Relationship between Psychosocial Work Hazards and Occupational Burnout among Direct Care Staff at Service Institutions for Individuals with Physical and Mental Disabilities

doi:10.21203/rs.3.rs-3908733/v1

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Research Article

Relationship between Psychosocial Work Hazards and Occupational Burnout among Direct Care Staff at Service Institutions for Individuals with Physical and Mental Disabilities

https://doi.org/10.21203/rs.3.rs-3908733/v1

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Background

Understanding the relationship between workplace hazards and occupational burnout among direct care staff at disability service institutions is crucial for cultivating positive workplace environments for employees at such institutions. This study investigated this relationship among direct support staff at disability service institutions and examined the factors associated with occupational burnout.

Methods

The Chinese versions of the Copenhagen Burnout Inventory, Effort–Reward Imbalance Model, and Demand–Control–Support Model were used to evaluate the work hazards and occupational burnout of direct care staff working at disability service institutions. A total of 361 Taiwanese direct care staff aged ≧ 20 years from six disability service institutions in Taiwan were recruited through convenience sampling, and the data were analyzed via SPSS 22.0 software.

Results

The mean total psychological job demands score was 19.4 ± 2.6 (range = 13–28), and the total job control score was 65.1 ± 7.7 (range = 42–96). The mean physical job demands score was 2.9 ± 0.6 (range = 1–4), and the total occupational burnout score was 7.7 ± 3.6 (range = 0–20). The correlation matrix revealed a significant relationship between individual psychosocial work hazards and occupational burnout (p < 0.01). Finally, a multivariate multiple regression model revealed that shift work, total job control, psychological job demands, and physical job demands were significantly associated with the total occupational burnout score after controlling for participants’ demographic factors (R² = 0.454, p < 0.001).

Conclusions

According to these findings, disability service institutions can cultivate positive workplace environments by understanding the workplace conditions, job stress, and personal characteristics of their employees and the interactions among them and by analyzing the effects of these factors on occupational burnout and workplace fatigue.

Work hazards

Occupational burnout

Health promotion

Positive workplace culture

Disability service institutions

Direct care staff

The participation of individuals with physical and mental disabilities in society is limited, and the health care needs and medical expenses of such individuals are often greater than those of the general population. However, the Taiwanese health-care system is often unable to provide individuals with disabilities with the appropriate care policies and services [1]. Furthermore, minimal consistent growth has been observed in the Taiwanese government's budget for mental and physical disability benefits [2]. Although Western countries continue to promote the deinstitutionalization of care for mental and physical disability and advocate community-based care models, Taiwan's institutional care model continues to fulfill the needs of Taiwanese individuals with disabilities. The number of disability service institutions in Taiwan increased from 244 in 2004 to 271 in 2018, indicating that the demand for institutional care in Taiwan has remained strong. According to government statistics, in 2018, approximately 22,387 individuals with physical and mental disabilities were scheduled to be placed in the 271 disability service institutions across Taiwan. Among these individuals, 15,838 (70.7%) were receiving full-time residential care, and 5,735 (25.6%) were receiving day care services at the institutions [3, 4]. The main function of a disability care institution is to provide a set of long-term care services for individuals with physical and mental disabilities who rely on others to perform activities of daily living, with the aim of improving or maintaining these individuals’ intrinsic capacity, thus increasing their ability to care for themselves and live independently.

The participation of individuals with physical and mental disabilities in society is limited, and the health care needs and medical expenses of such individuals are often greater than those of the general population. In general, individuals with mental and physical disabilities have poorer health, higher rates of disease [5–7], and greater medical needs and require greater social welfare and medical resources [8, 9]. In addition, individuals with physical and mental disabilities who have both cognitive and communicative functional limitations may have difficulty expressing themselves and be more dependent on care staff to provide behavioral support and assist them with activities of daily living. This results in a heavier workload for caregivers [10, 11], which has negative physical [11, 12] and psychological effects on caregivers [13] and may affect their quality of life [14].

Occupational burnout is a common health-related and behavioral indicator of excessive job stress, and it can negatively affect the overall social, financial, and mental health of care staff. Long-term job fatigue that exceeds physical and psychological available loads [15] can cause emotional exhaustion and physical fatigue [16], physical and psychological discomfort, lower back pain [17], musculoskeletal discomfort, and cardiovascular disease among care staff [18]. Occupational burnout, or job fatigue, is caused not only by genetic and physiological factors but also by personal, psychological/cognitive, lifestyle and work factors [19, 20].

