Give nine of resources analyzed for my annotated bibliographies.

Give nine of resources analyzed for my annotated bibliographies.

resources analyzed for my annotated bibliographies A
Give nine of resources analyzed for my annotated bibliographies.

Burnout, Informal Social Support
and Psychological Distress among
Social Workers
Esteban Sa´nchez-Moreno1,*, Iria-Noa de La Fuente Rolda´n2,
Lorena P. Gallardo-Peralta3, and Ana Barro´ n Lo´ pez de Roda4
1
Department of Sociology, Faculty of Social Work, Complutense University of Madrid, Madrid,
Spain
2
Department of Social Work, Faculty of Social Work, Complutense University of Madrid, Madrid,
Spain
3
Department of Philosophy and Psychology, Faculty of Social Sciences, University of Tarapaca´,
Arica, Chile
4
Department of Social Psychology, Faculty of Psychology, Complutense University of Madrid,
Madrid, Spain
*
Correspondence to Esteban Sa´nchez Moreno, Ph.D., Department of Sociology, Faculty of
Social Work, Complutense University of Madrid, Campus de Somosaguas, 28223 Pozuelo,
Madrid, Spain. E-mail: esteban.sanchez@cps.ucm.es
Abstract
Previous research has shown that social workers are a profession at risk of suffering a high
incidence of so-called burnout syndrome. Burnout is in turn related to psychological distress.
Social support from informal sources is a factor with potential to reduce the psychological
distress caused by burnout. However, the previous research has not considered
informal social support in sufficient detail. This article, using a cross-sectional study, analyses
the relationship between burnout, informal social support and psychological distress
in a sample of social workers in Spain (n ¼ 189). The results show a high incidence of
psychological distress and burnout, above all in terms of Emotional Exhaustion (EE). The
results of the hierarchical regression analysis confirm the importance of informal social
support as a variable negatively related to distress, even in the presence of burnout.
Surprisingly, organisational variables were not associated with distress. Longitudinal
and qualitative research is necessary to examine the nature of this relationship in detail.
Keywords: Burnout, social workers, distress, social support
Accepted: June 2014
# The Author 2014. Published by Oxford University Press on behalf of
The British Association of Social Workers. All rights reserved.
British Journal of Social Work (2014) 1–19 doi:10.1093/bjsw/bcu084
British Journal of Social Work Advance Access published September 2, 2014
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Background
Burnout syndrome relates to professions whose daily work has to do with
systematic and direct contact with people in need of care (Pines et al.,
1981). Maslach and Jackson (1982; Maslach, 1976), working on Freudenberger’s
(1974) proposals, established the grounds for psycho-social research on
burnout. The authors define the syndrome as a response to chronic work
stress, mainly related to those professions and services characterised by constant,
systematic and intense attention paid to people in need of care. Faced
with this situation, workers frequently develop a sense of professional failure,
in addition to a series of negative attitudes towards those people. It is important
to emphasise that burnout is not a form of psychological stress. Rather, it
is a response to chronic work stress resulting from the relationships established
between professional and client/user on the one hand, and professional
and institution on the other. Burnout is, moreover, a tri-dimensional
process composed of Emotional Exhaustion (EE), Depersonalisation (DP)
and reduced sense of Personal Accomplishment (PA), being defined by
the presence of feelings of EE, attitudes of DP towards clients and reduced
feelings of PA.
Bearing this definition in mind, social workers constitute an at-risk group
for burnout, since these professionals must cope with complex situations
where distress and suffering are characteristics of target groups for professional
intervention on a constant and systematic basis. There is a body of
international literature establishing social workers as an at-risk group and
analysing the incidence of burnout for this group (Barak et al., 2001; Cohen
and Gagin, 2005; Kim et al., 2011; Yu¨ru¨r and Sarikaya, 2012). Research conducted
by Gibson et al. (1989)focusing on social workers in Northern Ireland
found that 47 per cent of respondents showed DP and an even higher percentage
reported high levels of reduced PA. In New York, Martin and Schinke
(1998) found that social workers in the mental health and family fields
frequently developed burnout. Specifically, 57 per cent of mental health
and 71 per cent of family social workers presented high burnout levels. In
Chile, Barri´a (2002) found a burnout prevalence of 30.8 per cent among
social workers, and almost every respondent showed high levels of at least
one of its dimensions. Thus, social workers have a strong tendency to suffer
the phenomena studied. The same conclusion is valid for the study conducted
byEvans et al. (2006)in England and Wales, in which they found high levels of
EE and stress and that 19 per cent of respondents had low job satisfaction
levels. In Spain, research conducted to assess the prevalence of burnout is
scant (La´zaro, 2004; Grau and Sun˜ er, 2008; Hombrados and Cosano, 2013).
