Article Type: Original Articles
Resident Burnout may be Correlated with Immature and Neurotic Ego Defenses in a Sample from Turkey
Onur Hursitoglu, Ebru Findikli, Fatih Saglam, Adem Doganer
Objective: This study aimed to examine the levels of burnout syndrome in residents and demonstrate the relationship between burnout and sociodemographic variables. We also aimed to show whether the use of immature and neurotic defenses were related to burnout syndrome.

Methods: We aimed to include all 156 residents who were working at Kahramanmaraş Sütçü Imam University’s Medical School Hospital during October 2017. A sociodemographic data form, the Maslach Burnout Inventory (MBI), the Defense Style Questionnaire, and the Beck Depression and Beck Anxiety Inventories were administered to all participants.

Results: Higher MBI-Emotional Exhaustion (EE) scores were associated with an increased number of night shifts, being unwilling to train at the selected specialty, and increasing working hours. There were significant correlations between mature defense mechanism scores and MBI-Personal Accomplishment (PA) scores as well as immature defense mechanism scores and MBI-EE and MBI-Depersonalization (DP) scores.

Conclusions: A higher rate of burnout was encountered with the increased workload of residents. The increased use of immature defense mechanisms increases the severity of these symptoms. To be able to combat this situation; it is necessary to organize training modules on sound defense strategies against the difficulties in work environment and to set limitations on working prolonged hours.

REFERENCES

1.Kealy D, Halli P, Ogrodniczuk JS, Hadjipavlou G. Burnout among Canadian psychiatry residents: a national survey. The Canadian Journal of Psychiatry 2016;61(11):732-6.

2.Awa WL, Plaumann M, Walter U. Burnout prevention: A review of intervention programs. Patient Educ aCouns 2010;78(2):184-90.

3.Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annual Rev Psychol 2001;52(1):397-422.

4.Duquette A, Kérowc S, Sandhu BK, Beaudet L. Factors related to nursing burnout a review of empirical knowledge. Issues Ment Health Nurs 1994;15(4):337-58.

5.Dikmetaş E, Top M, Ergin G. An examination of mobbing and burnout of residents. Turk Psikiyatri Derg 2011;22(3):137-49.

6.Borritz M, Rugulies R, Christensen K, Villadsen E, Kristensen T. Burnout as a predictor of self-reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study. Occup Environ Med 2006;63(2):98-106.

7.Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, et al. Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational, multicenter, cross-sectional study. Intensive and Crit Care Nurs 2017;41:11-7.

8.Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine 2012;172(18):1377-85.

9.Asai M, Morita T, Akechi T, Sugawara Y, Fujimori M, Akizuki N, et al. Burnout and psychiatric morbidity among physicians engaged in end‐of‐life care for cancer patients: a cross‐sectional nationwide survey in Japan. Psycho‐Oncology 2007;16(5):421-8.

10.Navines R, Olive V, Ariz J, Lopez J, Tortajada M, Varela P. Stress and Burnout During the First Year of Residence Training in a University Teaching Hospital: Preliminary Date. Dual Diagnosis: Open Access 2016;1:17.

11.Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Medical Education 2016;50(1):132-49.

12.Doolittle BR, Windish DM, Seelig CB. Burnout, coping, and spirituality among internal medicine resident physicians. J Grad Med Educ 2013;5(2):257-61.

13.Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, et al. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. Medical Care 1999:1140-54.

14.West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA 2006;296(9):1071-8.

15.McCray LW, Cronholm PF, Bogner HR, Gallo JJ, Neill RA. Resident physician burnout: is there hope? Family medicine. 2008;40(9):626.

16.Koh MYH, Chong PH, Neo PSH, Ong YJ, Yong WC, Ong WY, et al. Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study. Palliative Medicine 2015;29(7):633-42.

