Burnout, Life Satisfaction, and Work-Related Quality of Life among Psychologists

doi:10.21203/rs.3.rs-3329403/v1

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Burnout, Life Satisfaction, and Work-Related Quality of Life among Psychologists

https://doi.org/10.21203/rs.3.rs-3329403/v1

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Background

Work-Related Quality of Life (WRQoL) is a multidimensional concept that is difficult to measure owing to the challenge of reaching a consensus on the factors involved. Although the WRQoL Scale has been proven effective in evaluating the construct in several countries, it has not been translated into Brazilian Portuguese until now. The aim of this study was to measure burnout, life satisfaction and WRQoL in psychologist, beyond validate the Brazilian Portuguese version of the WRQoL Scale, using psychology professionals as the target population.

Methods

610 psychologists participated in this study, who responded to the Maslach Burnout Inventory, Life Satisfaction Scale and the WRQoL Scale. Spearman's correlation and group comparison analyzes were performed. Bilingual translators translated the scale into Portuguese, then English, and finally back into Portuguese. Adjustments to the final scale were made through a focus group comprising psychology professionals. The scale was administered online using SurveyMonkey. Confirmatory Factor Analysis was used to test the existing models in the sample WRQoL Scale. Exploratory Factor Analysis was used to examine the potentially improved model fits.

Results

42% indicated adequate levels of satisfaction with life, 53% had burnout for Emotional Exhaustion and Depersonalization. Protective factors for the mental health of psychologists were identified. The final model to WRQoL Scale comprised 21 items distributed across 4 factors. The Cronbach's alpha reliability index was 0.94 and CR = 0.95.

Conclusions

This study provides evidence that the WRQoL Scale is a valid tool that can measure work-related quality of life.

burnout

life satisfaction

Work-Related Quality of Life Scale

psychometric validation

psychologist

Occupational activity is an essential aspect of life, and if it is perceived as a source of satisfaction, it contributes positively to overall life satisfaction [1]. However, psychologists require intense emotional effort to cope with the inherent needs of the profession owing to the nature of the professional experiences to which they are exposed [2–4].

Such effort, combined with the need to use empathy without adequate training, may contribute to the development of burnout [5]. A systematic review [6] confirmed that psychotherapists exhibit moderate to high levels of burnout on assessments.

Burnout arises as a consequence of prolonged exposure to chronic job-related stress [7]. It is characterized by three dimensions: emotional exhaustion (e.g., feelings of being overwhelmed), depersonalization (e.g., indifferent response), and reduced personal accomplishment or ineffectiveness (e.g., feelings of incompetence) [8].

The predictors of burnout include workload, shift work, conflicting work demands, lack of control and autonomy in the work environment, lack of social support [7–9], personality traits, stress coping modes, beliefs, personal attitudes, and work-life imbalance [2, 4, 6, 7, 8, 10].

A protective factor against burnout is adequate Work-Related Quality of Life (WRQoL) because, in addition to being a measure inversely correlated with burnout, it encompasses a broad range of work-related experiences [11, 12].

The aim of this study was to measure burnout, life satisfaction and WRQoL Scale in psychologist, beyond was the semantic and psychometric validation of the WRQoL Scale for Brazil.

This observational, cross-sectional study followed STROBE guidelines [13]. The study was divided into two main phases: the validation process of the WRQoL Scale and the measurement analyses of the WRQoL Scale, the Maslach Burnout Inventory (MBI-HSS), and the Life Satisfaction Scale (LSS).

Participants

The minimum effective sample size was set at 560 participants, taking into account the assumptions of factorability and the potential to conduct confirmatory and exploratory factor analyses with different subsamples [14]. The data were collected between March and August 2020 via an online platform.

A total of 803 psychologists agreed to participate in the survey. Of them, 193 dropped out during the completion of the instruments (86 dropped out when completing the sociodemographic questionnaire; 46, the LSS; 36, the MBI-HSS; and 35, the WRQoL), representing a sample loss of 24.03%. The final sample comprised 610 psychologists from all regions of Brazil. The inclusion criteria were as follows: (a) being a psychologist, (b) working in the field of psychology, and (c) having at least one year of training as a psychologist. No exclusion criteria were applied.