In spite of this, some articles do state the importance of the syndrome for
social workers. Research designed by Morales et al. (2004)for crisis intervention
and social services professionals found that half of respondents showed
high levels for at least one dimension of burnout, 23 per cent for two
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dimensions and 11.5 per cent for all three dimensions. Along the same lines, a
study completed by Jenaro et al. (2007)found that 20.4 per cent of workers in
human services were at risk of suffering burnout.
In summary, previous research has shown that social workers perform their
professional duties in a stressful social and organisational context (Pines and
Kafry, 1978; Acker, 1999; Kim and Stoner, 2008; Pasupuleti et al., 2009). For
this reason, burnout usually becomes a key dimension of professional intervention.
Some determinants in the emergence and development of burnout
among social workers are the constant social, demographic and political
changes affecting and modifying both client/user problems and professional
competences (Lloyd et al., 2002), scant social status and recognition for social
work, low salaries and resources for social intervention (Rupert and Morgan,
2005; Acker, 2008), and problems related to organisational structure and environment
determining role conflict and role ambiguity, lack of supervision
and coordination for work groups, and high staff turnover (Bennet et al.,
1993; Bradley and Sutherland, 1995).
In general terms, previous research is reasonably supportive of the idea that
burnout plays a role in the development of psychological distress and
emergence of psychological disorders (Pillay et al., 2005; Milfont et al., 2008;
Shanafelt and Dyrbye, 2012; Kozaka et al., 2013). Results from several
studies focusing on social workers indicate that the incidence of mental disorders
associated with burnout is considerably higher for social workers than for
other professions (Bennet et al., 1993; Lloyd et al., 2002). In this vein, Caughey
(1996) found that 72 per cent of social workers surveyed could be defined
as possible psychiatric cases, given the high levels of psychological distress
reported in relation to their professional performance. These findings are
very similar to those of Balloch et al. (1998) for the same professional group
and those of Collins and Parry-Jones (2000), who also noted that psychological
distress was associated with high levels of anxiety and depression. In summary,
previous research shows that burnout has significant negative consequences
for social workers’ mental health.
Given this relationship, a number of studies have focused on those variables
that may play a moderating role in the appearance of psychological distress following
the development of burnout. In this sense, one of the most important
variables is social support. There is abundant research considering social
support as a mediating variable between burnout processes and mental
health (Bennet et al., 1993; Pines et al., 2002; Collins, 2008; Yildirim, 2008).
Moreover, perceptions of both availability and lack of social support are
related to the development of burnout (Acker, 1999; Hamama, 2012a). Most
studies have focused on the formal social support networks maintained by
workers. These networks usually include co-workers, peers and supervisors
(Leiter and Maslach, 1988; Farber, 2000; Thomas and Rose, 2010; Hamama,
2012b). However, Baruch-Feldman et al. (2002) have pointed to the importance
of close personal relationships (family and friends). A few studies
(Maslach and Jackson, 1985; Greenglass et al., 1994; Huynh et al., 2013) have
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in fact shown that informal networks and relationships have important implications
for the development of burnout, and could even offer more effective
help than formal social support systems in alleviating this phenomenon
(Broadhead et al., 1983; House et al., 1988; House, 1991).
Informal social support focuses on a level of intimacy constructed within the
context of an interpersonal help system that shapes an ecological daily help
process in which people usually play complementary and interrelated roles
(Umberson and Montez, 2010). This level of social support involves feelings
of commitment and mutual exchanges and relationships with shared responsibility
for one another’s well-being. The level of social support is thus beneficial
preciselybecauseofthefunctions it fulfils.Asaresult,informalsocialsupportis
widely accepted as a key variable for health and well-being (Sa´nchez-Moreno
and Barro´n, 2003).
As reported byCollins (2008), social support becomes a major coping strategy,
since it enables the individual to deal with both instrumental (seeking
information, advice, etc.) and emotional (seeking affection, moral support,
etc.) issues, the latter relating to qualitative aspects of informal support. In
the context of formal systems and groups, support is based on an exchange
of resources aimed at satisfying the specific needs that can be met within
the most intimate relationships with family and friends. We therefore see
the importance of informal social support as a potential work–stress reducing
variable.
