Policies and interventions to promote mental health should be designed to effectively involve the work environment and process as a key arena for action . The majority of people in developed and developing countries now live in cities and are formally or informally linked to workplaces where most of their productive lives are spent . Studies have shown the importance of work stressors both in the generation and prevention of mental disorders , but there is still a lack of policies and interventions that effectively improve workers’ mental health and prevent disorders. Interestingly, even among mental health workers, work-related mental disorders are highly prevalent . Thus, work environments and processes are key elements in public health.
Burnout syndrome is an important work-related disorder of psychosocial origin, caused when stressful working conditions are endured. Its presence has been associated with a worsened self-perception of health and a large amount of somatic comorbidity . Burnout has traditionally been described as a relatively uniform entity in all individuals, with more or less consistent aetiology and symptoms . According to the classical definition, this syndrome includes the dimensions of exhaustion, cynicism and professional inefficacy , . ‘Exhaustion’ is the feeling of not being able to offer any more of oneself at an emotional level; ‘cynicism’ represents a distant attitude towards work, those served by it, and colleagues; and ‘inefficacy’ is the feeling of not performing tasks adequately or being incompetent at work. These dimensions are strongly associated with each other, providing a unitary although three-dimensional definition of burnout .
Nevertheless, different burnout types have been proposed, according to the degree of dedication at work . The ‘frenetic’ burnout type works increasingly harder, to the point of exhaustion, in search of success, and presents involvement, ambition and overload. The ‘under-challenged’ type has to cope with monotonous and unstimulating conditions that fail to provide satisfaction and feels indifference, boredom and lack of personal development. The ‘worn-out’ type gives up when faced with stress or the absence of gratification and shows lack of control, lack of acknowledgement and neglect , . The dimensions of overload, lack of development and neglect, belonging to the frenetic, under-challenged and worn-out subtypes, respectively, comprise a definition of burnout that comes close to the standard perspective , . ‘Overload’ refers to individuals’ feeling of risking health and personal life in the pursuit of good results and is significantly associated with exhaustion; ‘lack of development’ refers to the absence of personal growth experiences for individuals together with their desire to take on other jobs where they can better develop their skills and is markedly associated with cynicism; ‘neglect’ refers to individuals’ disregard as a response to any difficulty and is strongly associated with inefficacy , . While approaching the standard definition, the dimensions referred to in the typological model show little relation to each other, which allows a differential characterisation of the syndrome to be made by means of clinical profiles .
In general, ‘burnout’ is a subject’s response to chronic work-related stress and is an attempt to adapt to or protect oneself from it . Stress has been defined as the result of a relationship with the environment that the person appraises as significant for his or her well-being, and in which demands tax or exceed available coping resources. Coping is defined as cognitive and behavioural efforts to manage specific internal and/or external demands that are appraised as taxing or exceeding the person’s resources , . A person will be psychologically vulnerable to a particular situation if he or she does not possess sufficient coping resources to handle it adequately and places considerable importance on the threat implicit in the consequences of this inadequate handling. There are different general trends in coping with stress, such as cognitive or behavioural coping, cognitive or behavioural avoidance, emotion-focused coping or substance use –. From this perspective, burnout may be observed as a progressively developed condition resulting from the use of the ineffective coping strategies with which professionals try to protect themselves from work-related stress situations .
There is an accumulation of evidence linking coping styles with stress and burnout. At first, coping style was studied as a relatively stable characteristic of the person, regardless of the nature of the task or situation, showing that certain inflexible coping styles could be associated with higher levels of stress , . Subsequently, the emphasis was placed on the relationship between the coping style and the situation . Early research seemed to support the idea that problem-focused coping was a better strategy than emotion-focused coping for stress management. However, it was later found that there were sub-factors that did not allow the application of such a general conclusion . Problem-focused coping is not an appropriate strategy to address stress if the situation is uncontrollable or chronic , as it could lead, in this case, to a progressive process of behavioural disengagement . Emotional coping has been noted to be detrimental if it involves distancing, avoidance or denial regarding the situation but is an effective strategy if it involves a positive reappraisal , . In the long term, the key factor for developing the burnout syndrome seems to be the degree of passivity that the subject acquires , , .
So far, possible relationships between burnout types and coping strategies have not been explored. A better knowledge of the coping strategies associated with each burnout profile could promote the development of specific treatments and preventive programmes for the syndrome that might potentially be more effective . In this context, the aim of this work was to estimate the explanatory power of the different styles of coping with stress on the development of different burnout subtypes, evaluating the contribution of specific coping strategies. In general terms, the hypotheses were established according to the degree of dedication at work shown by the different burnout subtypes. The frenetic burnout subtype is a highly dedicated profile, which means that the related overload could be associated with active coping strategies, such as those included in problem-focused coping. The under-challenged burnout subtype is a profile characterised by an intermediate dedication to work, meaning that the related lack of development could be associated with avoidance coping strategies. The worn-out burnout subtype is a profile characterised by a low level of dedication, meaning that the associated neglect could be due to a behavioural impairment related to the use of disengagement strategies. In essence, this grading of the levels of dedication could be pointing to different stages in the longitudinal development of the syndrome. Different coping strategies for stress could be contributing to each of these , .
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