Burnout and personality in extreme nursing: an empirical study
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Original ar ticle
Burnout and personality in extreme nursing:
an empirical study
■ K.-E. Bühler, T. Land
Institute Psychotherapy and Medical Psychology, Julius-Maximilians-Universität, Würzburg (D)
Summary confirmed: personality is significantly related to
certain aspects of burnout. “Neuroticism”, “extra-
Bühler K-E, Land T. Burnout and personality in version”, “external locus of control”, “job-distance
extreme nursing: an empirical study. Schweiz Arch inability”, “existential frustration” and “ability of
Neurol Psychiatr 2004;155:35–42. love” prove to be personality traits with an impact
on the development or the presence of burnout.
Previous research into the causes of burnout has The evaluation of our data shows that the factor
mainly been concerned with external triggers, “Mental Health” or “Psychoprotection” is impor-
such as onerous work criteria or organisational or tant for all the burnout variables. It measures per-
social influences. On the other hand, the question sonality traits such as a high self-esteem, efficient
repeatedly posed is why, under the same working coping strategies and autonomy.
conditions, one individual burns out, while another The results of this study identifying mental
shows no symptoms at all. It seems fair to assume health as a consequence of a meaningful life as a
that other causes such as personality may also play protective factor, and an external locus of control,
a role but such factors as individual reactions and neuroticism and extraversion as factors promoting
personality have largely been ignored as a possible burnout, might in future both be used to predict
aetiology of burnout development. and prevent a burnout syndrome. As a conse-
In preparation of a long-term study, this gen- quence of our results individuals can use their
eral cross-sectional study investigates the relation- knowledge of their own personal disposition to
ship between burnout and personality variables. avoid the development of burnout; for example,
The different personality variables having a possi- by regulating their motivation and their engage-
ble impact on burnout were determined in a num- ment and enthusiasm for the job, and by seeking
ber of prestudies. The scales of these prestudies sensible leisure activities. On the other hand,
were selected according to their relevance for de- the empirically established association between
scriptive theories reported in scientific literature. personality and burnout can be used as a basis
The data were gathered from 119 people working for personality questionnaires to identify people
in intensive care units. The Maslach Burnout susceptible to burnout.
Inventory (MBI) was used as well as certain sub- Keywords: burnout; personality; intensive care;
scales of the following personality questionnaires: hospital
Eysenck Personality Inventory (EPI), Inventory of
Aggressivity (IA),Trier Personality Questionnaire
(TPQ), Scales of Control (SC), Locus of control Introduction
(LC) and the Logo-test (LOGO).All these aspects
were descriptively but not yet quantitatively re- Mental and physical states of exhaustion have
ported in scientific literature. been known for a long time, but it was Freuden-
Although multiple regression does not show berger in 1974 who first coined the term “burnout”
all the personality variables as predictors for the for the mental and physical exhaustion of voluntary
burnout dimensions, the research hypothesis is workers in various social fields [1].The term “burn-
out syndrome”, mainly applied to the caring pro-
fessions, defines the breakdown of energy resour-
Correspondence: ces and adaptability as a reaction to chronic stress
Prof. Dr. med. habil. Karl-Ernst Bühler [2–4]. It is generally conceptualised as a syndrome
Institute Psychotherapy and Medical Psychology
with three dimensions: emotional exhaustion,
Julius-Maximilians-Universität
Haafstrasse 12 depersonalisation and reduced feelings of personal
D-97082 Würzburg accomplishment [4]. We consider the burnout
35 SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 155 ■ 1/2004Table 1 Previous studies.
author title burnout-relevant personality items
Schulte, Silvia (1994) [12] The connection of the burnout construct – internal locus of control
with aspects of depression and locus – fatalistic external locus of control
of control. – generalised assessment of own ability
– social external locus of control
Niestrat, Frieda (1993) [13] Burnout, existential frustration and personal – existential frustration
life sense in educators.
Glaser, Helmut (1994) [14] The influence of biographic factors and – neuroticism
personality traits of extraversion and neuro- – extraversion
ticism on burnout.
Mahmoudpour, Hamidreza (1993) Burnout in teachers, an empirical study – self-aggression
[15] of personality traits considering the aspect
of aggression.
