The Evaluation of Burnout Syndrome among health professionals in Casablanca, Rabat and Kenitra

Zakaria Abidli¹, Sara Jadda¹_,Donia Kharbouch¹, Aicha Detsouli²_,Abdelrhani Mokhtari¹,

Asmaa Zaidouni³, Abdelmajid Soulaymani¹

¹Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco,

²Faculty of Sciences Mohammed V University Rabat, Morocco,

³Faculty of Medicine Rabat, Mohammed V University, Rabat, Morocco

*Corresponding Author E-mail: abidli@outlook.fr

ABSTRACT:

Objective: Today, workplace stress is a real scourge that has serious individual, organizational, social and economic consequences. The study aims to determine the prevalence of the three dimensions of burnout among health professionals in three cities in Morocco. Methods: This is a cross-sectional survey carried out mainly in three cities: Casablanca, Rabat and Kenitra. Among the 100 survey sheets, 83 respondents, including 16 general practitioners (19%), 29 specialist doctors (35%), 18 pharmacists (22%) and 20 nurses (24%). In our study, we used and the French version of the Maslach Burnout Inventory, which includes three scales: emotional exhaustion, depersonalization, and reduced personal accomplishment. Results: The indices calculated by Cronbach's alpha are very important for emotional exhaustion (α = 0.83), depersonalization (α = 0.67) and personal fulfilment (α =0.74). The results of the Maslach Burn out Inventory show that 33 (40%) of healers with a very high average score of 25.39 of emotional exhaustion. A level of depersonalization was found in 28 (34%) of the respondents, with a high average score of 8.65, while 5 (6%) healers with a low level of personal achievement. According to the variance analysis, there was a strong relationship between gender and the average personal achievement score (p=0.00), with a slightly high score among women at the level of emotional exhaustion. In regard to labour conflict and credit, there was a significant link with the three dimensions of MBI (p=0.00). Conclusion: Burnout is a real problem that affects the health professionals. Our study confirms this pathology by the prevalence of the three dimensions of Maslach. Our results call for the interest of a prevention program at different levels.

KEYWORDS: Burnout, Health professionals, Maslach, Morocco.

INTRODUCTION:

According to Lazarus and Folkman, psychological stress is defined as the subject's perception of an environment that threatens, exceeds the person's adaptive resources and compromises his well-being [1]. Work has long been considered a source of stress and many occupational stressors are known: overwork or lack of work, physical danger, organizational or interpersonal conflict, and family occupation could limit only a few of them[2,3, 4].

Some stressors are specifically related to the health function, such as the need to make vital decisions based on ambiguous information. The risk of error with serious consequences, contacts with emotional patients, their families and other health professionals [5].

In 1970, burnout syndrome was described as a particular form of chronic stress response in helping professions, including nurses, social workers and physicians [6-7] According to the American Institute of Stress, job stress is responsible for 75 to 90% of consultations and 60 to 80% of occupational accidents in the United States [8]. Health professionals in Morocco are a particular target for suffering because they are exposed to numerous health risks in relation to increasingly restrictive work situations. The high demand and the workload in Moroccan hospitals can be explained by the acute shortage of health personnel, According to the statistics of the National Order of Physicians and the Ministry of Health, the total number of doctors in 2014 was 19770 (7946 for the private sector and 11824 for the public sector) is a doctor for 1925 inhabitants, that of paramedics was 29025; a paramedic for 1339 inhabitants. According to the World Health Organization, the number of health professionals in Morocco did not reach the recommended critical threshold of 22.8 doctors, nurses and midwives per 10,000 inhabitants. In Morocco, the density was only 13.7 (5.2 doctors and 7.5 paramedics) per 10 000 inhabitants for the two sectors (about 60% for the public and 40% for the private sector [9-10]. Which could explain that the field of health in Morocco is one of the most stressful sectors and most exposed to burn out. A study conducted among doctors in training at the CHU IbnRochdin Morocco has shown that 31.8% of participants with severe burnout [11]. Unfortunately, the number of studies conducted to assess burnout among health professionals remains relatively low and the surveys are mainly descriptive. The Maslach Burnout Inventory (MBI) is the most commonly used measurement tool [4]. In this sense, the objective of this study is to evaluate the prevalence of the three dimensions of the burnout syndrome among health professionals and its relation to the socio-economic variables in the three Moroccan cities (Kenitra, Rabat and Casablanca).

