psychological distress, burnout and personality traits in

7/21/2019 Psychological Distress, Burnout and Personality Traits In

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ORIGINAL ARTICLE

Psychological distress, burnout and personality traits inDutch anaesthesiologists

A survey

Raymond A.B. van der Wal, Martin J.L. Bucx, Jan C.M. Hendriks, Gert-Jan Scheffer

and Judith B. Prins

BACKGROUND The practice of anaesthesia comes with

stress. If the demands of a stressful job exceed the resources

of an individual, that person may develop burnout. Burnoutposes a threat to the mental and physical health of the

anaesthesiologist and therefore also to patient safety.

OBJECTIVES Individual differences in stress appraisal (per-

ceived demands) are an important factor in the risk of

developing burnout. To explore this possible relationship,

we assessed the prevalence of psychological distress and

burnout in the Dutch anaesthesiologist population and inves-

tigated the influence of personality traits.

DESIGN Survey study.

SETTING Data were collected in the Netherlands from July

2012 until December 2012.

PARTICIPANTS We sent electronic surveys to all 1955

practising resident and consultant members of the DutchAnaesthesia Society. Of these, 655 (33.5%) were returned

and could be used for analysis.

MAIN OUTCOME MEASURES Psychological distress,

burnout and general personality traits were assessed

using validated Dutch versions of the General Health

Questionnaire (cut-off point 2), the Maslach Burnout

Inventory and the Big Five Inventory. Sociodemographic

variables and personality traits were entered into

regression models as predictors for burnout and psycho-

logical distress.

RESULTS Respectively, psychological distress and burnout

were prevalent in 39.4 and 18% of all respondents. Theprevalence of burnout was significantly different in resident

and consultant anaesthesiologists: 11.3% vs. 19.8% (x2 5.4;

P <0.02). The most important personality trait influencing

psychological distress and burnout was neuroticism:

adjusted odds ratio 6.22 (95% confidence interval 4.35 to

8.90) and 6.40 (95% confidence interval 3.98 to 10.3),

respectively.

CONCLUSION The results of this study show that psycho-

logical distress and burnout have a high prevalence inresidents and consultant anaesthesiologists and that both

are strongly related to personality traits, especially the trait of

neuroticism. This suggests that strategies to address theproblem of burnout would do well to focus on competence in

coping skills and staying resilient. Personality traits could be

taken into consideration during the selection of residents. In

future longitudinal studies the question of how personal and

situational factors interact in the development of burnout

should be addressed.

Published online 14 November 2015

IntroductionAnaesthesiologists deal with extreme working hours,

high-risk patients and situations and an increasingly

complex working environment.1– 6 Although the practice

of anaesthesia can be very stressful, this does not necess-

arily mean that an anaesthesiologist experiences

psychological or physiological symptoms of stress.7,8

However, it is known from psychological research that

stress reactions do occur when demands exceed

resources. Stress reactions manifest as not only beha-

vioural changes but also physical or psychological illness,

Eur J Anaesthesiol 2016; 33:179–186

Fromthe Departmentof Anaesthesiology,Pain and PalliativeMedicine (RABVDW, MJLB,G-JS); Radboud Institute for HealthSciences(JCMH); and Departmentof MedicalPsychology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (JBP)

Correspondence to Raymond A.B. van der Wal, Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Internalpostal code 717 PO Box 9101, 6500 HB Nijmegen, the NetherlandsTel: +31 24 361 4406; fax: +31 24 354 0462; e-mail: [email protected]

0265-0215 Copyright 2016 European Society of Anaesthesiology. All rights reserved. DOI:10.1097/EJA.0000000000000375

mailto:[email protected]

http://dx.doi.org/10.1097/EJA.0000000000000375

http://dx.doi.org/10.1097/EJA.0000000000000375

mailto:[email protected]



such as burnout.9 Burnout poses a threat to the mental

and physical health of the anaesthesiologist and therefore

also to patient safety. Burnout has been defined as a

syndrome with dimensions of emotional exhaustion,

depersonalisation and feelings of reduced personal

accomplishment.10 In psychiatry, the term depersonali-

sation is used to describe an anomaly in self-awareness. In

the context of burnout, however, depersonalisation refers

to an increased emotional distance between workers and

their clients or patients. This attitude may be the result of

emotional exhaustion and may lead to feelings of reduced

personal accomplishment.11

The transactional model of stress, developed by Lazarus

and Folkman,12 emphasises the active psychological

interaction between the stressor and the individual.

