Chapter 2: Factors contributing to burnout – Managing Burnout in the Workplace

2

Factors contributing to burnout

Abstract:

This chapter deals with the individual and socio-demographic factors which play a role in burnout. These factors include age or years of experience, personality, locus of control, marital status, gender, work–home interference and expectations. Environmental and organizational factors which could lead to burnout are also discussed including workload, underwork, type of work, physical environment, conflict, role conflict and role ambiguity, control, social support, reciprocity, social comparison and leadership style.

Key words

burnout

age and experience

personality

gender

work–home interference

expectations

workload and type of work

physical environment

conflict and support

Introduction

People do not generally burn out in response to one stressful factor in the workplace but rather to a number of factors working in concert (Gabris and Ihrke, 1996). But which factors? Since Freudenberger and Maslach first began writing about the syndrome, researchers have sought to isolate the workplace conditions responsible for burnout, and many of these conditions have been identified and confirmed by empirical studies over the years. For example, it is now widely recognized that workload (quantitative and qualitative) correlates positively with burnout (Maslach and Leiter, 1997), as do excessive job demands (Burisch, 2006).

Yet, despite such matters upon which there is agreement among researchers, there is much we still do not know. A number of studies, for instance, have provided us with mixed results in terms of whether certain socio-demographic factors might be responsible for burnout. Some researchers (Dillon and Tanner, 1995; Yildirim, 2008) have found no relation between the dimensions of gender, age or marital status and burnout, while others have determined that the relationship between these very dimensions is significant (Jackson, 1993; Cordes and Dougherty, 1993). Results such as these are confusing, to say the least, and remind us that more research is necessary to determine if, indeed, certain socio-demographic factors are significant, but only perhaps amongst certain groups or types of workers.

What follows is a brief overview of the various potential causes of burnout which have been studied and the extent to which these have been linked to the syndrome. Individual and socio-demographic factors are discussed first; this will be followed by a consideration of those workplace conditions which researchers believe put individuals at greater risk for burnout.

Individual and socio-demographic factors

Age or years of experience

Researchers have long attempted to determine whether age is a significant factor in employee burnout. Their findings are, however, mixed. Some studies have shown that age is significantly correlated with the three dimensions of burnout (Duffy et al., 2009), and that younger workers are more likely than their older counterparts to feel emotionally exhausted and to experience depersonalization (Williams, 1989). Why is this?

One theory is that it is common for young people to enter certain professions or lines of work for which they are not suited. This lack of “fit” is likely to lead to higher rates of stress and burnout resolved only when these individuals leave the field to look for another line of work. This “natural selection” implies that older workers who remain in the job or profession are more temperamentally suited to the job or are likely to have developed successful coping skills and strategies along the way (Brewer and Shapard, 2004).

A second theory to explain the difference in burnout scores between younger and older employees amongst certain groups of workers has to do with the amount of training or education required to do the job. Some workers are older than others when they enter the workplace. As a result, they have had more time to understand the pros and cons of their chosen profession, and have the maturity to handle better certain stressors. Individuals who enter the teaching profession, for instance, are generally younger when they start working than individuals who begin to practice medicine. The latter are more mature simply because it takes many more years of schooling and training to qualify as a physician. Hence the theory that, in those areas of employment in which professionals start working at a younger age, they are more likely to show higher rates of burnout than in the areas of employment in which professionals starting their careers are older (Brewer and Shapard, 2004).

Nonetheless, neither of the above theories accounts for the results of some studies which indicate no difference in burnout scores between younger and older employees (Konert, 1997; Ahola et al., 2008), or which indicate that burnout does not decrease significantly with age (Schwartz et al., 2007). Clearly, more research is needed to determine when and why age comes up as a significant factor.

If experience and age are two variables which are not always easily parcelled out, there also exists some uncertainty as to whether the number of years of experience at the job has any bearing on being at greater or lesser risk for burnout. Various studies have indeed suggested that workers who have not been on the job for a long time are more likely to experience burnout (Bennett and Michie, 1991; Kantas and Vassilaki, 1997; Brewer and Shapard, 2004).

These results, however, are not universally shared. Other studies (Gaines and Jermier, 1983; Ray and Miller, 1994; Haddad, 1998) have found no difference in levels of burnout between workers who were new to the job and those who had many more years of experience. Once again, the research raises as many questions as it answers and invites more investigation to determine how reliable age and years of experience are as predictors of burnout.

Personality

Workplace characteristics, far more than personality traits, are generally found to be the best predictors of burnout (Barber and Iwai, 1996; Thomsen et al., 1999). As Maslach and Leiter (1997) assert,

research and consulting work provide clear and consistent evidence that the roots of burnout stretch far beyond the individual and into the work environment. Burnout does not result from a genetic predisposition to grumpiness, a depressive personality, or general weakness. It is not caused by a failure of character or a lack of ambition. It is not a personality defect or a clinical syndrome. It is an occupational problem. (p. 34)

Yet despite such claims, theories do abound as to the types of individuals who are likely to burn out. These are said to include workaholics, enthusiastic high-achievers, and “type-A, driven, ‘stress junkie[s]’“ (Roberts, 1997). As Glouberman (2002) writes,

[t] hose of us prone to burnout tend to start out as high-energy, ambitious and capable achievers. Whatever our calling in life, we manage to be the people who are enthusiastic, work hard and do whatever needs doing no matter what the cost. We often perceive ourselves as holding together situations which would fall apart without us. Sometimes this is true. Many of us think of ourselves as unlimited in our energy, even as “Supermen” or “Superwomen”. This is less a matter of pride than a statement of how our life requires us to be. (p. 55)

Not everyone agrees, however, that enthusiastic over-achievers are most at risk. Some research indicates that employees who are sensitive and empathetic, or anxious and obsessive (Burke and Richardson, 1996) are more likely to burn out. The syndrome is also thought to occur more frequently among those employees who have unrealistic expectations about their career and accomplishments (Casserley and Megginson, 2009).

Empirical work has been able to show that, in the human services professions, perfectionists are particularly at risk. Individuals who score higher on perfectionism are those who generally experience greater stress levels, and those stress levels, in turn, lead to a greater likelihood of burnout (D’Souza et al., 2011).

As well, a study conducted by Casserley and Megginson (2009) found that individuals who derive a large part of their identity through their work and career and look for accolades or recognition in return are more liable to burn out. Casserley and Megginson interviewed 105 “high flyers” from the “high potential talent pool” at four different organizations. They discovered that employees who burn out set no boundaries between the job and home; personal sacrifices are viewed as part of the job as is the sacrifice of various physical and emotional needs.

Casserley and Megginson’s “high flyer” study revealed that these same employees have a poorly developed reflexive ability, i.e., they just respond to external stimuli, but lack the ability to discuss, evaluate, and interpret and thereby take control and make choices. Individuals who eventually suffered from burnout had the benefit of hindsight to help them understand what they experienced. When asked about what they were thinking as they were burning out, many said that they had focused only on the immediate problems of the job, finding themselves too exhausted or numbed to do much more.

In addition to diagnosing a poorly developed reflexive ability in burnout sufferers, researchers have also established a connection between burnout and neuroticism, as well as burnout and introversion (Fontana and Abouserie, 1993; Mills and Huebner, 1998; Zellars et al., 2000). Neuroticism is a personality trait; the term is used to describe individuals who “express more negative emotions, emotional instability and stress reaction and, therefore, they become more vulnerable to both burnout and the majority of psychopathological disturbances” (Cano-García, Padilla-Muñoz, and Carrasco-Ortiz, 2005, p. 937; Watson et al., 1994). Neurotic individuals are prone to worry, nervousness, and sadness. Because they are temperamental, they are less able to cope effectively with stress and are more prone to burnout. In contrast, those who are more emotionally stable are able to adapt more effectively to stressful situations.

