The relationship between burnout and adaptation of medical personnel

Ignateva Regina Aleksandrovna ORCID: 0009-0002-9564-2243 student; Institute of Clinical Psychology and Social Work ; Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation (Pirogov University) 117279, Russia, Moscow, Ostrovityanova str., 1, office 1128 r.lipskaya@gmail.com

Trubitsyna Lyudmila Valentinovna ORCID: 0000-0003-0479-1148 PhD in Psychology Associate Professor; Institute of Clinical Psychology and Social Work; Federal State Autonomous Educational Institution of Higher Education 'Pirogov Russian National Research Medical University' of the Ministry of Health of the Russian Federation 129344, Russia, Moscow, Ostrovityanova str., 1, office 1128 trubitsyna.lyudmila2015@yandex.ru Other publications by this author

For several decades now, the term "burnout" has been widely used in scientific and applied research to describe a state of psychological and emotional exhaustion resulting from prolonged exposure to stressors at work or in other areas of life ^{[1; 2]}. It is generally believed that the very term "burnout" was introduced in 1974 by the American psychiatrist X. Fredenberger, who opened a network of free clinics for substance abusers in the USA and Canada ^[3]. However, even before him, this phenomenon was repeatedly described in the literature ^[4]. Burnout syndrome is most often studied by medical professionals ^{[5; 6]} and educators ^{[7; 8]}, however, burnout is currently being actively studied by representatives of a wide variety of professions ^[9], for example, in the IT field ^[10], among police officers ^[11]. It was noted that in addition to the negative impact on the mental and somatic health of a doctor, burnout syndrome leads to a decrease in the quality of medical services, an increase in the number of medical errors and a slowdown in the decision-making process ^[12].

Despite the huge amount of research on the phenomenon of burnout, it is worth noting a serious problem associated with the age of onset of burnout, more precisely, with the duration of work leading to burnout. The second indicates the ambiguity of the interpretation of the term "burnout", because unpreparedness rather indicates a lack of adaptation, and many studies do not take into account the adaptability and duration of work of employees. The question of the influence of age and work experience on the development of burnout symptoms in representatives of helping professions remains open ^[13]. Only sometimes employees with less than 2 years of experience are excluded ^[14]. But there are studies that do not mention age in principle ^[15]. Often, the highest level of burnout is noted among employees who have been working for a very short time ^{[6; 16]}. And this raises the question of whether we are dealing with burnout or maladaptation. Our area of interest is to study the relationship between the concepts of adaptation and burnout.

The purpose of this study is to investigate the relationship between burnout and adaptation of medical personnel with different work experience.

There is no unambiguous definition of the concept of "adaptation" in psychology, just as there is no unambiguous definition of the concept of "burnout". In different schools and areas of psychology, the concept of "adaptation" is often interpreted and viewed in very different ways ^[17]. In our study, we relied on the model of social adaptation as a dynamic process and as a result of the harmonious interaction of an individual with the social environment A.A. Rean and colleagues^[18]. At the same time, adaptation is considered as a process and result of internal and external changes, and the concepts of "adaptation" and "adaptability" are considered synonymous.

Some authors see adaptation as a process with stages, a result with an assessment of success, and a phenomenon with the formation of neoplasms. Here we rely on the stages of professional adaptation by M.A. Dmitrieva: initial adaptation, stabilization, potential maladaptation, secondary adaptation, and age-related decline in adaptive abilities ^[19].

We believe that only secondary maladaptation should really be considered as a consequence of burnout, in all other cases we are dealing with a complex and uneven adaptation process. Professional deformations of physicians ^[20] caused by maladaptation can act as protective mechanisms that reduce emotional stress from excessive empathy for patients. When considering the stages, criteria, and factors of burnout and the features of maladjustment, we can see significant similarities.