During the primary appraisal, an individual identifies,

based on perceived demands, whether the stressor is a

threat or a neutral or a positive challenge. In the second-

ary appraisal, the individual then chooses how to use his

resources to cope. Threat appraisal and coping mechan-

isms may differ widely among individuals. When indi-

viduals have personality traits that make them resilient

and they are equipped with adequate resources to address

work-related demands, they are unlikely to manifest

symptoms of burnout.13 Literature suggests a relationship

between personality traits and coping strategies that

moderate the development of stress into burnout.14

Therefore, personality traits are an important element

in the process of developing burnout.15,16

The ‘Big Five’ model of personality traits is the most

established and validated system used in the literature.17

The ‘Big Five’ traits describing personality are neuroti-cism, extroversion, openness to experience, conscien-

tiousness and agreeableness. These personality traits

are considered to be relatively stable in an individual

over time and across situations.18

Until now, the relationships between personality traits,

stress and burnout have never been studied in anaesthe-

siologists. The only studies on personality traits in anaes-

thesiologists used tests which are now considered

obsolete.19–21 For that reason, the role of the ‘Big Five’

personality traits in anaesthesiologists’ psychological dis-

tress and burnout is unknown.

The objectives of this study were to examine the preva-

lence of psychological distress and burnout in Dutch

anaesthesiologists and explore the relationships between

psychological distress, burnout and personality traits.

MethodsThis survey study was approved on 2 April 2012 by the

local ethical committee (Commissie Mensgebonden

Onderzoek regio Arnhem-Nijmegen, the Netherlands,

Chairman Dr F.Th.M. Huysmans, Ethical Committee nr

2012/148).

In July 2012, questionnaires were sent to all 1955 con-

sultant and resident members of the Dutch Society of

Anaesthesia using the web-based program RadQuest.

Anonymity was guaranteed. RadQuest was developed

by the Department of Medical Psychology and the

Department of Instrumental Services of the Radboud

University Medical Centre, Nijmegen, the Netherlands.

Nonrespondents received an electronic reminder after 3

months. Data was collected until December 2012.

The questionnaire consisted of 206 items, including

general sociodemographic questions concerning sex,

age, number of children under 18, marital status, years

practising as an anaesthesiologist, subspecialty and

whether the respondent worked in an academic or com-

munity hospital, and as a resident or a consultant. The

questionnaire also contained several psychological instru-

ments validated in Dutch samples.

Psychological distress

Psychological distress was assessed by the General

Health Questionnaire 12 (GHQ-12).22 The GHQ-12

consists of 12 questions referring to unpleasant and

unusual mental phenomena and impairment of normal

functioning. Examples of questions asked are ‘Have you

been able to cope with your problems lately?’ and ‘Did

you have difficulty sleeping because of worrying lately?’

A 4-point Likert scale was used, ranging from never to

much more than usual. For each question, one point was

scored if one of the two least favourable options was

chosen. A sum of scores of two or more was considered

indicative of psychological distress, which is in line with

recommendations for use in the general population.22–25

Burnout

Burnout was measured with the Dutch version of the

Maslach Burnout Inventory, the Utrechtse Burnout

Schaal (UBOS-C).26 The UBOS-C consists of 20 items,

such as ‘At the end of the day I feel empty’ and ‘I do not

care what happens to my patients’. Each item is scored

using a 7-point Likert scale, ranging from never (0) to

daily (6). The average score per dimension is calculated

(emotional exhaustion, eight items; depersonalisation,

five items; personal accomplishment, seven items). Burn-

out has been defined as a combination of a high score onemotional exhaustion ‘and’ a high score on depersonali-

sation, a low score on personal accomplishment or both.

High or low scores in one of the dimensions have been

defined as scores above the 75th percentile or below the

25th percentile. These values are extensively described

in the accompanying manual of the UBOS-C. For this

study, we used the table for healthcare workers.26 The

Cronbach’s a of the dimensions of the UBOS-C

(emotional exhaustion, depersonalisation and personal

accomplishment) in our sample were 0.90, 0.70 and

0.75, respectively, confirming good internal consistency

of these dimensions.