In contrast to neurotic individuals, those who are introverted are described as passive, having a “lack of interest in social exchanges and less disposition towards positive emotionality; all of these being characteristics that foster emotional exhaustion and depersonalization while they diminish personal accomplishment” (Cano-García, Padilla-Muñoz, and Carrasco-Ortiz, 2005, p. 937). On the other hand, as one might expect, studies have shown that those who are extraverted, emotionally stable, open to experience, and agreeable are less likely to experience depersonalization, or to feel diminished personal accomplishment (Ghorpade et al., 2011).

In addition to their findings on the above personality traits, several studies have looked at “hardiness” as a psychological trait, and particularly the extent to which hardy individuals are less likely to experience burnout. Hardiness has three dimensions which have been observed: hardy individuals feel they are in control of situations; they are committed (i.e., involved in activities and curious about the world around them); and they are open to the challenges and opportunities presented by constant change in their lives. This attribute of hardiness is said to allow individuals to cope with and successfully resolve stressful situations; they are also less likely to view problems as personally threatening.

But on this matter of the extent to which hardiness buffers the effects of stress, research results have been inconsistent. Certain studies have found that hardiness does act as a buffer for men but plays no role whatever in helping women cope with workplace stress (Klag and Graham, 2004). Yet other researchers have found a significant positive relationship between a lack of hardiness and burnout in women (Topf, 1989; Boyle et al., 1991; Simoni and Paterson, 1997). Once again we might conclude that while research of this nature provides us with some insight into the linkage between personality and burnout, it also raises a number of questions as to how universally applicable the findings are.

Locus of control

Locus of control has to do with an individual’s beliefs about the future and who or what has the power to control future events. Individuals are said to have an internal locus of control when they believe they can control and, if necessary, change workplace events and environment. They feel that what happens to them is the result of their own actions, behavior or attitudes, and that it is largely within their power to make changes.

In contrast, individuals are said to have a locus of control that is external when they believe that forces or powers outside or beyond themselves are largely in control of their future and environment. This external power may be other people (i.e., people powerful enough to control how the future unfolds for others) or it may be thought of in terms of luck, chance or fate.

Studies have shown workers are more vulnerable to stress and burnout when they have a poorer locus of control, that is when they are more likely to assume that external forces have the power to steer the future than not (Schmitz et al., 2000). In other words, the perception of one’s locus of control has been found to be a predictor for burnout (Khajeddin, Shoushtari, and Hajebi et al., 2006).

Marital status

Longer life and better mental and physical health have been linked to stable, long-term marriages. A recent study involving “one billion person years across seven European countries … found that married persons had age adjusted mortality rates that were 10–15 percent lower than the population as a whole” (Gallacher and Gallacher, 2011). The longer one is married, the more physical and mental health benefits accrue; men who are married have been found to fare better in terms of their physical health while women fare better than men in terms of their mental health (Gallacher and Gallacher, 2011).

On the effects of marriage on burnout, however, research has shown mixed results. Some researchers have found no link whatever between marital status and whether one is more or less likely to burn out (Gaines and Jermier, 1983; Ross et al., 1989; Gulalp et al., 2008). Yet some studies do suggest that married individuals have reported significantly lower levels of psychological burnout symptoms than their unmarried colleagues (Ifeagwazi, 2005). Like many of the socio-demographic variables discussed above, these studies often raise as many questions as they answer and call for more investigation.

Gender

Research has also sent mixed signals in terms of whether gender plays a significant role in terms of who is at risk for burnout. One study, for example, found that certain stressors, such as bad bosses, are less likely to have a detrimental effect on women’s health and, interestingly, more likely to be problematic for men. When researchers looked at the hormone levels of male and female workers they found that

women had half the levels of inflammatory proteins – the things that make you fall over clutching your chest – in their blood than men. Why are women less likely to let the bastards grind them down? It seems that when the going gets tough, the women get networking. Scientists from the University of California, Los Angeles, say that when a woman encounters stress, her body releases the hormone oxytocin, which suppresses the impulse to flee and encourages her to gather with her clan. This process releases more oxytocin, which has a calming effect. This response doesn’t occur in men. They instead produce testosterone when stressed, which reduces the effects of oxytocin and triggers their fight-or-flight reflex. This only increases their stress, until they either fight, flee … or sit morosely in a corner and get bitterly, twistedly drunk. (Naish, 2005)

Given that other studies have found that the prevalence of burnout is likely to be much higher among women than men (e.g., Norlund et al., 2010), the above results tend only to muddy the waters further.

Purvanova and Muros (2010), for instance, have reviewed numerous burnout studies and believe that the research requires a more nuanced approach. They suggest women are more likely to report burnout and more likely to view themselves as emotionally exhausted. Men, on the other hand, are more likely to report depersonalization. When the numbers are translated into a percentage overlap statistic, 54 percent of women report experiencing emotional exhaustion compared with 46 percent of men. Likewise, 57 percent of men report experiencing depersonalization compared with only 43 percent of women.

In other words, men and women have been found to suffer from both mental and physical health problems when forced to endure chronic stress on the job. The extent to which their bodies and minds react to stress differs to some extent, however. These findings are discussed in greater depth in Chapter 7: Gender, Burnout and Work-related Stress.

Work-home interference

The specific phenomenon of one’s work life having a negative impact on one’s home life is called work–home interference (WHI). Work–home interference is defined as “a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible so that participation in one role [home] is made more difficult by participation in another role [work]” (Greenhaus and Beutell, 1985, p. 77). WHI means that individuals exposed to stress each day on the job find they cannot “turn it off” once they are home.

“Interference” happens when a work deadline requires an individual to forgo a family gathering (external interference) or when one cannot stop thinking about or being preoccupied by work (internal interference). Individuals with this particular problem cannot participate fully in and enjoy home life, and find recovery from the stresses of the workday much more difficult. Studies have shown that WHI can contribute to burnout (Peeters et al., 2005) in addition to bringing about a host of adverse health problems (Frone et al., 1997).

In contrast, when matters from one’s home life interfere negatively with one’s work life, researchers refer to this as home–work interference (HWI). HWI affects the ability to think, concentrate and perform tasks in the workplace as required (Demerouti et al., 2007).

WHI and HWI are common phenomena. One US study found that 85 percent of all workers have ongoing family responsibilities which could potentially interfere with work (HWI), and that the proportions of men and women who report WHI problems are almost identical (Bond et al., 1998).

As with other stressors on the job, there is a toll to be paid for HWI and WHI. Concerning the latter, a 2001 National Work–Life Conflict Study conducted for Health Canada found that employees who reported work/life conflict were, in the six months before the study took place:

1.7 times more likely to have sought care from a mental health professional,

1.7 times more likely to have received care on an outpatient basis three or more times,

1.6 times more likely to have seen a physician three or more times,

1.5 times more likely to have visited a hospital emergency room, and

1.4 times more likely to have had to spend at least one night in the hospital. (Health Canada, 2001)

The study determined that the cost of visiting a physician as a direct result of the physical and mental stresses and health-related problems inherent in work/life conflict was approximately C$650 million per year. Inpatient hospital care brought about for the same reason amounted to approximately C$2 billion per year, and emergency department visits once again made for the same reason amounted to approximately C$144 million per year.

The study also found that employees who experienced high levels of work/life conflict were

5.6 times more likely to report high levels of burnout, 2.4 times more likely to report high levels of depressed mood, 2.4 times more likely to say their health is fair/poor, 2.3 times as likely to report that they were in poor physical health, and 2.2 times as likely to report high levels of perceived stress. They were slightly less than half as likely to report high levels of life satisfaction. (Health Canada, 2001)

Work/life conflict was also found to be responsible for higher rates of absenteeism and a greater desire to find new employment.

In this particular study, women were far more likely to report work/life interference; however, the link between gender and WHI has not been definitively established. Other researchers, for example, have found no difference in the rate of burnout between men and women as a result of WHI (Putnik and Houkes, 2011) while some have found that WHI is much more strongly related to burnout in women (Peeters et al., 2005).

