Background: Burnout, especially emotional exhaustion, is common among mental healthcare providers (MHP). It is caused by exposure to prolonged stress related job conditions, such as secondary traumatisation. Social support is a protective factor for developing emotional exhaustion. In addition, higher levels of social support are associated with lower levels of secondary traumatisation. However, it is unclear how social support and secondary traumatisation are related. Social support may be a protective factor for developing secondary traumatisation, as it is for emotional exhaustion. On the other hand, MHP who suffer more from secondary traumatisation might experience less social support, for example because they fear stigmatisation. This study examined whether social support mediates the relationship between secondary traumatisation and emotional exhaustion. Further, it is explored whether the relation between secondary traumatisation and social support is moderated by profession (physicians, psychologists and case managers). Method: In total, 593 MHP participated in this cross-sectional study. Participants completed a questionnaire including demographic characteristics, secondary traumatisation, emotional exhaustion, and social support. Results: It was shown that no MHP experience high levels of secondary traumatisation and relatively few experience high levels of emotional exhaustion, while they do experience much social support. Furthermore, as hypothesized, it was found that the relationship between secondary traumatisation and emotional exhaustion is partially mediated by social support. Finally, no moderation effect of profession was found. Conclusion: These results imply that MHP have access to social support and make use of it, preventing emotional exhaustion. Mental healthcare organisations should maintain these resources for social support to prevent emotional exhaustion. MHP who are less inclined to seek social support should receive extra attention, as should MHP who are more at risk of secondary traumatisation. Even though MHP experience the availability of social support, still 25% of the MHP do experience emotional exhaustion. Future research should examine which factors for this group contribute to the development of emotional exhaustion so that appropriate measures can be taken.
References
[1]
Ariapooran, S. (2014). Compassion Fatigue and Burnout in Iranian Nurses: The Role of Perceived Social Support. Iranian Journal of Nursing and Midwifery Research, 19, 279-284.
[2]
Azam, K., Khan, A., & Alam, M. T. (2017). Causes and Adverse Impact of Physician Burnout: A Systematic Review. Journal of the College of Physicians and Surgeons Pakistan, 27, 495-501.
[3]
Bearse, J. L., McMinn, M. R., Seegobin, W., & Free, K. (2013). Barriers to Psychologists Seeking Mental Health Care. Professional Psychology: Research and Practice, 44, 150-157. https://doi.org/10.1037/a0031182
[4]
Boscarino, J. A., Adams, R. E., & Figley, C. R. (2010). Secondary Trauma Issues for Psychiatrists. Psychiatric Times, 27, 24-26.
[5]
Bovier, P. A., Arigoni, F., Schneider, M., & Gallacchi, M. B. (2009). Relationships between Work Satisfaction, Emotional Exhaustion and Mental Health among Swiss Primary Care Physicians. The European Journal of Public Health, 19, 611-617. https://doi.org/10.1093/eurpub/ckp056
[6]
Carlson, M. D., & Morrison, R. S. (2009). Study Design, Precision, and Validity in Observational Studies. Journal of Palliative Medicine, 12, 77-82. https://doi.org/10.1089/jpm.2008.9690
[7]
Chrestman, K. R. (1995). Secondary Exposure to Trauma and Self-Reported Distress among Therapists. In B. H. Stamm (Ed.), Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators (pp. 29-36). Sidran Press.