Many previous studies have indicated that working in disability services can be stressful and that care staff tend to experience a greater prevalence of depression, burden and psychological distress than the general population [13, 21, 22]. Occupational burnout has shown the highest correlations with negative job satisfaction, working and emotional demands and role conflicts [23]. Vassos et al. [24] reported that role ambiguity, as a workplace demand, and job feedback, as a workplace resource, were consistently associated with both work engagement and burnout in disability support workers. Another study showed that the self-reported health status of care staff and occupational burnout significantly predicted personal burnout [22]. A high workload, low job control and low colleague support were related to greater burnout and lower work engagement [25]. Many other factors, such as work overload, limited participation in decision-making, and front-line caregiving have been shown to be positively associated with staff burnout [26–29].

Absenteeism, resignation, accidents, and health problems caused by stress incur high costs for disability service institutions every year and directly affect the work performance and quality of care provided by employees at such institutions [30]. High employee turnover is a major problem faced by numerous disability service institutions [31]. Understanding workplace conditions, psychosocial work hazards, and occupational burnout among caregivers is crucial for cultivating positive workplace environments at disability service institutions. The Copenhagen Burnout Inventory, Demand–Control–Support Model, and Effort–Reward Imbalance Model are effective for assessing psychosocial work hazards and occupational burnout [32]. The Copenhagen Burnout Inventory comprises three subscales that measure burnout caused by different factors: the personal burnout subscale, which measures overall burnout (including that related to work and life outside work); the work-related burnout subscale, which measures occupational burnout; and the client-related burnout subscale, which measures burnout caused by interacting with clients at work [33, 34]. The Demand–Control–Support Model, which was proposed by Karasek and Theorell [35], states that a lack of job control is the main cause of job stress and that stress is caused by the interaction between workload and job control, specifically related to job content and organizational structure. The Effort–Reward Imbalance Model was developed according to social exchange theory, which suggests that stress is caused by an imbalance between effort and reward, particularly in situations involving high effort and low reward [36]. Overcommitted employees who experience an effort–reward imbalance are at a higher risk of stress-related adverse health effects [37]. A tendency to overwork is often observed in many suspected cases of overwork, and overworking is most common among middle-aged and highly educated men [38, 39]. Overworking and effort–reward imbalances are not equivalent to occupational burnout but are strong risk factors for burnout. Based on the above models, this study investigated the relationship between psychosocial hazards and occupational burnout among institutional caregivers to explore the correlations between the personal and professional characteristics of caregivers, the psychosocial work hazards they encounter, and their degree of occupational burnout; additionally, the factors related to occupational burnout among care staff working in disability service facilities were explored.

Previous studies on employee stress and workplace environments have employed instruments such as the Copenhagen Burnout Inventory, Effort–Reward Imbalance Model, and Demand–Control–Support Model [32], which can effectively be used to assess workplace stress among caregivers at disability service institutions [13, 40]. The research framework employed in this study was developed with reference to the above models to assess the job characteristics and occupational burnout of care staff at disability service institutions. The basic demographic characteristics and job perceptions of the participants as well as the characteristics of the institutions at which they were employed were first evaluated, and the effects of these factors on the participants’ workloads and degrees of occupational burnout were analyzed.

Target population

According to the “Overview of Welfare Service Institutions for People with Disabilities” published by the Department of Statistics of Taiwan’s Ministry of Health and Welfare at the end of 2020, Taiwan had 266 disability service institutions employing a total of 9,455 individuals. These employees included 6,134 direct care staff (1,122 men and 5,012 women), of whom 3,351 were training and teaching staff (488 men and 2,863 women) and 2,783 were life assistants (634 men and 2,149 women) [4]; these employees constituted the target population in the present study.

Sample size

The study population included 6,134 individuals. Accounting for a sampling error rate of 5% with a 95% confidence interval, a required sample size of 361 valid participants was obtained using the online version of the Creative Research Systems sample size calculator [41]. Six service institutions for individuals with mental and physical disabilities were selected through convenience sampling, and Taiwanese direct support staff aged ≧ 20 years were surveyed. This study received ethical approval from the Taipei MacKay Memorial Hospital Institutional Review Board (Case Number: 20MMHIS033e).

