Burnout, Psychological

Demographic data included age (≥14 years), sex, marital and employment status, religion, migrant background, education and total income of household.
The German version of the PSS-10 (PSS-10; [10 (link)]) was used to measure the degree to which life in the past month has been experienced as unpredictable, uncontrollable and overwhelming (e.g. “In the last month, how often have you felt nervous and "stressed"?) on a 5-point response scale (0 = “never”, 1=”almost never”, 2=”sometimes”, 3=”fairly often”, 4=”very often”). The scale was forward translated from English to German and subsequently back translated by two interdependent bilingual speakers. After reversing the scores on the four positively stated items (Items 4, 5, 7, and 8), a PSS-10 total score was obtained by summing up all 10 items. Higher scores indicated a higher level of perceived stress. As the PSS is not a diagnostic instrument, there are no cut-off scores.
In addition to the PSS-10, socio-demographic questions and additional psychological variables were measured by validated and standardized self-report inventories. These included screening questionnaires for depression and generalized anxiety (PHQ-4), the short form of the General Procrastination Scale (GPS-K), the Copenhagen Burnout Inventory (CBI), and the Life Satisfaction Questionnaire (FLZ-M) during the interview.
The PHQ-4 [28 (link)] consists of two items reliably assessing the core symptoms of depressed mood and loss of interest plus two screening items of the short form of the GAD-7 (Generalized Anxiety Disorder [GAD]-7 Scale) : “Feeling nervous, anxious or on edge” and “not being able to stop or control worrying”. The frequency of occurrence in the past two weeks was rated from 0 =”not at all”, 1 =”several days”, 2 =”over half the days”, and 3 =”nearly every day”. Answers of the first two items were added into a total score (0 to 6); a score ≥ 3 has a good sensitivity (87 %) and specificity (78 %) for major depression. Cronbach alpha in the present study was = .83. A sum score ≥ 3 (range 0–6) of the other two items indicates generalized anxiety with good sensitivity (86 %) and specificity (83 %), performing well as a screening tool for all anxiety disorders [29 (link)]. The internal consistency in the current study was Cronbach alpha = .77.
Procrastination was assessed by the 9-item short form of the General Procrastination Scale (GPS-K; [30 (link)]). Participants rated how characteristic they considered each behaviour (e.g. “I delay the completion of certain things”) on a 4-point scale (1=”very uncharacteristic” to 4 = “very characteristic”). The scale showed good reliability and validity in a representative German community sample [30 (link)]. The internal consistency was Cronbach alpha = .92.
The Copenhagen Personal Burnout Inventory (CBI; [31 (link)]) is part of the Copenhagen Psychosocial Questionnaire assessing physical and mental exhaustion, independently from work. It assessed the frequency of six items („How often do you feel …“): “tired, physically, emotionally exhausted, unable to go on, weak and prone to illness.” The items were rated on a 5-point scale 1 =”never/almost never”, 2 = “rarely”, 3 = “occasionally”, 4 = “often” to 5 = “always” (COPSOQ; [32 (link)]). The scale was reliable (Cronbach alpha in the present study = .91).
The Questionnaire on Life Satisfaction FLZ^M [33 ] is a multi-dimensional self-report measure of individual life satisfaction covering eight relevant areas of life (friends, leisure time activities/hobbies, general health, income, work/career school, housing/living conditions, family life and partnership/sexuality). Additionally, a sum score of all dimensions was used as an index of global life satisfaction. Respondents rated the present satisfaction with these dimensions on a scale from 1 = “dissatisfied” to 5 = “very satisfied”. As the scale bases conceptually on different domains, the life satisfaction sum-scores indicated only sufficient internal consistency (Cronbach alpha = .70).

Data from both a clinical and general population samples were included in the study. The clinical population consisted of patients seeking medical care at a specialized outpatient stress clinic; the Institute of Stress Medicine (ISM) located in Gothenburg, Sweden. All patients were ambulatory at the time of the study and none had received inpatient care due to their illness. They were referred from primary care units or occupational health care centres from the western part of Sweden and the referral criteria were stress-related exhaustion and a maximal duration of sick leave of six months. The patients included in this study were recruited between 2004 and 2009. All patients fulfilled the ICD-10 criteria for "other reaction to severe stress "(F.43.8A), which in Sweden has been further defined with diagnostic criteria of exhaustion which requires the presence of one or several clearly identifiable strain factors during at least six months [12 ]. During this period 354 patients were referred to the clinic and met these criteria, so entering the treatment program and thus were followed-up. To ensure that the exhaustion experienced by the patients is not due to other known causes, patients with known systemic or psychiatric disease (except depression, anxiety and exhaustion), present infection, body mass index below 18.5 or over 30 kg/m2, vitamin B12 deficiency, thyroid disorder or over-consumption of alcohol were excluded. Pregnant or breast-feeding patients were also excluded
Subjects from the general population were obtained from a survey study with the general aim to investigate different aspects of psychosocial work environment, stress, and stress-related health. This study population comprised a random sample (N = 5,300) of the 48,600 employees of Region Västra Götaland, a provider of public health care, and a random sample (N = 700) of the 2,200 social insurance office workers in the same geographical area. Inclusion criteria of at least one-year duration of employment (at least 50% of full-time) were applied. A postal questionnaire was used and the response rate after two reminders was 61%; thus in total 3,717 subjects responded. The majority was females (87%) and the average age of the participants was 47 years. From this population a stratified age-gender sample, comparable to the patient population, was randomly selected (n = 319). This was to ensure that the full range of burnout (e.g. low to high) was available to the psychometric analysis.

Parental burnout was assessed for comparative purposes with the Parental Burnout Inventory¹ (PBI, Roskam et al., 2017 (link)), a 22-item self-report questionnaire which has been created based on a deductive approach starting from the tridimensional model of professional burnout (Maslach and Jackson, 1981 (link); Maslach et al., 2001 (link)). The PBI consists of three subscales: Emotional Exhaustion (8 items) (e.g., I feel emotionally drained by my parental role), Emotional Distancing (8 items) (e.g., I sometimes feel as though I am taking care of my children on autopilot), and Loss of Parental Accomplishment (6 items) [e.g., I accomplish many worthwhile things as a parent (reversed)]. Items are rated on 7-point Likert scales: never (0), a few times a year or less (1), once a month or less (2), a few times a month (3), once a week (4), a few times a week (5), every day (6). In the current sample, Cronbach's alphas were 0.92, 0.89, 0.85 for the three subscales and 0.91 for the global score (i.e., the sum score of all PBI items). Alphas were similar in the French and English versions of the questionnaire with respectively 0.94 and 0.92 for Emotional Exhaustion, 0.87 and 0.90 for Emotional Distancing, 0.85 and 0.85 for Loss of Parental Accomplishment, and 0.92 and 0.91 for the global score.