Unfortunately, only a few studies attempt to compare the processes of burnout and adaptation, with either burnout being considered as one of the factors of maladaptation, or maladaptation as a factor of burnout ^{[21; 22; 23]}

In this study, we decided to test exactly how the criteria of adaptation and burnout are related. At the same time, we hypothesized that the criteria of burnout and adaptability offered in widely used tests are highly interconnected, which leads to difficulties in differentiating the phenomena of burnout and maladjustment (maladjustment). In addition, we assumed that the relationship between burnout and adaptability will vary depending on the length of service of doctors.

The research method

In the study, we used the questionnaires "Diagnosis of the level of emotional burnout" (V. V. Boyko) ^[24], "Methods for diagnosing professional burnout" (K. Maslach and S. Jackson, adaptation by N. E. Vodopyanova) ^[25] and "Methods for diagnosing socio-psychological adaptation" (K. Rogers and R. Diamond) ^[26].

The study involved 60 doctors (53 women, 6 men) aged from 24 to 77 years and with work experience from 1 year to 53 years. Depending on the length of service, all doctors were divided into 3 groups: experience from 1 to 5 years, work experience from 8 to and

The data was analyzed using the IBM Statistics SPSS program. The Spearman criterion, the Kraskel-Wallis criterion, and the Mann-Whitney criterion were used.

Analysis of the results

The study of the relationship between adaptation and burnout was conducted using the Spearman correlation coefficient. A large number of feedback loops have been found between various indicators of adaptability and indicators of burnout (see Fig. 1).

Fig. 1. Correlation galaxy of indicators of emotional burnout and socio-psychological adaptation (* p < 0,05 ** p < 0.01 (Spearman's rank correlation coefficient))

It was found that the integral indicator of adaptation negatively correlates with the phases of burnout — exhaustion, emotional deficit, personal detachment, as well as with dissatisfaction with oneself, trapped in a cage, anxiety and depression (p<0.01). In addition, a negative relationship with inadequate response was revealed (p<0.05). The integral indicator of adaptation also demonstrates a high negative correlation with psychosomatic disorders, emotional exhaustion, depersonalization and the systemic burnout syndrome index, while there is a positive relationship with a reduction in professional achievements (p<0.001).

Maladaptation demonstrates positive associations with phases of tension, dissatisfaction with oneself, a state of "trapped in a cage", exhaustion, personal detachment (p<0.01), as well as with phases of resistance and inadequate response. Positive correlations with the expansion of the sphere of economy, emotional deficit (p<0.05), anxiety and depressive states, psychosomatic disorders, emotional exhaustion, depersonalization and the systemic burnout syndrome index were also revealed. At the same time, a negative relationship was found with a reduction in professional achievements (p<0.001). The integral self-acceptance index shows negative correlations with the phases of tension, resistance and exhaustion, dissatisfaction with oneself (p<0.01), expansion of the sphere of economy, reduction of professional responsibilities, anxiety and depression (p<0.05), depersonalization and the systemic index of burnout syndrome. At the same time, a positive relationship was found with a reduction in professional achievements (p<0.001) and a negative relationship with the systemic burnout syndrome index (p<0.05).

Self—acceptance also demonstrates a positive relationship with the reduction of professional achievements (p<0.001) and a negative relationship with the systemic burnout syndrome index (p<0.05). This indicates that self-acceptance can help reduce professional burnout and improve adaptation.

The inability to accept oneself and other people has a strong connection with various aspects of burnout and maladjustment. This includes a phase of tension, dissatisfaction with oneself, anxiety and depressive states, inadequate response, decreased professional activity, emotional detachment, expansion of the sphere of economy, emotional exhaustion, psychosomatic disorders, depersonalization and a general indicator of burnout syndrome. Moreover, the inability to accept oneself and others negatively correlates with the level of professional achievements (p<0.001).