Interestingly, workplace conditions which could lead to work interfering with home life are far less likely to lead to burnout when an employee has a preference for those working conditions, even though they would not seem ideal to most. For example, research has shown that working long hours in and of itself is not a problem if an individual prefers working those hours (Barnett et al., 1999) and some fit exists between those hours and the individual’s family life.

Expectations

There is debate about whether unrealistic expectations about a job can lead to burnout. Certain studies have concluded that higher expectations are likely to result in burnout, while others have found no connection (Kirk and Koeske, 1995; Schaufeli and Enzmann, 1998). Part of the problem with inconsistent results has to do with how expectations are defined. For example, in the literature, “expectations” have been defined to mean such disparate things as desiring positive work relationships, or greater job satisfaction, or evidence of progress in the client group served, or greater personal effectiveness, or a more challenging job, or, finally, control over one’s work (Browning et al., 2006).

The idea of “expectations” can also include a search for meaning or significance in one’s work. Burnout, in this context, is “ ‘the failure of the existential quest’ – that moment when we wake up one morning and realize that what we’re doing has appallingly little value” (Senior, 2006). If employees are able to convince themselves their work is meaningful, they are generally able to carry on much longer than less convinced colleagues without burning out.

However we define “expectations,” it is clear that researchers see them as playing a large role in the burnout process. Alden Cass, who has worked as a therapist for high flyers on Wall Street, notes that the gulf between expectations of what a job will be like and what a job is actually like is generally responsible for the burnout he sees in clients. In that sense, the gulf between expectations and reality makes high-powered, corporate executives no different from public school teachers and others who work in less lofty positions. As Cass tells his clients, “[h]appiness is reality divided by expectations” (Senior, 2006).

Yet lowering one’s expectations does not sound like a particularly desirable thing to do, either from a personal or an organizational perspective. Clearly, organizations are unlikely to want to hire candidates who have low expectations. Nonetheless, some organizations, in an attempt to deal with unrealistic expectations, have tried out or tested methods such as the so-called “realistic job preview” (RJP) and “expectation lowering procedures” (ELP) in order to “adjust” the expectations of potential and new employees.

An RJP is included as an add-on to the job interview and is designed to provide both positive and negative information about the particular position and employment situation. For example, information about the job/position can include statements such as “… people are often terminated for major deviations from company policy. Some people believe that the supervision is too strict” and “[s]ome common complaints about working here are the short breaks” (Buckley et al., 2002, p. 275). Studies on the efficacy of the RJP are mixed; some produce little reduction in turnover while others have been somewhat more successful (Buckley et al., 2002).

Expectation lowering procedures, in contrast, focus on an employee’s expectations rather than on job-specific details. An ELP statement also accompanies a job interview and generally contains the following type of non-job specific information:

[w]e don’t want you to have “reality shock” when you discover this job isn’t everything you expected it to be. When you see someone doing the job, it may not seem that bad. But once you are the one performing the work, your perspective may be quite different. The difficulties and frustrations encountered on the job are usually greater than you realize they are. You need to develop realistic expectations about this position and your opportunities with this position. (Buckley et al., 2002, p. 276)

Whether the RJP and ELP are effective tools in combating burnout is not clear, but it has been suggested that the use of either or both in combination for that purpose might be worth studying in greater detail (Halbesleben and Buckley, 2004).

Environmental and organizational factors

Workload

Workload, overload, excessive demands and time pressure, all of which have been found to contribute to burnout, are strongly related to emotional exhaustion (Schaufeli and Enzmann, 1998; Maslach et al., 2001; Bakker et al., 2003; Bakker et al., 2005). As Maslach and Leiter (1997) explain:

[i]t is hard to find relief at work. Restful moments between events are gone. Each demand rolls without a break into the next. There is no time to catch your breath. Organizations seem to be testing the theory that people can work flat-out forever. But, with no time to recover, people soon find that their exhaustion just builds. Additional demands might be manageable if they were given more resources; extra support or equipment can turn increased demand into an opportunity. But instead, the current scramble for survival often results in a shortage of resources. (p. 39)

Overload is bad for both the individual and the organization – the quality of work drops, co-workers have no time for collegiality or to build community, and morale and motivation suffer.

Workload can be of two types – either quantitative (e.g., high job demands with too little time in which to carry out those demands) or qualitative (e.g., jobs with a great deal of complexity or requiring a great deal of concentration). Both can lead to burnout, particularly if employees have no opportunity to rest and recover between demands. Individuals who have an opportunity to rest whether at work or at home are far better able to recover from the stress of these demands (Shinn et al., 1984).

A number of models (e.g., Karasek, 1979; Hobfoll, 1989, 1998) have attempted to explain how job demands (such as workload, emotional demands and/or work pressure) can physically and psychologically affect employees and result in job strain along with numerous physiological and/or psychological consequences. Models of this sort suggest that the provision of additional resources to the employee (e.g., control, greater autonomy, opportunity for promotion, feedback and social support) can buffer the deleterious effects of workload demands and result in greater motivation and engagement.

Karasek’s (1979) job strain model, for example, posits that workers who have an excessive workload are less at risk for mental and physical health issues if they are permitted greater control (i.e., the ability to decide how aspects of the work are to be done). Karasek’s model has been used widely in studies on the effects of workplace stress on health.

The Job Demands–Resources Model (Bakker and Demerouti, 2007) is another model which begins with the proposition that employees are most susceptible to burnout in a work environment in which job demands are high. These demands are responsible for strain which leads to job performance problems as well as problems with health and general well-being. When employees are given additional resources (social support, the ability to vary tasks, decision-making power, feedback, rewards, job security) to meet the demands of their work, however, the outcome is greater job satisfaction, commitment and engagement in the workplace. This model, predicting that job demands play a role in burnout, and that those individuals with greater job resources are less likely to be disengaged from their work, has been supported by various studies (Bakker et al., 2005; Xanthopoulou et al., 2007).

Underwork

Underwork has been described in a number of ways including not being challenged enough on the job, or not having enough work to do, or lacking interest in the tasks that need to be done, or trying to look busy because there is not enough work. Interestingly, underwork like overwork is also a major source of workplace stress (Pines and Aronson, 1988). Certain experts who deal with the syndrome call it “boreout” – a syndrome with symptoms almost identical to burnout but which is differentiated by the fact that it afflicts the under-challenged (Uchtmann, 2012).

Peter Werder, co-author of Diagnosis Boreout (Rothlin and Werder, 2008), estimates that 15 per cent of all office staff are at risk of boreout/ burnout because they are “seriously underchallenged.” Werder and coauthor Philippe Rothlin based part of their research on a study of wasted time at work carried out in 2005 by America Online and Salary.com. In this survey, 10,000 workers were polled about distractions at work. One-third of all the employees surveyed said they wasted time because they did not have enough work to do.

The study also revealed that employees were paid $759 billion per year for work which they did not do. Using the internet for personal use made up 44.7 percent of the time wasted, followed by socializing with co-workers at 23.4 percent. Workers also conducted personal business (6.8 percent), made personal phone calls (2.3 percent) or ran errands (3.1 percent) during work time.

As with burnout, individuals with boreout are often despondent, unable to sleep, lack drive and are unable to enjoy life. They also suffer from the usual physical problems associated with burnout including stomach problems, fatigue and headaches. Werder and Rothlin estimate that 15 percent of all workers are on the path to boreout (Boyes, 2007) and that fixing the situation is more difficult than one might think:

“It is easier nowadays to confess to alcoholism than to tell your boss you are not being used properly,” said co-author Philippe Rothlin. While burnout and stress are socially acceptable, boreout is seen as slacking … Boreout works like this: a boss refuses to delegate work, frustrated underlings ask for more to do, but are trusted only with mind-numbing tasks. Eventually they stop asking and find ways to stretch out low-intensity tasks to fill time. But mimicking work day after day erodes self-esteem. Result: the boss hurtles towards burnout while at least some of his staff edge toward boreout. The symptoms are almost identical. (Boyes, 2007)

While employees fill their time with online surfing, email and blogging, these activities do little to fill the hole left by the engagement and challenge missing from the job. Workers fear the contempt of their supervisors if they confess, yet experts believe that changing jobs might be the only other way to fix the problem when one cannot go to management.