[8]
Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., & Benight, C. C. (2013). Secondary Traumatic Stress among Mental Health Providers Working with the Military: Prevalence and Its Work- and Exposure-Related Correlates. The Journal of Nervous and Mental Disease, 201, 917-925. https://doi.org/10.1097/NMD.0000000000000034
[9]
Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A Meta-Analysis of the Relationship between Job Burnout and Secondary Traumatic Stress among Workers with Indirect Exposure to Trauma. Psychological Services, 11, 75-86. https://doi.org/10.1037/a0033798
[10]
Clapp, J. D., & Beck, J. G. (2009). Understanding the Relationship between PTSD and Social Support: The Role of Negative Network Orientation. Behaviour Research and Therapy, 47, 237-244. https://doi.org/10.1016/j.brat.2008.12.006
[11]
Collins, S., & Long, A. (2003). Too Tired to Care? The Psychological Effects of Working with Trauma. Journal of Psychiatric and Mental Health Nursing, 10, 17-27. https://doi.org/10.1046/j.1365-2850.2003.00526.x
[12]
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86, 499-512. https://doi.org/10.1037/0021-9010.86.3.499
[13]
Dewa, C. S., Loong, D., Bonato, S., Thanh, N. X., & Jacobs, P. (2014). How Does Burnout Affect Physician Productivity? A Systematic Literature Review. BMC Health Services Research, 14, Article No. 325. https://doi.org/10.1186/1472-6963-14-325
[14]
Duan, X., Ni, X., Shi, L., Zhang, L., Ye, Y., Mu, H., Li, Z., Liu, X., Fan, L., & Wang, Y. (2019). The Impact of Workplace Violence on Job Satisfaction, Job Burnout, and Turnover Intention: The Mediating Role of Social Support. Health and Quality of Life Outcomes, 17, Article No. 93. https://doi.org/10.1186/s12955-019-1164-3
[15]
Ducharme, L. J., Knudsen, H. K., & Roman, P. (2008). Emotional Exhaustion and Turnover Intention in Human Service Occupations: The Protective Role of Coworker Support. Sociological Spectrum, 28, 81-104. https://doi.org/10.1080/02732170701675268
[16]
Duffield, C. M., Roche, M. A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A Comparative Review of Nurse Turnover Rates and Costs across Countries. Journal of Advanced Nursing, 70, 2703-2712. https://doi.org/10.1111/jan.12483
[17]
Eliacin, J., Flanagan, M., Monroe-DeVita, M., Wasmuth, S., Salyers, M. P., & Rollins, A. L. (2018). Social Capital and Burnout among Mental Healthcare Providers. Journal of Mental Health, 27, 388-394. https://doi.org/10.1080/09638237.2017.1417570
[18]
Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel.
[19]
Figley, C. R., & Ludick, M. (2017). Secondary Traumatization and Compassion Fatigue. In S. N. Gold, & S. N. Gold (Eds.), APA Handbook of Trauma Psychology: Foundations in Knowledge (pp. 573-593). American Psychological Association. https://doi.org/10.1037/0000019-029
[20]
Galbraith, N. D., Brown, K. E., & Clifton, E. (2014). A Survey of Student Nurses’ Attitudes toward Help Seeking for Stress. Nursing Forum, 49, 171-181. https://doi.org/10.1111/nuf.12066
[21]
Garcia, G. M., Desrumaux, P., Ayala Calvo, J. C., & Naouële, B. (2021). The Impact of Social Support on Emotional Exhaustion and Workplace Bullying in Social Workers. European Journal of Social Work, 25, 752-765. https://doi.org/10.1080/13691457.2021.1934417
[22]
Gómez-Urquiza, J. L., De la Fuente-Solana, E. I., Albendín-García, L., Vargas-Pecino, C., Ortega-Campos, E. M., & Canadas-De la Fuente, G. A. (2017). Prevalence of Burnout Syndrome in Emergency Nurses: A Meta-Analysis. Critical Care Nurse, 37, e1-e9. https://doi.org/10.4037/ccn2017508
[23]
Graber, J. E., Huang, E. S., Drum, M. L., Chin, M. H., Walters, A. E., Heuer, L., Tang, H., Schaefer, C. T., & Quinn, M. T. (2008). Predicting Changes in Staff Morale and Burnout at Community Health Centers Participating in the Health Disparities Collaboratives. Health Services Research, 43, 1403-1423. https://doi.org/10.1111/j.1475-6773.2007.00828.x
[24]
Greinacher, A., Derezza-Greeven, C., Herzog, W., & Nikendei, C. (2019). Secondary Traumatization in First Responders: A Systematic Review. European Journal of Psychotraumatology, 10, Article ID: 1562840. https://doi.org/10.1080/20008198.2018.1562840
[25]
Hamama, L., Hamama-Raz, Y., Stokar, Y. N., Pat-Horenczyk, R., Brom, D., & Bron-Harlev, E. (2019). Burnout and Perceived Social Support: The Mediating Role of Secondary Traumatization in Nurses vs. Physicians. Journal of Advanced Nursing, 75, 2742-2752. https://doi.org/10.1111/jan.14122
[26]
Han, S., Shanafelt, T. D., Sinsky, C. A., Awad, K. M., Dyrbye, L. N., Fiscus, L. C., Trocker, M., & Goh, J. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Annals of Internal Medicine, 170, 784-790. https://doi.org/10.7326/M18-1422
[27]
Hayes, A. F. (2013). Introduction to Mediation, Moderation and Conditional Process Analysis: Methodology in Social Sciences (p. 193). Kindle Edition.