180 van der Wal et al.




Personality traits

We used a Dutch translation of the Big Five Inventory

(BFI) questionnaire, examining the five traits in 44 items

on a 5-point Likert scale. The scores are averaged, so the

minimum score per trait is 1 point and the maximum

score is 5 points.27 The five traits are bipolar and cover a

high-to-low continuum. Extroversion (as opposed to

introversion, eight items) is associated with terms such

as playfulness, spontaneity, assertiveness and dominance.

Neuroticism (as opposed to emotional stability, eight

items) is associated with terms such as nervousness,

anxiety, moodiness and hostility. Openness to experience

(as opposed to conventional or conservative, 10 items) is

associated with terms such as originality, creativity, non-

religiousness, independence and having broad interests.

Conscientiousness (nine items) encompasses a variety of

descriptors concerning a person’s attitude to work and

achievement. The last trait is agreeableness, also known

as altruism (as opposed to hostility, nine items). This trait

is associated with qualities such as love, empathy, friend-liness and cooperation.18 The Cronbach’s a values of the

dimensions of the BFI (neuroticism, extroversion, open-

ness to experience, conscientiousness and agreeableness)

in our sample were 0.83, 0.81, 0.80, 0.76 and 0.74,

respectively, also confirming good internal consistency

of the BFI.

Statistical methods

The Mann –Whitney U test was used to test for differ-

ences between the function groups (consultants, resi-

dents) for continuous variables. The x2 test was used

for nominal variables and the Fisher exact test for two-by-two tables. Univariable logistic regression was used to

study the differences in sociodemographic variables and

the personality traits between anaesthesiologists with and

without burnout or psychological distress as measured

with the GHQ-12, separately. Categories of a specific

variable were grouped if there were small numbers. The

(crude) odds ratios (ORs) with 95% confidence intervals

(CIs) are presented.

Multivariable logistic regression with forward selection

procedures was used to identify the variables that con-

tributed independently to the risk of burnout and psycho-

logical distress as measured with the GHQ-12. Referencevalues were chosen arbitrarily; this statistical method

compares groups (within the variable) with each other

and it does not matter which group is chosen as the

reference group. Owing to the fact that forward selection

procedures do not identify other important variables,

probability values for entry into the model were con-

sidered to find close alternatives to the variables selected.

All sociodemographic variables and all personality trait

variables were valid for selection. The adjusted ORs with

95% CI of the final burnout model and of the final

psychological distress model are presented. The adjusted

R2 is presented to indicate the total percentage explained

variance in the outcome and the area under the receiver-

operating characteristic (ROC) curve is presented as a

measure of predictive discrimination.

In this study, we also aimed to identify the demographic

variables and the personality trait variables that are

related to each of the three dimensions of burnout,

separately. Univariable linear regression was used tostudy the influence of the demographic variables and

the personality trait variables on each of the three dimen-

sions of burnout, separately. The dependent variable was

the specific dimension of burnout. The (crude) regression

coefficients with 95% CI are presented.

Analogous to the methods described earlier, multivari-

able linear regression with forward selection procedures

was used to identify the variables that independently

influence a specific dimension of burnout. Reference

values were chosen arbitrarily. The adjusted regression

coefficients with 95% CI of the final models are pre-

sented. The R2

value is presented to indicate the totalpercentage explained variance. Again, close alternatives

to the final models are considered.

A P value of less than 0.05 was considered statistically

significant. Statistical analyses were performed using SAS

9.2 for Windows (SAS Institute Inc., Cary, North Car-

olina, USA) and SPSS Statistics for Windows (Version

20.0, IBM Corp., Armonk, New York, USA).

ResultsA total of 1955 anaesthesiologists were asked to partici-

pate; 655 (33.5%) questionnaires were returned and could

be used for analysis. Response rates of consultants andresidents were in the same range (35 and 27%, respect-

ively). Consultant anaesthesiologists returned 514 ques-

tionnaires and resident anaesthesiologists returned 141

questionnaires. Sociodemographic details are presented

in Table 1. The male : female ratio was 388 (59.2%): 267

(40.8%). Most of the respondents (577, 86.6%) were in a

relationship, 63 (9.6%) were single and 25 (3.8%) were

divorced or widowed. Approximately half of the respon-

dents (345, 54%) had children younger than 18 years of

age. The mean age of the respondents was 43.7 (26 to

64) years.