Schmieta, Maike (1992) [16] Burnout and mental health. – ability to love
– self-esteem
– personal satisfaction
Kiefl, Manuela (1992) [17] Type-A behaviour, coronar y vessel disease – reactive aggression
and burnout. – exactness
– appreciation need
– job-distance inability
syndrome to be a subclass of affective disorders, variables relevant for burnout (see table 1). The
either as an abortive form of minor depression scales of these prestudies were selected according
or dysthymia depending upon duration. In severe to their relevance for descriptive theories reported
cases a burnout syndrome can become an exhaus- in scientific literature. In detail these aspects were:
tion depression, i.e. a major depression. locus of control, sense of life, neuroticism, extra-
American burnout research, dominated by version, introversion, aggression, mental health
social psychologists, for a long time favoured the and type-A behaviour. All these aspects were
organisational and institutional aetiology hypo- descriptively but not yet quantitatively reported in
thesis of burnout being, among other things, a scientific literature. These prestudies empirically
reaction to chronic stress, job dissatisfaction [5] and quantitatively showed the questionnaires and
and an increasing loss of idealism and energy as a the scales in table 2 to be important for the assess-
result of working conditions [6]. The environment ment of personality traits influencing burnout. The
was considered to be the principal trigger for the aim of the present study is to confirm the impact
burnout process [7–9]. of selected personality variables on burnout in a
On the other hand, the question repeatedly cross-sectional design.
posed is why, under the same working conditions,
one individual burns out, while another shows no
symptoms at all. It seems fair to assume that other Methods
causes such as personality may also play a role.
There is evidence, such as the long-term study of Subjects
teachers by Jackson, Schwab and Schuler that
could not establish any connection between work- The investigation was carried out using question-
ing conditions and burnout [10], that working con- naires and based on a random sample of nursing
ditions are not the only reason. staff in intensive care units of 10 German hospitals.
Perlman and Hartman criticise the lack of Other caring personnel were not included in
studies dealing with the connection between the analysis of data. The usable response rate
burnout and personality [11]. The lack of research was 63% and thus comparable to other surveys
studies in this field leaves the concept of burnout with response rates of 57% [24] and 72% [25].
as a descriptive term with little insight into the basic The questionnaires were anonymously answered
causes and effects. For this reason, we wanted to by N = 117, i.e. N = 91 women (76.5% of the total)
investigate the influence of personality dimensions and N = 26 men (21.8% of the total) of the nursing
on burnout. As an empirical approach, several staff. For further sociodemographic data see
prestudies aimed at a reduction of personality table 3.
36 SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 155 ■ 1/2004Table 2 Questionnaires and scales.
questionnaire scales
Maslach Burnout Inventor y (MBI) [4] emotional exhaustion (EE) (C-alpha = 0.89)
depersonalisation (D) (C-alpha = 0.64)
personal accomplishment (PA) (C-alpha = 0.89)
Eysenck Personality Inventor y (EPI) [18] extraversion (EXTRA) (Split-Half = 0.75)
neuroticism (NEURO) (Split-Half = 0.78)
Inventor y of Aggressivity (IA) [19] reactive aggressivity (RA) (C-alpha = 0.68)
self aggression (SA) (C-alpha = 0.72)
Scales of Control [20] appreciation need (AN) (C-alpha = 0.74)
exactness (E) (C-alpha = 0.77)
job-distance inability (JDI) (C-alpha = 0.79)
Trier Personality Questionnaire (TPQ) [21] personal satisfaction (PS) (C-alpha = 0.86)
self-esteem (S) (C-alpha = 0.80)
ability to love (AL) (C-alpha = 0.73)
Locus of Control (LC) [22] generalised assessment of own ability (AOA) (C-alpha = 0.76)
internal locus of control (I) (C-alpha = 0.70)
social external locus of control (SE) (C-alpha = 0.73)
fatalistic external locus of control (EF) (C-alpha = 0.75)
Logo test [23] existential frustration (EF) (C-alpha = 0.83)
Instruments superordinate factors were again correlated with
the MBI variables (Spearman correlation).
The instruments that were used are listed in All statistical procedures were performed by
table 2. the Statistical Package for Social Science (SPSS)
for Windows.
Statistical Analysis
Results
First, stepwise multiple regression analyses were
done to assess the predictivity of personality vari- The following personality variables proved to be
ables on burnout and partialise out intercorrela- significant predictors of the criteria variable
tions. The subscales of the personality scales were “emotional exhaustion” (EE) (table 4): “fatalistic
taken as predictors to determine whether they external locus of control” (FE) p =love” (AL) = 0.0004; “extraversion” (EXTRA) Table 5 shows the results of the factor analysis.
p = 0.00018 and “neuroticism” (NEURO) p = On the basis of the screeplot a three-factor model
0.0025 are significant predictor variables. With an has been chosen with eigenvalues >1.
adjusted R-square (0.24, p 0.5 were
26–30 years 36 30.1% taken into account, the variables “reactive aggres-
31–35 years 23 19.3% sion” (factor 2), “neuroticism” and “extraversion”
(factor 3) do not appear in this factor model
36–40 years 13 10.8%
because of their low loading on the respective
41–45 years 12 10.1%
factors. Furthermore, the authors consider the
46–50 years 0 0.0% variables “neuroticism” and “extraversion” as in-
>50 years 2 1.6% dividual personality factors already confirmed
by different personality factor models [26].As both
family
variables turn out to have an impact on at least
single 59 49.6% two of the three burnout variables in the multiple
married 46 38.7% regression, their role in the burnout process will be
divorced/separated 10 8.4% discussed.