The general aim of this study consists specifically of examining the relationshipbetweeninformalsocialsupport,burnoutandpsychologicaldistressamong
social workers in Madrid (Spain). Given the scarcity of existing research in
Spain, one of the specific aims is to evaluate the incidence of burnout and psychological
distress in a sample reflective of the socio-demographic composition
of the profession in the aforementioned city. We also seek to analyse the roles
played by burnout and by social support emanating from informal sources in
psychological distress in the case of social workers. In this respect, it is worth
stressing the importance of considering the potential of informal social
support to reduce the negative consequences of burnout and thus addressing
one of the more notable gaps in the literature, as outlined in preceding
paragraphs.
Method
Participants and procedure
Two hundred social workers from public social services in Madrid were contacted
by telephone to participate in our study, of whom 189 ultimately participatedinourcross-sectionalresearch(94.5per
cent responserate).Self-report
questionnaires were distributed by mail to the social workers that voluntarily
agreed to participate. The participants answered the questionnaires and
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returned them by mail. To present the research, a letter was enclosed with each
questionnaire that introduced the research team, the context and purpose of
the research, and the structure of the questionnaire, and also guaranteed
participant anonymity.
The sample was predominantly female (87.3 per cent, n ¼ 165). The
average age was 41.8 years, ranging from twenty-three to sixty years. The majority
of the professionals were married or living with a partner (70.4 per cent,
n ¼ 133) and 51.9 per cent (n ¼ 98) had children.
With respect to employment, the average duration of occupation as a social
worker was eight years and more than half of participants (56.6 per cent, n ¼
107) had working experience of between sixteen and thirty years. Participants
had spent an average of seven years in their current position. Approximately
one-third of respondents (32.3 per cent, n ¼ 61) had been in their current position
for fifteen to thirty years, 32.8 per cent (n ¼ 62) for six to fifteen years
and, finally, 33.9 per cent (n ¼ 64) for one to five years. Only 1 per cent
(n ¼ 2) had spent over thirty years in their current position.
Regarding agency size, the average was thirty-five workers per agency.
Institutions with one to fifteen workers accounted for 34.4 per cent (n ¼
65) of the sample, with 23.3 per cent (n ¼ 44) employing sixteen to thirty
workers, 15.9 per cent (n ¼ 30) employing thirty-one to sixty workers and
21.7 per cent (n ¼ 41) with more than sixty workers. Finally, subjects reported
an average of thirty-five clients per week, distributed in intervals from one to
twenty-five clients (44.4 per cent, n ¼ 84), from twenty-five to fifty clients
(30.7 per cent, n ¼ 58) and more than fifty clients (12.7 per cent, n ¼ 24).
Finally, all participants were professionals from public social services. Of
the participants, 138 (73 per cent) worked in the Social Services Network
and fifty-one (27 per cent) worked in the Public Health System. Of the
former, eighty-eight participants (63.9 per cent) performed their professional
work in Primary Social Care and fifty (36.1 per cent) were employed in Specialized
Social Care (elderly, mental health, education, children and family,
etc.). This is representative of social work in Spain, where professionals
principally work within the public system.
The study was approved by the ‘Faculty Postgraduate Committee’ (Faculty
of Social Work at Complutense University of Madrid). In addition, all
participants in the study provided verbal consent after being contacted by
the research team.
Measures
A socio-demographic and job data questionnaire was used. It included
workers’ socio-demographic variables (i.e. gender, age, marital status and
number of children), professional experience and experience in current position,
and variables relating to the workplace including caseload (number of
clients) and size of agency (number of employees).
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Burnout was assessed with the Maslach Burnout Inventory–Human Service
Survey (MBI–HSS) (Maslach and Jackson, 1986), using the Spanish version
developed by Seisdedos (1997). The MBI is a twenty-two-item scale including
three dimensions: Emotional Exhaustion (EE; nine items), Depersonalisation
(DP; five items) and Personal Accomplishment (PA; eight items). EE
describes the feeling of being emotionally overextended and exhausted, DP
reflects an impersonal and unfeeling attitude towards professional services
clients and PA describes feelings of success and competence regarding one’s
work, principally with relation to clients. Participants were asked to rate how
often they felt the feelings described for each item on a seven-point Likert
scale, ranging from ‘never’ (0) to ‘every day’ (6). The three-factor MBI structure
has been replicated using different samples (Maslach and Jackson, 1981;
Lee and Ashforth, 1996; Schaufeli et al., 2001) and has been used with social
worker samples (Kim and Ji, 2009; Hamama, 2012a, 2012b). The internal
consistency of the MBI in our research was 0.848.