Analysis of the respondents and nonrespondents for sexratio, consultant : resident ratio and the percentage work-

ing in an academic centre or a community hospital

showed that these ratios were close, indicating that as

far as these variables are concerned we have a

representative sample.

Table 2 summarises psychological distress, burnout and

personality traits in consultants and residents. Of all

respondents, 39.4% indicated that they had experienced

psychological distress (40.1% of consultants and 36.9%

of residents). No significant differences were found

between consultants and residents nor were differences

Psychological distress, burnout and personality 181




found between anaesthesiologists working in academic

centres and those working in community hospitals.

In total, 18% of respondents met the predefined criteria

for burnout. The respective values for consultants

and residents were 19.8 and 11.3%. This difference

was significantly different (x2 5.4; P <0.02). No signifi-

cant differences were found between men and women,

consultant or resident, or between anaesthesiologists

working in an academic centre or in a community

hospital. The small differences in personality traits

between consultants and residents did not reach

statistical significance.

Table 3 shows the crude and the adjusted ORs with 95%

CI for the sociodemographic variables and the personality

traits influencing psychological distress and burnout. In aunivariable (crude) analysis, variables are analysed in

isolation and the reference values chosen are arbitrary

(divorced, having no children and being a resident). In a

multivariable analysis, all variables are analysed together.

The personality trait neuroticism was the most import-

ant factor positively influencing the presence of psycho-

logical distress, so neuroticism is a risk factor. Other

relevant, but less important, factors are having children

and the personality trait openness. Multivariable

logistic regression with selection procedure was used.

The adjusted R2 of the multivariable model was 0.27,

indicating that 27% of the observed variability could be

explained by this model. The area under the ROC curvewas 0.76, indicating a good discriminatory power of the

final model.

Neuroticism was again the most important factor posi-

tively influencing the presence of burnout, so neuroti-

cism is a risk factor. Protective personality traits are

extroversion and agreeableness. Sociodemographic vari-

ables did not have an effect. Multivariable logistic

regression with selection procedure was used. The

adjusted R2 of the multivariable model was 0.34, indi-

cating that 34% of the observed variability could be

explained by this model. The area under the ROC curve

was 0.83, indicating a good discriminatory power of thefinal model.

Table 4 presents the crude and the adjusted regression

coefficients with 95% CI of the demographic variables

and the personality traits influencing the three dimen-

sions of burnout. Emotional exhaustion was indepen-

dently related to neuroticism, extroversion and

openness. Sociodemographic variables had no effect.

All five personality traits and also three sociodemo-

graphic variables (sex, age and being a consultant) were


Table 2 Psychological distress, burnout and personality traits in consultant and resident anaesthesiologists

Total (nU655) Consultants (nU514) Residents (nU141)

n (%) Mean (SD) n (%) Mean (SD) n (%) Mean (SD)

Psychological distress (GHQ-12) 258 (39.4%) 206 (40.1%) 52 (36.9%)

Burnout (UBOS-C) 118 (18.0%) 102 (19.8%) 16 (11.3%)

Emotional exhaustion (0–6) 1.53 (0.99) 1.57 (1.04) 1.39 (0.75)

Depersonalisation (0–6) 1.14 (0.75) 1.16 (0.77) 1.12 (0.65)

Personal accomplishment (0–6) 4.2 (0.69) 4.2 (0.71) 4.17 (0.64)

Personality traits (Big Five)

Neuroticism (1–5) 2.36 (0.60) 2.37 (0.62) 2.34 (0.54)

Extraversion (1–5) 3.43 (0.60) 3.40 (0.60) 3.54 (0.56)

Openness to experience (1–5) 3.54 (0.54) 3.55 (0.54) 3.48 (0.52)

Agreeableness (1–5) 3.75 (0.47) 3.73 (0.47) 3.83 (0.45)

Conscientiousness (1–5) 3.89 (0.47) 3.90 (0.48) 3.86 (0.42)

GHQ-12, general health questionnaire with cut-off point 2; SD, standard deviation; UBOS-C, Utrechtse Burnout Schaal.

