Towards a Brief Definition of Burnout Syndrome by Subtypes

Development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12)

Jesús Montero-Marín; Petros Skapinakis; Ricardo Araya; Margarita Gili; Javier García-Campayo

Health and Quality of Life Outcomes. 2011;9(74)

Background

Burnout syndrome is considered a uniform condition with relatively consistent aetiology and symptoms resulting from prolonged exposure to chronic stressors in the workplace.^[1] This syndrome tends to be given standard operationalization through the "Maslach Burnout Inventory General Survey" (MBI-GS) by means of the dimensions of 'exhaustion', 'cynicism' and professional 'inefficacy'.^[2] 'Exhaustion' is the feeling of not being able to offer any more of oneself at an emotional level; 'cynicism' is contemplated as a distant attitude towards work; and 'inefficacy' is the feeling of not performing tasks adequately.

Clinical experience, however, shows that burnout is manifested in different ways that can be classified depending on the level of dedication with which individuals cope with work-related tasks.^[3,4] The "frenetic" burnout sub-type is characterized by the investment of a large amount of time to work and is common in highly involved, ambitious and overloaded individuals. 'Involvement' is the investment of every effort required to overcome difficulties; 'ambition' is a great need to obtain important success and achievements at work; and 'overload' is risking one's own health and neglecting of one's own personal life in the pursuit of good results.^[4–7] The "underchallenged" burnout subtype is influenced by the occupation type. It appears in indifferent and bored individuals who do not find personal development in their work. 'Indifference' is lack of concern, interest and enthusiasm in work-related tasks; 'boredom' is caused by the understanding of work as a mechanical and routine experience with little variation in activities; and 'lack of development' is the absence of personal growth experiences for individuals together with their desire for taking on other jobs where they can better develop their skills.^[4–7] The "worn-out" burnout subtype is determined by the rigidity of the organizational structure of an individual's workplace and is characterized by a lack of control over results, lack of recognition for efforts and neglect of responsibilities. 'Lack of control' is the feeling of helplessness as a result of dealing with many situations that are beyond their control; 'lack of acknowledgement' is the belief that the organizations those individuals work for fail to take their efforts and dedication into account; and 'neglect' refers to individuals' disregard as a response to any difficulty.^[4–7]

This conceptualization of burnout, operationalized through the "Burnout Clinical Subtype Questionnaire" (BCSQ-36), is very useful for the specific evaluation of the syndrome and for the design of treatment strategies depending on the characteristics of each clinical case. This is practicable given that it provides a broader framework that exceeds the possibilities for evaluation and intervention implicit in the standard design of the MBI-GS, which is more directed towards a unified (although three-dimensional) definition of the syndrome.^[7,8]

The dimensions of 'overload', 'lack of development' and 'neglect', belonging to the subtypes of "frenetic", "underchallenged" and "worn-out", respectively, could construct a brief definition of burnout that is able to bring the typological perspective of the BCSQ-36 closer to the MBI-GS standard.^[8] These dimensions have been proposed as a definition of burnout that could cover common ground between the typological and standard approaches, and have been selected as a result of a second order factor analysis, carried out between the dimensions of BCSQ-36 and MBI-GS taken together.^[1,2,4,7,8] These dimensions showed good discriminant validity, which makes them very useful for the brief identification of clinical subtypes of burnout.^[8] However, it is necessary to explore and confirm the structure of this new definition, in view of the fact that it groups the items of the original scale in a different way. It will also be necessary to analyse its criterion validity because this new design reduces the extent of the initial typological definition.

The main objectives of this study were to test the factorial structure of the differential design proposed by means of the dimensions of 'overload', 'lack of development' and 'neglect' through the BCSQ-12, and to estimate its discriminatory strength compared to the dimensions of 'exhaustion', 'cynicism' and 'inefficacy' of the MBI-GS standard. We also proposed to evaluate the internal consistency of the dimensions and possible differences caused by gender and occupation.

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Table 1. Characteristics of the study participants
variables	total sample n_T = 826	sub-sample 1 n₁ = 413	sub-sample 2 n₂ = 413	p
Age				0.242
Md (SD)	40.26 (9.52)	40.64 (9.59)	39.87 (9,46)
Sex				0.362
male	366 (44.31)	176 (42.62)	190 (46.00)
Stable Relationship				0.999
yes	647 (78.33)	324 (78.45)	323 (78.21)
Education				0.667
secondary	119 (14.41)	64 (15.50)	55 (13.32)
university	423 (51.21)	208 (50.36)	215 (52.06)
doctorate	284 (34.38)	141 (34.14)	143 (34.62)
Occupation				0.988
TRS	372 (45.04)	185 (44.79)	187 (45.28)
ASP	351 (42.49)	176 (42.62)	175 (42.37)
TRA	103 (12.47)	52 (12.59)	51 (12.35)
Length of service				0.210
< 4 years	184 (22.28)	85 (20.58)	99 (23.97)
4–16 years	353 (42.74)	172 (41.65)	181 (43.83)
> 16 years	289 (34.99)	156 (37.77)	133 (32.20)
Contract duration				0.775
permanent	503 (60.90)	254 (61.50)	249 (60.29)
Contract type				0.718
full-time	750 (90.80)	377 (91.28)	373 (90.31)
Sick leave				0.201
yes	256 (30.99)	119 (28.81)	137 (33.17)

The figures represent frequencies, percentages (in brackets) and the p value associated with an χ² contrast between sub-sample 1 and sub-sample 2 except for the age variable where the figures represent means, standard deviations and the p value associated with a t contrast.