The twenty-eight-item version of Goldberg’s General Health Questionnaire
(Goldberg, 1978; Goldberg and Williams, 1988), adapted and validated into
Spanish by Lobo et al. (1986), was used to assess psychological distress. This
questionnaire is a screening instrument that estimates psychiatric morbidity
and analyses the assessment a person makes of his/her own state of well-being,
especially as regards certain emotional orpsychological states that generate psychological
distress. It consists of twenty-eight items divided into four seven-item
scales: somatic symptoms (GHQA), anxiety/insomnia (GHQB), social dysfunction
(GHQC) and severe depression (GHQD). Participants evaluate the
occurrence of each item on a four-point response scale ranging from ‘less than
usual’ (0) to ‘much more than usual’ (3). The factor structure of the GHQ-28
has been validated in various studies (Banks, 1983; Medina-Mora et al., 1983).
The internal consistency of the GHQ in our research was 0.939.
Finally, to analyse the social support networks that professionals have
outside of work, we used an adaptation of the Social Resources Inventory
(SRI) developed by Di´az Veiga (1987). It includes different social support
dimensions: objective and structural factors (frequency of contact with networks),
subjective factors (satisfaction with networks) and functional
aspects (emotional, instrumental or both). These dimensions are assessed
with relation to four contact areas: partner, children, wider family and
friends. For each area of contact and satisfaction, scores range from 1 to
3. Montorio (1994) determined the internal consistency indices, finding
values ranging from 0.35 to 0.86 depending on the sample. The internal
consistency value in our research was 0.722.
Results
As shown in Table 1, in terms of the MBI dimensions, the average social
worker scores are similar to the average scores for the normative sample
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(Seisdedos, 1997) for the DP and PA dimensions. However, there is a difference
as regards the EE dimension, where the sample returned higher average
scores. The sample thus had a high level of EE, moderate levels of DP and a
PA higher than the sample for the Spanish adaptation of the MBI. In fact, as
seen in Table 2, more than half of participants (55.6 per cent) reported high
EE levels, 30.7 per cent showed high DP attitudes and 21.2 per cent of professionals
reported feelings of low PA. While the majority of participants experienced
positive feelings towards the work they were doing (PA, 39.2 per cent),
according to Spanish norms, the sample was mainly characterised by its high
EE level and moderate DP level (39.7 per cent).
As regards psychological distress, the average for social workers for the
global GHQ-28 score is slightly higher than that indicated in the cut-off
points. That is, as may be observed from Table 3, the total average obtained
was 23.37+12.01, and thus the average was above the cut-off points established
in the Spanish adaptation of the questionnaire (Lobo et al., 1986).
Although most of the professionals (56.6 per cent) did not present a possible
case of psychological distress, 41.8 per cent did obtain scores above the
cut-offs. The high percentages for scale C (social dysfunction) stand out.
As regards the organisational variables, PA is greater among those individuals
attending to a higher number of users per week (r ¼ 0.352; p ¼ 0.000)
and lesser among those social workers carrying out their professional work
Table 1 Comparison of burnout scores of social workers with scores for the normative sample
(Seisdedos, 1997)
Group MBI subscales
Spanish norms for MBI (N ¼ 1,138) EE DP PA
Mean 20.36 7.62 35.71
Standard deviation 11.30 5.01 8.0
Social workers sample (N ¼ 189) EE DP PA
Mean 26.16 7.51 36.94
Standard deviation 10.08 5.43 7.81
EE, Emotional Exhaustion; DP, Depersonalisation; PA, Personal Accomplishment.
Table 2 Incidence of low, moderate and high levels of burnout
Low Moderate High
n % n % n %
EE 23 12.2 56 29.6 105 55.6
DP 50 26.5 75 39.7 58 30.7
PA 40 21.2 64 33.9 74 39.2
Note: the cut-off points for each MBI dimension are those established in the Spanish adaptation of the
Manual (Seisdedos, 1997). EE—high: =25, moderate: 24–15, low: =14; DP—high: =10, moderate: 9 –4,
low =3; RP—high: =40, moderate: 39 –33, low: =32. EE, Emotional Exhaustion; DP, Depersonalisation;
PA, Personal Accomplishment.
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in institutions with a higher number of employees (r ¼ –0.171; p ¼ 0.025).
The data also reveal correlations between the GHQ subscales and certain
work variables. In this regard, the professional experience variable shows a
significant positive correlation with the global score for GHQ-28 (r ¼
0.157; p ¼ 0.032), with the severe depression variable (r ¼ 0.164; p ¼ 0.024)
and with the anxiety and insomnia variable (r ¼ 0.163; p ¼ 0.026). In the
same manner, the experience in current position variable correlates with
the severe depression subscale (r ¼ 0.163; p ¼ 0.025). These results suggest
that certain professional variables may influence psychological distress in
social workers.