Reliability and validity of the research instruments

In this study, data were collected through a cross-sectional survey conducted using a self-administered structured questionnaire. The data collection procedure first involved inviting the disability service institution to participate in the study, after which the researchers explained the study purposes to the institutional participants. After the participants provided informed consent, they could complete the questionnaire within two weeks. The questionnaire consisted of three main sections: basic caregiver information (demographic information, organizational characteristics, and overall job perceptions), job characteristics, and occupational burnout. Workplace hazards and occupational burnout were evaluated using the Job Characteristics Scale and Occupational Burnout Scale, respectively; Chinese versions of both scales have been developed and validated [42]. Both scales are in the public domain and can be used freely if cited properly [43, 44]; the scales also have good reliability and validity [33, 45]. The validity of the other sections (personal demographics, workplace characteristics, and overall job perceptions) was evaluated through expert face validity tests; the questionnaire was revised according to experts’ opinions to improve its validity. Regarding the reliability of this study, the Cronbach’s alpha was 0.833.

The psychosocial work hazards scale used in this study consisted of three aspects: job control (9 items), psychological job demands (7 items), and physical job demands (1 item). Each item on the questionnaire was rated on a 4-point Likert scale (from 1 = strongly disagree to 4 = strongly agree). The occupational burnout scale consisted of 5 items. The participants were asked to rate each of the items on a Likert scale, with responses of never, rarely, sometimes, often, and always corresponding to scores of 1 to 5. The reliability of the job control items, psychological job demands items, and occupational burnout scale items were calculated by the Cronbach’s alpha values, which were 0.556, 0.346, and 0.892, respectively.

Statistical analysis

After the questionnaires were collected, they were checked and analyzed by SPSS 22.0. Descriptive statistical analysis was performed; the participants’ demographic data, institutional characteristics, overall job perceptions, professional characteristics, and occupational burnout levels are presented herein as frequencies, percentages, means, maximum and minimum values, and standard deviations, as appropriate. Pearson's correlation analysis was used to examine correlations among the mean values of job control, psychological job demands, physical job demands, and occupational burnout. For multivariate analysis, a multiple regression model was used to explore the factors related to the job characteristics of and occupational burnout among the participants, controlling for basic demographic factors, institutional characteristics, and job perception–related variables.

Participants’ demographic and working characteristics

The study participants included 361 institutional direct support staff members, comprising 311 women (86.1%) and 50 men (13.9%), with an average age of 46.6 years (range: 20–67 years). Of these participants, 73.1% and 26.9% were married and unmarried, respectively. The greatest proportion of the sample had an education level below high school (44.6%), followed by a bachelor’s degree (39.3%) and a college diploma (16.1%). Most of the participants (73.8%) had a specific religious belief. Regarding family background, 71.2% of the participants had children; the remaining 28.8% had no children.

Information regarding the participants’ professional characteristics is presented in Table 1. The participants were divided into two groups according to their job title: institutional training and teaching staff (66.5%) and life assistants (33.5%). Both of these jobs involve providing direct services to people with disabilities. Of the participants, 96.9% reported that they worked 5 days per week, 88.3% reported that they worked 8 hours per day, and 53.4% and 46.6% had less than and more than 9 years of experience, respectively, working at their institutions. Regarding shift work in their institutions, 32.9% of the participants expressed that they were required to work shifts; the remaining 67.1% were not. Approximately 40%, 53.7%, and 6.4% of the participants perceived their health status to be very good or excellent, average, and poor or very poor, respectively. In an additional comparison of the participants’ perceived health status before working at their respective institutions and their current perceived health status, 60% of the participants reported that their current health status was approximately the same as or worse than that before their employment at their respective institutions.

Table 1

Working characteristics of the study participants (N = 361)
Variable	n	%	Mean ± S.D.
Job category
Training and teaching staff	240	66.5
Living assistant	121	33.5
Working days weekly (n = 360)			5.02 ± 0.17 (4–6)
≦5 days	351	97.5
6 days	9	2.5
Working hours daily (n = 359)			8.17 ± 0.68 (4–12)
≦8 hours	320	89.1
>8 hours	39	10.9
Disability service experience
No	311	86.1
Yes	50	13.9
Disability working years (n = 358)			9.73 ± 8.28 (0.08–35.08)
<9 years	191	53.4
≧9 years	167	46.6
Shift work (n = 359)
No	241	67.1
Yes	118	32.9
Health status
Excellent + good	144	39.9
Fair + poor	217	60.1

