Association Study Of Job Stress, Burnout And Presenteeism In Health Care Workers

Objective:To describe the prevalence of job stress, job burnout and presentieesm among health care workers in the top three hospitals of Shanghai, and to estimate the mediating effect of job burnout as a mediator on job stress and presenteeism.Methods:This study was conducted through a cross-sectional survey. Eight hospitals were selected from Shanghai medical trade unions with stratified random sampling. All eligible participants were included with informed consent. A questionnaire was completed by themselves independently. The questionnaire covered information on demograghics, job characteristics, job burnout, job stress and presenteetism. Job burnout was measured by Maslach Burnout Inventory-General Survey (Chinese version), job stress by job content questionnaire (Chinese version) and effort-reward imbalance questionnaire (Chinese version), and presenteeism by Stanford Presenteeism Scale. It was used to analysing the whole data by the statistical analysis technique including chi-square test, t-test, one-way ANOVA, missing value analysis, logistic regression analysis, structural equation model and so on.Results:1. Basic information:There were a total of2456participants attending this survey with participation ratio being98.2%. There were677males (27.6%) and1772females (72.1%), who were mainly under40years old and had associate college degree or above. Most respondents (90.5%) had registered permanent residence of Shanghai.43.8%of total respondents were nurses and29.9%were doctors. A large proportion of participants had5working years or below or11to20working years, and primary level of professional qualifications.47.9%of total respondents were permanent staff. There were significant differences among age, education, occupation, working years, professional qualification and authorized strength varying from gender, but no significant differences in registered permanent residence and shift work.2. Status of job stress in respondents:The mean scores of job demands, job control, social support and demands-control ratio in all participants were3.66±0.84,2.90±0.63,3.78±0.71and1.34±0.52, respectively. The rate of job stress in respondents was72.5%. The persons, who were characterized by the age of31to40years old, doctors or nurses and holding professional qualifications, tended to be more stressful. And it was also showed that the respondents, who were characterized by having registered permanent residence of Shanghai, Subtropical high title or above and no working in shifts, could obtain more social support which was a positive factor for stress. The mean scores of effort, reward, over-commitment and effort-reward ratio in all participants were respectively3.07±0.99,3.87±0.92,2.74±0.89and0.92±0.83. The rate of effort-reward imbalance was30.5%. The persons, who were characterized by male, doctors or nurses,6to20working years, no authorized strength and shift working, tended to be effort-reward imbalance. That is, they were more stressful.3. Status of job burnout in respondents:The mean scores of emotional exhaustion, depersonalization, personal accomplishment and burnout were2.88±1.55,2.06±1.63,4.12±1.14and2.34±1.11, respectively. It was showed that the percentage of59.3in all participants had mild or moderate burnout, and15.0%had severe burnout. The participants who were characterized by the age of31to40years old, doctors or nurses and working in shifts tended to be more burnout.4. Status of presenteeism in respondents:The mean score of presenteeism was15.24±3.89. The ones who were characteristic by doctors or nurses,6to10working years and working in shifts tended to have a higher score of presenteeism.5. Correlation analysis between job stress and burnout:Compared with job demand-control model (JDC), effort-reward imbalance model (ERI) had more explanatory power for emotional exhaustion, depersonalization and burnout by controlling the effect of social and demographic factors. On contrary, JDC model, especially the variable of social support, had more explanatory power for personal accomplishment.6. Correlation analysis between job stress and presenteeism:There were positive correlations between presenteeism and job demands, effort and over-commitment, and negative correlations between presenteeism and job control, social support and reward. ERI model had more explanatory power for presenteeism by controlling social and demographic factors with logistic regression analysis.7. Correlation analysis between job burnout and presenteeism:There were positive correlations between presenteeism and burnout, emotional exhaustion and depersonalization, negative correlations between presenteeism and personal accomplishment. Burnout had stable explanatory power for presenteeism by controlling social and demographic factors with logistic regression analysis.8. Correlation analysis among job stress, burnout and presenteeism:Compared with JDC model, ERI model combinding with emotional exhaustion, depersonalization and personal accomplishment had more explanatory power for presenteeism by controlling the effect of social and demographic factors with logistic regression analysis. The analysis results of structural equation model showed that the structure factor of direct effect from stress to burnout was0.79(P<0.001), from stress to presenteeism was0.38(P<0.001) and from burnout to presenteeism was0.68(P<0.001). The structure factor of indirect effect of burnout from stress to presenteeism was0.54(P<0.001).Conclusions:There were high prevalence of job stress, burnout and presenteeism among health care workers in top three hospitals of Shanghai. It was showed that job burnout may play a mediating role between job stress and presenteeism, that is, job stress could directly affect on presenteeism, and meanwhile indirectly impact on presenteeism by burnout. Especially, job stress resulting from effort-reward imbalance which may lead to higher job burnout prevalence could have a negative effect on presenteeism.