With respect to the association between burnout and psychological distress,
Table 4 records the correlations for the study variables, with the following
results standing out. The EE dimension correlates significantly and
positively with each one of the GHQ subscales. These associations are
repeated for the DP dimension exclusively with the anxiety and insomnia
(r ¼ 0.321; p ¼ 0.000), severe depression (r ¼ 0.220; p ¼ 0.003) and global
GHQ-28 score (r ¼ 0.233; p ¼ 0.002) subscales. The PA dimension is significantly
negatively associated with all the GHQ-28 subscales, except somatic
symptoms.
Considering the different social support dimensions analysed by SRI, significant
negative associations were found for the EE dimension with the variables
of satisfaction with support of extended family (r ¼ –0.293; p ¼ 0.000)
and satisfaction with support of friends (r ¼ –0.179; p ¼ 0.015). Each and
every one of the GHQ-28 subscales are significantly negatively associated
with overall satisfaction with support, with satisfaction of professionals
with the contact maintained with spouse or partner, with satisfaction with
family contact and with satisfaction with friendships (see Table 4). Furthermore,
the global support measure correlates with all the subscales measuring
psychological distress, except for the severe depression subscale. There is also
a statistically significant association between the frequency of partner contact
measure and different GHQ-28 subscales (somatic symptoms: r ¼ –0.174;
Table 3 Descriptive statistics for GHQ-28
Descriptives GHQA GHQB GHQC GHQD GHQ
M 7.02 7.20 7.54 1.72 23.37
SD 4.25 4.69 2.42 2.75 12.01
Percentages n % n % n % n % n %
Possible case 90 47.6 98 51.9 136 72.0 13 6.9 79 41.8
No case 97 51.3 90 47.6 52 27.5 176 93.1 107 56.6
GHQ, General Health Questionnaire; GHQA, somatic symptoms; QHQB, anxiety and insomnia; GHQC,
social dysfunction; GHQD, severe depression; GHQ, global average score. Cut-off points—Global: =23;
each subscale: =7.
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Table 4 Matrix of associations among main study variables
EE DP PA GHQA GHQB GHQC GHQD GHQ
GHQA 0.524** 0.115 –0.098
GHQB 0.590** 0.321** –0.178*
GHQC 0.352** 0.118 –0.160*
GHQD 0.406** 0.220* –0.250**
GHQ 0.573** 0.233* –0.189*
Number of users –0.025 0.078 0.352** –0.044 –0.037 –0.024 –0.036 –0.042
Number of workers 0.089 0.011 –0.171* 0.091 0.097 0.088 0.070 0.117
Professional experience 0.124 –0.083 –0.130 0.116 0.163* 0.101 0.164* 0.157*
Experience in current position 0.117 –0.024 0.016 0.129 0.120 0.097 0.163* 0.143
Overall support –0.070 –0.088 0.004 –0.160* –0.197** –0.189** –0.127 –0.191**
Satisfaction with overall support –0.112 –0.080 –0.020 –0.221* –0.265** –0.259** –0.181* –0.274**
Overall contact frequency –0.022 –0.093 0.026 –0.078 –0.111 –0.110 –0.064 –0.089
Satisfaction with partner support –0.104 –0.023 0.083 –0.256** –0.238** –0.256** –0.164* –0.282**
Satisfaction with child support 0.059 –0.101 –0.077 0.018 –0.017 –0.050 0.023 –0.006
Satisfaction with family support –0.293** –0.104 –0.017 –0.195** –0.343** –0.343** –0.302** –0.294**
Satisfaction with friend support –0.179* 0.024 –0.031 –0.248** –0.266** –0.228** –0.197** –0.267**
Frequency of partner contact –0.069 –0.019 0.064 –0.174* –0.152* –0.194** –0.136 –0.189**
Frequency of child contact 0.058 –0.116 –0.075 0.035 0.003 –0.024 0.053 0.020
Frequency of family contact –0.071 –0.125 0.110 0.021 –0.050 0.031 –0.017 0.041
Frequency of friend contact –0.057 0.049 0.090 –0.057 –0.078 0.050 –0.063 –0.025
EE, Emotional Exhaustion; DP, Depersonalisation; PA, Personal Accomplishment; GHQ, global score; GHQA, somatic symptoms; QHQB, anxiety and insomnia; GHQC, social
dysfunction; GHQD, severe depression.
* p = 0.05; ** p = 0.01.
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p ¼ 0.017; anxiety and insomnia: r ¼ –0.152; p ¼ 0.037; social dysfunction:
r ¼ –0.194; p ¼ 0.008; and overall score: r ¼ –0.189; p ¼ 0.010).