Psychosocial work hazards and occupational burnout

Regarding psychosocial work hazards (Table 2), 65.9% and 4.7% of the participants agreed and strongly agreed, respectively, with Q1 (My job requires me to work fast); 67.6% and 10.2% agreed and strongly agreed, respectively, with Q2 (My job requires me to work hard); 54% and 3% agreed and strongly agreed, respectively, with Q3 (My workload is excessive); 56.5% and 3.3% agreed and strongly agreed, respectively, with Q4 (I have insufficient time to complete my work); 74.8% and 12.7% agreed and strongly agreed, respectively, with Q5 (My work requires me to concentrate for long periods); 74.5% and 11.6% agreed and strongly agreed, respectively, with Q6 (I am very busy at work); and 46.5% and 23.5% agreed and strongly agreed, respectively, with Q7 (My colleagues at my workplace are inadequate). The mean and standardized total psychological job demands scores were 19.4 ± 2.6 (range: 13–28) and 58.8 ± 12.5 (range: 28.6–100), respectively.

Table 2

Psychological job demand–related responses of the study participants (N = 361)
Scale item	Strongly disagree n (%)	Disagree n (%)	Agree n (%)	Strongly agree n (%)
Q1. My work requires me to work fast.	2 (0.6)	104 (28.8)	238 (65.9)	17 (4.7)
Q2. My work requires me to work hard.	4 (1.1)	76 (21.1)	244 (67.6)	37 (10.2)
Q3. My workloads are excessive.	13 (3.6)	142 (39.3)	195 (54.0)	11 (3.0)
Q4. I have not enough time to get the job done.	14 (3.9)	131 (36.3)	204 (56.5)	12 (3.3)
Q5. My work requires me to be concentrate on job for long time.	2 (0.6)	43 (11.9)	270 (74.8)	46 (12.7)
Q6. I am very hectic at work.	1 (0.3)	49 (13.6)	269 (74.5)	42 (11.6)
Q7. My colleagues at my workplace are inadequate	7 (1.9)	101 (28.0)	168 (46.5)	85 (23.5)
Total score^a (Mean ± S.D.)	19.4 ± 2.6 (range: 13–28)
Standardized score^b (Mean ± S.D.)	58.8 ± 12.5 (range: 28.6–100)
^aTotal score = Q1 + Q2+(5-Q3)+(5-Q4) + Q5 + Q6 + Q7
^bStandardized score=[(total score-7)÷(28 − 7)] ×100%

As indicated in Table 3, the mean and standardized total job control scores were 65.1 ± 7.7 (range: 42–96) and 57.1 ± 10.6 (range: 25–100), respectively. Overall, 69.3% and 28.5% of the participants agreed and strongly agreed, respectively, with Q1 (“My work requires me to learn new things”); 74% and 15.8% agreed and strongly agreed, respectively, with Q2 (“My job involves a lot of repetitive tasks”); 72% and 16.6% agreed and strongly agreed, respectively, with Q3 (“My work requires me to be creative”); 60.7% and 6.1% agreed and strongly agreed, respectively, with Q4 (“My work allows me to make my own decisions”); 59% and 4.4% agreed and strongly agreed, respectively, with Q5 (“My work requires high-level skills”); 37.4% and 2.8% agreed and strongly agreed, respectively, with Q6 (“I’m not permitted to decide how I do my work”); 72.6% and 13.9% agreed and strongly agreed, respectively, with Q7 (“I can do a variety of things at my job”); 64.3% and 1.9% agreed and strongly agreed, respectively, with Q8 (“My opinions affect things that happen at work”); and 66.8% and 3.3% agreed and strongly agreed, respectively, with Q9 (“My work provides opportunities for me to develop my abilities”).