Emotional comfort and discomfort also show an inverse relationship with the integral indicator of adaptation. Emotional comfort is negatively associated with phases of tension and dissatisfaction with oneself (p<0.01), a state of being trapped in a cage, anxiety and depression, exhaustion, emotional detachment, psychosomatic disorders, phases of resistance, inadequate response, expansion of the sphere of economy and a decrease in professional activity. At the same time, emotional discomfort correlates positively with the listed indicators (p<0.01) and negatively with the level of professional achievements (p<0.001).

There is an inverse correlation between the level of emotional comfort and the phase of exhaustion, emotional deficit, psychosomatic disorders, as well as the systemic index of professional burnout syndrome. At the same time, a positive association of emotional comfort with a reduction in professional achievements was found (p<0.05). There was also a significant feedback relationship between adaptivity and the state of being "trapped in a cage" and depersonalization (p<0.05). In addition, a positive association of adaptability with a reduction in professional achievements (p<0.001) was found.

The interpretation of the results of the correlation analysis allows us to conclude that the socio-psychological adaptation of a personality is so closely interrelated with the level of emotional burnout that the use of these two concepts may seem redundant.

However, using the nonparametric Kruskal-Wallace criterion, we compared three groups of doctors with different professional experience. Significant differences in burnout and adaptation rates were found between the three groups. This division into groups eliminated the problem of the lack of a direct correlation between age and burnout. The nonlinear relationship between burnout and age could be the reason why some studies have not found correlations between these parameters.

Fig. 2. Diagrams of the "box plot" criteria of emotional burnout in groups of doctors with a duration of work in the medical field of 1-5 years, 6-15 years and more than 16 years (Kraskel-Wallis H-test, * p ⩽ 0.05, ** p ⩽ 0.01)

Fig.3. Diagrams of the "box plot" criteria of professional burnout in groups of doctors with a duration of work in the medical field of 1-5 years, 6-15 years and more than 16 years (Kraskel-Wallis H-test, * p ⩽ 0.05, ** p ⩽ 0.01)

4. Diagrams of the "box with a mustache" of adaptation parameters (integral indicators) in groups of medical personnel with 1-5 years of experience in the medical field, 6-15 years and more than 16 years (Kraskel-Wallis H-test, * p ⩽ 0.05, ** p ⩽ 0.01)

When comparing groups with different work experience in pairs (Fig. 2-4), it was found that people with average (6-15 years) and long (more than 16 years) work experience differs only in some indicators of adaptation and psychosomatic disorders. It can be assumed that the differences in burnout may be less pronounced for experienced and highly qualified employees. When working with this category of specialists, it may be advisable to investigate the factors of secondary maladaptation.

People with short and medium (first and second groups), as well as with short and long (first and third groups) work experience showed marked differences in most criteria of burnout and adaptation. The first group turned out to be the least adapted, which requires the development and implementation of active measures to "adapt" them to their professional activities.

Significant differences were found between people in the first and second groups in all the main indicators of adaptation. This is logical, since the beginning of professional activity is often accompanied by a low fitness for professional duties. According to the burnout scales, the differences related to anxiety and depression, psychosomatic disorders and depersonalization, which may be due to low adaptability.

Differences were found between the subjects with a large difference in seniority (the first and third groups), primarily in terms of burnout criteria: stress and exhaustion phases. The integral indicators of adaptation also differed, but to a lesser extent than in groups with short and medium experience. This may indicate a decrease in adaptability in the third group and the development of burnout in people with extensive work experience.

Next, to analyze the relationship between the parameters of professional burnout and the level of adaptation in three groups of subjects, we again turned to correlation analysis using the Spearman correlation coefficient.

Statistically significant correlations were found in the group of medical professionals with 1 to 5 years of work experience (Group 1), shown in Fig. 5.

Figure 5. Correlation galaxy of interrelations between the parameters of professional burnout and adaptability in a group of medical professionals with 1-5 years of experience in the medical field.