Instruments

Sociodemographic and labor questionnaire. It included questions about age, sex, level of education, marital status, place of residence, number of children, length of experience, area of work, job satisfaction (e.g., how satisfied are you with your profession?), and self-care (e.g., do you engage in any leisure activities?).

Work-Related Quality of Life (WRQoL) Scale. The translated and adapted version that was administered to the participants comprises 21 items distributed across 4 factors (General Well-Being, Home-Work Interface, Working Conditions, and Capabilities and Abilities). The responses are measured on a 5-point Likert-type scale (e.g., 1 = strongly disagree, 5 = strongly agree). The higher the score, the higher the work-related quality of life [15].

Life Satisfaction Scale (LSS). It assesses the judgments people make about their overall life satisfaction [16]. It comprises 5 items and responses are measured on a 7-point Likert-type scale, ranging from 1(strongly disagree) to 7(strongly agree). The possible score range is from 5 (low satisfaction) to 35 (high satisfaction), with a neutral point of 20 [17].

Maslach Burnout Inventory (MBI-HSS). It assesses professional burnout [18]. It comprises 22 items divided into 3 domains: Emotional Exhaustion (EE), Depersonalization (DP), and Professional Accomplishment (PA). The answers are provided on a 5-point Likert-type scale ranging from 1 (never) to 5 (always). For the Emotional Exhaustion and Depersonalization subscales, higher scores indicate greater degree of burnout. However, lower scores on the Professional Accomplishment subscale indicate higher degree of burnout. Scale scores are considered separately [19].

Procedures

Before the study commenced, the WRQoL scale was translated and semantically validated. The English version was translated using the back translation procedure [20, 21]. The scale was translated by three independent bilingual translators. After the final translation into Brazilian Portuguese, a focus group with 11 people was conducted for the semantic validation of the instrument. The participants comprised psychologists working in different fields of psychology (clinical, teaching, school, psychological evaluation, organizational, and social). The first author considered all the observations made by the group and semantically adapted the translation. The final version was approved by the same group.

The scale, along with the other instruments, was entered into SurveyMonkey, which was used as a tool for online data collection. The initial invitation to participate in the study was made through social media to psychology professionals, regional professional councils, and psychologist-related organizations. The sample was characterized as non-probabilistic, specifically using a snowball sampling technique. Participants had access to the consent form, and only after accepting it, could they access the scale. Participants were also asked to invite at least one more colleague, if possible, to participate in the study.

Data Analysis

The data analysis was performed using R 4.2.0, in RStudio 2022.02.3. The sample was characterized by descriptive statistics (frequency, mean, median, mode, minimum and maximum values, and standard deviations), differentiating categorical variables from continuous variables.

Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used. The database was randomly divided using an R command, selecting 280 participants for EFA (subsample 1) and the remaining 330 participants CFA (subsample 2).

EFA was used for subsample 1 to determine the psychometric properties of the instrument and analyze the initial internal consistency. Direct Oblimin Rotation was used to identify correlations among the components. Parallel analysis was performed to determine the number of factors. Items with factor loadings equal to or greater than 0.30 [22] were retained.

In subsample 2, CFA was conducted to confirm the structure identified in the EFA. The model was estimated using the robust maximum likelihood method. The following fit indices were used: SB χ²; RMSEA (Root Mean Square Error of Approximation), cutoff ≤ 0.08; SRMR (Standardized Root Means Squared Residual), cutoff ≤ 0.08;); CFI (Comparative Fit Index) and NNFI (Nonnormed Fit Index), cutoff ≥ 0.95 [23].

To determine the internal consistency of the final model, Cronbach's alpha (α) and Intraclass Correlation Coefficient (ICC) with a cutoff of ≥ 0.70 were used [24].

The continuous variables were tested for normal distribution using the Kolmogorov–Smirnov test. Spearman correlations were performed to test the potential correlation of the WRQoL scale and the other instruments. A statistical significance level of p ≤ 0.05 was used as a parameter to interpret the results. The correlation coefficient of 0.10 was considered small, 0.30, medium, and 0.50, large. Additionally, Cohen's d of 0.20 was considered small, 0.50, medium, and 0.80, large in effect size [25]. For comparing sociodemographic characteristics, group comparisons were performed using the following tests: Chi-square, Mann–Whitney U, and Kruskal–Wallis, depending on the distribution type.