Table 2. Exploratory Factor Analysis – weightings and communalities
Items	Factor
Items	1	2	3	h²
3. When things at work don't turn out as well as they should, I stop trying	0.72	0.13	0.07	0.54
6. I give up in response to difficulties in my work	0.85	0.15	0.14	0.76
9. I give up in the face of any difficulties in my work tasks	0.73	0.17	0.14	0.58
12. When the effort I invest in work is not enough, I give in	0.82	0.12	0.09	0.70
2. I would like to be doing another job that is more challenging for my abilities	0.02	0.85	0.05	0.73
5. I feel that my work is an obstacle to the development of my abilities	0.29	0.68	0.22	0.62
8. I would like to be doing another job where I can better develop my talents	0.12	0.92	0.04	0.86
11. My work doesn't offer me opportunities to develop my abilities	0.22	0.72	0.02	0.58
1. I think the dedication I invest in my work is more than what I should for my health	0.07	0.13	0.80	0.67
4. I neglect my personal life when I pursue important achievements in my work	0.09	0.02	0.82	0.67
7. I risk my health when I pursue good results in my work	0.06	0.01	0.77	0.60
10. I overlook my own needs to fulfil work demands	0.20	0.11	0.68	0.52

Extraction method: Maximum Likelihood with Varimax orthogonal rotation on sub-sample 1. h² = communalities. Bold = belonging factor

Table 3. Exactness of BCSQ-12 according to MBI-GS
	criterion: 'exhaustion' (cut-off point 'overload'≥3.38)		criterion: 'cynicism' (cut-off point 'L.development'≥3.63)		criterion: 'inefficacy' (cut-off point 'neglect'≥2.63)
	index	95% IC	index	95% IC	index	95% IC
Sensitivity *	75.89	70.07–81.72	70.71	65.21–76.22	71.19	64.23–78.14
Specificity *	62.35	58.40–66.30	70.57	66.66–74.48	67.03	63.33–70.72
PPV^a *	42.82	37.83–47.81	55.15	49.87–60.44	37.06	31.78–42.34
NPV^b *	87.44	84.19–90.69	82.48	78.93–86.06	89.51	86.68–92.33
OMR^c *	33.98	30.69–37.27	29.38	26.22–32.55	32.08	28,84–35.33
PLR^d	2.02	1.78–2.29	2.40	2.07–2.79	2.16	1.87–2.49
NLR^e	0.39	0.30–0.49	0.42	0.34–0.50	0.43	0.34–0.55
OR^f	5.25^g	3.62–7.60	6.77^h	4.79–9.57	5.21ⁱ	3.57–7.60

*values given as percentages. a = Positive predictive value. b = Negative predictive value. c = Overal misclassification rate. d = Positive likelihood ratio. e = Negative likelihood ratio. f = Adjusted Odds Ratio by means of multivariate logistic regression models controlling age, sex, stable relationship, education, occupation, length of service, contract duration and contract type. g = Wald p < 0.001; H-L p = 0.451. h = Wald p < 0.001; H-L p = 0.093. i = Wald p < 0.001; H-L p = 0.216. Values obtained from the total sample (n_T).

Table 4. Descriptive statistics for BCSQ-12 items
items	Mn	SD	Q₁	Mdn	Q₃	min	max	asym^a	kurt^b	Item-rest
1. I think the dedication I invest in my work is more than what I should for my health	3.83	1.66	3.00	4.00	5.00	1.00	7.00	0.09	-0.80	0.75
4. I neglect my personal life when I pursue important achievements in my work	3.10	1.71	2.00	3.00	4.00	1.00	7.00	0.57	-0.56	0.75
7. I risk my health when I pursue good results in my work	3.43	1.69	2.00	3.00	5.00	1.00	7.00	0.33	-0.73	0.74
10. I overlook my own needs to fulfil work demands	3.53	1.63	2.00	3.00	5.00	1.00	7.00	0.21	-0.73	0.69
2. I would like to be doing another job that is more challenging for my abilities	3.42	1.86	2.00	3.00	5.00	1.00	7.00	0.31	-0.90	0.77
5. I feel that my work is an obstacle to the development of my abilities	3.08	1.64	2.00	3.00	4.00	1.00	7.00	0.61	-0.29	0.72
8. I would like to be doing another job where I can better develop my talents	3.68	1.86	4.00	4.00	5.00	1.00	7.00	0.14	-1.01	0.82
11. My work doesn't offer me opportunities to develop my abilities	3.53	1.86	2.00	3.00	5.00	1.00	7.00	0.30	-0.96	0.73
3. When things at work don't turn out as well as they should, I stop trying	2.46	1.26	1.00	2.00	3.00	1.00	7.00	0.92	1.08	0.61
6. I give up in response to difficulties in my work	2.36	1.24	1.00	2.00	3.00	1.00	7.00	0.88	0.90	0.74
9. I give up in the face of any difficulties in my work tasks	2.12	1.09	1.00	2.00	3.00	1.00	7.00	1.05	1.84	0.68
12. When the effort I invest in work is not enough, I give in	2.48	1.20	1.00	3.00	3.00	1.00	7.00	0.69	0.64	0.74

