leave level (56%) or if the sick leave level was "unchanged" (44%) at follow-up. The association between change in sick leave and predictors measuring psychosocial working conditions and coping strategies at work were analyzed using logistic regression.

Results The predictor, low control at work, was associated with unchanged sick leave at follow-up. When background characteristics were taken into account, usage of covert coping towards supervisors and covert coping towards workmates, respectively, also predicted unchanged sick leave level. High overcommitment was of borderline significance and associated with a reduced sick leave level at follow-up.

Conclusions Patients with burnout who have experienced low control at work and used covert coping towards supervisors and/or workmates have a higher risk of not reducing their sick leave after rehabilitation. The workplace may contribute to a reduction of sick leave lengths with a more flexible work environment and improvement in communication strategies for employees and supervisors.

Keyword
Burnout, professional, Cohort, Control, Coping, Overcommitment, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-37895 (URN)10.1007/s10926-010-9250-8 (DOI)000287505100004 ()20552390 (PubMedID)
Available from: 2010-11-18 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
4. Personal Resources and Support When Regaining the Ability to Work: An Interview Study with Exhaustion Disorder Patients
Open this publication in new window or tab >>Personal Resources and Support When Regaining the Ability to Work: An Interview Study with Exhaustion Disorder Patients
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2013 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 2, 270-279 p.Article in journal (Refereed) Published
Abstract [en]

Purpose The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. Methods Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. Results A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. Conclusions Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.

Place, publisher, year, edition, pages
Springer, 2013
Keyword
Return to work, Burnout, Social support, Coping, Qualitative research
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-60966 (URN)10.1007/s10926-012-9396-7 (DOI)000319683500013 ()23114722 (PubMedID)
Available from: 2012-11-07 Created: 2012-11-06 Last updated: 2017-12-07Bibliographically approved

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