Type of work

Burnout research originated with the study of individuals in occupations which involved “people work” – specifically where those people were needy or in trouble and required empathy (patients, inmates, students, clients, etc.) (Maslach et al., 2001). Studies have also been done of blue-collar (unskilled and skilled) and white-collar (low-medium skilled and high skilled) workers who do not work principally with people, but, instead, with things or data. Such studies have established that burnout also exists among those employee populations not employed in the human services professions (Norlund et al., 2010).

Yet the bulk of the research still takes place in the human services fields (among physicians, nurses, and teachers, for example) and, since occupation-specific burnout studies have been underway for several decades, researchers have had the opportunity to compare rates of burnout across professions. Schaufeli and Enzmann (1998), for example, compared a number of studies conducted in the United States which measured the emotional exhaustion levels of a variety of different occupations. Teachers were found to have the greatest levels of emotional exhaustion; workers in the social services and medicine had intermediate levels, and workers in mental health and post-secondary education had the lowest levels. Physicians and police officers exhibited some of the highest levels of depersonalization.

When they compared studies of the same occupational groups in the Netherlands, the authors found that the results were much the same, indicating that proneness to burnout in certain occupations is relatively predictable despite differences between countries, cultures and languages (Schaufeli and Buunk, 2002). Indeed, burnout research in countries around the world reveals far more commonalities than differences, suggesting that certain jobs along with their corresponding pressures are often the same despite geographic location.

Physical environment

The physical environment in which one works plays an important role in burnout (Demerouti et al., 2001). For example, an uncomfortable physical environment – one in which workers are exposed to noise, extremes of temperature, dirt, noxious substances, poor lighting and crowding – is one in which workers are more likely to be at risk for burnout (Pines and Aronson, 1988).

Another potential source of stress and burnout is the exposure to physical job risks such as poor air quality (Leiter, 2005) or the potential for injury or safety incidents in an unsafe workplace (Rundmo, 1996; Leiter, 2005; Day et al., 2009). Nurses who suffer higher numbers of needlestick injuries (Clarke et al., 2002), for example, or who are exposed to infected patients and/or materials (Leiter, 2005) are more likely to suffer from emotional exhaustion – one of the key elements of burnout.

But workers need not be exposed to actual risk in order to experience higher levels of stress. Even the perception of risk (i.e., the “subjective assessment of the probability of a specified type of accident happening and how concerned we are with such an event” (Marek et al., 1985, p. 152)) plays a key role in increasing stress. Accordingly, perceived risk exists alongside actual harsh physical working conditions as a predictor of the mental and physical health of employees (Eide et al., 1985; Ulleberg and Rundmo, 1997).

Cox and Tait (1991) describe a model of risk in which workers judge how significant a hazard is by assessing its lethalness (the severity of the harm that might be inflicted), prevalence (the estimation of frequency of harm), and control. A worker’s estimation of the extent to which a hazard is lethal and prevalent also contributes to that worker’s sense of vulnerability.

Control over environment, in contrast, allows workers to cope with workplace stress more effectively. The more workers feel they are able to control risk, the less vulnerable they are likely to feel (Ferguson et al., 1994). Proper training can also increase a worker’s sense of control, as does adherence to strict safety policies and standards (Leiter and Robichaud, 1997). Not surprisingly, more control is linked to a diminished risk for burnout.

Conflict

Although conflict may occur for many reasons, the feeling that one has too much work and too few resources with which to carry it out is likely to contribute to interpersonal conflict in the workplace (Maslach et al., 2001). Such conflict is not just limited to difficulties with co-workers and supervisors; it may also involve human services recipients (patients, students, patrons, etc.) and their families.

Social support, particularly from one’s peers, has been shown to help employees better endure the stresses of the workplace. It is no wonder, therefore, that conflict on the job has been shown to decrease job satisfaction (Abrahamson et al., 2009), and is associated with higher levels of burnout (Embriaco et al., 2007). Indeed, research has revealed that this kind of conflict does not have to be unrelenting to increase the risk of burnout; even periodic but emotionally intense episodes of conflict can do the same (Brotheridge and Grandey, 2002).

Role conflict and role ambiguity

Role conflict and role ambiguity have both been linked to burnout. Role ambiguity is a term used to describe the lack of clarity, certainty and/or predictability one might have expected with regards to behaviour in a job (due, perhaps to an ill-defined or ambiguous job description and/or uncertain organizational objectives). Employees who work hard on what they think is an important project only to find it shelved or placed on the back burner, as well as employees who don’t understand the scope and parameters of their job, the goals they should be pursuing, and what their priorities should be are more likely to suffer from role ambiguity.

In contrast, role conflict involves competing and incompatible demands placed on an employee. This can involve the sometimes contradictory demand of being both a supervisor and a friend, the irreconcilable demands of providing good service while striving to reduce costs, or the difficulties of doing a job which is at odds with one’s own values. Where role conflict and role ambiguity are high, high levels of burnout are also found (Tunc and Kutanis, 2009).

Control

An employee is said to have control when she is able to participate in and influence workplace decision-making and is also able to exercise professional autonomy. Control has to do not only with how and when the job is done, but also how much leeway employees have in determining when they can take a break or when they can schedule their vacation. Those with a significant amount of control are “much more likely to influence their workload, rewards, social interactions, and institutional justice than are people lacking control” (Leiter, 2005, p. 132).

Control in the workplace is important for both physical and mental well-being. The Whitehall Studies, led by Sir Michael Marmot, professor of epidemiology and public health at University College, London, involved a survey of 30,000 British civil servants – a group overwhelmingly middle class with free health care – over the course of three decades. The first of the Whitehall studies found that the lower the employees were in rank, the higher their rates of physical and mental illness including heart, lung, digestive and back problems, depression and suicide. Workers at the very bottom had a risk of death that was four times higher and workers in the middle had a risk of death that was two times higher than the person at the top. The main cause, according to the researchers, was ongoing stress due to a lack of autonomy in the job. Their conclusion was that giving employees more control would improve their health (Contenta, 2010).

Other studies have shown that increased job control can cut the levels of coronary heart disease, depression and absenteeism (Karasek, 1990). In addition, workers who are allowed to actively participate in workplace decision-making show higher levels of efficacy (i.e., the sense that one is performing tasks adequately and is competent at work) and lower levels of emotional exhaustion (Cherniss, 1980; Lee and Ashforth, 1990; Leiter, 1992).

In terms of burning out, workers who feel they have little job autonomy or control are at greater risk (Paine, 1982; Glass et al., 1993). Lack of control can take a number of different forms including supervisors who micromanage or organizations that do not allow employees to participate in policy or other work-related decisions (Glass et al., 1993). Lack of control is particularly stressful in an environment in which downsizing and job restructuring are taking place.

As Maslach and Leiter (1997) note, employees who lack control are generally not permitted to resolve problems as they arise, and generally must go through some straight-jacketed organizational structure on even the smallest issues. After a time, solving problems through the “proper channels” becomes more exhausting and problematic than it is worth. The organization suffers because employees start to ignore problems or to work around them, and workers suffer because of the added stress of dealing with ongoing problems.

Social support

Researchers are interested in the interaction between social support, stress management and burnout. Social support has been defined as “an exchange of resources between at least two individuals perceived by the provider or recipient to be intended to enhance the well being of the recipient” (Shumaker and Brownell, 1984). It fosters a feeling of belonging: with social support, individuals feel that they are cared for by others, can draw upon the resources of others and/or have others upon whom they can rely. This type of support can be emotional or physical; it can involve the giving of advice or the provision of tangible aid or resources.

