Nursing and Health Sciences (2001), 3, 6971

Research Article

Burnout versus depression and sense of coherence: Study of Greek nursing staff
Athanassios Tselebis, rn, msc (psych),1 Aikaterini Moulou, rn2 and Ioannis Ilias, md, dsc 3
1 3

Department of Psychiatry, Sotiria Hospital, 2Blood Bank and Tranfusion Unit,A. Fleming Hospital and Klimax Foundation,Athens, Greece

Abstract

We assessed the relationships between burn out, depression and sense of coherence (SOC) using the Maslach Burnout Inventory, Becks depression inventory and Antonovskys SOC questionnaire in a large sample of 17 male and 62 female Greek nurses. Analysis showed that SOC in nursing staff was correlated with burnout (BO) and depression, while the latter was correlated to a lesser degree with BO. The relationship of BO with depression seems to be the result of the relationship between depression and SOC. Thus, we could hypothesize that the degree of SOC renders persons either vulnerable or resistant to both depression and BO, though further studies are warranted. In the hospital setting, the intervention by specialized personnel in order to assist nursing staff with BO may be an appealing option. Further, prevention programs aimed at helping individuals prone to BO could also be envisaged. burnout, nursing staff, questionnaires, professional psychology.

Key words

INTRODUCTION
Burnout (BO) is a state of physical, emotional and mental exhaustion caused by long-term involvement in situations that are emotionally demanding (Pines & Aronson, 1988) and is encountered frequently in health services personnel. The etiology of BO is apparently multifactorial. Excessive workloads, long working hours, frequent exposure to the dying process of inpatients, lack of personal motivation and misguided career expectations, among other factors, have been seen as causes of BO (Vachon, 1978; Maloney, 1982; Ongle, 1983; Maslach & Jackson, 1984; Mor & Laliberte, 1984; Cooper & Baglioni, 1988; Fong, 1993; Papadatou et al., 1994). Few studies have addressed the relationship between BO and personality traits, but some researchers believe that BO is in fact a variant of depression (Iacovides et al., 1997; Iacovides et al., 1999). Kobasa et al. (1982), using a questionnaire analogous to Antonovskys sense of

coherence (SOC) questionnaire, have proposed that subjects who are more resistant to stress are also more resistant to BO (Antonovsky, 1996). According to Antonovsky (1996), ethnic differences exist within SOC. Consequently, the aim of the present study was to assess the relationships between BO, depression and sense of coherence in Greek nurses using the (MBI), Becks depression inventory (BDI) and the SOC (Maslach & Jackson, 1986; Beck & Steer, 1987).

SUBJECTS AND METHODS

A random sample of 17 male and 62 female nurses in general internal medicine, general surgery and respiratory medical wards in one of the largest hospitals in Greece were included in the study (mean age SD : 34.7 5.5 years; mean SD work experience in the health sector : 11.0 6.3 years). Thirty-nine subjects were married and 40 subjects were single, while three of the single subjects were divorced. All the subjects replied in one sitting to the validated Greek versions of the MBI, the BDI and SOC questionnaires. Comparisons of MBI, BDI and SOC scores between men and women, single and married subjects were made

Correspondence address: Athanassios Tselebis, 4, Tsotakou Str., Ambelokipi, GR-11526, Athens, Greece. E-mail: ilias@compulink.gr Received 11 April 2001; accepted 9 May 2001.

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using the Students t-test while correlations were assessed between age, years of work experience, MBI, BDI and SOC scores and implementing the Bonferroni correction (Curtin & Schulz, 1998).

RESULTS
Men presented higher personal achievement scores on the MBI compared to women, while women showed higher scores on the BDI. Sentimental exhaustion and depersonalization scores from the MBI and SOC scores did not differ between the sexes. Moreover, no signicant differences between the parameters were noted between married and single subjects (Table 1). Signicant correlations emerged in the three different components of the MBI, as well as between each component and SOC scores. The SOC was also signicantly correlated with BDI. Correlation analysis showed that SOC was negatively, and strongly, correlated with BDI. The SOC scores were correlated with all MBI categories

(negatively with sentimental exhaustion and deperzonalization, positively with personal achievements). However, BDI was positively correlated with sentimental exhaustion and negatively with personal achievements from the MBI, though at a lesser degree than SOC (Table 2).

DISCUSSION
Analysis showed that SOC in nursing staff was correlated with BO and depression, while depression was correlated to a lesser degree with BO. Consequently, the relationship between BO and depression seems to be the result of the relationship between depression and SOC. Hence, we could hypothesize (and in a sense generalize from nursing staff to susceptible individuals) that the degree of SOC renders people either vulnerable or resistant to both depression and BO. This working model is in accordance with Antonovskys theoretical postulate, which considered SOC as a primordial, evolutionally acquired and immutable human trait (Antonovsky, 1996). Further,

Table 1. Results (mean SD) of the Maslach Burnout Inventory (MBI), Becks Depression Inventory (BDI) and Antonovskys Sense of Coherence questionnaire (SOC) MBI (Sentimental exhaustion) Men (n = 17) Women (n = 62) Married (n = 39) Single (n = 40) Total (n = 79) 24.47 12.43 21.83 9.94 21.20 9.61 22.11 11.93 22.40 10.50 MBI (Personal achievement) 38.41 4.40* 35.36 6.54* 37.52 5.36 36.00 6.36 36.03 6.20

MBI (Depersonalization) 10.65 6.75 8.07 6.30 8.07 5.86 7.63 6.15 8.63 6.15

SOC 67.10 12.00 62.63 11.56 67.43 10.78 63.03 11.13 63.60 11.70

BDI 4.94 4.20* 8.00 6.88* 5.83 5.50 7.51 7.73 7.34 6.50

* Comparison of men versus women, P < 0.05, t-test.

Table 2. Correlation coefcients (r) of age (AGE), years of work experience (EXP), Maslach Burnout Inventory (MBI), Becks depression inventory (BDI) and Antonovskys sense of coherence questionnaire (SOC) MBI (Sentimental exhaustion) -0.20 -0.07 MBI (Personal achievement) -0.01 +0.09 -0.26*

EXP +0.83

MBI (Depersonalization) -0.07 -0.23 +0.60* -0.36*

SOC +0.17 +0.15 -0.55* +0.44* +0.45*

BDI -0.31 +0.05 +0.38* -0.38* +0.27 -0.58* AGE EXP MBI (Sentimental Exhaustion) MBI (Personal Achievement) MBI (Depersonalization) SOC

* Correlation is signicant at the P < 0.05 level, implementing the Bonferroni correction.

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it is in accordance with studies on a fewer number of nurses conducted in Switzerland, Sweden and the United States (Lewis et al., 1992; Lewis et al., 1994; Palsson et al., 1996; Aries & Ritter, 1999). Intercorrelations among MBI categories have been described and are, essentially, proof of the questionnaires internal validity (Maslach & Jackson, 1986). No correlations between MBI and years of work experience were found with the subjects of this study. This nding has been corroborated by other researchers, though at variance from the original hypothesis of Maslach (Papadatou et al., 1994; Maslach, 1982). From a practical point of view, BO is a considerable primary burden of nursing staff who are entrapped in a displeasing condition, and of hospital administrators who face the risk of low-level functioning within their domain of responsibility. The study of BO is an expanding eld and the comprehension of BO demands the implementation of further studies including the study of anxiety as a personality trait and/or the effect of family support. The intervention by specialized personnel in order to help nursing staff with BO in a hospital setting might be an appealing option. In addition, preventive programs need to be implemented in order to help individuals who might be prone to BO.

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