Personality and Individual Dierences 39 (2005) 625635

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Stress and burnout: The signicant dierence

Ayala Malach Pines
a

a,*

, Giora Keinan

School of Management, Ben-Gurion University, Israel b Tel-Aviv University, Israel

Received 12 May 2004; received in revised form 3 February 2005; accepted 22 February 2005 Available online 11 April 2005

Abstract Burnout is often conceptualized within the framework of stress research. The present manuscript contends that while burnout and strain are both adverse responses to job stressors they seem to have dierent antecedents, correlates and consequences. The existential perspective is oered as a theory based approach to dierentiate the two concepts and point to the distinct features of burnout. Path analysis of data obtained from 1182 Israeli police ocers during a Palestinian uprising revealed good reconstruction by the theoretical model and provided tentative support for this proposition. As predicted, job stressors (assumed to be antecedent variables) were more highly correlated with strain than with burnout whereas job importance (assumed to be an intervening variable) was more highly correlated with burnout than with strain. Burnout was more highly correlated than strain with such (outcome) variables as job dissatisfaction, desire to quit the job, physical and emotional symptoms and perceived performance level. Implications for dierential treatment of stress and burnout are oered suggesting that the focus in treating burnout should be on enhancing peoples sense of their works importance and signicance. 2005 Elsevier Ltd. All rights reserved.
Keywords: Stress; Burnout; Existential; Signicance; Police

Corresponding author. E-mail address: pinesa@som.bgu.ac.il (A.M. Pines).

0191-8869/$ - see front matter 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.paid.2005.02.009

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1. Introduction Burnout is often conceptualized within the framework of stress research (e.g., Cooper, Dewe, & ODriscoll, 2001; Farber, 1983; Hobfoll & Shirom, 2000; Kop, Euwema, & Schaufeli, 1999; Maslach, Schaufeli, & Leiter, 2001; Paine, 1982; Row, 2000; Schaufeli & Greenglass, 2001; Shirom, 2003; Vachon, 2000; Vettor & Kosinski, 2000). Maslach et al. (2001), for example, dene burnout as a prolonged response to chronic emotional and interpersonal stressors on the job (p. 397). Hobfoll and Shirom (2000) view it as a consequence of ones exposure to chronic job stress; Cooper et al. (2001) as caused by chronic job stress and Schaufeli and Enzmann (1998) as a special type of prolonged occupational stress that results particularly from interpersonal demands at work (p. 8). The problem with conceptualizing burnout within the framework of stress research, as noted by Schaufeli and Enzman, is that the concept of stress is plagued by the same sort of denitional ambiguity as burnout. Cox (1985) wrote that the concept of stress is elusive because it is poorly dened. There is no single agreed denition in existence. It is a concept which is familiar to both layman and professional alike; it is understood by all when used in a general context but by very few when a more precise account is required (p. 1). Toch (2002) also argued that stress tends to be oversold as a general term in which causes and consequences are often confused. Not much, then, is gained by putting burnout within the conceptual framework of stress. In addition, there is ample anecdotal evidence to suggest that burnout is not always the result of high stress. At times, stress at work implies that ones work is important and thus is associated with lower burnout. A hospital nurse provides an example: The days I enjoy work most are the days in which I work the hardest she says. Burnout develops when there is nothing I can do to help a patient (Pines, 2000). The current paper contends, based on an application of existential theory, that while burnout may be a sub-category of stress, it seems to have somewhat dierent antecedents, correlates and consequences. According to the existential perspective, the root cause of burnout lies in peoples need to believe that their lives are meaningful, that the things they do are useful and important (Clarkson, 1992; Pines, 1993; Yiu-kee & Tang, 1995). The striving to nd meaning in ones life is the primary motivational force in man wrote Frankle (1976, p. 154). Peoples need to believe that the things they do are meaningful is their way of coping with the angst caused by facing their mortality (Becker, 1973). People who expect to derive a sense of existential signicance from their work, enter their chosen careers with high goals and expectations, idealistic and motivated. When they feel that they have failed, that their work is insignicant, that they make no dierence in the world, they start feeling helpless and hopeless and eventually burn out. Indirect support for the existential perspective can be found in studies that demonstrated a consistent negative correlation between burnout and a sense of signicance at work (e.g., Pines, 2000, 2002). However, correlations do not imply causality and it is possible that one of the outcomes of burnout is the feeling that the work is insignicant, or it could be that both burnout and lack of signicance are the results of a third, more general stress factor.