Table 1 Sociodemographic variables of consultant and resident anaesthesiologists

Total (nU655) Consultants (nU514) Residents (nU141)

Sex

Male 388 (59.2%) 335 (65.2%) 53 (37.6%)

Female 267 (40.8%) 179 (34.8%) 88 (62.4%)

Age (years) 43.7 (26 to 64) 47.2 (30 to 67) 31 (26 to 48)

Relationship

Single 63 (9.6%) 34 (6.6%) 29 (20.6%)Marrieda 567 (86.6%) 455 (88.5) 112 (79.4%)

Divorcedb 25 (3.8%) 25 (4.9%) 0 (00.0%)

Childrenc

Yes 354 (54.0%) 317 (61.7%) 37 (26.2%)

No 301 (46.0%) 197 (38.3%) 104 (73.8%)

Hospital

Academic centre 295 (45.0%) 171 (33.3%) 124 (87.9%)

Community hospital 360 (55.0%) 343 (66.7%) 17 (12.1%)

Data are number (percentage) or median (range). a Including living together. b Including widowed (n¼2). c Children under the age of 18 years.




independently related to depersonalisation. Personal

accomplishment was related to all five personality traits

and one sociodemographic variable (having a relation-

ship). Of the five personality traits, neuroticism was the

most important risk factor for the three dimensions of

burnout. Logistic regression with selection procedure

was used.

The observed variability ( R2) values explained by these

three multivariable models were 36, 28 and 31%, respect-

ively.

DiscussionThe problem of psychological distress and burnout has

been acknowledged in our literature for over 15 years and

the present study proves that the problem still needs

attention. To our knowledge, this is the first study relat-

ing both psychological distress and burnout to personality

traits in anaesthesiologists.Our results indicate that there is a high prevalence of

psychological distress in our sample of Dutch consultant

and resident anaesthesiologists (39.4%). This means that

a significant proportion experience unpleasant and unu-

sual mental phenomena and impairment of normal func-

tioning. This percentage is almost double that of the

general population (22.8%) but compares with the per-

centage in other first-line healthcare workers in the

Netherlands.24

The prevalence of burnout in the total study group was

18%, which is on the low side of the range of 20 to 40%

burnout in anaesthesiologists reported in previous Euro-

pean publications.1,2,5,28,29

When interpreting this result, it is important to realise

that the prevalence of burnout in the general Dutch

population is 13%. This is amongst the lowest in

Europe according to a Dutch report from 2013 whichcompared Dutch general occupational burnout with

European figures.30 Another interesting aspect of these

studies is that they reported an increased prevalence of

burnout in residents.28,31–34 This is in contrast to the

result of the present study, in which burnout was less

prevalent in residents (11.3%) than in consultants

(19.8%).

From a study performed by a Dutch insurance company

among Dutch general practitioners, it is known that not

all doctors with burnout symptoms seek help or stop

working.35 If these findings are also applicable to the

Dutch anaesthesiologist population, it may be that col-leagues experiencing symptoms of burnout keep on

working and potentially pose a threat to their own mental

and physical health as well as to patient safety.

When all variables (sociodemographic and personality)

are taken into consideration, our multivariable analysis

showed neuroticism to be the most important factor

increasing the risk for presence of psychological distress

(OR 6.22) and presence of burnout (OR 6.40). Extrover-

sion was the most important protective factor for burnout

(OR 0.44). Separation of results from residents and con-

sultants did not improve the final model.