Sample Characterization

Of the participants, 87% are women and 34.7% have a monthly income between $520.80 and $1,041.60. Most of the professionals have graduate degrees (68.9%), are unemployed (43.0%), and have more than one job (58.3%) — Table 1.

Table 1

Sociodemographic characteristics of the sample (n = 610).
Variables		n (%)
Region in which you live	Northeast	204 (33)
	North	45 (7.4)
	Southeast	151 (24.7)
	South	147 (24.2)
	Midwest	63 (10.4)
Training	Undergraduate Degree	84 (13.8)
	Specialization	420 (68.9)
	Master's Degree	84 (13.8)
	PhD	22 (3.6)
Work activity	Employed	187 (30.7)
	Unemployed	262 (43.0)
	Both	138 (22.6)
How satisfied are you professionally	Very much	110 (18.0)
	Quite	323 (53.0)
	Indifferent	33 (5.2)
	Little	122 (20)
	Very little	22 (3.6)
Would you change your profession	Yes	146 (23.9)
	No	464 (76.1)
*The sum of the number of responses may differ from the total sample because of missing data. ^IBrazil is divided into 5 major regions.

--------------------------------------------Insert Table 1 here---------------------------------------------

Regarding the participants' health and quality of life issues, 55.1% are undergoing psychotherapeutic treatment, 44.6% have a diagnosed anxiety condition, and 26.7% have been diagnosed with depression. Additionally, 22.5% are taking psychotropic medication, and 18.7% have been absent from work owing to emotional issues. Furthermore, the majority answered that they engage in leisure activities (87.4%) and physical activity (63.3%).

Exploratory Factor Analysis

The semantic validation of the WRQoL scale resulted in a 28-item version (Supplementary Material 1), which was approved by the focus group and subsequently subjected to factor analyses.

Evaluation of skewness and kurtosis did not indicate severe outliers. The correlation between items was verified, and items 1, 15, and 27 were identified as having correlation values below 0.30 with several other items, which may indicate their possible exclusion in subsequent analyses.

The Kaiser-Meyer-Olkin (KMO) was 0.93, indicating factorability of the items, which was confirmed by Bartlett's test (χ²=4757.657, Degrees of freedom = 378, p ≤ 0.0001). All the anti-image matrix values for each item were above 0.50, indicating adherence to the initial model. Parallel analysis was performed and potentially indicated 5 factors.

Correlation between the factors was confirmed, so Oblimin Rotation was performed. The analysis indicated the presence of 5 factors. However, item 1 ("I have a set of goals that allows me to accomplish my work") was excluded because it did not have a minimum weight of 0.30 in any factor. Additionally, items 8 ("My current workload satisfies my personal circumstances") and 11 ("When I do a good job, I am praised by my supervisor") were excluded because they did not show a minimum difference of 0.10 in weight in different factors. The composite reliability (CC) for the scale was 0.95, factor 1 was 0.91, factor 2 was 0.75, factor 3 was 0.80, factor 4 was 0.89, and factor 5 was 0.74.

Confirmatory Factor Analysis

CFA was conducted with subsample 2. This indicated a decline in factor 5 due to correlation values lower than 0.30 in three out of four items. The final CFA model showed the following model fit values: χ²= 894.610; gl = 183; p < 0.001; CFI = 0.993; NNFI = 0.992; RMSEA = 0.083 (CI = 0.075–0.090). Thus, the final model presented 4 factors and 21 items (Fig. 1). Item 12 ("Lately, I have been feeling unhappy and depressed") was reversed.

--------------------------------------------Insert Fig. 1 here---------------------------------------------

Cronbach's alpha was calculated for the final structure confirmed by CFA, considering the entire study sample (N = 610). The values for the overall WRQoL scale were as follows: α = 0.94 (95% CI [0.94–0.95]) for Factor 1, α = 0.92 (95% CI [0.91–0.93]) for Factor 2, α = 0.87 (95% CI [0.85–0.89]) for Factor 3, α = 0.88 (95% CI [0.87–0.90]) for Factor 4, and α = 0.80 (95% CI [0.77–0.82]) for Factor 5.