[28]
Hernandez, S. H., Morgan, B. J., & Parshall, M. B. (2016). Resilience, Stress, Stigma, and Barriers to Mental Healthcare in US Air Force Nursing Personnel. Nursing Research, 65, 481-486. https://doi.org/10.1097/NNR.0000000000000182
[29]
Honkonen, T., Ahola, K., Pertovaara, M., Isometsä, E., Kalimo, R., Nykyri, E., Aromaa, A., & Lönnqvist, J. (2006). The Association between Burnout and Physical Illness in the General Population Results from the Finnish Health 2000 Study. Journal of Psychosomatic Research, 61, 59-66. https://doi.org/10.1016/j.jpsychores.2005.10.002
[30]
Imai, H., Nakao, H., Tsuchiya, M., Kuroda, Y., & Katoh, T. (2004). Burnout and Work Environments of Public Health Nurses Involved in Mental Health. Occupational and Environmental Medicine, 61, 764-769. https://doi.org/10.1136/oem.2003.009134
[31]
Johnson, J., Hall, L. H., Berzins, K., Baker, J., Melling, K., & Thompson, C. (2018). Mental Healthcare Staff Well-Being and Burnout: A Narrative Review of Trends, Causes, Implications, and Recommendations for Future Interventions. International Journal of Mental Health Nursing, 27, 20-32. https://doi.org/10.1111/inm.12416
[32]
Jones, N., Whybrow, D., & Coetzee, R. (2018). UK military Doctors; Stigma, Mental Health and Help-Seeking: A Comparative Cohort Study. BMJ Military Health, 164, 259-266. https://doi.org/10.1136/jramc-2018-000928
[33]
Kelsey, E. A., West, C. P., Cipriano, P. F., Peterson, C., Satele, D., Shanafelt, T., & Dyrbye, L. N. (2021). Suicidal Ideation and Attitudes toward Help Seeking in US Nurses Relative to the General Working Population. American Journal of Nursing, 121, 24-36. https://doi.org/10.1097/01.NAJ.0000798056.73563.fa
[34]
Kerasidou, A., & Horn, R. (2016). Making Space for Empathy: Supporting Doctors in the Emotional Labour of Clinical Care. BMC Medical Ethics, 17, Article No. 8. https://doi.org/10.1186/s12910-016-0091-7
[35]
Kim, B., Jee, S., Lee, J., An, S., & Lee, S. M. (2018). Relationships between Social Support and Student Burnout: A Meta-Analytic Approach. Stress and Health, 34, 127-134. https://doi.org/10.1002/smi.2771
[36]
Kraus, V. I. (2005). Relationship between Self-Care and Compassion Satisfaction, Compassion Fatigue, and Burnout among Mental Health Professionals Working with Adolescent Sex Offenders. Counselling and Clinical Psychology Journal, 2, 81-88.