Table 3 Sociodemographic variables and personality traits influencing psychological distress and burnout

Psychological distress (GHQ-12) Burnout (UBOS-C)

u ni va riable a nal ysi s mul tivaria ble an alysis u ni va ria bl e a nal ysi s mul ti va ria ble an alysis

ORcrude (95%CI) ORadj (95%CI) ORcrude (95%CI) ORadj (95%CI)

Sociodemographics

Gender – –

Male 0.71 (0.52 to 0.98) 0.88 (0.59 to 1.32)

Female 1.00 (reference) 1.00 (reference)

Age, years 0.98 (0.97 to 1.00) – 0.99 (0.98 to 1.02) –

Relationship –

Single 1.05 (0.41 to 2.65) 0.92 (0.32 to 2.69) 2.93 (0.78 to 11.0)

Marrieda 0.66 (0.30 to 1.48) 0.47 (0.19 to 1.18) 1.51 (0.44 to 5.16)

Divorcedb 1.00 (reference) 1.00 (reference) 1.00 (reference)

Childrenc –

Yes 1.46 (1.06 to 2.00) 1.82 (1.24 to 2.66) 1.19 (0.80 to 1.78)

No 1.00 (reference) 1.00 (reference) 1.00 (reference)

Function –

Consultant 1.14 (0.78 to 1.68) – 1.93 (1.10 to 3.40)

Resident 1.00 (reference) 1.00 (reference)

Personality traits

Neuroticism 5.56 (3.96 to 7.80) 6.22 (4.35 to 8.90) 8.77 (5.67 to 13.6) 6.40 (3.98 to 10.3)

Extraversion 0.49 (0.34 to 0.59) – 0.27 (0.18 to 0.39) 0.44 (0.28 to 0.69)

Openness 0.99 (0.74 to 1.32) 1.58 (1.12 to 2.23) 0.89 (0.61 to 1.29) 1.77 (1.10 to 2.83)

Agreeableness 0.58 (0.41 to 0.82) – 0.25 (0.16 to 0.40) 0.52 (0.30 to 0.89)

Conscientiousness 0.67 (0.48 to 0.93) – 0.37 (0.24 to 0.57) –

Univariable logistic regression and multivariable logistic regression with selection procedure was used. ‘–’, not selected; adj, adjusted for all other variables in the model;CI, confidence interval; crude, univariable model; GHQ-12, General Health Questionnaire with cut-off point 2; OR, odds ratio; UBOS-C, Utrechtse Burnout Schaal.a Including living together. b Including widowed (n¼2). c Children younger than 18 years of age. Theadjusted R 2 valuesof the final model ofGHQ-12and ofburnout were27 and 34%, respectively.





T a b l e 4

S o c i o d e m o g r a p h i c v a r i a b l e s a n d t h e p e r s o n a l i t y t r a i t s i n fl u e n c i n g t h e t

h r e e d i m e n s i o n s o f b u r n o u t

E m o t i o n a l e x h a u s t i o n

D e p e r s o n a l i s a t i o n

P e r s o n a l a c c o m

p l i s h m e n t

U n i v a r i a b l e a n

a l y s i s

M u l t i v a r i a b l e a n a l y s i s

U n i v a r i a b l e a n a l y s i s

M u l t i v a r i a b l e

a n a l y s i s

U n i v a r i a b l e a n a l y s i s

M u l t i v a r i a b l e a n a l y s i s

b c r u d e

( 9 5 %

C I )

b a d j

( 9 5 %

C I )

b c r u d e

( 9 5 %

C I )

b a d j

( 9 5 %

C I )

b c r u d e

( 9 5 %

C I )

b a d j

( 9 5 %

C I )

S o c i o d e m o g r a p h i c s

S e x

–

–

M a l e

0 . 1

7 ( 0 . 3

2 t o

0 . 0

1 )

0 . 1

5 ( 0 . 0

4 t o 0 . 2

7 )

0 . 1

9 ( 0 . 0

8 t o

0 . 3

0 )

0 . 0

1 ( 0 . 0

9 5 t o 0 . 1

2 )

F e m a l e

0 . 0

0 ( r e f e r e n c e

)

0 . 0

0 ( r e f e r e n c e )

0 . 0

0 ( r e f e r e n c e )

0 . 0

0 ( r e f e r e n c e )

A g e ( y e a r s )

0 . 0

0 ( 0 . 0

0 t o 0

. 0 0 )

–

0 . 0

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2 t o 0 . 0

0 )

–

0 . 0

0 ( 0 . 0

0 t o 0 . 0

1 )

–

R e l a t i o n s h i p

–

–

S i n g l e

0 . 4

6 ( 0 . 7

8 t o

0 . 1

4 )

0 . 0

1 ( 0 . 2

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5 )

