1. Background
Work is a major part of each person's life and causes the independence and self-esteem development in people (1, 2). Job stress can be formed in certain professions and is gradually turned into a job burnout and consequently, it leads to the physical and emotional burnout (1-4) and finally to the job attitude change (5).
Burnout is a syndrome that consists of three components; emotional exhaustion, depersonalization and the lack of personal success (6); it is seen mostly in jobs to help people such as counselors, teachers, social workers, doctors, nurses etc. (2, 7-9). In the field of rehabilitation, job burnout occurs due to the prolonged treatment process, which is done on most clients (10-13).
The results of studies, which were carried out in 1982 and 2006 showed that the level of job burnout was from mild to moderate among the speech- language pathologists (SLPs) (13-18), and were linked to the factors such as job dissatisfaction, job inefficiency, poor management, and insufficient income. Meanwhile, factors such as gender and work load resulted from case load size influence on the personal life of therapists (10, 15, 19). In addition, different studies indicated that the high level of job stress had the significant relationship with the increased burnout (13, 20-24).
The only study conducted on the SLPs’ job satisfaction in Iran showed that the job satisfaction scores were low among SLPs (25). Also, job burnout can be a factor for work leave or work absence, reduced self- confidence and decreased responsibility among SLPs. Also, it is followed by lowering the quality of services to the recipients along with the high costs for society. As no study has been done about job burnout among the Iranian SLPs, thus, this study investigated it and the factors associated with it among them.
2. Methods
This is a descriptive cross - sectional study conducted on 182 SLPs via convenience sampling method. The study was approved by the Ethics Committee of Semnan University of Medical Sciences. The inclusion criteria included the SLPs with at least a bachelor's degree, a minimum of 2- year work experience in the public or private institutions, and the lack of any acute and chronic diseases during this study. Of the 250 questionnaires distributed among the SLPs participating in the 13th National Congress of Speech Therapy in Iran (2015), 182 questionnaires were returned for the study.
Two types of questionnaires were used to collect the data; the first questionnaire contained 13 items; five were about the demographic information (education, age, gender, marital status, and number of children) and eight items were about job information (work domain, work experience, and working hours per week, the average monthly income, the average case load size per week, type of visit place (in public / private institute, or both of them), and place visit (treatment center, home or both of them), and participating in the retraining courses. To evaluate the internal consistency of this questionnaire, it was filled out by 10 participants and then the reliability (α= 90%) was obtained. The second questionnaire was Maslach Burnout inventory (MBI) (26) including 22 items; nine items were related to the emotional exhaustion, five for depersonalization assessment, and eight about feelings of personal accomplishment. Validity and reliability in MBI obtained higher than 76% in all dimensions in Iran (27).
In general, if the scores of emotional exhaustion and depersonalization become higher and if the score of personal efficacy is lower, the job burnout severity is higher. On the basis of the reference scores, the overall scores under 18 show no burnout, 19 to 53 indicate the mild burnout, 54 to 89 suggest the moderate burnout, and 90 to 108 are considered as the severe job burnout. To comply with ethical principles, the questionnaire was anonymous and the cases filled out the informed consent form.
2.1. Data Analysis Method
To analyze the data, SPSS-16 was used, and to determine the relationship between the job and individual factors with job burnout, the statistical χ2 test and the logistic regression correlation were used.
3. Results
This study investigated the job burnout and the factors with any possible effect among SLPs. The severe, moderate, mild, and asymptomatic categories were used to express the intensity.
This study showed that SLPs had the severe job burnout with 2.2 % (N = 4), the moderate burnout; 53.3% (N = 97), mild burnout; 44% (N = 80), and no job burnout; 0.5% (N = 1), (Table 1). By reviewing each of the dimensions of job burnout, 154 cases (84.6%) were with the emotional exhaustion, 168 cases (92.3%) with depersonalization, and 52 cases (28.6%) had the personal inefficacy (Table 2).
Table 1.The Prevalence of Job Burnout Severity Among Speech-Language Pathologists
| The Burnout Degree | N (%) |
|---|---|
| No Burnout (18 ≥) | 1 (0.5) |
| Mild (19 - 53) | 80 (44) |
| Moderate (54 - 89) | 97 (53.3) |
| Severe (90 - 108) | 4 (2.2) |
Table 2.Classification of the Dimensions of Job Burnout Severity Among Speech-Language Pathologists
| The Dimensions of Burnout | N (%) |
|---|---|
| Emotional exhaustion | |
| Mild (≤ 16) | 140 (77) |
| Moderate (17 - 26) | 35 (19.2) |
| Severe (≥ 27) | 7 (3.8) |
| Depersonalization | |
| Mild (≤ 6) | 141 (77.5) |
| Moderate (7 - 12) | 33 (18.1) |
| Severe (≥ 13) | 8 (4.4) |
| Personal accomplishment | |
| Low (≤ 39) | 52 (28.6) |
| High (> 39) | 130 (71.4) |
In the investigation conducted between the demographic and job characteristics with burnout, a significant relationship was shown between job burnout and income (P = 0.03), case load size per week (P = 0.019), and retraining courses per year (P = 0.05). Therefore, SLPs who had more case load size per week, but less income and less retraining courses, faced with more job burnout (Table 3).