Table 6 shows the correlation results between
household the three personality factors of the factor model
single 28 23.5% and the burnout variables of MBI. The factor
more persons 86 72.3% “mental health” or “psychoprotection” shows a sig-
nificant negative correlation to all three burnout
duration of occupation variables (inversed sign for “personal accomplish-
1–2 years 20 16.8% ment”). The factor “external locus of control” cor-
3–4 years 17 14.3% relates significantly positively with the burnout
5–7 years 19 16.0% variable “emotional exhaustion” and positively
8–11 years 19 16.1%
with the variable “depersonalisation”. The person-
ality factor “type-A behaviour” shows no signifi-
12–15 years 16 13.4%
cant correlation to the burnout factors.
>15 years 20 16.5%
Table 4 Multiple regression.
emotional exhaustion personal accomplishment depersonalisation
multiple R 0.66609 0.37752 0.51920
Beta p Beta p Beta p
fatalistic external locus of control 0.35 0.000
job-distance inability 0.27 0.000
existential frustration 0.25 0.000 –0.32 0.000
neuroticism 0.24 0.002 0.25 0.002
extraversion 0.20 0.006 0.22 0.014 0.27 0.001
ability of love –0.30 0.000
38 SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 155 ■ 1/2004Table 5 Factor analysis.
factor variables interpretation
mental health or – generalised assessment of own ability (+) items of self-confidence, life fulfilment,
psychoprotective factor – self-esteem (+) positive emotions towards oneself
– ability to love (+) and others
– personal satisfaction (+)
– internal locus of control (+)
– existential frustration (–)
externality – fatalistic external locus of control the variable of external locus of control
– social external locus of control in connection with self-aggression
– self-aggression
type-A behaviour – appreciation need (+) the three scales of control
– job-distance inability (+)
– exactness (+)
Discussion the direct influence of neuroticism on psycholo-
gical indisposition [24–26, 30, 31]. In spite of nor-
Although multiple regression does not show all mally conformist social behaviour, a basically
the personality variables as predictors for the neurotic personality displays neurotic behaviour
burnout dimensions, the research hypothesis is mainly in stress situations. Subjectively, these per-
confirmed, personality is significantly related to sons experience more lack of success in what they
certain aspects of burnout. “Neuroticism”, “extra- set out to do, and stress is experienced more nega-
version”, “external locus of control”, “job-distance tively, independent of type and time of the stress
inability”, “existential frustration” and “ability of situation. Because of misinterpretation of subjec-
love” prove to be personality traits with an impact tive and objective stress these individuals are
on the development or the presence of burnout. significantly less able to deal adequately with
stressors, as is particularly notable in fields of work
where situational stress is unavoidable, e.g. in
Neuroticism and burnout intensive care units. As subjective or objective
stress is often described as a basic prerequisite for
Empirical connections between neuroticism and burnout [29], neuroticism accelerates the burnout
burnout were found in 1978 [27]. Our investiga- process through a disproportionally pronounced
tions confirm the results of Piedmont, who found feeling of stress.
that people with high neurotic values also show
higher values for the burnout variables “emo-
tional exhaustion” and “depersonalisation” [28]. Extroversion and burnout
Neuroticism is sometimes described as a super-
ordinate for characteristics of general personality, In contrast to the general statements of personal-
needs and motives that predispose burnout [29]. It ity literature, which evaluate extraversion as a
is a factor of psychological vulnerability which is psycho-protective factor and equate it with hap-
probably made up of several subfactors. Anxiety, piness [26], our results show a positive connection
diminished self-esteem, feelings of guilt and com- between “extraversion”, “emotional exhaustion”
pulsive tendencies, as well as the tendency to and “depersonalisation”. This might be due to the
worry, irritability and depression are all part of a weighting of the subdimensions of the extraversion
neurotic personality [29]. Various authors confirm scale. Piedmont was able to show that the sub-
Table 6 Spearman correlation of the 3 factors and the MBI-variables.