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Studies also demonstrated that aspects of work that correlate with burnout tend to be those that provide workers with a sense of signicance. Thus, the burnout of 100 hospital nurses was not correlated with the number of hours they worked (r = .08), but it was signicantly correlated with their sense of accomplishment (r = .43) (Pines, 2000). Also, in the case of 66 managers, feeling overextended was not correlated with burnout (r = .05), but it was signicantly correlated with having inuence (r = .40) (Kafry & Pines, 1980). Indirect support for the existential perspective was also obtained in hundreds of burnout workshops with professionals from a wide range of occupations that demonstrate a relationship between the goals and expectations professionals had when they entered their career and the stressors that eventually caused their burnout. For nurses, the most important goal was to help people in pain, consequently their greatest cause of burnout is witnessing human pain without being able to help. For teachers, the most important goal was to educate students, inuence and inspire them. Consequently, the major causes of their burnout are discipline problems and students being disruptive and impertinent. For managers, the most important goal was to have a signicant impact on the organization. Consequently, their most powerful cause of burnout is not having enough power and resources to have a real impact (Pines, 2002). Clinical work with burned out professionals also suggests that burnout is often related to a lack of a sense of signicance at work. When that sense of signicance is restored, the problem of burnout is resolved (Pines, 2002a). These three sets of datacorrelational studies of career burnout, data gathered during burnout workshops, and clinical work with burned out professionalsdid not test directly the existential perspective. The current study was designed to do that. A theoretical model derived from the existential perspective on burnout was tested using a large sample of police ocers. There were two main reasons for the choice of police ocers: First, police culture has certain features that seem especially relevant for testing the existential perspective such as an emphasis on heroism and the importance of the work (e.g. Fielding, 1988; Reiner, 2000). Second, police work is considered highly stressful (e.g. Anshel, 2000; Brown & Campbell, 1994; Dick, 2000; Kroes, 1988; Spielberger, 1979; Toch, 2002; Violanti & Paton, 1999) and burnout causing (e.g. Alexander, 1999; Burke, 1994; Golembiewski, Sun, Lin, & Boudreau, 1995; Goodman, 1990; Loo, 1994; Perrier, 1984; Violanti & Aron, 1994). The study was conducted during a period of heightened stress for Israeli police ocers as a result of a Palestinian uprising. The theoretical model (see Fig. 1) addressed the relationship between strain and burnout (as adverse responses) to work stressors (as antecedent variables), work importance (as an intervening variable) and various stress outcomes (such as job satisfaction and performance as consequences). Based on the existential perspective the following hypotheses were proposed: There will be a certain correlation between general level of strain and burnout as adverse responses to work stress. Work stressors will be more highly correlated with strain than with burnout. Work importance/signicance will be more highly correlated with burnout than with strain.

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Stress outcomes symptoms strain Adverse Responses

leave importance satisfaction stressors

burnout performance

Fig. 1. Theoretical model.

Consequences such as perceived performance level, job dissatisfaction, desire to quit and symptoms will be more highly correlated with burnout than with strain.

2. Method 2.1. Overview A path analysis was chosen to test the theoretical model because of its ability to estimate every path in the model, an ability that is critical in models with few variables. The analysis was done using the data of a study of stress and burnout among Israeli police ocers. The data were collected during 2001 and part of 2002, amidst the second Palestinian uprising, a time of unusually high stress for the Israeli police. 2.2. Participants The study involved 1182 Israeli police ocers, mean age 35.9 (SD = 7.5), mean education 14 years (SD = 2.4), 81% male and 19% female. Seventy four percent served on the regular police force and 26% were prison personnel. 2.3. Procedure Questionnaires were group administered to the participants (in groups of 710) by clinical psychology graduate students who received special training. After each group administration one or two of the respondents (chosen in random) were asked to take part in an interview. All together