[37]
Lee, E., Jeong, Y. M., & Yi, S. J. (2020). Nurses’ Attitudes toward Psychiatric Help for Depression: The Serial Mediation Effect of Self-Stigma and Depression on Public Stigma and Attitudes toward Psychiatric Help. International Journal of Environmental Research and Public Health, 17, 5073-5082. https://doi.org/10.3390/ijerph17145073
[38]
Lopez-Lopez, I. M., Gómez-Urquiza, J. L., Cañadas, G. R., De la Fuente, E. I., Albendín-García, L., & Cañadas-De la Fuente, G. A. (2019). Prevalence of Burnout in Mental Health Nurses and Related Factors: A Systematic Review and Meta-Analysis. International Journal of Mental Health Nursing, 28, 1035-1044. https://doi.org/10.1111/inm.12606
[39]
Marshall, E. J. (2008). Doctors’ Health and Fitness to Practise: Treating Addicted Doctors. Occupational Medicine, 58, 334-340. https://doi.org/10.1093/occmed/kqn081
[40]
Maslach, C., & Jackson, S. E. (1981). The Measurement of Experienced Burnout. Journal of Organizational Behavior, 2, 99-113. https://doi.org/10.1002/job.4030020205
[41]
Maslach, C., & Jackson, S. E. (1986). Maslach Burnout Inventory (2nd ed.). Consulting Psychologists Press.
[42]
McCall, S. V. (2001). Chemically Dependent Health Professionals. Western Journal of Medicine, 174, 50-54. https://doi.org/10.1136/ewjm.174.1.50
[43]
Michelson, T., & Kluger, A. (2021). Can Listening Hurt You? A Meta-Analysis of the Effects of Exposure to Trauma on Listener’s Stress. International Journal of Listening, 1-11. https://doi.org/10.1080/10904018.2021.1927734
[44]
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in Mental Health Services: A Review of the Problem and Its Remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39, 341-352. https://doi.org/10.1007/s10488-011-0352-1
[45]
Norman, J., & Rosvall, S. B. (1994). Help-Seeking Behavior among Mental Health Practitioners. Clinical Social Work Journal, 22, 449-460. https://doi.org/10.1007/BF02190333
[46]
O’Connor, K., Neff, D. M., & Pitman, S. (2018). Burnout in Mental Health Professionals: A Systematic Review and Meta-Analysis of Prevalence and Determinants. European Psychiatry, 53, 74-99. https://doi.org/10.1016/j.eurpsy.2018.06.003
[47]
Panagioti, M., Panagopoulou, E., Bower, P., Lewith, L., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., & Esmail, A. (2017). Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-Analysis. JAMA Internal Medicine, 177, 195-205. https://doi.org/10.1001/jamainternmed.2016.7674
[48]
Penix, E. A., Kim, P. Y., Wilk, J. E., & Adler, A. B. (2018). Secondary Traumatic Stress in Deployed Healthcare Staff. Psychological Trauma: Theory, Research, Practice, and Policy, 11, 1-9. https://doi.org/10.1037/tra0000401
[49]
Pinikahana, J., & Happell, B. (2004). Stress, Burnout and Job Satisfaction in Rural Psychiatric Nurses: A Victorian Study. Australian Journal of Rural Health, 12, 120-125. https://doi.org/10.1111/j.1440-1854.2004.00572.x
[50]
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and Resampling Strategies for Assessing and Comparing Indirect Effects in Multiple Mediator Models. Behavior Research Methods, 40, 879-891. https://doi.org/10.3758/BRM.40.3.879
[51]
Roberts, F., Teague, B., Lee, J., & Rushworth, I. (2021). The Prevalence of Burnout and Secondary Traumatic Stress in Professionals and Volunteers Working with Forcibly Displaced People: A Systematic Review and Two Meta-Analyses. Journal of Traumatic Stress, 34, 773-785. https://doi.org/10.1002/jts.22659
[52]
Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The Relationship between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine, 32, 475-482. https://doi.org/10.1007/s11606-016-3886-9
[53]
Schaufeli, W. B., & van Dierendonck, D. (2000). Utrechtse Burnout Schaal (UBOS): Testhandleiding. (Utrecht Burnout Scale. Test Manual). Harcourt Test Services.
[54]
Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2009). The Stigma of Psychiatric Treatment and Help-Seeking Intentions for Depression. European Archives of Psychiatry and Clinical Neuroscience, 259, 298-306. https://doi.org/10.1007/s00406-009-0870-y
[55]
Sedgwick, P. (2014). Non-Response Bias versus Response Bias. British Medical Journal, 348, g2573. https://doi.org/10.1136/bmj.g2573
[56]
Sen, A. (1980). Equality of What? The Tanner Lecture on Human Values, 1, 197-220.
