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)

Results

Characteristics of the Study Participants

A response rate (RR) of 25.81% was obtained, with 'TRS' (RR = 20.04%) being less participative than 'ASP' (RR = 33.24%) and 'TRA' (RR = 35.76%) (p < 0.001). Table 1 shows the socio-demographic and occupational characteristics of the participants. No significant differences were found between the sub-samples in any of them.

Factorial Validity

Exploratory Factor Analysis (EFA) over n₁ All the items presented values of r > 0.30 in the correlations matrix, with 89.39% of them being significant. 83.33% of the MSA were > 0.80 and absolute anti-image values approached 0. The KMO was = 0.83, the matrix determining factor = 0.001 and Bartlett's test p < 0.001. Consequently, the data distribution enabled EFA to be performed legitimately. This analysis provided an unforced solution for three factors. The first ('neglect') explained 37.53% of the variance (eigenvalue = 4.50); the second ('lack of development') explained 20.13% (eigenvalue = 2.41); and the third ('overload') explained 16.12% (eigenvalue = 1.94). The scree test allowed the solution to be accepted as adequate. In total, 73.78% of the variance was explained. Table 2 shows the rotated factor solution and h² values.

Confirmatory Factor Analysis (CFA) over n₂ Mardia's coefficient was = 66.77 (p < 0.001), which made it possible to use the ML estimation method in conditions of distance from the assumption of multivariate normality. Figure 1 shows the results of CFA from an analytical perspective. The fit indices for this model were: χ² = 149.61 (gl = 51; p < 0.001), χ²/gl = 2.93, GFI = 0.941, AGFI = 0.911, RMSEA = 0.068 (90% CI = 0.055–0.080), SRMR = 0.059, NFI = 0.943, NNFI = 0.951, IFI = 0.962 and CFI = 0.962. The entry into the model of those correlations between the error terms with modification indices that showed significant reductions in the value of χ² [e₄-e₅ (r = 0.13; p = 0.015), e₄-e₁₀ (r = 0.19; p = 0.009), e₅-e₆ (r = 0.18; p = 0.002), e₅-e₁₁ (r = 0.20; p < 0.001) y e₆-e₁₁ (r = 0.15; p = 0.014)], gave the following indices: χ² = 112.04 (gl = 46; p < 0.001), χ²/gl = 2.44, GFI = 0.958, AGFI = 0.929, RMSEA = 0.059 (90% CI = 0.045–0.073), SRMR = 0.057, NFI = 0.958, NNFI = 0.963, IFI = 0.975 and CFI = 0.974.

(Enlarge Image)

Figure 1.

Analytical perspective of Confirmatory Factor Analysis^†.

Criterial Validity

When predicting 'exhaustion', the area under the ROC curve for 'overload' was = 0.75, this was = 0.80 for 'lack of development' relative to 'cynicism' and = 0.74 for 'neglect' relative to 'inefficacy' (p < 0.001). Table 3 shows the accuracy of cut-off points that optimized the sensitivity-specificity ratio ['overload'≥3.38 (se = 75.89; sp = 62.35); 'lack of development'≥3.63 (se = 70.71; sp = 70.57); 'neglect'≥2.63 (se = 71.19; sp = 67.03)].

Descriptives, Internal Consistency and Contrasts

25.06% of participants in the total sample presented high or very high scores in only one of the MBI-GS dimensions; 16.46% did so in two of them; and 8.11% in all three. Table 4 shows the descriptives for the BCSQ-12 items, while Table 5 shows those corresponding to the BCSQ-12 and MBI-GS dimensions, as well as contrast with regard to sex and occupation. The results of the internal consistency analysis showed that removal of items separately caused the α value to decrease in all cases. No differences were found with regard to sex, but there were differences depending on occupation. Teaching or research staff (TRS) showed higher levels of 'exhaustion' than administration or service personnel (ASP), TRS and trainees (TRA) presented higher levels of 'overload', ASP showed higher levels of 'lack of development' (p < 0.001). TRA showed lower levels of 'neglect' than ASP (p = 0.004).

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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)

Results

Characteristics of the Study Participants

Factorial Validity

Criterial Validity

Descriptives, Internal Consistency and Contrasts

Tables

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Figure 1.

Figure 1.

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