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24% of the studys participants were interviewed. Participants were assured that their responses will be kept strictly anonymous. 2.4. Instrument The instrument used the study was built based on the literature on police stress and burnout, interviews with a wide range of police ocers, eld visits and burnout workshops with high and middle ranking ocers. The instrument was pilot tested on a sample of 30 police ocers. It had two parts: a self-report questionnaire and a structured interview. The self-report questionnaire included four parts: (1) dierent aspects of the work that were known (based on the literature and the pilot study) to be stressful for police ocers (e.g. irregular hours, the possibility of getting hurt). (2) Responses to these stressors in terms of overall level of strain and burnout. (3) Various physical and emotional symptoms (e.g. nervousness, headaches, back pains), performance level, job satisfaction, and desire to leave the police force. (4) Dierent aspects of the work, among them the works is importance and signicance. Work stressors. Respondents rated the degree of stress they felt as a result of 30 specic stressors from 1 = not at all stressful, to 5 = very stressful, with the option of answering NR = not relevant. A combined score was created by adding up all responses to the individual items. Cronbach alpha for the stressors questionnaire was .95. Overall level of strain. After rating the level of stress caused by 30 work stressors, respondents were asked to rate their general level of work strain (from very low = 1 to very high = 9). The evaluation of overall strain using a single item following a detailed list of stressors is an acceptable research practice (Cohen, Kessler, & Underwood Gordon, 1995; Keinan, 1994; Moos & Schaefer, 1993). The Burnout Measure (BM) is a self-report measure. Items are evaluated on 7-point frequency scales and assess the persons level of physical, emotional and mental exhaustion. The BMS, the short version of the BM used in the study, includes 10 items, measuring the levels of physical, emotional and mental exhaustion of the individual. Respondents are asked to rate the frequency in which they experience each of the items appearing in the questionnaire (such as being tired or helpless), on a scale ranging from 1 (never) to 7 (always). The BMS was shown to be a reliable and valid research instrument, with internal consistency coecients around .85 (Pines, 2005). The BM was shown to have clinical validity (Schaufeli, Bakker, Hoogduin, Schaap, & Kladler, 2001), to measure burnout in diverse occupations and was used in many countries (Pines & Aronson, 1988; Schaufeli & Van Dierendonck, 1993; Shirom, 2003). Performance level. Respondents were asked to estimate their level of performance on a percentage scale ranging from 1% = very low, all the way to 100% = very high. Physical and emotional symptoms. Respondents were asked to what extent they suer, when on the job, from 11 physical and emotional symptoms, from 1 = not at all to 5 = very much. Work importance and signicance. Respondents were asked to what extent they feel that their work is important and makes a signicant contribution on a scale ranging from 1 = not at all to 5 = very much so. During the interview they were asked to elaborate on the most signicant thing they do as part of their police work. Work satisfaction and desire to quit the police force. Respondents were asked to rate how satised they are from their job and whether they would have opted to quit if given another job both on a scale ranging from 1 = not at all to 5 = very much.

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3. Results Table 1 shows that strain and burnout have dierent correlations with job stressors (assumed antecedent variables), with works importance (assumed intervening variable) and with physical and emotional symptoms, performance level, job satisfaction and desire to quit the force (assumed stress outcomes). All the dierences between these correlations were signicant, as assessed by Z tests based on Z-Fisher transformations. A path analysis (see Fig. 2) revealed good reconstruction by the theoretical model. In Table 2, the simple correlations between job stressors and both performance and job satisfaction was very close to the correlation reconstructed through the model with slight under-tting. The simple r between job stressors and both on-the-job symptoms and a desire to quit was very close to the coecient r reconstructed through the model, with slight over-tting. The over-tting in the last
Table 1 Pearson correlations with stress and burnout Burnout Burnout Strain Stressors Symptoms Performance Importance Satisfaction Leave force p < .05. p < .01. *** p < .001 (two-tailed).
** *

Strain .53*** 1.00 .65*** .40*** .07* .04 .17** .28**

p dierence by Fisher Z

1.00 .53*** .54*** .73*** .15** .24** .41** .37**

*** *** * *** *** *

Stress Outcomes symptoms R2=.53 .03 .11 leave R2=.14 .07 .01

Adverse Responses

strain R2=.42 .65 -.01

importance satisfaction R2=.17 .71 .31 -.45 -.15 burnout R2=.34 -.21 .53

-.05 stressors

performance R2=.02

Fig. 2. Path analysis.