[57]
Siebert, D. C., & Siebert, C. F. (2007). Help Seeking among Helping Professionals: A Role Identity Perspective. American Journal of Orthopsychiatry, 77, 49-55. https://doi.org/10.1037/0002-9432.77.1.49
[58]
Sorgaard, K. W., Ryan, P., Hill, R., Dawson, I., & Group, O. (2017). Sources of Stress and Burnout in Acute Psychiatric Care: Inpatient vs. Community Staff. Social Psychiatry and Psychiatric Epidemiology, 42, 794-802. https://doi.org/10.1007/s00127-007-0228-6
[59]
Stamm, B. H. (2010). The Concise ProQOL Manual. ProQOL org.
[60]
Sweileh, W. M. (2020). Research Trends and Scientific Analysis of Publications on Burnout and Compassion Fatigue among Healthcare Providers. Journal of Occupational Medicine and Toxicology, 15, Article No. 23. https://doi.org/10.1186/s12995-020-00274-z
[61]
Taris, T., Houtman, I., & Schaufeli, W. (2013). Burnout: De stand van zaken. Tijdschrift Voor Arbeidsvraagstukken, 29, 241-257. https://doi.org/10.5117/2013.029.003.241
[62]
Tay, S. (2016). Lived Experience of Mental Health Problems among Clinical Psychologists, Stigma and Its Impact on Disclosure and Help-Seeking. Doctoral Dissertation, UCL (University College London).
[63]
Tay, S., Alcock, K., & Scior, K. (2018). Mental Health Problems among Clinical Psychologists: Stigma and Its Impact on Disclosure and Help-Seeking. Journal of Clinical Psychology, 74, 1545-1555. https://doi.org/10.1002/jclp.22614
[64]
Toth, K. E., & Dewa, C. S. (2014). Employee Decision-Making about Disclosure of a Mental Disorder at Work. Journal of Occupational Rehabilitation, 24, 732-746. https://doi.org/10.1007/s10926-014-9504-y
[65]
van Veldhoven, M., Prins, J., Van der Laken, P., & Dijkstra, L. (2014). VBBA2.0: Update van de standaard voor vragenlijstonderzoek naar werk, welbevinden en prestaties. SKB.
[66]
Velando-Soriano, A., Ortega-Campos, E., Gómez-Urquiza, J. L., RamírezBaena, L., De La Fuente, E. I., & Cañadas-De La Fuente, G. A. (2020). Impact of Social Support in Preventing Burnout Syndrome in Nurses: A Systematic Review. Japan Journal of Nursing Science, 17, e12269. https://doi.org/10.1111/jjns.12269
[67]
Wallace, J. E. (2012). Mental Health and Stigma in the Medical Profession. Health, 16, 3-18. https://doi.org/10.1177/1363459310371080
[68]
Wallace, J. E., & Lemaire, J. (2009). Physician Well Being and Quality of Patient Care: An Exploratory Study of the Missing Link. Psychology, Health & Medicine, 14, 545-552. https://doi.org/10.1080/13548500903012871
[69]
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis. The Lancet, 388, 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X
[70]
Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., Lynde, D., & Drake, R. E. (2008). The Role of Staff Turnover in the Implementation of Evidence-Based Practices in Mental Health Care. Psychiatric Services, 59, 732-737. https://doi.org/10.1176/ps.2008.59.7.732
[71]
WHO (World Health Organization) (2019). ICD-11 for Mortality and Morbidity Statistics.
[72]
Yates, M., & Samuel, V. (2019). Burnout in Oncologists and Associated Factors: A Systematic Literature Review and Meta-Analysis. European Journal of Cancer Care, 28, e13094. https://doi.org/10.1111/ecc.13094
[73]
Zhang, J.-Y., Shu, T., Xiang, M., & Feng, Z.-C. (2021). Learning Burnout: Evaluating the Role of Social Support in Medical Students. Frontiers in Psychology, 12, Article ID: 625506. https://doi.org/10.3389/fpsyg.2021.625506