Table 3

Job control–related responses of the study participants (N = 361)
Scale item	Strongly disagree n (%)	Disagree n (%)	Agree n (%)	Strongly agree n (%)
Q1. My work requires me to learn new things.	4 (1.1)	4 (1.1)	250 (69.3)	103 (28.5)
Q2. There are a lot of repetitive tasks in my work.	1 (0.3)	36 (10.0)	267 (74.0)	57 (15.8)
Q3. My work requires me to be creative.	3 (0.8)	38 (10.5)	260 (72.0)	60 (16.6)
Q4. My work allows me to make my own decisions.	8 (2.2)	112 (31.0)	219 (60.7)	22 (6.1)
Q5. My work requires high level of skills.	6 (1.7)	126 (34.9)	213 (59.0)	16 (4.4)
Q6. I don’t get to decide on how I would do my work.	11 (3.0)	105 (56.8)	135 (37.4)	10 (2.8)
Q7. I can do a variety of things at my job.	1 (0.3)	48 (13.3)	262 (72.6)	50 (13.9)
Q8. My opinions affect things that happen at work.	8 (2.2)	114 (31.6)	232 (64.3)	7 (1.9)
Q9. My work provides opportunities for me to develop my abilities.	7 (1.9)	101 (28.0)	241 (66.8)	12 (3.3)
Total Score^a (Mean ± S.D.)	65.1 ± 7.7 (range: 42–96)
Standardized score^b (Mean ± S.D.)	57.1 ± 10.6 (range: 25–100)
^aTotal score = SD + DA
Skill discretion, SD; SD=[Q1 + Q3 + Q5 + Q7 + Q9+(5-Q2)] × 2
Decision authority, DA; DA=[Q4 + Q8+(5-Q6)] × 4
^bStandardized score=[(total score-24)÷(96 − 24)] ×100%

Regarding the participants’ physical job demands scores, 74.5% and 25.5% of the participants agreed and disagreed, respectively, with the statement “My job requires a lot of physical effort.” The mean physical job demands score was 2.9 ± 0.6 (range: 1–4), indicating that most of the participants considered their work to be physically demanding.

Regarding occupational burnout among the participants (Table 4), 13.9% and 3.6% of the participants felt that their work was emotionally exhausting most or all of the time, respectively; 9.7% and 1.7% felt that their work was frustrating most or all of the time, respectively; 10.5% and 3.9% felt worn out at the end of the working day most or all of the time, respectively; 8.6% and 3% felt exhausted in the morning at the thought of another day at work most or all of the time, respectively; and 3.3% and 0.8% felt that every working hour was tiring for them most or all of the time, respectively. The mean total occupational burnout score was 7.7 ± 3.6 (range: 0–20). Table 5 presents the correlations between individual psychosocial work hazards and occupational burnout, all of which were significant (p < 0.01).

Table 4

Occupational burnout–related responses of the study participants (N = 361)
Scale item	Never n (%)	Seldom n (%)		Sometimes n (%)	Often n (%)	Always n (%)
Q1. Is your work emotionally exhausting?	25 (6.9)	106 (29.4)		167 (46.3)	50 (13.9)	13 (3.6)
Q2. Does your work frustrate you?	22 (6.1)	125 (34.6)		173 (47.9)	35 (9.7)	6 (1.7)
Q3. Do you feel worn out at the end of the working day?	23 (6.4)	131 (36.3)		155 (42.9)	38 (10.5)	14 (3.9)
Q4. Are you exhausted in the morning at the thought of another day at work?	46 (12.7)	153 (42.4)		120 (33.2)	31 (8.6)	11 (3.0)
Q5. Do you feel that every working hour is tiring for you?	81 (22.4)	189 (52.4)		76 (21.1)	12 (3.3)	3 (0.8)
Total score^a (Mean ± S.D.)			7.7 ± 3.6 (range: 0–20)
Standardized score^b (Mean ± S.D.)			38.4 ± 18.0 (range: 0-100)
^a Total score of work-related burnout = Q1 + Q2 + Q3 + Q4 + Q5
^b Standardized score = total score of work-related burnout × 5

Table 5

Correlations between psychosocial work hazards and occupational burnout among the study participants (N = 361)
Scales	Job control	Psychological job demands	Physical job demands
Psychological job demands	-0.046
Physical job demands	-0.074	0.503^*
Work-related burnout	-0.199^*	0.608^*	0.378^*
^*p: <0.01

Regression analysis of occupational burnout

Table 6 presents the results of the factor analysis of occupational burnout performed using the multiple regression model. After controlling for demographic factors, the total occupation burnout score was significantly associated with shift work (p = 0.048), total job control score (p < 0.001), psychological job demands score (p < 0.001), and physical job demands score (p = 0.041) (R² = 0.454, p < 0.001). Participants with shift work, a lower job control total score, a higher psychological job demands total score and a higher physical job demands score were more likely to have a greater occupation burnout score than their counterparts.