MATERIALS AND METHODS:

This is a cross-sectional study that lasted five months, from January to June 2018. The study concerned health professionals (general practitioners, specialists, pharmacists and nurses) working in public hospitals in the three cities (Kenitra, Rabat and Casablanca). A survey sheet is distributed to health professionals and requested for completion outside working hours. The anonymity of the technical data sheet guarantees the confidentiality of the respondents' data. The data collection was done through a questionnaire containing two parts. The first one had included socio-demographic variables such as age, sex, professional status, sector of activity and professional experience. While, the second one corresponded to the French version of the Maslach Burn out Inventory (MBI). Furthermore, our population is Franco-Arab-speakers, the psychometric qualities of the MBI and its French version are satisfactory [4, 12, 13]. The MBI, in its French form, was used to assess the prevalence of burnout. It was presented as a self-administered survey sheet consisting of 22 items, assessing three dimensions: emotional exhaustion (EE), depersonalization (DP) and personal achievement (PA). A score was calculated and a severity rating (low, moderate, high) and it was given for each dimension according to internationally standards. The frequency of symptoms was measured by a six-point scale or zero corresponds to the "never" response and six corresponds to the "every day" response.Emotional exhaustion (EE) was considered moderate for a score greater than or equal to 18, and high for a score greater than 30. Depersonalization (DP) was considered moderate for a score between six and 11, and high for a score above 12. Finally, the decrease in the sense of Personal Achievement (PA) was considered moderate for a score between 34 and 39, and high for a score below 33 [12, 14].

The statistical methodology was based on two axes: descriptive statistics and analytical statistics. We calculated, in the first part, the frequencies and characteristics of each variable studied which could give a general idea of the respondents. The results were expressed as a percentage for the qualitative variables and as an average ± standard deviation for the quantitative variables. Then, we used, in a second step, the χ² test to determine if a significant difference exists between qualitative variables and the variance analysis (ANOVA), which will allow us to compare quantitative and qualitative variables. The measurement of the internal consistency of the three dimensions of Maslach Burn out Inventory (MBI) was verified using the Cronbach coefficient. Acceptable alpha values are normally above 0.70 [15].

RESULTS:

Among the 100 sheets that were sent to health professionals working in hospitals in the three cities (Kenitra, Rabat and Casablanca), 83 participants were interviewed in this study, with a participation rate of 83%. The majority of the healers interviewed work in the city of Kenitra with 36 respondents, which corresponds to 43% followed by health professionals working in the city of Casablanca with 28%, while 29% work in the city of Rabat. Our study was carried out on 16 general practitioners (19%), 29 specialist physicians (35%), 18 pharmacists (22%) and 20 nurses (24%) (Table 2). The mean age of the respondents was 53.5 ± 7.3 years. These were 46 women (55%) and 37 men (45%), with a sex ratio (female / male) of 1.44 in favour of women. The mean professional experience was 20.44 years, with extremes ranging from 3 to 39 years (Table 1).

The average of professional experience was 20.44 years, with extremes ranging from 3 to 39 years. Indeed, to check the internal consistency of different classification criteria of the MBI survey sheet, we deduced the compatibility of the component questions by searching for the Cronbach index. So, the indices calculated found were very important for emotional exhaustion (α = 0.83), depersonalization (α = 0.70), and the feeling of personal achievement (α = 0.80). In the light of these results, we could already provide the internal reliability of our survey sheet adapted to the Moroccan context (Table 2).

Table 1. Socio-demographic parameters of the population

Variables	Effective’s	Percentages
Sex
Women	46	55%
Man	37	45%
Total	83	100%
Status
General practitioners	16	19%
Specialist physicians	29	35%
Pharmacists	18	22%
Nurses	20	24%
Total	83	100%
City
Casablanca	24	29%
Rabat	23	28%
Kénitra	36	43%
Total	83	100%

Table 2. Cronbach's index according to the three dimensions of MBI

The three dimensions of MBI	The Cronbach index (α)
Emotional exhaustion	α=0.80
Depersonalization	α=0.70
A sense of personal accomplishment	α=0.83

The results of the MaslachBurn out Inventory showed that 33 (40%) of healers with a very high degree of emotional exhaustion, which corresponds to an average score of 25.39. A high level of depersonalization was found is 28 (34%) of the respondents, which corresponded to an average score of 8.65. While, only 5 (6%) of healers had a low level of personal achievement (Table 3).

