© Borgis - New Medicine 4/2011, s. 143-147
*Emőke Fülöp1, Ágnes Devecsery2, Katalin Hausz3, Zsuzsanna Kovács1, Márta Csabai4
Relationship between empathy and burnout among psychiatric residents
1Semmelweis University Faculty of Health Sciences, Department of Applied Psychology
Head of Faculty: Prof. dr. Judit Mészáros
2University of Pécs, Doctoral School of Psychology
Head of Faculty: Prof. dr. János László
3Integrated Postgraduate Training Center of South-Pest County, Non-profit Ltd.
Head of Company: Vallo Péter
4Institute of Psychology University of Szeged
Head of Faculty: dr. Ágnes Szokolszky
Summary
Aim. To study the causal factors of empathy and burnout and the effect of emotional involvement on medical doctors.
Material and methods. Descriptive study at 4 Hungarian medical faculties with 67 psychiatry residents. Instruments: Maslach Burnout Inventory (Maslach and Jackson, 1986), Interpersonal Reactivity Index (Davis, 1980), Patient-Practitioner Orientation Scale (Krupat, E. et al. 2000), and Secondary Traumatic Stress Scale (Bride 2003). Statistics: Spearman correlation, Kruskal-Wallis test, Mann-Whitney U test, factor analysis with Varimax rotation.
Results. High emotional exhaustion among 32.8% of residents, high level of depersonalization of 29.9%, decrease of personal effectiveness of 52.2%. Significantly higher depersonalization for men (p ≤ 0.05). Significantly more subjective experience of symptoms of arousal for women than men (p = 0.028). Empathic distress (Interpersonal Reactivity Index) is accompanied by emotional exhaustion (p < 0.001), reduced personal accomplishment (p < 0.001), and each symptom of secondary trauma (p < 0.001). Emotional exhaustion correlates with all three symptoms of secondary trauma (p < 0.001).
Factor analysis of the questionnaires revealed two main factors: the first factor we named “reactive empathy” or “mentalization”. The second factor included components related to emotional contagion and its consequence, burnout.
Conclusions. Experience of emotional contagion may predict the manifestation of burnout. Regulation of the intensity of emotional states, perspective change and empathic concern determine that form of empathy which has a positive effect on both the patient and the therapist.
Introduction
Numerous experiments confirm the importance of the relationship between the patient and the practitioner regarding the course of the illness and the healing process (1, 2). In many cases, however, the interpersonal relationship with the patients or their relatives may be straining for the practitioners due to the intense emotional load they carry. It has been suggested in many recent studies that excessive emotional involvement might lead to burnout (3, 4).
According to the definition of Maslach (5), a burnout process can be measured and described in three dimensions, which are: emotional exhaustion, depersonalization, and reduced personal accomplishment accompanied by negative self-evaluation.
Figley (6) underlines that although empathy enables the helpers to understand the traumatized state of the patient, it also makes them more susceptible to possible trauma. He denoted this emotional and behavioral disorder caused by exposure to another person’s traumatic experience as secondary traumatic stress disorder (also known as compassion fatigue). Chrestman (7) pointed out the similarity between the symptoms of primary and secondary traumatic stress: intrusions, physiological arousal and avoidance. The observer enters the same emotional state as that of the patient.
In the case of psychiatrists, their relationship with patients is different since it is considered more long-term and requires a higher level of emotional involvement. This puts them in a special position among doctors. Psychiatrists establish the most complex form of relationship with their patients; moreover, they often get to know traumatizing stories. When starting out on their careers, these difficulties add up to even more serious risks as they lack the necessary skills to tackle these experiences, have to deal with a great deal of responsibility, and the perceived control over their work is low. According to the review of the literature by McCray et al. (8), international studies show that 40-75% of the resident doctors have to face burnout. Compared to those of other specialists, mortality and morbidity rates are significantly worse (9).