Table 6

Multiple regression analysis of the occupational burnout scores of the study participants (N = 347)
Variable	β	S.D.	t value	p value
Constant	0.469	1.948	0.241	0.810
Gender (Men vs. Women)	0.473	0.456	1.038	0.300
Age (<45 vs. ≥45)	-0.622	0.377	-1.650	0.100
Education (Senior high and less vs. College and above)	-0.022	0.380	-0.057	0.954
Marital status (Unmarried vs. Married)	-0.555	0.386	-1.437	0.152
Religion (No vs. Yes)	-0.147	0.355	-0.413	0.680
Job category (Training and teaching staff vs. Living assistant)	-0.563	0.366	-1.540	0.125
Working days weekly ( ≦ 5 vs. 6)	0.473	0.954	0.496	0.620
Working hours daily ( ≦ 8 vs.>8)	-0.168	0.493	-0.340	0.734
Work Shift (No vs. Yes)	-0.680	0.343	-1.982	0.048
Job control total score	-0.101	0.020	-4.961	<0.001
Psychological job demands total score	0.672	0.068	9.839	<0.001
Physical job demands score	0.578	0.281	2.054	0.041
R² = 0.454; Adjusted R² = 0.434
F = 23.102, P value < 0.001

Occupational burnout is a disease characterizing modern society and is a major public health issue. According to the “Overview of Welfare Service Institutions for People with Disabilities” published by the Department of Statistics of Taiwan’s Ministry of Health and Welfare at the end of 2018, Taiwan is home to 271 disability service institutions employing a total of 9,261 employees (1,817 men and 7,444 women; male/female = 1/4). The main categories of employees at these institutions are administrative staff, social workers, nursing staff, trainers, training and teaching staff, life assistants, other medical staff, and other staff. Among these professionals, training and teaching staff and life assistants are primarily responsible for providing front-line care services; the total number of front-line care service workers in Taiwan is 5,978 (1,023 men and 4,955 women; male/female = 1/4.8) [4]. The collected data reflect a considerable gender imbalance among the caregivers employed at disability service institutions in Taiwan and an even greater gender imbalance in the front-line care service workforce. Caregiving is traditionally considered women's work [46], and the role of men in caregiving is often overlooked in traditional cultures [47]. However, although the disability care industry is female-dominated, nearly one-fifth of employees at disability service institutions in Taiwan are men. Male caregivers at disability service institutions face work-related problems that differ from those encountered in ordinary workplaces, and their responses to such problems are worthy of attention.

The incidence of stress-related illnesses is significantly greater among people with high-stress work conditions and low social support [48]. Caregivers often encounter problems related to job stress and high workloads; shift work; inadequate workplace equipment, social support, supervisor appreciation, and preemployment training; and a lack of fun at work [49–52]. These problems often affect their willingness to stay at their workplaces. Overall, high workloads, low job control, and low social support are key factors that contribute to occupational burnout.

Numerous studies have yielded empirical evidence showing that excessive work hours increase the risk of physical and mental health problems such as hypertension [53, 54], acute myocardial infarction, occupational injuries [55], and workplace negligence [56]. Oliver et al. [57] noted that occupational burnout could be a potential negative consequence for caregivers working in intellectual disability institutions and quality services. Some studies have shown that caregivers at intellectual disability institutions are at risk of burnout [58] and have higher levels of occupational burnout than general employees [22, 59].

Associated factors of occupational burnout

Occupational absenteeism, staff turnover, accidents, and health problems caused by stress incur high costs for disability service institutions every year and directly affect the work performance and quality of care provided by employees at such institutions [30]. High employee turnover is a major problem faced by numerous disability service institutions [31].

Caregivers play a major role in providing institutional care and services to individuals with physical and mental disabilities [30]. Many studies have shown that institutional caregivers often overwork, experience high levels of job stress, and have high turnover rates [11, 60–62]. The physical and mental health of employees with high levels of job stress is often poor. Poor-quality or insufficient institutional and social support may also negatively affect the health of employees. Overall, employees working in disability service institutions have poorer self-perceived health than the general population. The present study revealed that those participants with shift work, a lower total job control score, a higher psychological job demands score, and a higher physical job demands score were significantly more likely to experience total occupational burnout according to a multivariate multiple regression model. Previous studies revealed that external effort, internal effort, and work feedback were significant predictors of the physical and mental health of employees [12, 13]; in addition, poorer self-perceived health status was found to be significantly associated with depression among employees [51]. Lin et al. [63] conducted a study on the physical activity and exercise habits of caregivers working in disability service institutions and discovered that employees with more work hours per week were less likely to engage in regular physical activity, thereby affecting their health behaviors and indicating that their physical activity should be increased to improve their health.

