Professional burnout in Staff of Mental Units: The Role of Working Conditions

syndrome among professors of modern higher educational institutions. The traditional factors have been weighted down with stresses originated from the educational institution. The essential role in the occurrence of negative psycho-emotional states of teachers is performed by the organizational stress, which the administration is mainly responsible for. With the general systemic negative issues on the background the serious source of stress is organizational problems and changes in educational institutions. Systemic measures aiming at creation of an amiable psychosocial environment are expected to be the job burnout prevention and job burnout overcoming resource for professors. The creation of an internal social cultural space will mitigate the impacts of the external environment and allows to develop new plans of personal professional development for every teacher.


Aim of this study is to investigate the level of professional burnout of mental health employees and to investigate the possible influence of various mental health factors on professional burnout. A cross-sectional methodology was employed to this study. A cohort of 217 employees
who work in mental health settings in Greece was recruited.Data were collected with a three -part structured questionnaire consisted by questions on personal, professional and demographic data of the respondents, questions whose answers will give the profile of the working conditions and the Maslach Burnout inventory.The average age was (39.00 ± 8. 19) years, 75.11 % were women, 60.2 % declared married, 47.5 % of the sample members have graduated from higher education institutes (and as for the profession 63.13 % are nurses, 14.28 % doctors and 22.59 % other specialties.Burnout levels were found to be can moderate, with the occupation, in particular nursing, understanding the context and purpose of work and cooperation between professionals, being aggravating factors.Research findings have shown moderate levels of burnout and several factors have been found to have an impact.Experience has been found as the most important factor for mental health sector.
Key words: professional burnout; mental health staff; working conditions.