Considering that the WRQoL scale has been translated into several languages, a descriptive comparison of the different validations is proposed in Table 2.

Table 2

Comparison with translations of the WRQoL scale in other languages.
Autor	Country	Scale Used	Sample Calculation	Study population	Participants	Sex	Mean Age	CFA	Average overall score	Internal Consistency
Van Laar e Easton (2012)	United Kingdom	24	Yes	Employees of the UK National Health Service	953	86% F 14% M	± 45 years	yes		α = 0.91
Dai et al. (2016)	Thailand	24	No	Nurses	30 in phase 1 and 213 in phase 2	97.7% F 2.3% M	34.57 years	no	4.3 (0.42); used 0–5 scale	α = 0.88
Shabaninejad et al. (2012)	Iran	24	No	Family Doctors	84			no	46 (12); used a scale of 0–100	α = 0.78
Gomes et al. (2013)	Portugal	24	No	Higher education professors of nursing	183			no
Garzaro et al. (2020)	Italy	32	No	Hospital nurses and doctors	430	74.2% F 25.8% M	44.5 (± 9.45) years	yes
Shukla et al. (2017)	India	24	Yes	Employees of a hospital	132	50.75% F 49.24% M	31 (± 8 years)	no	4; used 0–5 scale	α = 0.82
The present study	Brazil	24	Yes	Psychology professionals	610	87% F 13% M		yes		α = 0.94
Note: F = Female, M = Male.

--------------------------------------------Insert Table 2 here---------------------------------------------

Results of the MBI, LSS, and WRQoL scales and their correlations

The mean LSS score was 24.05 (± 6.14) points, and 39% of the psychologists were satisfied with their lives. More than half of the professionals had moderate to high levels of Emotional Exhaustion (EE − 79%) and Depersonalization (DP − 60.2%). The mean WRQoL score was 55.00 (± 14.32) points. The scores of the factors evaluated in the WRQoL scale indicated, in general, adequate levels of work-related quality of life — Table 3.

Table 3

Results of the MBI, Life Satisfaction Scale (LSS), and Work-Related Quality of Life (WRQoL) Scale.
Scales ^a	n (%)	Median (IQR)	Mean (SD)	Interquartile Range
Overall life satisfaction (5–35 points)		26.0 (8.0)	24.05 (6.14)	0.49
Extremely dissatisfied	11 (1.8%)
Dissatisfied	41 (6.7%)
Moderately dissatisfied	69 (11%)
Neutral	27 (4.4%)
Moderately satisfied	142 (23%)
Satisfied	238 (39%)
Extremely satisfied	82 (13%)
MBI Emotional Exhaustion (9–45 points)		23.0 (9.0)	7.88 (6.6)	0.42
Low	124 (20%)
Moderate	326 (53%)
High	160 (26%)
MBI Depersonalization (5–25 points)		7.0 (4.8)	7.88 (2.72)	0.22
Low	244 (40%)
Moderate	322 (53%)
High	44 (7.2%)
MBI Personal Accomplishment Burnout (8–40 points)		16.0 (4.0)	15.99 (3.67)	0.29
Low
Moderate	2 (0.3%)
High	608 (99.7%)
WRQoL Factor 1: General Well-Being (0–40 points)		28.0 (10.0)	26.02 (7.45)	0.59
WRQoL Factor 2: Home-Work Interface (0–12 points)		8.0 (3.0)	7.47 (2.81)	0.22
WRQoL Factor 3: Working Conditions (0–16 points)		11.0 (4.0)	10.14 (3.74)	0.30
WRQoL Factor 4: Capacity and Ability (0–16 points)		12.0 (3.0)	11.36 (2.85)	0.23
WRQoL Total (0–84 points)		57.0 (19.0)	55.0 (14.32)	1.14
Notes: ^aMinimum and maximum values of the scales in parentheses. Confidence interval 0.95. IQR = interquartile range. SD = standard deviation.