A.M. Pines, G. Keinan / Personality and Individual Dierences 39 (2005) 625635 Table 2 Simple and reconstructed correlations between stressors and their consequences Simple Performance Job satisfaction Desire to leave Symptoms .09 .17 .21 .43 Reconstructed .07 .19 .24 .40

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two cases can be explained by the existence of additional paths to the ones included in the model (e.g., a path connecting strain and burnout). Despite this slight over-tting and the rst two cases slight under-tting, the results overall seem to suggest that the theoretical model is ecient, and the subset of selected variables and their paths describe properly the relationship between the stressors and their dierent consequences. The model suggests a high path coecient (.65) between specic work stressors and the general level of strain reported by the respondents. There was a lower path coecient between those work stressors and level of burnout (.53). There was no signicant path coecient between the stressors and the sense of importance and signicance respondents derived from their work (.05), or between the sense of signicance and importance and the level of strain (.01), but there was a signicant path coecient between their sense of importance with their level of burnout (.21). There were also signicant path coecients between burnout and on-the-job symptoms (.71), satisfaction from the job (.45), the desire to quit the job (.31) and perceived level of performance (.15). There were far smaller path coecients between those outcome variables and the general level of strain. The interview material also revealed the signicant role played by the respondents sense of their works importance. Here are some examples of responses ocers gave when asked to explain what in their work gives them a sense of signicance: The importance of the work, the interest, and the feedback from the public. I save lives. Situations in which you feel that you helped society, you contributed. I feel that I have a great deal of inuence. Helping a person in distress.

4. Discussion Results of the path analysis demonstrate that the theoretical model underlying it is appropriate. The variables chosen for the model are relevant to the relationship between work stressors and their consequencesphysical and emotional symptoms, perceived performance level, job satisfaction and desire to quit the job. Furthermore, path coecients leading from work stressors through works importance to burnout are dierent from those leading through strainas seen in the path analysis. The fact that the correlations reconstructed by the model do not dier from the simple correlations obtained, strengthens the results of the path analysis. The path analysis provides tentative support for the notion that burnout and strain, despite both being adverse responses to work stressors have somewhat dierent antecedents, correlates and consequences. As predicted, work stressors (assumed antecedent variables) were more highly correlated with strain than with burnout, whereas the works importance was more highly correlated with burnout than with strain. Burnout was also more highly correlated than strain with