Part of social support concerns appreciation. Pines and Aronson (1988) write,

[t]ime and again we have found that, in a given organization, individuals hunger for appreciation. People who feel unappreciated almost never reach out to show appreciation of someone else’s work. Our experience has shown that one of the best ways for individuals to encourage others to pay attention to their work is to start acknowledging the good work of others. When individuals, on their own, reach out to give each other needed support and needed appreciation, the reaching out mushrooms and grows exponentially. Moreover, peer appreciation (which is easy to institute) reduces the need for approval from above (which is frequently difficult, if not impossible, to institute). (p. 30)

Social support is said to be a major buffer against stress (Cohen and Wills, 1985; Bates and Toro, 1999) and a lack of social support has been found to be a predictor of burnout as many as ten years later (Kalimo et al., 2003).

Nonetheless, as we have noted with similar kinds of research, the results of studies on social support have not always been consistent (Prag, 2003). Some studies have found no or little connection between stress, burnout and supervisory support (Beehr and McGrath, 1992; Burke and Greenglass, 1995). Others claim to have established a link between a reported lack of supervisory support and greater ensuing risk for burnout (Seltzer and Numerof, 1988; Cheuk et al., 1994).

From the perspective of younger employees, supervisory support has also been found to be significantly associated with reducing job stress (Boyas et al., 2012). In other words, younger workers tend to rely far more on assistance and encouragement from their supervisors to help buffer higher levels of job stress. Older workers, by implication, are more self-reliant and/or have worked out other means of social support to help them cope with workplace stressors.

Research also indicates that individuals who have high levels of social support in the form of positive conversations with co-workers are less likely to experience future higher levels of emotional exhaustion and cynicism – two hallmarks of burnout (Halbesleben and Buckley, 2006). Similarly, those who have a network of colleagues with similar interests and concerns have lower scores in terms of emotional exhaustion and depersonalization (Ross et al., 1989).

Reciprocity

Reciprocity involves the amount an individual invests in a particular relationship with another and whether, and to what extent, that investment is returned. In the case of workers who feel they are contributing more to relationships with clients, patrons, patients, etc. than is being returned, there is an increased risk of burnout. For example, research involving nurses (Van Yperen et al., 1992; Schaufeli and Janczur, 1994), teachers (Van Horn et al., 2001), police officers (Kop et al., 1999), social workers (Truchot et al., 2000) and general practitioners (Bakker et al., 2000) has confirmed that there is a positive relationship between professionals who perceive a lack of reciprocity with their human services recipients and the three dimensions of burnout: emotional exhaustion, depersonalization and reduced personal accomplishment. One study of primary care physicians carried out over the course of ten years found that frequent contact with demanding patients not only leads to higher burnout scores but continues to aggravate the condition over time (Schaufeli et al., 2011).

But a perceived lack of reciprocity may exist not only with the recipients of one’s care but also with colleagues. This latter situation has been found to be significantly associated with burnout (Kop et al., 1999; Van Horn et al., 2001). It is also true when such employees feel they are not benefitting as much in their relationships with their supervisors (Prins et al., 2008).

Such a perception of inequity may apply not only to co-workers and supervisors, but also to organizations. Workers naturally seek to have their contributions (time, effort, loyalty, skill) returned by their employing organization in the way of gratitude, remuneration, status, or greater input. Organizations whose workers feel a lack of this reciprocity play a key role in determining emotional exhaustion and depersonalization (Rose et al., 2010).

Where a perceived imbalance or inequity between input and output occurs, workers will attempt to correct the balance; where that balance cannot be corrected, they will experience significant distress and dissatisfaction (van Dierendonck et al., 2001). Indeed, employees who feel a lack of reciprocity with their employing organization have been found to experience an even greater distress than when that lack of reciprocity exists with patients and co-workers (Rose, 2010). As Maslach, Schaufeli and Leiter (2001) note,

[t]he organizational context is … shaped by larger social, cultural, and economic forces. Recently, this has meant that organizations have undergone a lot of changes, such as downsizing and mergers, that have had significant effects on the lives of their employees. This is perhaps most evident in changes in the psychological contract – i.e. the belief in what the employer is obliged to provide based on perceived promises of reciprocal exchange (Rousseau, 1995). Now employees are expected to give more in terms of time, effort, skills, and flexibility, whereas they receive less in terms of career opportunities, lifetime employment, job security, and so on. Violation of the psychological contract is likely to produce burnout because it erodes the notion of reciprocity, which is crucial in maintaining well-being. (p. 409)

In order to be viewed as a satisfying relationship, the investments and outcomes must be perceived by the employee as being more or less fair and equal.

Social comparison

Researchers have found a link between social comparison and burnout. Social comparison involves the comparison employees make between themselves and their peers. Employees will, in theory, experience stress when they see that some of their peers are paid more or appear to be better treated than themselves.

Social comparison research involves such equations as: “when I see colleagues who experience more difficulties than I do, I am happy that I am doing so well myself;” “when I see colleagues who are doing worse [than I am], I experience fear that my future will be similar;” “when I see colleagues who are doing better than I am, I feel frustrated about my own situation;” and “when I see colleagues who are doing better than I am, I realize that it is possible to improve” (Carmona et al., 2006, p. 90). Research has established that employees who identify with those who appear to be doing worse than themselves and contrast themselves with those who are doing better are more likely to be at risk of burnout (Brenninkmeijer et al., 2000; Carmona et al., 2006).

Leadership style

It is, of course, no surprise to learn that an employee’s supervisor/manager can be a source of negative emotions in the workplace. There is an established link between type of leadership style, negative emotions, stress and burnout. One study involving employees reporting negative and positive emotions at work found that 7 percent of positive emotional events were attributable to “acts of management,” as were 22 percent of negative emotional events (Basch and Fisher, 2000). Employees who were asked to remember an emotional event in the workplace involving their supervisor/manager were more likely to remember one which involved negative rather than positive emotions (Dasborough, 2006).

Leadership style in terms of credibility has to do with the extent to which workers feel they can trust the person in charge. The extent to which a leader is considered credible or trustworthy involves such factors as how openly leaders communicate with their employees, whether they do what they’ve promised to do, and whether they explain what they find important and what their vision is (Gabris and Ihrke, 1996, p. 233; Kouzes and Posner, 1987, 1993). Where workers feel they can trust their managers/supervisors, they are less likely to question managerial objectives or to refrain from volunteering to take on additional work required to accomplish these objectives. Where leadership credibility is low, the extent to which employees are burned out is likely to be higher (Gabris and Ihrke, 1996).

Researchers have sought to categorize and identify a leadership style which is less likely to result in employee stress. Bass (1998), for example, describes three types of leadership style: transformational, transactional, and laissez-faire. A transformational leadership style is one in which the leader attempts to inspire and motivate by appealing to an individual’s sense of self-worth in addition to other unique emotional and developmental needs. Such a leader may use material as well as psychological rewards, but the emphasis is on the psychological and includes positive feedback and praise.

In contrast, transactional leadership, according to Bass, is of three types. These are, in his terminology: contingent reward, management by exception-active, and management by exception-passive. “Contingent reward” involves the provision of a reward (money, positive feedback, commendation) in exchange for good job performance. “Management by exception” may be active or passive. In the active form, the leader monitors an employee’s work, and if job performance deviates from expected performance standards, correction in the shape of negative feedback, discipline or punishment takes place. In the passive form, the leader is not actively involved in the monitoring of work, and only steps in when any deviation is brought to his or her attention. Laissez-faire leadership is, in contrast to the transformational and transactional models described above, the absence of leadership.

Research has linked this matter of leadership style to the perception of job-related stress in employees (Sosik and Godshalk, 2000). Specifically, transformational leadership has been associated with enhanced task performance and the sense on the part of employees that they had greater social support than perceived with other leadership styles. In addition, employees working with a transformational leader rather than a transactional leader are less likely to see an impending stressor as threatening. Transformational leadership has been found to increase well-being and job satisfaction, and to decrease burnout in employees (Weberg, 2010).

