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Meta-Analysis
. 2017 Mar 16;17(1):264.
doi: 10.1186/s12889-017-4153-7.

A systematic review including meta-analysis of work environment and burnout symptoms

Gunnar Aronsson  1 , Töres Theorell  2   3 , Tom Grape  4 , Anne Hammarström  5 , Christer Hogstedt  6 , Ina Marteinsdottir  7 , Ingmar Skoog  8 , Lil Träskman-Bendz  9 , Charlotte Hall  10
Affiliations
Meta-Analysis

A systematic review including meta-analysis of work environment and burnout symptoms

Gunnar Aronsson et al. BMC Public Health. .

Abstract

Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies - original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.

Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.

Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.

Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

Keywords: Burnout; Cynicism; Emotional exhaustion; GRADE system; Job control; Job demands; Meta-analyses; Personal accomplishment; Review; Social support.

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Figures

Fig. 1
Fig. 1
Flow chart of the literature search, screening, review- and quality assessment
Fig. 2
Fig. 2
Association between low level of control (e.g. decision latitude and authority are used as synonyms of control) and development of emotional exhaustion. The graph is based on data from the least adjusted model in studies expressing the strength of the association either as odds ratios or as correlations (the latter have been transformed into odds ratios). 1Data have been re-calculated to show the association between low level of control and development of emotional exhaustion (data in these studies are originally presented as association between high level of control and emotional exhaustion)
Fig. 3
Fig. 3
Association between job demands and development of emotional exhaustion. The graph is based on data from the least adjusted model in studies expressing the strength of the association either as odds ratios or as correlations (the latter have been transformed into odds ratios). Please note that data from two more studies (Lorente Prieto 2008 and Koponen, 2010) are included in the evidence-rated result; however data from these studies could not be illustrated in the graph due to the data format
Fig. 4
Fig. 4
Association between low workplace support and development of emotional exhaustion. The graph is based on data from the least adjusted model in studies expressing the strength of the association either as odds ratios or as correlations (the latter have been transformed into odds ratios). Please note that data from two more studies (Burke 1995 and Koponen 2010) are included in the evidence-rated result; however data from these studies could not be illustrated in the graph due to the data format
See this image and copyright information in PMC

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