Female caregivers usually experience greater job stress than male caregivers do, and numerous explanations of the gender differences in job stress among institutional caregivers have been proposed [64–66], especially because women are more likely to be affected by additional stressors, such as financial problems and household chores. However, the present findings do not agree with those of previous studies. The main reason might be the difference in the sex ratio of the sample representative in this study, which needs to be investigated in the future. In addition, caregiving intensity is the main source of burnout and stress among male caregivers [67]. Structural factors, including job compensation, privileges, opportunities for advancement, and responsibilities, may contribute to differences in work stress [68]. In addition, although the workplace and job content of male and female caregivers at a given institution may be the same, gender differences in the caregiving process may result in gender differences in job stress [69].

Many of the study limitations include the following: disability institutions were difficult to recruit for participation in this study; therefore, we used convenience sampling instead of random sampling in this study. Because of its cross-sectional design, this study could not demonstrate a causal relationship between participants’ occupational burnout and its associated factors. The sex ratio of care staff in the study population was 0.22 (male vs. female); however, in this study, the ratio was 0.16. The representation of male participants in this study was slightly lower than that of the study population. Many factors, such as the employment type and economic status of the participants and the size of the organization, are important for preventing burnout among the care staff; these factors need to be considered in future studies. Furthermore, as the questionnaire collected self-reported data, recall bias might also have occurred in the study. Despite these limitations, this study is one of the first to explore the relationship between psychosocial work hazards and occupational burnout among staff working at disability service facilities in Taiwan, so the data can provide useful information for further mental health policy initiatives. Based on the present findings, future research should explore the long-term effects of psychosocial work hazards and occupational burnout among care staff working at disability service facilities and work to facilitate appropriate workplace health promotion programs to improve care staff’s health.

The study revealed that institutional staff members with shift work, lower job control, greater psychological job demands and greater physical job demands are more likely to have higher occupational burnout scores than their counterparts are. Similar to our study 10 years ago [22], the subjects in this study had higher occupational burnout and likewise greater work stress than did average full-time employees [70]. This evidence suggests a greater level of occupational burnout among staff at disability institutions for people with disabilities. To ensure the well-being and job rights of institutional staff, addressing the determinants of occupational burnout in future health planning is needed. Workplace health promotion is not limited to focusing on enhancing individual skills and abilities; sustainable operation and development of a disability service institution can be achieved only by strengthening cross-departmental cooperation, establishing a supportive workplace environment, transforming the organizational culture, and allowing for public health policy interventions. Disability service institutions are places where health promotion is crucial [71]. By providing insight into the personal characteristics, workplace conditions, and feelings of and interactions among care staff at such institutions, as well as analyzing the effects of such factors on occupational burnout, the results of this study may serve as a reference for disability service institutions looking to cultivate positive workplace environments for care staff.

Competing interests: The authors declare no conflict of interest.

Ethics approval and consent to participate: This study was approved by Taipei MacKay Memorial Hospital Institutional Review Board, approval number 20MMHIS033e, and informed consent was obtained from all participants. All methods were performed in accordance with the Declaration of Helsinki.

Consent for publication: Not applicable.

Funding: This research received no external funding.

Author Contributions: Conceptualization and methodology, J.D.L. and L.P.L.; data collection and analysis, L.P.L.; supervision, J.D.L.; writing—original draft, L.P.L.; writing—review and editing, J.D.L.; All authors have read and agreed to the published version of the manuscript.

Data Availability Statement: The data presented in this study are available on request from the corresponding author for research purposes.

Acknowledgements: We would like to thank the staff at service institutions for individuals with disabilities who participated in the study.

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No competing interests reported.

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Relationship between Psychosocial Work Hazards and Occupational Burnout among Direct Care Staff at Service Institutions for Individuals with Physical and Mental Disabilities

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Introduction

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Reliability and validity of the research instruments

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Research results

Participants’ demographic and working characteristics

Psychosocial work hazards and occupational burnout

Regression analysis of occupational burnout

Discussion

Associated factors of occupational burnout

Conclusions

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