There were many negative correlations between rates of adaptation and burnout. This indicates that professionals with less work experience who show signs of maladaptation also show symptoms of professional burnout. Significant correlations were found between the reduction of professional achievements and the integral indicator of acceptance of others, as well as between emotional exhaustion and external control, escapism (p<0.05). A negative relationship between emotional exhaustion and internality was also found. Depersonalization is inversely correlated with the integral index of acceptance of others, as is the systemic index of burnout syndrome with adaptability (p<0.05). In addition, a significant negative relationship was found between the systemic burnout syndrome index and the integral acceptance index of others (p<0.001). Significant negative correlations of the integral indicator of adaptation with such scales of emotional burnout as the stress phase, the expansion of the sphere of economy, the exhaustion phase, emotional deficit, personal detachment (p<0.05), the resistance phase and the reduction of professional responsibilities (p<0.01) were revealed. In addition, the inverse relationships of the integral index of emotional well-being with the stress phase, self-dissatisfaction, anxiety and depressive states were revealed. personal detachment (p<0.05), expansion of the sphere of economy (p<0.01), phase of resistance and reduction of responsibilities (p<0.001).

Data analysis showed significant negative correlations between adaptability and emotional deficit (p<0.01), as well as a significant positive relationship between maladaptivity and reduction of professional responsibilities (p<0.01). A positive correlation was found between the phase of resistance and the tendency to escapism, as well as with the scale of sincerity (p<0.05). At the same time, the scale of sincerity is negatively related to the reduction of professional responsibilities (p<0.05).

Among employees with short work experience, emotional comfort shows a negative relationship with the expansion of the sphere of economy (p<0.05) and emotional deficit (p<0.01), while emotional discomfort is positively associated with the phase of tension, anxiety and depression (p<0.05), the phase of resistance (p<0.01) and reduction of responsibilities. (p⩽0.001). Inadequate response is also positively correlated with escapism (p<0.05).

In the second group (6-15 years of work experience) Significant correlations between burnout and adaptability scales were also revealed (Fig.6). We observe a strong correlation between professional burnout and adaptation criteria, which highlights their interdependence. The severity of signs of burnout may depend on the employee's adaptability to the workplace or profession.

Figure 6. Correlation galaxy of interrelations between the parameters of professional burnout and adaptability in the group of medical workers with 6-15 years of experience in the medical field.

In the group of employees with work experience from six to fifteen years, statistically significant correlations were found between the level of emotional burnout and self-acceptance, decreased professional achievements and adaptability. There is also a link between psychosomatic disorders and maladaptive manifestations (p<0.05). Emotional burnout shows a positive correlation with conformity (p<0.01). It is negatively related to the integral indicator of the desire for dominance (p<0.05).

Psychosomatic problems among doctors with 6-15 years of experience are associated with emotional discomfort, conformity, and escapism (p<0.05). The burnout scale "Emotional detachment" correlates with emotional discomfort, external control, and negatively with the integral index of internality (p<0.05).

The expansion of the economy zone significantly correlates with a low level of self-acceptance. Experiencing stressful situations, feeling hopeless, and emotional disorientation are significantly correlated with emotional discomfort (p<0.05). Internal control positively correlates with the phase of resistance (p<0.05), and self—rejection with the expansion of the sphere of economy (p<0.01).

In group 3, consisting of respondents with work experience of 16 years or more, significant correlations between burnout and adaptation were also found (Fig. 7). All integral indicators of adaptation demonstrate a significant negative relationship with all criteria of professional burnout, with the exception of the reduction of professional achievements.

Figure 7. Correlation galaxy of interrelations between the parameters of professional burnout and adaptability in a group of medical professionals with more than 16 years of experience in the medical field.

The integral indicator of acceptance of others demonstrates a statistically significant inverse relationship with emotional exhaustion (p<0.05) and a significant negative correlation with depersonalization and the systemic index of occupational burnout syndrome (p<0.001). There is also a positive correlation with an increase in professional achievements (p<0.01). In turn, an increase in professional achievements is associated with increased adaptability and self-acceptance (p<0.05).