To understand the role played by burnout and informal social support in
psychological distress, three theoretical models of increasing complexity
were formulated and tested through a hierarchical regression analysis. The
first model exclusively included the various burnout dimensions (EE, DP
and PA) as independent variables. The second included the burnout dimensions
and variables related to social support. The third and final model, in
addition to the preceding variables, included the aforementioned work and
organisational variables. Of these, the third model does not increase the
explicatory capacity of the preceding ones (F ¼ 2.065; p ¼ 0.089).
As may be observed in Table 5, for model 1 (which explains 35.1 per cent of
the GHQ-28 variance), only the EE burnout dimension shows a significant
association with distress (b ¼ 0.562; p ¼ 0.000). In model 2, significant
Table 5 Hierarchical linear regression models for psychological distress (GHQ)
Model B SE b b t p
1 (p , 0.01) (Constant) 11.160 4.729 2.360 0.020
EE 0.703 0.088 0.562 7.975 0.000
DP 0.118 0.167 0.049 0.702 0.484
PA –0.178 0.106 –0.109 –1.678 0.095
2 (p , 0.01) (Constant) 23.980 9.713 2.469 0.015
EE 0.547 0.086 0.437 6.393 0.000
DP 0.270 0.154 0.113 1.749 0.083
PA –0.213 0.099 –0.131 –2.157 0.033
Frequency of partner contact 3.619 1.838 0.334 1.969 0.051
Satisfaction with partner support –5.173 1.818 –0.475 –2.845 0.005
Frequency of child contact 13.713 3.892 1.635 3.523 0.001
Satisfaction with child support –13.614 3.959 –1.603 –3.438 0.001
Frequency of family contact 3.729 2.067 0.111 1.804 0.073
Satisfaction with family support –3.353 1.884 –0.115 –1.779 0.077
Frequency of friend contact 1.453 1.503 0.068 0.967 0.335
Satisfaction with friend support –4.144 1.735 –0.171 –2.388 0.018
3 (n.s.) (Constant) 23.222 10.130 2.292 0.023
EE 0.529 0.085 0.423 6.188 0.000
DP 0.243 0.155 0.102 1.571 0.119
PA –0.176 0.104 –0.109 –1.697 0.092
Frequency of partner contact 3.031 1.837 0.280 1.650 0.101
Satisfaction with partner support –4.453 1.830 –0.409 –2.433 0.016
Frequency of child contact 14.042 3.897 1.674 3.604 0.000
Satisfaction with child support –14.372 3.956 –1.692 –3.633 0.000
Frequency of family contact 3.252 2.051 0.097 1.586 0.115
Satisfaction with family support –3.724 1.873 –0.128 –1.988 0.049
Frequency of friend contact 1.091 1.494 0.051 0.730 0.467
Satisfaction with friend support –4.348 1.733 –0.179 –2.509 0.013
Professional experience 0.194 0.473 0.033 0.411 0.681
Number of workers 0.011 0.005 0.133 2.174 0.031
Number of users –0.019 0.036 –0.034 –0.540 0.590
Experience in current position 0.359 0.359 0.074 1.001 0.319
EE, Emotional Exhaustion; DP, Depersonalisation; PA, Personal Accomplishment.
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associations appear between distress and the following variables: EE (b ¼
0.437; p ¼ 0.000), PA (b ¼ –0.131; p ¼ 0.033), satisfaction with partner relationship
(b ¼ –0.475; p ¼ 0.005), frequency and satisfaction of contact with
children (b ¼ 1.635; p ¼ 0.001 and b ¼ –1.603; p ¼ 0.001, respectively),
and finally, satisfaction with relationship maintained by professionals with
close friends (b ¼ –0.171; p ¼ 0.018). This model explains 47.6 per cent of
the GHQ variance.
Discussion
The participants in our study reported higher burnout levels than those found
in previous research (Maslach et al., 1996; Jenaro et al., 2007; Lernihan and
Sweeney, 2010). The sample was characterised by an elevated presence of
emotional exhaustion, which was present for more than half of participants.
This is consistent with numerous studies showing that, for social workers,
emotional exhaustion is the most prevalent dimension (Bradley and Sutherland,
1995; Evans et al., 2006; Acker, 2008). Though many variables influence
the development of burnout, it should not be forgotten that one of the fundamental
aspects of social work is the establishing of a highly emotionally
charged relationship between professional and user. As recorded in various
investigations since this phenomenon was first studied, those professions
with heightened emotional demands, characterised by direct and continuous
contact with persons in situations of need, are precisely those presenting the
greatest risk of suffering burnout (Maslach, 1978; Soderfeldt et al., 1995;
Maslach and Leiter, 1997).