Introduction.
Burnout was approached as a syndrome, caused mainly by stress which presents with emotional exhaustion, depersonalization and reduced personal accomplishment, especially among humanitarian and social service professions (e. g. nurses).Professional burnout can be distinguished from stress, since the former has long-term nature, while the latter is usually considered as something more transient [4,10,21,25].In the literature, one can find numerous studies that support this threedimensional perception of Burnout [5].Its substantial overview identifies it as a "construct" with a social dimension, but at the same time, it has specific clinical overtones.Apart from Maslach's three-dimensional model, other Burnout models have been created providing the theoretical framework for several surveys while efforts have been made towards the integration of these models [15,17].All these models give a mediating role in the professional burnout in a process which makes stress along with interpersonal and working causes, the precursors of occupational burnout, which, in turn, brings about certain changes in attitude and behavior of employees [6,17].
As mentioned above, much of the research on the work environment and mental health has used the framework of the aforementioned four psychosomatic states: stress, burnout, depression, anxiety, well-being.More precisely, the standard set of these surveys deals with the identification of factors associated with personal -the employees' -and labor factors.Personal factors are further subdivided into personality traits, gender and other demographics (income, education), while Labor factors may include job stressors, supporting employees and the opportunities for working conditions improvement [16].
Dolan examined the relationship between burnout and job satisfaction in nurses and found that job satisfaction is a reliable indicator of burnout.These results coincide with the findings of Pines & Kanner in Dolan [8].Nursing staff reported low job satisfaction and higher levels of burnout in relation to the rest of the hospital staff.The conclusion drawn was that the psychological pressure (stress), which leads to Burnout, was caused primarily by the workload demands, when specific labor standards were not met, secondly by the inability to meet the demands of patients resulting in feelings of guilt and dissatisfaction, and thirdly, by the employees' difficulty to adequately meet the physical and psychological needs of patients.These findings appear to be confirmed over time since more recent studies have come to similar results [14,27].
In another article by Fletcher, it was examined not only nurses' job satisfaction but also their dissatisfaction.The questionnaires were posted to 5,192 registered nurses, 1,78 of which were returned duly completed.The researchers examined job satisfaction, satisfaction and patient safety, the role of head nurses as well as the nurses' intention to remain in the healthcare sector.Job satisfaction has been assessed at various levels, which concerned nursing unit gains, job performance, intrinsic values of work, and patient care issues.The results showed that the staff appears to be overcome by a feeling of job devaluation and even feels indignant with the financial gain being more important than the patients.
Regarding the job performance of their colleagues, many said they had higher expectations of them and they were disappointed on the way.In addition, nurses' working values seem to be derived from the provision of care and the fact that the services they offer improve patients' health.When examining patient care issues, concern was raised about the perception that patient care is not at the level it should be due to organizational changes related to staffing and delegation of tasks to nurses [9].
The research of Ersin Ukun et al. [10] focused on the staff of the hospital units and correlated the dimensions of professional burnout with job satisfaction.The findings of the research have shown a strong correlation between satisfaction and the three dimensions of burnout.In particular, satisfaction is positively related to personal accomplishment and negatively to emotional exhaustion and depersonalization.The greater the job satisfaction the lower the levels of nurses' emotional exhaustion and depersonalization.The same conclusions came from the study of S. Tabolli et al. [26], involving nurses of a general hospital in Italy.In conclusion, high levels of job satisfaction exhibit protectionist characteristics against burnout [10,26].
Despite the numerous studies on burnout in health professionals, few are those that focus on mental health professionals and how even more including a variety of specialties beyond nursing staff.
Purpose The purpose of this study is to investigate the level of professional burnout of mental health employees and to investigate the possible influence of various mental health factors on professional burnout.In a health system central to which is the investigation of the professional burnout of employees, working conditions and personal and demographic data could be classified as influencing factors.
Methodology A cross -sectional methodology was employed to this study.A cohort of 217 employees who work in mental health settings in Greece was recruited.The subjects included patients who 18 years old and more, had the ability to communicate in Greek, currently working in a mental health setting, an adequate level of cooperation and perceived ability and hadn't been diagnosed with any psychiatric condition.
Ethical Consideration All participants have signed a consent form to participate in the study.They had been informed of their rights to refuse or to discontinue participating in the study.All ethical standards of Helsinki Declaration were followed.In addition, permission for the study was obtained from the ethical and scientific committees of the participating units.
Measures A three -part structured questionnaire was used as the data gathering tool. 1.The first group includes questions on personal, professional and demographic data of the respondents (11 questions).2. The second group consists of questions whose answers will give the profile of the working conditions (11 questions).3. The third group is the Maslach Burnout inventory.This group consists of three sub-groups of questions that express staff's emotional exhaustion, personal accomplishment and depersonalization.Statistical analysis Percentages, means and standard deviations were calculated in order to provide a broader view of the data.Also, multiple regression analyses were used to determine the way that demographic data and working conditions affect burnout.Results indicated differences with a probability of less than or equal to 0.05 were accepted as significant.For statistical analysis, we used statistical program SPSS 22.
Demographic, Professional and Personal data Demographic Characteristics Tabl. 1 shows the demographic and job features of the sample.The average age of the staff that works in mental health units is 39.00±8.19years.Regarding gender, the percentage of men is 24.88 % (n = 54) and of women 75.11 % (n = 163).As for marital status, 60.2 % declared married (mean score = 0.94, 0 = single, 1 = married, 2 = divorced) and 38.9 % of the married declared that they do not have children.The 47.5 % of the sample members have graduated from higher education institutes (universities and technological educational institutes) and as for the profession 63.13 % are nurses, 14.28 % doctors and 22.59 % other specialties.The mean score of years in the profession for the sample is (9.31 ± 7.50) years and for years in a department is (4.07 ± 4.27) years.Working Conditions.Working conditions are presented in Tabl. 2. Low mean deviations indicate that employees are little or not at all (e.g.adequate number of staff) satisfied with the working conditions.It is also confirmed by the results of the 11 questions relating exclusively to the environment and working conditions (Tabl.2).Specifically, in question 4 (working conditions) the mean 1.58 is placed between the range "a little" and "enough".Professional Burnout.The levels of burnout are presented in Table 3. Mean deviations indicate that in general, staff burnout is moderate.The exception is the emotional exhaustion variable, with a deviation (18.46) close to moderate range limit (21-30), however, the result is below the lowest minimum value and therefore its level may be considered low.On the other hand, the values associated with the dimension of personal accomplishment (37.28) are close to the limit of the highest value ( 35).The same applies to the value of depersonalization (6.73) which is closer to the low depersonalization limit (5).In general and in accordance not only with the results but also to the "base" scale, burnout falls into the category of moderate burnout.