Mn = mean. SD = standard deviation. Mdn = median. Q₁ = percentile-25. Q₃ = percentile-75. min = minimum score. max = maximum score. asym = asymmetry. kurt = kurtosis. Item-rest = correlation coefficient item-rest (r between each item and the remaining items belonging to the same factor). a = typical asymmetry error = 0.08 for all items. b = typical kurtosis error = 0.17 for all items. Values obtained from the total sample (n_T = 826).

Table 5. Descriptive statistics, Cronbach's α and contrasts with regard to sex and occupation for the BCSQ-12 and MBI-GS dimensions
	(n)	BCSQ-12			MBI-GS
	(n)	Overload	L. Development	Neglect	Exhaustion	Cynicism	Efficacy
Total	826
Mn		3.47	3.43	2.35	2.24	2.01	4.47
SD		1.42	1.57	1.00	1.42	1.57	0.97
Mdn		3.25	3.25	2.25	2.00	1.50	4.58
Q₁		2.50	2.25	1.50	1.20	0.75	3.83
Q₃		4.50	4.50	3.00	3.20	3.00	5.17
min		1.00	1.00	1.00	0.00	0.00	0.00
max		7.00	7.00	6.25	6.00	6.00	6.00
asym^a		0.34	0.28	0.48	0.71	0.78	-0.72
kurt^b		-0.50	-0.62	0.06	-0.14	-0.23	0.71
α		0.87	0.89	0.85	0.91	0.92	0.82
Male	366
Mdn		3.25	3.50	2.25	1.80	1.75	4.50
Q₁		2.50	2.25	1.50	1.00	1.00	3.83
Q₃		4.50	4.62	3.00	3.00	3.00	5.17
α		0.86	0.88	0.86	0.91	0.91	0.81
Female	460
Mdn		3.25	3.25	2.50	2.00	1.50	4.67
Q₁		2.50	2.25	1.50	1.00	1.00	3.83
Q₃		4.50	4.25	3.00	3.20	2.94	5.17
α		0.88	0.89	0.84	0.92	0.92	0.83
p ^c		0.502	0.082	0.480	0.194	0.108	0.124
TRS	372
Mdn		3.75	3.00	2.25	2.00	1.50	4.50
Q₁		3.00	1.75	1.50	1.40	0.75	3.83
Q₃		5.00	4.00	3.00	3.60	3.00	5.00
α		0.87	0.86	0.84	0.92	0.92	0.82
ASP	351
Mdn		3.00	4.00	2.50	1.80	1.75	4.67
Q₁		2.25	3.00	1.50	1.00	1.00	4.00
Q₃		3.50	5.00	3.00	2.80	3.00	5.17
α		0.85	0.90	0.86	0.90	0.91	0.82
TRA	103
Mdn		3.50	3.00	2.00	2.00	1.50	4.50
Q₁		2.50	1.75	1.25	1.00	0.75	3.67
Q₃		5.25	4.00	2.75	3.40	2.75	5.50
α		0.87	0.91	0.86	0.93	0.94	0.85
p ^d		< 0.001	< 0.001	0.016	0.006	0.305	0.155
TRS vs ASP		< 0.001	< 0.001	0.322	0.001	0.123	0.056
TRS vs TRA		0.456	0.622	0.023	0.466	0.786	0.344
ASP vs TRA		< 0.001	< 0.001	0.004	0.202	0.501	0.863

Mn = mean. SD = standard deviation. Mdn = median. Q₁ = percentile-25. Q₃ = percentile-75. min = minimum score. max = maximum score. asym = asymmetry. kurt = kurtosis. a = typical asymmetry error = 0.08. b = typical kurtosis error = 0.17. c = Mann-Whitney contrast. d = Kruskal-Wallis contrast.

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Towards a Brief Definition of Burnout Syndrome by Subtypes

Development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12)

Background

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References

Authors and Disclosures

Authors and Disclosures

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