Conclusion

A number of links have been established between various individual, socio-demographic and workplace characteristics and the potential risk for burnout. Some of these links are tenuous; others are clear cut and well established. An excessive workload, for example, has been shown to have a significant connection with burnout as has having little control over how the job is done. Other factors, such as lack of social support from colleagues or superiors, have been shown in some cases to be a important predictors of the syndrome.

For Leiter and Maslach (2005), burnout is more than merely the alignment of risk factors, but can instead be explained by the level of “mismatch” between an individual and six strategic areas of the workplace: workload, control, reward, community, fairness and values. These authors suggest that many of the factors discussed above fall into one of these six categories. Even certain individual and socio-demographic factors could be said to belong, to some extent, to some of these categories.

In Chapter 8, Symptom Recognition and Preventing Burnout, we look specifically at these six strategic areas and discuss how to handle, cope with or eliminate the various factors that contribute to burnout. In our next chapter, however, we turn to information professionals specifically and how budget cuts, downsizing and other pressures have added to the stresses of the workplace.

References

Abrahamson, K., Suitor, J., Pillemer, K. Conflict between nursing home staff and residents. Journal of Aging and Health. 2009; 21(6):895–912.

Ahola, K., Honkonen, T., Virtanen, M., Aromaa, A., Lönnqvist, J. Burnout in relation to age in the adult working population. Journal of Occupational Health. 2008; 50(4):362–365.

Bakker, A.B., Demerouti, E. The job demands–resources model: State of the art. Journal of Managerial Psychology. 2007; 22:309–328.

Bakker, A.B., Demerouti, E., Schaufeli, W.B. Dual processes at work in a call centre: An application of the job demands–resources model. European Journal of Work and Organizational Psychology. 2003; 12(4):393–417.

Bakker, A.B., Demerouti, E., Euwema, M.C. Job resources buffer the impact of job demands on burnout. Journal of Occupational Health Psychology. 2005; 10:170–180.

Bakker, A.B., Schaufeli, W.B., Sixma, H.J., Bosveld, W., Dierendonck, D. Patient demands, lack of reciprocity, and burnout: A five-year longitudinal study among general practitioners. Journal of Organizational Behavior. 2000; 21(4):425–441.

Barber, C.E., Iwai, M. Role conflict and role ambiguity as predictors of burnout among staff caring for elderly dementia patients. Journal of Gerontological Social Work. 1996; 26:101–116.

Barnett, R.C., Gareis, K.C., Brennan, R.T. Fit as a mediator of the relationship between work hours and burnout. Journal of Occupational Health Psychology. 1999; 4:307–317.

Basch, J., Fisher, C.D. Affective events–motion matrix: A classification of work events and associated emotions. In: Ashkanasy N.M., Härtel C.E.J., Zerbe W.J., eds. Emotions in the Workplace: Research, Theory, and Practice. Westport, Connecticut: Quorum; 2000:36–48.

Bass, B.M. Transformational Leadership: Industrial, Military, and Educational Impact. Mahwah, New Jersey: Erlbaum; 1998.

Bates, D.S., Toro, P.A. Developing measures to assess social support among homeless and poor people. Journal of Community Psychology. 1999; 27:137–156.

Beehr, T.A., McGrath, J.E. Social support, occupational stress and anxiety. Anxiety, Stress and Coping. 1994; 5:7–19.

Bennett, L., Michie, P. Quantitative analysis of burnout and its associated factors in AIDS nursing. AIDS Care. 1991; 3(2):181–193.

Bond, J.T., Galinsky, E., Swanberg, J.E. The 1997 National Study of the Changing Workforce. New York, New York: Families and Work Institute; 1998.

Boyas, J., Wind, L.H., Kang, S. Exploring the relationship between employment-based social capital, job stress, burnout, and intent to leave among child protection workers: An age-based path analysis model. Children and Youth Services Review. 2012; 34:50–62.

Boyes, R. “Boreout” emerging as new office disease; An estimated 15 percent of workers on path to ailment. Calgary Herald. A22, 15 September 2007.

Boyle, A., Grap, M., Younger, J., Thornby, D. Personality hardiness, ways of coping, social support and burnout in critical care nurses. Journal of Advanced Nursing. 1991; 16:850–857.

Brenninkmeyer, V., Van Yperen, N., Buunk, B.P. I am not a better teacher, but others are doing worse: Burnout and perceptions of superiority among teachers. Social Psychology of Education. 2000; 4(3–4):259–274.

Brewer, E.W., Shapard, L. Employee burnout: A meta-analysis of the relationship between age or years of experience. Journal of Human Resource Development Review. 2004; 3(2):102–123.

Brotheridge, C.M., Grandey, A.A. Emotional labor and burnout: Comparing two perspectives of people work. Journal of Vocational Behavior. 2002; 60:17–39.

Browning, L., Ryan, C., Greenberg, M., Rolniak, S. Effects of cognitive adaptation on the expectation–burnout relationship among nurses. Journal of Behavioral Medicine. 2006; 29(2):139–150.

Buckley, M.R., Mobbs, T.A., Mendoza, J.L., Novicevic, M.M., Carraher, S.M., Beu, D.S. Implementing realistic job previews and expectation-lowering procedures: A field experiment. Journal of Vocational Behavior. 2002; 61:263–278.

Burisch, M. Das Burnout-Syndrom: Theorie der inneren Erschöpfung [The burnout-syndrome: A theory of inner exhaustion]. Heidelberg, Germany: Springer Medizin Verlag; 2006.

Burke, R.J., Greenglass, E. A longitudinal study of psychological burnout in teachers. Human Relations. 1995; 48(2):187–202.

Burke, R.J., Richardson, A.M. Stress, burnout and health. In: Cooper C.L., ed. Stress, Medicine and Health. Boca Raton, Florida: CRC Press; 1996:101–117.

Cano-García, F.J., Padilla-Muñoz, E.M., Carrasco-Ortiz, M.A. Personality and contextual variables in teacher burnout. Personality and Individual Differences. 2005; 38(4):929–940.

Carmona, C., Buunk, A.P., Peiró, J.M., Rodríguez, I., Bravo, M.J. Do social comparison and coping styles play a role in the development of burnout? Cross-sectional and longitudinal findings. Journal of Occupational and Organizational Psychology. 2006; 79:85–99.

Casserley, T.B., Megginson, D. Learning from Burnout: Developing Sustainable Leaders and Avoiding Career Derailment. Oxford, UK: Butterworth-Heinemann; 2009.

Cherniss, C. Professional Burnout in Human Service Organizations. New York, New York: Praeger; 1980.

Cheuk, W.H., Wong, K.S., Rosen, S. The effects of spurning and social support on teacher burnout. Journal of Social Behavior and Personality. 1994; 9:657–664.

Clarke, S.P., Sloane, D.M., Aiken, L.H. Effects of hospital staffing and organizational climate on needlestick injuries to nurses. American Journal of Public Health. 2002; 92(7):1115–1119.

Cohen, S., Wills, T.A. Stress, social support, and the buffering hypothesis. Psychological Bulletin. 1985; 98:310–357.

Contenta, S. “21st century syndrome” or just a case of the blahs? An intriguing diagnosis posits that we live in an age so stressful we can no longer cope. Toronto Star. IN01, 2010.

Cordes, C.L., Dougherty, T.W. A review and an integration of research on job burnout. Academy of Management Review. 1993; 18:621–656.

Cox, S.J., Tait, N.P., Reliability, Safety and Risk ManagementAn Integrated Approach. Butterworth-Heinemann: London, UK, 1991.

Dasborough, M.T. Cognitive asymmetry in employee emotional reactions to leadership behaviors. The Leadership Quarterly. 2006; 17:163–178.