In our study, we were interested to investigate the degree of burnout of psychiatry residents and medical specialist candidates, and examine the relationship between emotional involvement, communicational skills and symptoms of burnout.
Participants
In our exploratory/descriptive, cross-sectional study we used questionnaires and qualitative analysis. It was carried out between March and May 2011 in four medical universities in Hungary (in Budapest, Debrecen, Pécs and Szeged) within the framework of a regular psychiatry residency training program. Each day of the training program we were able to conduct the research before the training started. Participants were informed in writing about the aim, process and duration of the research, in which participation was voluntary. Also, they were not paid for doing so. Our sample consisted of 67 psychiatry residents and medical specialist candidates (51 women and 16 men) with a mean age of 31.45 years (SD = 5.8). The following socio-demographic characteristics were taken into account: age, marital status, number of children, number of medical specialty exams, and work experience in health care. The data were analyzed using the statistical software tool SPSS.
Method
Burnout was measured with the Maslach Burnout Inventory (MBI) (10). The assessment of the results was based on a scale developed on a normative sample by Ádám et al. (11).
Secondary traumatic stress was measured with the Secondary Traumatic Stress Scale (STSS) (12), which consists of subscales estimating intrusion, arousal and avoidance.
Empathy was measured by the Interpersonal Reactivity Index (IRI) (13), which includes 28 affirmations in four subscales (perspective taking, fantasy scale, empathic concern and personal distress).
With the Patient-Practitioner Orientation Scale (PPOS) (14) we examined which part of the communication is emphasized by the practitioner when interacting with patients, as well as to what extent they take into account their points of view and personality. It was the first time that the questionnaire was used in Hungary.
The questionnaire includes 18 affirmations in two subscales. The subscale of sharing reflects to what extent the respondent believes that a) in order to ensure an effective healing process, the practitioner and the patient must be treated equally in terms of power and control, and b) doctors should share as much information with their patients as possible. The subscale of caring reflects to what extent the respondent believes that during the healing process the emotions and the whole personality of the patient should be taken into consideration, and that a satisfying interpersonal relationship is of paramount importance.
Results
Socio-demographic characteristics of the sample
The socio-demographic characteristics of the participating psychiatry residents and medical specialist candidates are shown in Tables 1 and 2. 23% of the participants were male and 77% female. According to age distribution, the sample consists of mostly young adults in their 30s. On average, participants have five years of work experience in health care, and most of them have not yet taken their medical specialty exam. 66% of them live in marriage or partnership, and the majority have one child.
Table 1. Socio-demographic characteristics 1.
| | Minimum | Maximum | Mean | SD |
| Age (years) | 25 | 54 | 31.45 | 5.789 |
| Number of children | 0 | 3 | 0.38 | 0.818 |
| Number of exams | 1 | 3 | 1.12 | 0.445 |
| Experience (years) | 0.5 | 30 | 4.659 | 5.466 |
Table 2. Socio-demographic characteristics 2.
| | Value | Number of participants |
| Sex | men/women | 16/51 |
| Marital status | single/domestic
partnership/married | 25/21/20 |
Prevalence of burnout
The prevalence of major emotional exhaustion, depersonalization and decrease in performance among psychiatry residents and medical specialist candidates was 32.8%, 29.9% and 52.2%, respectively.
As regards the relationship between the aspects of burnout and socio-demographic characteristics, there is a significant sex-related difference in depersonalization (Mann-Whitney U test: z = -2.344; p < 0.05), which means that this phenomenon is more frequent in men. Figure 1 shows that, despite the different sample size, the prevalence of low, medium and high degree of depersonalization differs in the two sexes.
Fig. 1. Sex-related difference in depersonalization.
There is a significant difference in the arousal subscale of secondary trauma, meaning that women are more subject to experience symptoms of arousal than men. (Mann-Whitney U test: z = -2.197; p < 0.05).
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Piśmiennictwo
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