Although the proportion of social workers affected by psychiatric distress
is lower than that reported in other studies (Caughey, 1996;Evans et al., 2006),
it remains consistent with the relevant literature that shows the high levels of
psychological distress present among these professionals in comparison to
other occupational groups and to the general population (Thompson et al.,
1996; Balloch et al., 1998; Rossi et al., 2012).
Our results show that 41.8 per cent of participants obtained scores above
the cut-off points, especially with respect to social dysfunction (72 per
cent), which, according to the Spanish adaptation of the questionnaire
(Lobo et al., 1986), indicates that these professionals present a possible psychiatric
case on the basis of self-reporting levels of distress. However, as
pointed out by Makowska et al. (2002) in their study of the validity of the
GHQ, these findings must be interpreted cautiously due to the limitations
of the measurement instrument. In particular, it is possible that estimates
may overemphasise the incidence of disorders, leading to persons being erroneously
classified as ‘psychiatric cases’ when, in reality, they are healthy. In
any event, within the context of the present study, the GHQ does not serve
a diagnostic purpose, and in fact the independent variables considered in
the multivariate analyses reflect the presence of the symptoms identified in
Burnout, Informal Social Support, and Psychological Distress Page 11 of 19
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the various instrument subscales, and not a diagnosis of a possible psychiatric
case.
Nevertheless, the strong association found between burnout and psychological
distress does render these levels of distress particularly important.
Our results reinforce the findings of previous research (Bennet et al., 1993;
Lloyd et al., 2002). Furthermore, it is the emotional exhaustion dimension
that shows greater correlations with lack of health or well-being, which
again indicates the fundamental role of emotions within professions such
as social work, with managing emotions forming an integral part of daily
professional life.
One of the fundamental aims of this research was to analyse the role played
by informal social support in psychological distress, considering it together
with burnout. Our results suggest that the association between informal
social support and burnout is specific, with the key variable being satisfaction
with social support. Additionally, the results suggest that informal social
support is particularly important in those situations in which burnout is
also a key factor in accounting for the psychological distress. In general
terms, our results fit a model of direct effect of informal social support. In
this regard, the results of the regression analysis undertaken suggest that an
association exists between emotional exhaustion and the low personal accomplishment,
on one hand, and psychological distress on the other. To
this association, positive in statistical terms, one must add the opposing association
between specific dimensions of social support (satisfaction with
partner, friend and family contact) and psychological distress. Those social
workers that suffer burnout would thus benefit from having access to an effective
informal social network, which would provide support in functional
terms. This benefit should not arise through sharing aspects of daily work
in a manner that may compromise professional ethics by breaching client–
professional confidentiality. Rather, we refer here to the potential buffering
effect of informal sources of social support, forming part of a mutual assistance
system based on reciprocity offered by both instrumental and, more importantly,
emotional social support. This is particularly significant given the
high levels of emotional exhaustion in our study. An effective system of informal
social support would create a natural space for well-being separate from
the distress caused by the social worker’s professional situation.
On this point, it is worth emphasising that, in our results, the quality of
social support (Brown and Harris, 1978), in our case expressed as satisfaction
with social support, is the variable associated with the reduction of psychological
distress. This is a finding consistent with the previous research,
which highlights the positive effect of informal social support from a subjective
and functional perspective (Ogus, 1990; Barro´n and Sa´nchez-Moreno,
2001; Yildirim, 2008).
As regards the structural dimensions of support, only frequency of contact
with children shows a significant positive association with psychological distress.
As indicated in other studies (Blanch and Aluja, 2012), a possible
Page 12 of 19 Esteban Sa´nchez-Moreno et al.
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explanation may lie in the dimension of gender. Our sample is predominantly
female (a fact reflecting the realities of the profession in Spain), perhaps
leading to the existence of difficulties in reconciling the family and professional
lives that generate a double working day. In this regard, it is unsurprising
that, faced with these balancing difficulties, there is an equivalent
doubling in work overload, generating greater stress and psychological distress,
particularly among women (Parasuraman and Simmers, 2001; O’Driscoll
et al., 2004; Jua´rez, 2007; Rubino et al., 2013).