Day, A.L., Sibley, A., Scott, N., Tallon, J.M., Ackroyd-Stolarz, S. Workplace risks and stressors as predictors of burnout: The moderating impact of job control and team efficacy. Canadian Journal of Administrative Sciences. 2009; 26(1):7–22.

Demerouti, E., Bakker, A.B., Nachreiner, F., Schaufeli, W.B. The job demands–resources model of burnout. Journal of Applied Psychology. 2001; 86(3):499–512.

Demerouti, E., Taris, T.W., Bakker, A.B. Need for recovery, home–work interference and performance: Is lack of concentration the link? Journal of Vocational Behavior. 2007; 71:204–220.

Dillon, J.F., Tanner, G.R. Dimensions of career burnout among educators. Journalism & Mass Communication Educator. 1995; 50(2):4–13.

D’Souza, F., Egan, S.J., Rees, C.S. The relationship between perfectionism, stress and burnout in clinical psychologists. Behaviour Change. 2011; 28(1):17–27.

Duffy, B., Oyebode, J.R., Allen, J. Burnout among care staff for older adults with dementia: The role of reciprocity, self-efficacy and organizational factors. Dementia. 2009; 8:515–541.

Eide, R., Hellesøy, O.H., Gogstada, C. Associations between experiences of environmental factors and health. In: Hellesøy O.H., ed. Work Environment Statfjord Field: Work Environment, Health, and Safety on a North Sea Oil Platform. Oslo, Norway: Universitetsforlaget; 1985:317–324.

Embriaco, N., Azoulay, E., Barrau, L., Kentish, N., Pochard, F., Loundou, A., Papazian, L. High level of burnout in intensivists: Prevalence and associated factors. American Journal of Respiratory and Critical Care Medicine. 2007; 175(7):686–692.

Fenlason, K.J., Beehr, T.A. Social support and occupational stress: Effects of talking to others. Journal of Organizational Behavior. 1994; 15(2):157–175.

Ferguson, E., Cox, T., Farnsworth, W., Leiter, M., Irving, K. Nurses’ anxieties about biohazards as a function of context and knowledge. Journal of Applied Social Psychology. 1994; 24(10):926–940.

Fontana, D., Abouserie, R. Stress levels, gender and personality factors in teachers. British Journal of Educational Psychology. 1993; 63:261–270.

Frone, M.R., Russell, M., Cooper, M.L. Relation of work–family conflict to health outcomes: A four-year longitudinal study of employed parents. Journal of Occupational and Organizational Psychology. 1997; 70:325–335.

Gabris, G.T., Ihrke, D.M. Job burnout in a large federal agency: Phase model implications for how employees perceive leadership credibility. Public Administration Quarterly. 1996; 11(2):220–249.

Gaines, J., Jermier, J.M. Emotional exhaustion in a high stress organization. Academy of Management Journal. 1983; 26(4):567–586.

Gallacher, D., Gallacher, J. Are relationships good for your health? Student BMJ, 19:d404. Retrieved from Student BMJ: http://student.bmj.com/student/view-article.html?id=sbmj.d404, 2011.

Ghorpade, J., Lackritz, J., Singh, G. Personality as a moderator of the relationship between role conflict, role ambiguity, and burnout. Journal of Applied Social Psychology. 2011; 41:1275–1298.

Glass, D.C., McKnight, J.D., Valdimarsdottir, H. Depression, burnout, and perceptions of control in hospital nurses. Journal of Consulting and Clinical Psychology. 1993; 61(1):147–155.

Glouberman, D. The Joy of Burnout. Isle of Wight: Skyros Books; 2002.

Greenhaus, J.H., Beutell, N.J. Sources of conflict between work and family roles. Academy of Management Review. 1985; 10:76–88.

Gulalp, B., Karcioglu, O., Sari, A., Koseoglu, Z. Burnout: Need help? Journal of Occupational Medicine and Toxicology. 2008; 3(1):32.

Haddad, A. Sources of social support among school counselors in Jordan and its relationship to burnout. International Journal for the Advancement of Counseling. 1998; 20:113–121.

Halbesleben, J.R.B., Buckley, M.R. Burnout in organizational life. Journal of Management. 2004; 30(6):859–879.

Halbesleben, J., Buckley, M.R. Social comparison and burnout: The role of relative burnout and received social support. Anxiety, Stress & Coping. 2006; 19(3):259–278.

Canada, Health. Work–life conflict in Canada in the new millennium: Executives Summary. Retrieved from http://www.hc-sc.gc.ca/ewh-semt/pubs/occup-travail/balancing_six-equilibre_six/sum-res-eng.php, 2001.

Hobfoll, S.E. Stress, Culture, and Community. New York, New York: Plenum Press; 1998.

Hobfoll, S.E. Conservation of resources: A new attempt at conceptualizing stress. American Psychologist. 1989; 44(3):513–524.

Ifeagwazi, C.M. The influence of marital status on self-report of symptoms of psychological burnout among nurses. Omega. 2005; 52(4):359.

Jackson, R.A. An analysis of burnout among school of pharmacy faculty. American Journal of Pharmaceutical Education. 1993; 57(1):9–17.

Kalimo, R., Pahkin, K., Mutanen, P., Toppinen-Tanner, S. Staying well or burning out at work: Work characteristics and personal resources as long-term predictors. Work & Stress. 2003; 17:109–122.

Kantas, A., Vassilaki, E. Burnout in Greek teachers: Main findings and validity of the Maslach Burnout Inventory. Work & Stress. 1997; 11(1):94–100.

Karasek, R.A. Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly. 1979; 24:285–308.

Karasek, R. Lower health risk with increased job control among white collar workers. Journal of Organizational Behavior. 1990; 11(3):171–185.

Khajeddin, N., Shoushtari, M., Hajebi, A. The impact of perception of locus of control on burnout syndrome among nurses in a psychiatric hospital. Iranian Journal of Psychiatry and Clinical Psychology. 2006; 12(1):43–48.

Kirk, S.A., Koeske, G.F. The fate of optimism – A longitudinal study of case managers’ hopefulness and subsequent morale. Research on Social Work Practice. 1995; 5(1):47–61.

Klag, S., Graham, B. The role of hardiness in stress and illness: An exploration of the effect of negative affectivity and gender. British Journal of Health Psychology. 2004; 9:137–161.

Konert, E., Relationship among middle-school teacher burnout, stress, job satisfaction and coping stylesUnpublished PhD Dissertation. Detroit, Michigan: Wayne State University, 1997.

Kop, N., Euwema, M., Schaufeli, W. Burnout, job stress and violent behavior among Dutch police. Work & Stress. 1999; 13:326–340.

Kouzes, J.M., Posner, B.Z. The Leadership Challenge: How to Get Extraordinary Things Done in Organizations. San Francisco, California: Jossey-Bass; 1987.

Kouzes, J.M., Posner, B.Z. Credibility: How Leaders Gain and Lose it, Why People Demand it. San Francisco, California: Jossey-Bass; 1993.

Lee, R.T., Ashforth, B.E. On the meaning of Maslach’s three dimensions of burnout. Journal of Applied Psychology. 1990; 75:743–747.

Leiter, M.P. Burn-out as a crisis in self-efficacy: Conceptual and practical implications. Work & Stress. 1992; 6(2):107–115.

Leiter, M.P. Perception of risk: An organizational model of burnout, stress symptoms, and occupational risk. Anxiety, Stress, and Coping. 2005; 18:131–144.

Leiter, M.P., Robichaud, L. Relationships of occupational hazards with burnout: An assessment of measures and models. Journal of Occupational Health Psychology. 1997; 2(1):35–44.

Lyons, J.B., Schneider, T.R. The effects of leadership style on stress outcomes. The Leadership Quarterly. 2009; 20(5):737.

Marek, J., Tangernes, B., Hellesøy, O.H. Experience of risk and safety. In: Hellesøy O.H., ed. Work Environment Statfjord Field: Work Environment, Health, and Safety on a North Sea Oil Platform. Oslo, Norway: Universitetsforlaget, 1985.