0 . 3

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6 )

0 . 3

5 ( 0 . 6

2 t o 0 . 0

8 )

M a r r i e d a

0 . 2

8 ( 0 . 5

6 t o

0 . 0

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0 . 0

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D i v o r c e d b

0 . 0


)

0 . 0

0 ( r e f e r e n c e )

0 . 0

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0 ( r e f e r e n c e )

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–

–

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N o

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)

0 . 0

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0 . 0

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F u n c t i o n

–

–

C o n s u l t a n t

0 . 1

9 ( 1 . 2

2 t o 1

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0 . 0

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R e s i d e n t

0 . 0


)

0 . 0

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0 . 0

0 ( r e f e r e n c e )

0 . 0

0 ( r e f e r e n c e )

P e r s o n a l i t y t r a i t s

N e u r o t i c i s m

0 . 9

5 ( 0 . 8

4 t o 1

. 0 5 )

0 . 8

9 ( 0 . 7

8 t o 1 . 0

0 )

0 . 5

3 ( 0 . 4

5 t o 0 . 6

2 )

0 . 3

7 ( 0 . 2

6 t o

0 . 4

7 )

0 . 5

3 ( 0 . 6

1 t o 0 . 4

5 )

0 . 3

1 ( 0 . 4

0 t o 0 . 2

2 )

E x t r o v e r s i o n

0 . 5

5 ( 0 . 6

8 t o

0 . 4

3 )

0 . 2

1 ( 0 . 3

2 t o 0 . 9

4 )

0 . 4

0 ( 0 . 5

0 t o 0 . 3

2 )

0 . 2

0 ( 0 . 2

9 t o 0 . 1

0 )

0 . 3

6 ( 0 . 2

8 t o 0 . 4

5 )

0 . 1

0 ( 0 . 0

1 t o 0 . 1

8 )

O p e n n e s s

0 . 0

8 ( 0 . 2

3 t o

0 . 0

5 )

0 . 1

7 ( 0 . 0

5 t o 0 . 2

9 )

0 . 0

7 ( 0 . 1

8 t o 0 . 0

3 )

0 . 1

4 ( 0 . 0

4 t o

0 . 2

3 )

0 . 3

0 ( 0 . 2

1 t o 0 . 4

0 )

0 . 1

2 ( 0 . 0

3 t o 0 . 2

1 )

A g r e e e a b l e n e s s

0 . 4

3 ( 0 . 6

0 t o

0 . 2

8 )

0 . 4

8 ( 0 . 6

0 t o 0 . 3

6 )

0 . 1

8 ( 0 . 3

0 t o 0 . 0

6 )

0 . 5

4 ( 0 . 4

4 t o 0 . 6

5 )

0 . 2

8 ( 0 . 1

8 t o 0 . 3

9 )

C o n s c i e n t i o u s n e s s

0 . 2

6 ( 0 . 4

2 t o

0 . 0

9 )

0 . 4

7 ( 0 . 5

9 t o 0 . 3

5 )

0 . 2

1 ( 0 . 3

2 t o 0 . 0

1 )

0 . 5

2 ( 0 . 4

1 t o 0 . 6

3 )

0 . 2

6 ( 0 . 1

6 t o 0 . 3

7 )

U n i v a r i a b l e l i n e a r r e g r e s s i o n a n d m u l t i v a r i a b l e l i n e a r r e g r e s s i o n w i t h s e l e c t i o n p r o c e d u r e w a s u s e

d .

b , r e g r e s s i o n c o e f fi c i e n t , t h a t i s c h a n g e p e r u n

i t i n c r e a s e o r c o m p a r e d w i t h t h e r e f e r e n c e , r e s p e c t i v e l y ; ‘ – ’ , n o t s e l e c t e d ; a d j ,

a d j u s t e d f o r a l l o t h e r v a r i a b l e s i n t h e m o d e l ; C I , c

o n fi d e n c e i n t e r v a l ; c r u d e , u n i v a r i a b l e m o d e l . a

I n c l u

d i n g l i v i n g t o g e t h e r .

b

I n c l u d i n g w i d o w e d ( n ¼

2 ) . c

C h i l d r e n y o u n g e r t h a n 1 8 y e a r s o f a g e . T

h e a d j u s t e

d R 2

v a l u e s o f t h e fi n a l m o d e l

o f e m o t i o n a l e x h a u s t i o n ,

d e p e r s o n a l i s a t i o n a n d

p e r s o n a l a c c o m p l i s h m e n t w e r e 3 6 ,

2 8 a n d 3 1 %

, r e s p e c t i v e l y .