17.Pompili M, Rinaldi G, Lester D, Girardi P, Ruberto A, Tatarelli R. Hopelessness and suicide risk emerge in psychiatric nurses suffering from burnout and using specific defense mechanisms. Arch Psychiatr Nurs 2006;20(3):135-43.

18.Regan A, Howard RA, Oyebode JR. Emotional exhaustion and defense mechanisms in intensive therapy unit nurses. J Nerv Ment Dis 2009;197(5):330-6.

19.Freud A. The ego and the mechanisms of defense. NY: International Universities Press. 1936 196650-3.

20.Bond M, Perry JC. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Am J Psychiatry 2004;161(9):1665-71.

21.Akkerman K, Lewin TJ, Carr VJ. Long-term changes in defense style among patients recovering from major depression. J Nerv Ment Dis 1999;187(2):80-7.

22.Pollock C, Andrews G. Defense styles associated with specific anxiety disorders. Am J Psychiatry 1989;146(11):1500-2.

23.Ergin C. Doctor, nurses burnout and Maslach burnout scale adaptation. VII National Psychology Congress Scientific Studies. 1992;22:25.

24.Çam O. Investigation of validity and reliability of burnout inventory. Turkish Journal of Psychology. 1992:155-60.

25.Andrews G, Singh M, Bond M. The Defense Style Questionnaire. J Nerv Ment Dis 1993;181(4)246-56.

26.Yılmaz N, Gençöz T, Ak M. Psychometric Properties of the Defense Style Questionnaire: A Reliability and Validity Study. Turkish Journal of Psychiatry 2007;18(3):244-53.

27.Tanaka S, Yoshida K, Katayama H, Kohmura K, Kawano N, Imaeda M, et al. Association of Beck Depression Inventory score and Temperament and Character Inventory-125 in patients with eating disorders and severe malnutrition. J Eat Disord 2015;3(1):36.

28.Hisli N. Reliability and validity of Beck Depression Inventory among university students. Journal of Turkish Psychology 1989:7:3-13.

29.Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56(6):893-7.

30.Ulusoy M, Sahin NH, Erkmen H. the Beck Anxiety Inventory: Psychometric Properties. J Cogn Psychother 1998;12(2):163-72.

31.McManus I, Winder B, Gordon D. The causal links between stress and burnout in a longitudinal study of UK doctors. The Lancet 2002;359(9323):2089-90.

32.Pantenburg B, Luppa M, König H-H, Riedel-Heller SG. Burnout among young physicians and its association with physicians’ wishes to leave: results of a survey in Saxony, Germany. J Occup Med Toxicol 2016;11(1):2.

33.Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work–life balance, and burnout. Obstet Gynecol 2007;109(4):949-55.

34.Biaggi P, Peter S, Ulich E. Stressors, emotional exhaustion and aversion to patients in residents and chief residents-what can be done? Swiss Med Wkly 2003;133(23-24):339-46.

35.Armutlukuyu M. The evaluation of burnout levels of the academic staff and research assistants working at Medical faculties. Master thesis Selcuk University School of Medicine, Konya 2014. (Turkish).

36.Can H, Güçlü YA, Doğan S, Erkaleli MB. Burnout Syndrome Among The Resident Doctors In Surgical And Nonsurgical Clinics. The Journal of Tepecik Education and Research Hospital 2010;20 (1):33-40.

37.Miranda B, Louzã MR. The physician’s quality of life: Relationship with ego defense mechanisms and object relations. Compr Psychiatry 2015;63:22-9.

38.Machado L, Tavares H, Petribú K, Pinto T, Cantilino A. Happiness and defense styles in psychiatrists. J Nerv Ment Dis 2016;204(3):181-7.

39.Raggio B, Malacarne P. Burnout in intensive care unit. Minerva Anestesiol 2007;73(4):195-200.



Key words: Anxiety, burnout, defense mechanisms, depression, professional, residents
Psychiatry and Behavioral Sciences 2019;9(3):69-77
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License