Maslach, C., Leiter, M.P. The Truth about Burnout: How Organizations Cause Personal Stress and What to Do about it. San Francisco, California: Jossey-Bass; 1997.

Maslach, C., Schaufeli, W.B., Leiter, M.P. Job burnout. In S.T. Fiske, D.L. Schachter, and C. Zahn-Waxler (Eds.). Annual Review of Psychology. 2001; 52:397–422.

Mills, L.B., Huebner, E.S. A prospective study of personality characteristics, occupational stressors, and burnout among school psychology practitioners. Journal of School Psychology. 1998; 36:103–120.

Naish, J. Killer bosses The Times, Career 4, 24 November 2005.

Norlund, S., Reuterwall, C., Höög, J., Lindahl, B., Janlert, U., Birgander, L.S. Burnout, working conditions and gender – results from the northern Sweden MONICA Study. BMC Public Health. 2010; 10:326.

Paine, W.S. Job Stress and Burnout: Research, Theory, and Intervention Perspectives. Beverly Hills, California: Sage; 1982.

Peeters, M.C.W., Montgomery, A.J., Bakker, A.B., Schaufeli, W.B. Balancing work and home: How job and home demands are related to burnout. International Journal of Stress Management. 2005; 12(1):43–61.

Pines, A., Aronson, E. Career Burnout: Causes and Cures. New York: The Free Press; 1988.

Prag, P.W. Stress, burnout, and social support: A review and call for research. Air Medical Journal. 2003; 22(5):18–22.

Prins, J.T., Gazendam-Donofrio, S.M., Dillingh, G.S., van de Wiel, H.B.M., van der Heijden, F.M.M.A., Hoekstra-Weebers, J.E.H.M. The relationship between reciprocity and burnout in Dutch medical residents. Medical Education. 2008; 42(7):721–728.

Purvanova, R.K., Muros, J.P. Gender differences in burnout: A metaanalysis. Journal of Vocational Behavior. 2010; 77(2):168–185.

Putnik, K., Houkes, I., Work related characteristics, work–home and home–work interference and burnout among primary healthcare physicians: A gender perspective in a Serbian context. BMC Public Health, 11, 716. 2011 Retrieved from http://www.biomedcentral.com/1471-2458/11/716

Ray, E.B., Miller, K.I. Social support, home/work stress, and burnout: Who can help? Journal of Applied Behavioral Science. 1994; 30(3):357–373.

Roberts, G.A. Prevention of burn-out. Advances in Psychiatric Treatment. 1997; 3:282–289.

Rose, J., Madurai, T., Thomas, K., Duffy, B., Oyebode, J. Reciprocity and burnout in direct care staff. Clinical Psychology & Psychotherapy. 2010; 17(6):455–462.

Ross, R., Altmaier, E., Russell, D. Job stress, social support, and burnout among counseling centre staff. Journal of Counseling Psychology. 1989; 36(4):464–470.

Rothlin, P., Werder, P. Boreout: Overcoming Workplace Demotivation. London, UK: Kogan Page; 2008.

Rousseau, D. Psychological Contracts in Organizations: Understanding Written and Unwritten Agreements. Thousand Oaks, California: Sage; 1995.

Rundmo, T. Associations between risk perception and safety. Safety Science. 1996; 24(3):197–209.

Schaufeli, W.B., Buunk, B.P. Burnout: An overview of 25 years of research and theorizing. In Schabracq M.J., Winnubst J.A.M., Cooper C.L., eds.: The Handbook of Work and Health Psychology, 2nd ed, Chichester, UK: Wiley, 2002.

Schaufeli, W.B., Enzmann, D. The Burnout Companion to Study and Practice: A Critical Analysis. London, UK: Taylor and Francis; 1998.

Schaufeli, W.B., Janczur, B. Burnout among nurses: A Polish–Dutch comparison. Journal of Cross-Cultural Psychology. 1994; 25:95–113.

Schaufeli, W.B., Maassen, G.H., Bakker, A.B., Sixma, H.J. Stability and change in burnout: A 10-year follow-up study among primary care physicians. Journal of Occupational and Organizational Psychology. 2011; 84(2):248.

Schmitz, N., Neumann, W., Oppermann, R. Stress, burnout and locus of control in German nurses. International Journal of Nursing Studies. 2000; 37(2):95–99.

Schwartz, R.H., Tiamiyu, M.F., Dwyer, D.J. Social worker hope and perceived burnout. Administration in Social Work. 2007; 31(4):103–119.

Seltzer, J., Numerof, R.E. Supervisory leadership and subordinate burnout. Academy of Management Journal. 1988; 31:439–446.

Senior, J. Can’t get no satisfaction: In a culture where work can be a religion, burnout is its crisis of faith. http://nymag.com/news/features/24757/, 26 November 2006.

Shinn, M., Rosario, M., Morch, H., Chestnut, D.E. Coping with job stress and burnout in the human services. Journal of Personality and Social Psychology. 1984; 46:864–876.

Shumaker, S.A., Brownell, A. Toward a theory of social support: Closing conceptual gaps. Journal of Social Issues. 1984; 40(4):11–36.

Simoni, P., Paterson, J. Hardiness, coping, and burnout in the nursing workplace. Journal of Professional Nursing. 1997; 13(3):178–185.

Sosik, J.J., Godshalk, V.M. Leadership styles, mentoring functions received, and job-related stress: A conceptual model and preliminary study. Journal of Organizational Behavior. 2000; 21:365–390.

Thomsen, S., Soares, J., Nolan, P., Dallender, J., Arnetz, B. Feelings of professional fulfillment and exhaustion in mental health personnel. Psychotherapy and Psychosomatics. 1999; 68(3):157–164.

Topf, M. Personality, hardiness, occupational stress, and burnout in critical care nurses. Research in Nursing & Health. 1989; 12:179–188.

Truchot, D., Keirseblick, L., Meyer, S. Communal orientation may not buffer burnout. Psychological Reports. 2000; 86:872–878.

Tunc, T., Kutanis, R.O. Role conflict, role ambiguity, and burnout in nurses and physicians at a university hospital in Turkey. Nursing & Health Sciences. 2009; 11(4):410–416.

Uchtmann, J., Underchallenged and underworked. The Nation. 22 January 2012.

Ulleberg, P., Rundmo, T. Job stress, social support, job satisfaction and absenteeism among offshore oil personnel. Work & Stress. 1997; 11(3):215–228.

van Dierendonck, D., Schaufeli, W.B., Buunk, B.P. Burnout and inequity among human service professionals: A longitudinal study. Journal of Occupational Health Psychology. 2001; 6(1):43–52.

Van Horn, J.E., Schaufeli, W.B., Taris, T.W. Lack of reciprocity among Dutch teachers: Validation of reciprocity indices and their relation to stress and wellbeing. Work & Stress. 2001; 15(3):191–213.

Van Yperen, N.W., Buunk, A.P., Schaufeli, W.B. Communal orientation and the burnout syndrome among nurses. Journal of Applied Social Psychology. 1992; 22:173–189.

Watson, D., Clark, L.A., Harkness, A.R. Structures of personality and their relevance to psychopathology. Journal of Abnormal Psychology. 1994; 103:18–31.

Weberg, D. Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly. 2010; 34(3):246–258.

Williams, C.A. Empathy and burnout in male and female helping professionals. Research in Nursing & Health. 1989; 12:169–178.

Xanthopoulou, D., Bakker, A.B., Demerouti, E., Schaufeli, W.B. The role of personal resources in the job demands–resources model. International Journal of Stress Management. 2007; 14(2):121–141.

Yildirim, I. Relationships between burnout, sources of social support and sociodemographic variables. Social Behavior and Personality. 2008; 36(5):603–616.

Zellars, K.L., Perrewé, P.L., Hochwarter, W.A. Burnout in health care: The role of the five factors of personality. Journal of Applied Social Psychology. 2000; 30:1570–1598.