Factors associated with burnout among Chinese hospital doctors: a cross-sectional study

BMC Public Health

Lie Wang¹  Xue Zhao¹  Fei Gao¹  Yang Wang¹  Li Liu¹  Hui Wu¹ 

[1] Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China

关键词: Occupational stress;    Maslach Burnout Inventory-General Survey;    Doctors;    Burnout;   

Others  :  1161878
DOI  :  10.1186/1471-2458-13-786

 received in 2012-12-04, accepted in 2013-08-27,  发布年份 2013

【 摘 要 】

Background

Burnout has been a major concern in the field of occupational health. However, there is a paucity of research exploring the factors related to burnout among Chinese doctors. Investigation of these factors is important to improve the health of doctors and the quality of healthcare services in China.

Methods

The study population consisted of 1,618 registered hospital doctors from Liaoning province of China. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey. Occupational stress was measured using the Chinese versions of the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire. Data were collected on the respondents’ demographic characteristics and work situations. Of the doctors solicited for enrollment, 1,202 returned the completed questionnaire (555 men, 647 women), giving a response rate of 74.3%. A general linear regression model was applied to analyze the factors associated with burnout.

Results

The burnout mean scores were 11.46 (7.51) for emotional exhaustion, 6.93 (5.15) for cynicism, and 24.07 (9.50) for professional efficacy. In descending order of standardized estimates, variables that predicted a high level of emotional exhaustion included: high extrinsic effort, dissatisfaction with doctor-patient relationship, high overcommitment, working >40 h per week, low reward, and high psychological job demands. Variables that predicted a high level of cynicism included: high extrinsic effort, low reward, dissatisfaction with doctor-patient relationship, high overcommitment, low decision authority, low supervisor support, and low skill discretion. Variables that predicted a low perceived professional efficacy included: high psychological job demands, low coworker support, high extrinsic effort, low decision authority, low reward, and dissatisfaction with doctor-patient relationship.

Conclusions

These findings suggest that occupational stress is strongly related to burnout among hospital doctors in China. Strategies that aim to improve work situations and decrease occupational stress are necessary to reduce burnout, including health education, health promotion, and occupational training programs.