Multivariable Regression models.The results of multivariable regression analysis are presented in Tabl. 4. With regard to the specialty of the eight models introduced in the models, only nurses presented statistically significant and only in the equation of emotional exhaustion.Working conditions are also significant for professional burnout.One of the two conditions that are statistically significant is whether the employee thinks that his / her role has been clearly explained to his / her workplace, affecting the variables of emotional exhaustion and depersonalization.The more meaningful the role, the lower the levels.The other condition is the satisfaction derived from working with their colleagues.This affects personal accomplishment and even the greater the satisfaction is, the greater the feeling of personal accomplishment.Finally, the degree of adequacy of staff size (number of employees) and staff satisfaction from their salary have been presented as significant variables only in emotional exhaustion.Discussion.The purpose of this study was to investigate the levels of burnout in mental health professionals as well as the effect that demographics and working conditions may have on the onset of the syndrome.Overall, the levels of burnout can be characterized as moderate, with the occupation, in particular nursing, understanding the context and purpose of work and cooperation between professionals, being aggravating factors.
The levels of burnout of the present study come to reinforce other studies that have taken place in Greek hospitals and report the levels as moderate [11,20].In the mental health sector, both the desire to help people and the orientation towards professional reintegration seem to have a positive impact on reducing depersonalization.It is quite evident that the motives for the employment decision in mental health units have a different impact.They're very likely to be closely related to specific characteristics of the field (of patients).Even those who decide to offer their services based on their professional rehabilitation to patients with mental or psychological problems, either intimately or subconsciously, are psychologically and intellectually properly prepared to deal with the conditions that will come forward.Besides, as mentioned above, one of the reasons for the professional burnout is the unrealistic expectations of employees, both from themselves and from the working conditions in general [1,9,23].It is also expected that mental health staff will adapt to patient data more easily for the reasons outlined above (clear landscape).For instance, staff dealing with patients with acute chronic disorders are more likely to be aware, either by themselves or by briefing with superiors -that patients' recovery rates are lower than in patients with mild disorders.Such adaptation to the actual conditions of care and the possibilities for patients to restore their mental health, can help significantly to mitigate the occurrence of burnout.It is noteworthy that the absence of nursing staff from employment is determined to a significant degree by their unfulfilled professional expectations, such as higher wages, delegating responsibilities and, to a lesser extent, working activities quality [13].
Questions such as whether the original incentive to healthcare work can inhibit or even alleviate burnout could be answered by a more in-depth study that will focus on the initial motivation of employees.
However, in contrast to the demographic factors, the theoretical background for the influence of the working environment and conditions in this mental and spiritual health, is and has been documented in both theoretical and empirical level.С Е К Ц І Я 1 P. P. Janssen et al. [13] report a large number of such models as the Michigan Model, the model for the work stress and health, Karasek's Job Demand-Control Model (JD-C), the DC/S Model (demand-control support) and other.Perhaps the most important of the theories regarding the framework and the relationship of the employee with his working environment is the Transactional Theory which focuses on the ERI model (Effort-Reward Imbalance).The Hobfoll's Conservation resource theory, the centre of which is the person itself and his inability to respond to work demands can be added to these [12].Therefore, while investigating the causes of burnout, labor factors should be taken into account.It should be noted that five of the seven factors found statistically significant in the explanation of professional burnout have an impact on emotional exhaustion, suggesting that as long as this dimension is concerned, the impact of working condition is considerably greater.It is worth mentioning, however, that in personal accomplishment two of the three factors are linked to staff meetings and relations with colleagues.This result is in agreement with D. W. Rees' results [24], which concluded that bad relationships with colleagues and supervisors are the most important stressor in the workplace.Although it has been shown that shifts affect the burnout of employees, this research does not support this [7].Possibly, shifts if combined with the workload and employees' awareness of their role, could highlight its importance [3,20,22].
T. Lundstrom et al. [18] suggested that if natural working environment -that is to say, working conditions -is at bad levels, it could be a stressor that will surely lead to burnout.In the present study, working conditions proved to be important only for the health staff group.An interesting study would be to separate the working conditions according to their level (good conditions, poor conditions) and based on this level to investigate their effects on professional burnout.
According to data from the Third European Survey Conditions, employees' exposure to equipment hazards, labor intensification and workplace practices are the primary cause of health problems experienced by workers in the European community.In a sample of 21,500 employees, the most common health problems presented were headaches (33 %), stress (28 %), muscular neck and shoulder pains (23 %) and burnout (23 %).Further research on working conditions (e.g.room space, equipment, ventilation etc.) could reveal more information [19].
The lack of significance of the factor regarding the number of people the employee is dealing with on a daily basis was an unexpected finding.It is expected that the higher the number the more frequently would be the symptoms of burnout [2].Probably the number of people that the employee is engaged with daily affect his performance, which in turn, is partly due to burnout [4].Therefore, there may be an indirect rather than direct connection between this interpretive variable and the three dimensions of burnout.In addition, our sample consisted of various specialties.Possibly, a research exclusively on nurses would lead to different outcomes about the importance of the number of people with whom the employee deals every day.

Table 1 .
Demographic conditions Statistics

Table 2 .
Working Conditions Statistics

Table 4 .
Multivariable Regression models *The significance level in brackets.