This compares with studies in the general population.

People who score high on neuroticism tend to have an

increased susceptibility to their environment, a tendency

to be anxious and insecure and a high performance drive.

This predisposes them towards developing burnout.

People who score highly on extroversion tend to seek

interactions with other people, and this may help coun-

teract the process of depersonalisation. They also tend to

appraise problems in a positive way, which reduces stress

and therefore risk of burnout.

Individuals with certain personality types may choose

high-stress occupations, so doctors who choose to pursue

a career in anaesthesia might have personality traits that

make them fit for the specific stressful demands of the job

and hence reduce the chance of developing burnout.

However, stress will be experienced more intensely by

individuals with some personality traits and hence will

predispose them to developing burnout. Some studies

suggest that certain personalities tend to choose specific

medical specialties.36,37 For example, anaesthesiologists

have been reported as more intelligent, self-sufficient,

dominant, tense and introverted than general prac-

titioners.38

Personality traits are important in burnout and psycho-

logical distress, and they are considered to be stable in

time and hard to change. Therefore, strategies to address

these problems can be focused on reinforcing the coping

strategies of the individual. Educational programmes

should be directed at personal competence and staying

resilient, as well as professional knowledge and skills. For

example, it has been suggested that trainee anaesthesiol-

ogists should be taught beneficial coping styles.6 Person-

ality testing may be used in selection of residents to

reduce burnout in future anaesthesiologists. Further-

more, it is recommended that colleagues should be

educated about recognising symptoms indicating burn-

out, such as a detached and cynical attitude towards

patients and coworkers.

A cause for concern inour study isthe low response rate of

33.5%. Similar studies3,8,31,34,39–41 have reported

response rates of 27 to 76%. In these studies, response

rates were inversely related to the number of participants

addressed. Our response rate of 33.5% is similar to themean response rate of 34.6% found in a meta-analysis of

56 internet-based surveys.42 The authors of this meta-

analysis also emphasise that the representativeness of a

sample is much more important than the response rate

obtained. Our data proved to be representative for socio-

demographic variables, which argues in favour of the

premise that no responder bias has occurred. It can be

argued that anaesthesiologists who have burnout may

tend not to react to professional e-mails or fill out

work-related questionnaires. However, the reverse may

also be true; such anaesthesiologists may be eager to share

data to call attention to their situation. Even if selection

bias had occurred, the high prevalence of psychological

distress is still very disturbing.

In future longitudinal studies, the question of how

personal and situational factors interact in the complex

process of the development of burnout should be

addressed. Considering coping strategies would be inter-

esting in this regard. In addition, the relationshipbetween burnout and sick leave, suicide rate, critical

incidents and substance abuse should be studied further.

This knowledge could then be used to develop specific

strategies to reduce anaesthesiologist burnout. Further-

more, future research aimed at defining which specific

personality traits are desired in aspiring anaesthesiolo-

gists is needed because the BFI tool is an instrument

which assesses general personality traits.

We conclude that personality traits of anaesthesiologists

are strongly related to the presence or absence of psycho-

logical distress and burnout, with neuroticism as the most

important trait influencing the presence of both psycho-logical distress and burnout, making it an important

risk factor.

Acknowledgements relating to this articleAssistance with the study: we would like to thank Ria te Winkel for

assistance in compiling the questionnaires, Michiel Vogelaar for

assistance in data collection and database building and Mark van

Ooijen for assistance in data collection.

Financial support and funding: this work was supported by internal

funding of the Department of Anaesthesiology, Pain and Palliative

Medicine of the Radboud University Nijmegen Medical Center,

Nijmegen, the Netherlands.

Declaration of interests: none.

Presentation: preliminary data from this study were presented orally

at the annual meeting of the Dutch Anaesthesia Society in May

2013, Maastricht, the Netherlands.

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