Regarding organisational variables, certain studies have shown that professional
experience and current position decrease psychological distress
(Furnham, 2001). After years of experience, social workers acquire a
greater mastery of the activities, tasks and emotions associated with the job
and develop strategies to cope with stress, which they modulate based on
their experiences in previous situations. However, our results are contrary
to previous findings in this respect. One possible explanation for this is
that, despite the knowledge acquired through experience, constant and prolonged
contact with the problems of clients and the institutional framework
could cause the professional to feel progressively overwhelmed, increasing
distress and feelings of burnout due to the emotional overload generated
by many years of professional practice. For our sample, the effects of the
Great Recession (during which time the field research for this study was
carried out) may have exacerbated this process. There has been radical
growth in inequality and an increasing proportion of the population have
ever-greater socio-economic needs. Together with falling levels of resources
available for social intervention, these factors have created a context in which
it is the professionals with greater experience who may be better equipped to
appreciate the significance of this growing inequality, experiencing higher
levels of professional frustration, workplace stress and burnout.
In any case, it is noteworthy that organisational variables did not play an
important role in our study. In fact, in the hierarchical regression analyses
undertaken, the contribution of the variables considered (size of organisation,
workload, experience in position) did not satisfy the statistical
significance conditions for incorporation into the psychological distress explicatory
model. These results are inconsistent with the previous literature
on this issue (Pines et al., 1981; Drory and Shamir, 1988; Burke and Richardsen,
1996; Maslach and Leiter, 1997; Hamama, 2012a). A possible explanation
may lie in the variables selected, which in the case of social workers
may not be those of greatest importance in the development of burnout
and psychological distress. Specifically, it appears necessary to determine
the organisational variables that relate to the emotional exhaustion dimension,
as this is the dimension of greatest importance in the explanation of
burnout among professionals according to the results obtained.
In this respect, certain variables that may play a significant role in the
development of burnout and psychological distress in social workers, which
have not been analysed in depth in this study, are those related to the
Burnout, Informal Social Support, and Psychological Distress Page 13 of 19
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interpersonal system of the organisation, principally as regards service users.
It cannot be forgotten that social workers work with an oppressed population.
From the perspective of anti-oppressive social work (Dominelli, 2002),
‘service users’ become an excluded social category within a social structure
that exacerbates inequalities and social division. In this regard, it is necessary
for the professional to confront their own prejudices and, further, to focus
their intervention not merely on the person, but also on the exclusive and
unequal system. Along these lines, resolute institutional support for case advocacy
actions may assist in reducing burnout levels, helping the professional
achieve a sense of agency and mastery in seeking to effect institutional and
structural change with respect to oppressive situations. This is applicable
both for depersonalisation—given the involvement with the needs of the
groups and individuals on behalf of which case advocacy is implemented—
and personal accomplishment, since case advocacy may contribute to improving
the tools and strategies of social change that characterise social
work intervention.
Conclusion
Our study demonstrates the great impact of the workplace environment on
social workers, suggesting that this profession is associated with a high risk
of suffering burnout and psychological distress. In this regard, this research
makes its contribution within the framework of a scarcity of studies examining
the relationship between burnout and psychological distress in Spain. But
this contribution undoubtedly has certain limitations. First, it is necessary to
design more complex research. Longitudinal studies and/or statistically representative
samples would be of great use in understanding the development
of burnout over the course of professional careers. It would also clearly be
particularly useful to undertake research through the development of qualitative
designs. This strategy would be particularly important in understanding
the experience that professionals themselves have of burnout, thereby
achieving a more detailed understanding of the mechanisms linking it with
psychological distress in professionals. Second, our study did not include
measures for formal and professional social support. Though the existing literature
has clearly documented the association between this kind of support
and burnout, future research could focus on the relationship between informal
social support and professional social support, in addition to the processes
by which such a relationship influences burnout levels experienced
by social workers. The aim would be to determine the extent to which
sources of support are complementary, additive or act as functional substitutes,
among other possibilities, and to identify the impact of these dynamics
in burnout. The results of this type of research may help to identify keys
for developing policies aimed at reducing workplace stress and psychological
distress.
Page 14 of 19 Esteban Sa´nchez-Moreno et al.
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Within the context of these limitations, the current research makes a contribution
to knowledge of the incidence of burnout in Spain, a country in
which previous research is scarce. Perhaps the most noteworthy element of
the results obtained relates to the importance of informal social support.
Given this importance, it would be worth designing prevention and intervention
strategies concerning burnout among social workers taking the aforementioned
trend into account. Taking part in informal social activities
represents one possible approach to prevent burnout and psychological distress
and offers an example of the aforementioned space for well-being
(Yukelson, 1997). This strategy would be even more effective if complemented
by effective social support within the workplace environment, such as
peer-support groups (Schaufeli and Enzmann, 1998).
As our results suggest, these strategies would be particularly useful to
reduce EE, the variable more closely related to psychological distress in
the case of social workers. In future research, a joint consideration of the
formal and informal dimensions of social support would permit a precise
evaluation of each dimension’s role and the specific patterns of their association
with burnout and psychological distress.
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