factor 1 factor 2 factor 3
mental health externality type-A behaviour
emotional exhaustion –0.27** 0.27** 0.14
personal accomplishment 0.32*** 0.03 0.02
depersonalisation –0.20* 0.18* –0.08
* Signif. LE 0.05; ** Signif. LE 0.01; *** Signif. LE 0.001; 2-tailed
39 SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 155 ■ 1/2004variable “excitement seeking” of the extraversion enced emotional stress and leads to emotional
scale correlates positively with the burnout vari- exhaustion. There are studies which substantiate
able “emotional exhaustion” [28]. The search for that emotionalism is in general more unstable in
something new, adventurousness and impulsive- individuals with high scores on “external locus of
ness characterise the extrovert. Individuals seeking control” than those with high “internal locus of
excitement and deliberately taking risks have a control” [37, 38].
greater tendency to become emotionally exhaust-
ed. Under the title “First inflamed then burnt out”,
Schwanold, Anderson and Sachse describe the Mental health and burnout
process of emotional exhaustion [32] of caring
people changing from highly motivated beginners The evaluation of our data shows that the factor
to resigned, unfeeling and callous professionals. “mental health” or “psychoprotection” is impor-
Freudenberger and Richelson write in the same tant for all the burnout variables. It measures per-
vein: “Burning out is confined mainly to dynamic sonality traits such as high self-esteem, efficient
and ambitious men and women, who, in all that coping strategies and autonomy. A person is men-
they do, give of their best and with heart and soul” tally well to the extent to which he or she succeeds
[33]. Emotional exhaustion and depersonalisation in dealing with internal and external demands [39].
are here to be seen as the end of a process that takes Internal demands are for example daily needs,
place in people who have battled on to the end of while external demands, in the field of caring
their emotional strength [25]. professions, are for example dealing with patients.
Anticipated or actual failures are accompanied
by negative emotions which lead to physical and
External locus of control and burnout psychological withdrawal from patients. The suc-
cessful mastering of work demands or personal
In agreement with the general literature,our results aims lead to positive emotions [40]. These emo-
show a clear prognosis value of the personality tions develop a certain regulating behavioural
factor “external locus of control” for the burnout character and in a feedback process influence the
process [34–36]. Of great significance for the personality.
burnout process is whether the individual believes “Ability to love” can be seen as a universal
that his or her own behaviour determines what indicator for mental health [41]. Low scores for
he or she encounters [29]. People scoring high in “ability to love” have an influence on the strength
“external locus of control” generally expect that of the burnout factor “depersonalisation”. It
important events in their lives are determined by describes people who are in general indiffe-
forces beyond their control (i.e. powerful others, rent towards other people, having difficulties in
chance, luck). empathising, being neither very helpful nor con-
The factor “external locus of control” corre- siderate. Since they generally show little interest
lates positively with the burnout variables “emo- in the lives of friends, they form fewer friend-
tional exhaustion” and “depersonalisation”. This ships and appear unsociable and introverted. An
confirms an association between externality, help- inability to perceive that other people have similar
lessness and self-aggression as a consequence of feelings, impulses and thoughts as oneself is caused
frustration [23]. Longer periods of helplessness by a basic inability to love. Although the variable
and frustration diminish emotional resources and “ability to love” is not explicitly mentioned in
may therefore lead to emotional exhaustion. association with burnout, the literature describes
Depersonalising behaviour can be interpreted as different personality types susceptible to burnout
a protective reaction to the emotional overload. whose common factor is the inability to express
The variable “locus of control” appears to be emotions [42]. The protective function of mental
influenced by one’s coping strategies. Distress health for the prevention of burnout is well known
increases when emotion-focused coping strategies [41]. Burnout may also be described as a state of
are used with stressors perceived as controllable “mental illness” as opposed to mental wellness.
or when problem-focused strategies are used with The results of this study, identifying mental
uncontrollable stressors [36]. Individuals with high health as a consequence of a meaningful life as a
scores on “external locus of control” attempt to protective factor, and an external locus of control,
use emotion-focused coping strategies even with neuroticism and extraversion as factors promoting
stressors basically perceived as controllable, such burnout, might in future both be used to predict
as time pressure, staff management or schedule. and to prevent a burnout syndrome. As a conse-
This mismatch increases the subjectively experi- quence of our results individuals can use their
40 SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 155 ■ 1/2004knowledge of their own personal disposition to 15 Mahmoudpour H. Burnout bei Lehrern, eine empirische
avoid the development of burnout; for example, by Untersuchung von Persönlichkeitsmerkmalen unter
regulating their motivation and their engagement besonderer Berücksichtigung des Aggressionsaspekts
[Diplomarbeit].
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cally established association between personality Gesichtspunkten mit besonderer Berücksichtigung des
and burnout can be used as a basis for personality Konzeptes seelischer Gesundheit – eine Vergleichsstudie
[Diplomarbeit].
questionnaires to identify people susceptible to
Marburg: Philipps-Universität Marburg; 1992.
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17 Kiefl M. Typ-A-Verhalten, Koronare Herzerkrankung
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