--------------------------------------------Insert Table 3 here---------------------------------------------

The LSS showed negative association with all scales of the MBI (p < 0.001), with higher correlation in the EE domain (Rho=-0.47) and Personal Accomplishment Burnout (Rho=-0.45), and positive association with all factors of the WRQoL scale (p < 0.001), with high correlation for factor 1 (Rho = 0.76) and the overall WRQoL scale (Rho = 0.67). The MBI showed good correlation between its scales (p < 0.001), and the MBI EE and the MBI DP were highly correlated with factor 1 of the WRQoL scale (Rho=-0.59 and Rho=-0.31, respectively) and the overall scale (Rho=-0.59 and Rho=-0.29, respectively). The highest correlations of MBI personal achievement burnout and the WRQoL scale were with factor 1 (Rho=-0.56), factor 4 (Rho=-0.55), and the overall WRQoL scale (Rho = 0.57). All WRQoL factors were strongly correlated among themselves (p < 0.001) and with the total scale (p < 0.001), confirming that the scale measures what it proposes.

For this study, we translated the WRQoL Scale into Brazilian Portuguese and validated this version, which showed adequate psychometric properties and evidence that the scale is relevant for assessing Work-Related Quality of Life. The Cronbach's alpha (α = 0.94) of this version was higher than those of the original scale (α = 0.91) [15] and other translations [26–30]. However, differences were found between the present results and the original scale and the other translated versions. In the Brazilian Portuguese version of the WRQoL scale, the following factors were confirmed: General Well-Being (10 items), Home-Work Interface (3 items), Working Conditions (4 items), and Capacity and Ability (4 items).

There are some possible explanations for the divergences between the Brazilian version of the WRQoL scale and the original scale in English and other languages. First, CFA was not conducted for some translated versions, which may have resulted in a different number of items and factors. The focus group suggested that some translated terms needed to be modified to enhance the understanding of the target audience. Most of the target audience comprised self-employed professionals or workers from institutions. Furthermore, this translation was a first for a Latin American country, and it may differ from translations in European and Asian countries because of the language and culture [31]. However, the psychometric properties and structure of the Brazilian Portuguese version are strongly supported by the statistical analyses performed.

Analysis of the responses in the LSS revealed that over 50% of the sample expressed satisfaction and extreme satisfaction with their lives. This result likely indicates a sense of self-realization both personally and professionally, which was also observed by Moreno-Milan et al. [32].

A significant portion of the participating professionals presented moderate to high levels of EE and DP (79% and 60.2% respectively), indicating a high level of burnout, which is higher than the values reported by Simionato and Simpson [6] for psychotherapists (54.54% of the sample). Despite the levels of EE and DP, high personal accomplishment (PA) was prevalent. This finding is consistent with previous studies on health professionals [33–35], which indicates that despite experiencing burnout, health professionals have adequate levels of PA. This may be due to the association of this work with the perception of being useful and contributing to the development of others [3, 10].

Of the three dimensions of burnout, EE was the most prevalent in the present sample, and it has been found in samples of healthcare professionals, such as physicians and nurses [7, 12, 36]. Other studies on psychotherapists indicate the presence of moderate to high levels of EE, with percentages ranging from 32.01% [6] to 47.9% [10].

The three dimensions of the Burnout scale correlated negatively with the four factors of the WRQoL scale as well as the overall scale. This indicates a negative association between psychologists' burnout and quality of work life, which was also found by Kim et al. [37] in their survey of nurses. The balance between personal life and work is reported in the literature as predictive of burnout [6, 38]. In other words, higher levels of burnout are associated with lower levels of WRQoL in the "Home-work interface," indicating a moderate association between these two factors [11].

In literature, the negative association between WRQoL and burnout is portrayed through ergonomic problems, work pressure, and factors in the work context, such as high psychological, emotional, cognitive, and psychic demands and a lack of favorable working conditions [11, 39]. Hence, conducting an in-depth study on the actual working conditions of psychologists could facilitate interventions aimed at enhancing their working conditions.