Table 4: Distribution of sub-dimension levels according to the three dimensions of MBI (N=83)

	Average EE score		Average EP score		Average AP score
Gender	Average	P value	Average	P value	Average	P value
Woman	25.39	0.57⁽^n.s)	8.65	0.62^(n.s.)	28.65	0.01**
Man	24.39		8.40		28.48
Professional status
Specialist doctor	24.93	0.76 ^(n.s.)	8.36	0.59 ^(n.s.)	28.64	0.47 ^{( N.S)}
General practitioner	24.53		8.36		28.36
Pharmacist	25.93		8.71		28.32
Nurse	24.64		7.44		28.32
Place of exercise
Casablanca	24.69	0.44 ^(n.s.)	8.08	0.19 ^(n.s.)	28.47	0.25 ^{( N.S)}
Rabat	24.93		8.36		28.64
Kenitra	25.78		8.36		28.65
Workplace conflicts
Yes	38,97	0.00**	13,22	0.00**	23,70	0.00**
No	27,38		7,45		30,19
Credit
Yes	32.25	0.00**	14.12	0.00**	24,95	0.00**
No	26.41		8.36		28.70

EE: Emotional Exhaustion, DP: Depersonalization., PA: Personal Achievement, N.S: Non-significant,** significant.

DISCUSSION:

Burnout in hospitals is a real problem that affects the mental health of healers both in national and international scales. In our study, we noted a very high score as pathological scores of emotional exhaustion with a percentage of 40% and 34% having a high depersonalization score. While, only 6% were being a low score of personal accomplishment feeling. In Spain, a study carried out on 2290 healers in five hospitals in the province of Girona. It found that 41.6% of respondents with a very high emotional exhaustion score [16]. The same result which we could pretend have in our study. In addition, in France, 26% of general practitioners had a high level of emotional exhaustion [17]. The Maslach Burnout Inventory (MBI) version is considered as internationally known assessment tools adapted for healers, Thanks to its psychometric properties, according to Agoub M, Cronbach'sα of the MBI sub-dimensions of the French version is satisfactory (EE = 0.90, DP = 0.64 and AP = 0.74) [18]. The indices previously studied are in agreement with our study (EE = 0.83, DP = 0.67, AP = 0.74). Similarly, we did not find an association between the two dimensions of the MBI (emotional exhaustion and depersonalization) and gender. But, there was a correlation between gender and a sense of personal achievement. The role of gender is controversial, probably in relation to the fact that women, in some cases, combine other extra-professional stressors with the difficulty of reconciling work and family responsibilities [11]. We found a correlation between workplace conflict and the three dimensions of the MBI with (p<0.00), as well as, a correlation between credit and the three dimensions of the MBI. It can be noted that credit and conflict at work are among the factors that trigger emotional exhaustion. According to the literature review, several others have determined a positive correlation between family life and psychic and job satisfaction [5, 19, 20]. Other authors consider burnout is a response to the emotional tension generated by healers with others [21]. The accumulation of stress and the failure of coping strategies [22]. Many people choose addiction as a solution or strategy against stress at work, despite the fact that is not always the best solution.

Otherwise, several studies have shown that there is a strong correlation between addiction and burnout. The burnout emotional component is associated with behaviours, which are potentially risky for healers and their patients, such as excessive alcohol consumption and psychotropic drug use making healers less effective, because depersonalization is often perceived as a form of personal failure that will be expressed through decreased professional achievement [23, 24].

CONCLUSIONS:

It was concluded that burnout is a real problem. Faced with this alarming situation, the responsible authorities must multiply their efforts to limit this scourge.

CONFLICT OF INTEREST

The authors have no conflict of interest.

FUNDING:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

ACKNOWLEDGEMENT:

Our thanks go to the health professionals who have agreed to participate in this survey. as well as the PPR-B-MOKHTARI-FS-UIT-KENITRA.

CONTRIBUTIONS OF THE AUTHORS:

A.D, M.F and A.S: Scientific supervision, and revision of the article.

S.J, A.Z and D.K: Translation because our country is a French-speaking Arab country.

Z.A: Lead author in charge of data collection and final drafting of the article.

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Received on 16.05.2019 Modified on 14.06.2019

Research J. Pharm. and Tech. 2019; 12(11):5219-5222.

DOI: 10.5958/0974-360X.2019.00903.X

The three dimensions of MBI	Low	Moderate	High	Average score	P value
Emotional exhaustion	24(29%)	26(31%)	33(40%)	25.39	0.44^N.S
Depersonalization	28(34%)	27(33%)	28(34%)	8.65	0.98^N.S
Personalachievement	5(6%)	21(25%)	57(69%)	28.65	0.00**