【 授权许可】

   
2013 Wu et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Maslach C, Jackson SE, Leiter MP: Maslach Burnout Inventory, Manual 3rd Edition. Palo Alto, CA, USA: University of California, Consulting Psychologists Press; 1996.
• [2]Wright JG, Khetani N, Stephens D: Burnout among faculty physicians in an academic health science centre. Paediatr Child Health 2011, 16:409-413.
• [3]Garrosa E, Moreno-Jiménez B, Liang Y, González JL: The relationship between socio-demographic variables, job stressors, burnout, and hardy personality in nurses: an exploratory study. Int J Nurs Stud 2008, 45:418-427.
• [4]Schulz M, Damkröger A, Heins C, Wehlitz L, Löhr M, Driessen M, Behrens J, Wingenfeld K: Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings. J Psychiatr Ment Health Nurs 2009, 16:225-233.
• [5]Guido Lde A, Goulart CT, da Silva RM, Lopes LF, Ferreira EM: Stress and burnout among multidisciplinary residents. Rev Lat Am Enfermagem 2012, 20(6):1064-1071.
• [6]Ashtari Z, Farhady Y, Khodaee MR: Relationship between job burnout and work performance in a sample of Iranian mental health staff. Afr J Psychiatry (Johannesbg) 2009, 12:71-74.
• [7]Peterson U, Demerouti E, Bergström G, Samuelsson M, Asberg M, Nygren A: Burnout and physical and mental health among Swedish healthcare workers. J Adv Nurs 2008, 62:84-95.
• [8]Alacacioglu A, Yavuzsen T, Dirioz M, Oztop I, Yilmaz U: Burnout in nurses and physicians working at an oncology department. Psychooncology 2009, 18:543-548.
• [9]Ilhan MN, Durukan E, Taner E, Maral I, Bumin MA: Burnout and its correlates among nursing staff: questionnaire survey. J Adv Nurs 2008, 61:100-106.
• [10]Siu C, Yuen SK, Cheung A: Burnout among public doctors in Hong Kong: cross-sectional survey. Hong Kong Med J 2012, 18:186-192.
• [11]Selmanovic S, Ramic E, Pranjic N, Brekalo-Lazarevic S, Pasic Z, Alic A: Stress at work and burnout syndrome in hospital doctors. Med Arh 2011, 65:221-224.
• [12]Chopra S, Sotile WM, Sotile MO: Physician burnout. JAMA 2004, 291:633.
• [13]Liu XL, Sun HW, Jiang NZ: Present situation and prospect of doctor’s burnout. Medicine and Society 2009, 22:53-55. (in Chinese)
• [14]Wang LJ, Chen CK, Hsu SC, Lee SY, Wang CS, Yeh WY: Active job, healthy job? Occupational stress and depression among hospital physicians in Taiwan. Ind Health 2011, 49:173-184.
• [15]Agerbo E, Gunnell D, Bonde JP, Mortensen PB, Nordentoft M: Suicide and occupation: the impact of socio-economic, demographic and psychiatric differences. Psychol Med 2007, 37:1131-1140.
• [16]Schernhammer ES, Colditz GA: Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004, 161:2295-2302.
• [17]Li L: Social Medicine. Beijing: People’s medical publishing house; 2007:155.
• [18]Zhang Y, Feng X: The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei China: a cross-sectional study. BMC Health Serv Res 2011, 11:235. BioMed Central Full Text
• [19]Wang H, Zhang N: Analysis on the status of occupational burnout among doctors. Zhong Guo Jian Kang Xin Li Xue Za Zhi 2008, 16:397-399. (in Chinese)
• [20]Maccacaro G, Di Tommaso F, Ferrai P, Bonatti D, Bombana S, Merseburger A: The effort of being male: a survey on gender and burnout. Med Lav 2011, 102:286-296.
• [21]Piko BF: Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey. Int J Nurs Stud 2006, 43:311-318.
• [22]Escribà-Agüir V, Martín-Baena D, Pérez-Hoyos S: Psychosocial work environment and burnout among emergency medical and nursing staff. Int Arch Occup Environ Health 2006, 80:127-133.
• [23]Karasek R, Theorell T: Healthy work: stress, productivity, and the reconstruction of working life. New York: Basic Books; 1990.
• [24]Tsai FJ, Chan CC: Occupational stress and burnout of judges and procurators. Int Arch Occup Environ Health 2010, 83:133-142.
• [25]Siegrist J: Adverse health effects of high-effort/low-reward conditions at work. J Occup Health Psychol 1996, 1:27-41.
• [26]Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R: The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 2004, 58:1483-1499.
• [27]Zhu W, Wang ZM, Wang MZ, Lan YJ, Wu SY: Occupational stress and job burnout in doctors. Sichuan Da Xue Xue Bao 2006, 37:281-283. (in Chinese)
• [28]Smith DR, Tang S: Nursing in China: historical development, current issues and future challenges. Int J Nurs Stud 2004, 5:16-20.
• [29]Wang Y, Chang Y, Fu JL, Wang L: Work-family conflict and burnout among Chinese female nurses: the mediating effect of psychological capital. BMC Public Health 2012, 12:915. BioMed Central Full Text
• [30]Zhu W, Wang ZM, Wang MZ, Lan YJ, Wu SY: Job burnout and contributing factors for nurses. Sichuan Da Xue Xue Bao 2006, 37:632-635. (in Chinese)
• [31]Wu S, Zhu W, Wang Z, Wang M, Lan Y: Relationship between burnout and occupational stress among nurses in China. J Adv Nurs 2007, 59:233-239.
• [32]Wu H, Zhao Y, Wang JN, Wang L: Factors associated with occupational stress among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health 2010, 83:155-164.
• [33]Gao YQ, Pan BC, Wu H, Wang L: A survey study on depressive symptoms of nurses and their correlation with nurse-patient relationship. Journal of China Medical University 2011, 40:547-548. (in Chinese)
• [34]Yang WJ, Li J: Measurement of psychosocial factors in work environment: application of two models of occupational stress. Zhong Hua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2004, 22:422-426. (in Chinese)
• [35]Li J, Yang W, Cheng Y, Siegrist J, Cho SI: Effort-reward imbalance at work and job dissatisfaction in Chinese healthcare workers: a validation study. Int Arch Occup Environ Health 2005, 78:198-204.
• [36]National Bureau of Statistics: China Statistical Yearbook [M]. Beijing: China Statistics Press; 2011.
• [37]Zhou ZT: Investigation on job burnout status of policemen of one public security sub- bureau. China Journal of Health Psychology 2009, 17:11-18.
• [38]Al-Dubai SA, Rampal KG: Prevalence and associated factors of burnout among doctors in Yemen. J Occup Health 2010, 52:58-65.
• [39]Gabbe SG, Melville J, Mandel L, Walker E: Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention. Am J Obstet Gynecol 2002, 186:601-612.
• [40]Wang Y, Liu L, Wang JN, Wang L: Work-family conflict and burnout among Chinese doctors: the mediating role of psychological capital. J Occup Health 2012, 54:232-240.
• [41]Liu L, Chang Y, Fu JL, Wang JN, Wang L: The mediating role of psychological capital on the association between occupational stress and depressive symptoms among Chinese physicians: a cross-sectional study. BMC Public Health 2012, 12:219. BioMed Central Full Text
• [42]Huang JM, LIU HC, Song XR: The research about present status and their relationship of occupational stress and job burnout in medical personnel. Int J Nurs 2010, 29:492-494.
• [43]McManus IC, Winder BC, Gordon D: The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet 2002, 359:2089-2090.
• [44]Ozyurt A, Hayran O, Sur H: Predictors of burnout and job satisfaction among Turkish physicians. Q J Med 2006, 99:161-169.