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such (assumed outcome) variables as lack of job satisfaction, a desire to quit the job, physical and emotional symptoms and perceived performance levelthus conrming all four of the studys hypotheses. The quotes from the interviews demonstrated the role played by the works importance and signicance. Of course, path analysis does not prove causality, only implies it. It is only possible to talk very cautiously about probable antecedents and consequences on the basis of a path analysis, even when one knows that job stressors usually precede physical and emotional symptoms and job dissatisfaction. The fact that the data presented are supported by interview materials in which the ocers elaborated on the causes and consequences of their burnout, permits cautious condence in them. Future research will need to put the model into a more stringent test using an experimental design. The study may be criticized for using a unique occupational group during a uniquely stressful time, namely Israeli police ocers who were studied during a violent Palestinian uprising. In response it can be noted that the majority of studies on burnout focused on documenting its existence within a certain organization (Maslach & Leiter, 1997) or occupation (e.g. nurses, teachers, police ocers). The underlying assumption being that burnout is a universal phenomenon that can be best explained by the demands of a particular occupation. Furthermore, the few studies that examined burnout cross-culturally (e.g. Golembiewski, Boudreau, Munzenrider, & Huaping, 1996), like the current study, did so in an eort to document its universality. The results are not assumed to be specic to the Israeli police in the time of the Intifada, but to be generalizable to every stressful occupation and every period of high stress. This assumption will need to be tested in future studies that will be done in other countries and on other occupations. Does the existential perspective on burnout falsify a stress perspective? Not necessarily. It can be argued, based on Maslach and Schaufelis (1993) work for instance, that lack of works significance is one of the demands at the workplace that tax individuals resources. Based on Hobfoll and Freedy (1993) and Hobfoll and Shirom (2000), it can be suggested that signicance is one of the resources that need conservation, and when it is lost, the result is burnout. Based on Cooper et al. (2001) it can be argued that lack of signicance is especially stressful for service professionals and results in this extreme manifestation of job related strain. Or else, following Schaufeli and Enzmann (1998), it can be said that lack of signicance reects an imbalance between job demands and workers response capability. Given that burnout had a higher correlation with symptoms than level of strain, an alternative interpretation could be that burnout is part of and a specic member of the cluster of adverse reactions or else that burnout is potentially the most serious adverse reaction from the presented set of symptoms and the correlations are picking this up. It can also be argued that peoples questioning of the meaningfulness of their lives can explain other adverse reactions to stressors, besides burnout. Thus Folkman and Moskowitzs (2000) note that meaning has long been implicated in the appraisal of stress . . . where it helps to determine the personal signicance of a stressful situation . . .The appraised or situational meaning shapes the emotions the person experiences in the stressful encounter. Appraised situational meaning contrasts with global meaning, which refers to more abstract, generalized meaning related to peoples fundamental assumptions, beliefs, and expectations about the world and the self in the world (p. 651). It seems that burnout is neither the result of a situational lack of signicance nor the result of a generalized sense of insignicance as evident in the fact that one can burn

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out in one sphere of life (work), but not in another (marriage) (Pines, 1996). Instead, burnout seems to result from an appraisal that ones contribution is insignicant. An example of Folkman and Moskowitzs (2000) global meaning in the sense of abstract, generalized meaning related to peoples fundamental assumptions, beliefs, and expectations about the world and the self in the world, is Jano-Bulmans (1992) assumptive world theory. JanoBulmans (1989) World Assumptions Scale assesses peoples assumptions about the worlds benevolence, lifes meaningfulness and worthiness of the self. Research has shown that these assumptions are shattered by trauma, whereas in burnout, lack of meaning is an antecedent rather than a result. Another example of global meaning is Antonovskys (1987) sense of coherence dened as a view of the world as comprehensible, manageable, and meaningful. Burnout, however, is not a result of viewing the world as meaningless, but only of viewing ones contribution to it as such. None of the alternative interpretations oered help clarify the uniqueness of burnout within a stress framework. This brings up again the criticisms raised against burnout as a phenomenon in search of a theory (Burisch, 1993) that has typically been studied in a somewhat atheoretical fashion (Hobfoll & Freedy, 1993). The existential perspective does not imply that other adverse reactions besides burnout cannot be the result of lack of meaning in peoples life, neither does it suggest that stress and burnout are entirely dierent. Burnout is viewed as a subcategory of stress with certain distinct traits (thus a certain correlation between strain and burnout can be expected, and was indeed found). It still has an advantage over the suggestions to view burnout within a general stress theory or as a form of occupational stress, as stress has become an over-general and umbrella like concept. The existential perspective also has an important practical implication. It can be translated into a treatment approach for burnout. The assumption underlying this approach is that in order to treat or prevent burnout, the focus should not be on reducing job stress, but rather on enhancing peoples sense that their work is important and makes a signicant contribution. This goal can often be achieved without signicant monetary expense, a huge advantage in times of shrinking budgets. Acknowledgments The Study was supported by a grant from the Israeli Ministry of Public Security. The authors wish to thank the Head of the Bureau of the Chief Scientist, the Head of the Social Sciences Division and the members of the studys Steering Committee for their invaluable help and support during all stages of the research. The views and opinions presented in this article represent only the views of the authors who bear sole responsibility for the papers content. The authors also wish to thank Prof. Charles Spielberger for his valuable comments on the manuscript. References
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