The “personal accomplishment” dimension in Burnout and its negative correlation with the “Capacity and Ability” domain of the WRQoL scale could be attributed to the diminished sense of competence to fulfill work responsibilities [4]. Hammond et al. [2] identified intensive work demands on psychologists, which require additional effort and skills to manage.

In agreement with a previous study [15, 40], they identified that overall life satisfaction influences WRQoL. Life satisfaction is positively associated with the sense of being better prepared to develop new skills [41].

In general, the participants showed adequate levels of life satisfaction, despite the data being collected during the pandemic. Perhaps this finding stem from the nature of the psychologist's profession, as they may have felt useful to others [3] heightened by the perception of contributing to a global phenomenon, namely, the increase in mental health demand during the pandemic period [42].

Finally, this study has limitations and strengths. A limiting factor is the period of data collection, which was at the beginning of the COVID-19 pandemic. This is because some findings in the literature indicate changes in the mental health of healthcare professionals during this period [43, 44].

On the other hand, the present study has strengths that contribute to the reliability of its results. These points include: diversity of activities among psychology professionals; participation of professionals from all over Brazil; use of different sub-samples for exploratory and confirmatory factor analyses; use of different instruments based on the international scientific literature to assess aspects of psychologists' mental health.

Measuring work related quality of life presents challenges owing to the lack of a single concept and a lack of consensus among scholars regarding the factors involved. The WRQoL Scale has proven to be a good measuring instrument in several countries. The Brazilian version demonstrated adequate psychometric properties, as evidenced by its construct validity and internal consistency. This provides evidence that the WRQoL scale can be effectively used for assessing work related quality of life.

Because it is a scale based on a multidimensional concept, the instrument can be used in various work contexts. The easy access to the instrument by researchers makes it a viable option for use in research. This study was conducted with psychology professionals, and it is important to expand this research to include other occupations in the future.

In addition to validating the WRQoL scale, it is important to examine the moderate to high levels of burnout in the sample. The high levels of EE may be associated with the nature of the profession, which generally deals with people who are suffering. There is room for reflection on educational programs in colleges and universities to promote a less technical approach, including the inclusion of additional modules on self-care, social skills training, and problem-solving. It is also necessary to provide ongoing training throughout one's career, emphasizing the importance of professional organizations as support for professionals who are experiencing burnout.

Composite Reliability

CFA

Confirmatory Factor Analysis

CFI

Comparative fit index

Depersonalization

Emotional Exhaustion

EFA

Exploratory Factor Analysis

ICC

Intraclass Correlation Coefficient

KMO

Kaiser-Meyer-Olkin Test

LSS

Life Satisfaction Scale

MBI-HSS

Maslach Burnout Inventory

NNFI

Nonnormed Fit Index

Personal Accomplishment

RMSEA

Root Mean Square Error of Approximation

SRMR

Standardized Root Means Squared Residual

WRQoL

Work-Related Quality of Life

Ethics approval and consent to participate

Participation was voluntary and anonymous. All participants provided informed consent, and the study was conducted in accordance with the Declaration of Helsinki. The study protocol received approval from the National Research Ethics Commission [Certificate of Presentation for Ethical Review (CAAE): 62908016.2.0000.5624], after submission to the Ethics Committee of the University Center of Juazeiro do Norte (Unijuazeiro).

Consent for publication

Not applicable.

Availability of data and materials

All data needed to evaluate the conclusions in the paper are present in the paper. Researchers interested in accessing the data are asked to write to the corresponding author.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors' contributions

S.M.S.F. participated in the conceptualization, methodology, validation, formal analysis, resources and data curation, and writing (original draft preparation, review, and editing). V.Z. participated in the conceptualization, methodology, formal analysis, writing (original draft preparation, review, and editing), and project administration. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

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No competing interests reported.

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Burnout, Life Satisfaction, and Work-Related Quality of Life among Psychologists

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Abstract

Background

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Background

Methods

Participants

Instruments

Procedures

Data Analysis

Results

Sample Characterization

Exploratory Factor Analysis

Confirmatory Factor Analysis

Results of the MBI, LSS, and WRQoL scales and their correlations

Discussion

Conclusion

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