Let's analyze the relationship between emotional burnout and adaptation in people with long professional experience (group 3). Personal detachment negatively correlates with integral indicators of internality, adaptation (p<0.05) and emotional comfort (p<0.01), but is positively associated with maladaptivity, emotional discomfort, external control (p<0.01), rejection of others, internal control and escapism (p<0.05). The Self-rejection scale demonstrates positive associations with the phases of resistance and exhaustion, as well as with emotional deficits. The integral indicator of acceptance of others is inversely correlated with dissatisfaction with oneself, feeling trapped and the phase of exhaustion (p<0.05).

Doctors with more than 16 years of professional experience have significant associations between rejection of others and emotional discomfort, as well as phases of tension, self-dissatisfaction, anxiety, depression, and exhaustion (p<0.05). Negative correlations of the integral indicator of self-acceptance with resistance and the integral indicator of adaptation with self-dissatisfaction (p<0.05) were found. The integral indicator of emotional comfort in people with more than 16 years of work experience negatively correlates with self-dissatisfaction, anxiety and depression, exhaustion and emotional deficit (p<0.05). The Caged scale has an inverse relationship with internality, but a positive correlation with external control (p<0.01). The scale of "Experiencing circumstances" is related to internal control (p<0.05), an integral indicator of the desire for dominance, and dominance itself (p<0.01). In group 3, weak positive associations were found between dominance and phases of tension and exhaustion, external control and psychosomatic disorders, listlessness and anxiety with depressive states (p<0.05).

Conclusion

Thus, the correlation analysis of the criteria of burnout and adaptation in groups with different professional experience has again shown a high relationship between them. The numerous correlations between the parameters of burnout and adaptation suggest that these phenomena are two sides of a single process. Burnout rates prevail when maladaptation is detected. This observation may indicate that existing questionnaires do not clearly differentiate the phenomena of burnout and maladjustment, making it impossible to distinguish between these two processes and understand what we are dealing with: maladjustment or burnout.

The relationship between the criteria of professional burnout and adaptation is significant. Burnout diagnostic techniques often signal problems for employees who have not yet fully adapted to the workplace. These techniques do not allow for a clear distinction between burnout and adaptation.

Theoretically, many signs of maladaptation in the initial period of professional activity may be similar to symptoms of burnout. However, among young professionals, detachment is probably more often due to a lack of skills and experience of adaptation, ways of coping with difficulties and solving complex problems. This can lead to avoidance of communication with patients and a decreased sense of competence and productivity. In the group of doctors with experience from 6 to 15 years, an inverse relationship was found between burnout and adaptation criteria, but there are fewer of them than among young specialists.

The hypothesis that maladjustment and burnout reflect the same processes has been largely confirmed. The number of correlations between the results of the techniques is so high that it makes it difficult to differentiate them. The question arises about the expediency of using two terms to describe virtually the same phenomenon. In our opinion, the existence of two terms is justified, taking into account their relationship with the duration of work.

The criteria for adaptation and professional training vary depending on the length of service. For young professionals, the phenomena of maladaptation or an incomplete adaptation process come to the fore. Signs of burnout in this case can be considered as a consequence of unsuccessful adaptation and enhance it. In this case, we can talk about burnout due to unsuccessful adaptation. Doctors with long and average experience can talk about true burnout, the signs of which are more pronounced. The interrelationships of professional burnout with adaptation and professional demand are obvious, but in this context, we can talk about secondary maladaptation resulting from burnout.

In accordance with this, it is necessary to develop recommendations for the development of adaptation or for the prevention of burnout, depending on the length of service. Our study also raises the question of the need to develop tests that make it possible to differentiate low adaptability and burnout as phenomena that have initially different natures and different manifestations, although they can enhance each other.