Table 3.The Relationship of the Individual and Job Characteristics with Job Burnout (χ2 Test) Among Speech-Language Pathologists
| Variables | Burnout | |||
|---|---|---|---|---|
| Mild | Moderate | Severe | P | |
| Age | 0.58 | |||
| ≤ 35 | 1 (0.8) | 55 (49) | 64 (53.2) | |
| > 35 | 0 (0) | 25 (40) | 37 (60) | |
| Gender | 0.42 | |||
| Female | 0 (0) | 51 (45.1) | 62 (54.9) | |
| Male | 1 (1.4) | 29 (42) | 39 (56.6) | |
| Marital status | 0.25 | |||
| Single | 1 (1.4) | 27 (38.6) | 42 (60) | |
| Married | 0 (0) | 53 (47.3) | 59 (52.7) | |
| Education | 0.59 | |||
| Bachelor | 1 (1.1) | 40 (46) | 46 (52.9) | |
| Higher than bachelor | 0 (0) | 39 (41.5) | 55 (58.5) | |
| Number of children | 0.61 | |||
| 0 | 1 (1) | 45 (44.6) | 55 (54.4) | |
| 1 | 0 (0) | 13 (35.1) | 24 (64.9) | |
| ≥ 2 | 0 (0) | 22 (50) | 22 (50) | |
| Income per month, Rials | 0.03 | |||
| Less than 10 millions | 1 (1.4) | 33 (45.8) | 38 (52.8) | |
| 10 to 20 millions | 0 (0) | 29 (45.3) | 35 (54.7) | |
| More than 20 millions | 0 (0) | 18 (32.1) | 28 (67.9) | |
| Work experience | 0.83 | |||
| 8 > | 1 (1.1) | 42 (46.2) | 48 (52.7) | |
| 8 - 14 | 0 (0) | 18 (9.42) | 24 (57.1) | |
| > 14 | 0 (0) | 20 (40.8) | 29 (59.2) | |
| Case-load size per week | 0.019 | |||
| 25 ≥ | 1 (1.4) | 40 (58) | 28 (40.6) | |
| 26 - 50 | 0 (0) | 34 (37.4) | 57 (62.6) | |
| > 50 | 0 (0) | 6 (27.3) | 16 (72.7) | |
| Working hour per week | 0.38 | |||
| 25 > | 1 (1.4) | 35 (50) | 34 (48.6) | |
| 25 - 40 | 0 (0) | 29 (43.3) | 38 (56.7) | |
| > 40 | 0 (0) | 16 (35.6) | 29 (64.4) | |
| Work place | 0.38 | |||
| Public | 0 (0) | 30 (50) | 30 (50) | |
| Private | 0 (0) | 31 (43.7) | 40 (56.3) | |
| Both of them | 1 (1.4) | 19 (37.3) | 31 (60.8) | |
| Visit place | 0.45 | |||
| Treatment center | 1 (1.4) | 57 (44.9) | 69 (53.7) | |
| Home | 0 (0) | 0 (0) | 4 (100) | |
| Both of them | 0 (0) | 23 (45.1) | 28 (54.9) | |
| Work domain | 0.19 | |||
| Language | 1 (3) | 11 (33.3) | 21 (63.6) | |
| Speech | 0 (0) | 10 (62.5) | 6 (37.5) | |
| Both of them | 0 (0) | 59 (44.7) | 74 (55.3) | |
| Second job | 0.4 | |||
| Yes | 0 (0) | 15 (55.6) | 12 (44.4) | |
| No | 1 (0.6) | 65 (41.9) | 89 (47.4) | |
| Executive responsibility | 0.37 | |||
| Yes | 0 (0) | 24 (38.1) | 39 (61.9) | |
| No | 1 (0.8) | 56 (47.1) | 62 (52.1) | |
| Retraining courses per year | 0.05 | |||
| < 5 hours | 1 (0.8) | 56 (44.9) | 63 (54.3) | |
| 5 - 10 hours | 0 (0) | 17 (53.1) | 15 (46.9) | |
| > 10 hours | 0 (0) | 8 (26.7) | 22 (73.3) | |
aValues are expressed as N (%).
Logistic regression correlation showed that only the case-load size per week was significantly correlated with a job burnout (r = 0.12). In fact, SLPs with case-load size had the further job burnout; in other words, for each increase at one case, 0.12 increased in average in job burnout score (Table 4).
Table 4.The Relationship of the Case Load Size with Burnout Among Iranian Speech-Language Pathologists
| Model | Unstandardized Coefficients | Standardized Coefficients | Sig. | |
|---|---|---|---|---|
| B | Std. Error | Beta | ||
| Case-load size | 0.12 | 0.049 | 0.180 | 0.015 |
4. Discussion
In this study, most SLPs (177 cases; 97.3%) had mild to moderate job burnout. This study showed that job burnout among the Iranian SLPs was higher than SLPs lived in other countries (13, 18, 19). Meanwhile, job burnout among the Iranian SLPs is higher than the other rehabilitation professionals such as physiotherapists; chiefly, in the studies done by Schuste et al. (53%) (10), and Pavlakis (21%) (11). Also, Mozayan’s study showed that job burnout was more observed among the occupational therapists (80.4%) (12).
This study indicated that the prevalence of emotional exhaustion and depersonalization were high in SLPs (84.6% for emotional exhaustion and 92.3% for depersonalization), but in intensity, job burnout was mostly mild. As the sessions for patients occur continuously, thus, the SLPs are engaged with the patients’ problems. This would affect their emotions and may cause some emotional exhaustion. In depersonalization, which is a reaction to the compatibility with emotional exhaustion (28), the various factors that play the role in burnout including human relationships between employees within an organization, coordination between their efforts with their reward amount (29), hereditary, social, and family factors (30). To improve the job burnout they should be prevented. In addition, 28.6% of SLPs had low personal accomplishment indicating their negative attitude towards themselves and their career; indicating that there was no job interest, no job satisfaction, and no sufficient clinical skill. Also, their self-esteem was low too.
The findings showed that there was a relationship between the individual and job factors with job burnout. In addition, there was a direct relationship between the job burnout and case-load size resulted from the number of patients, however, there was an inverse relationship between the income level and retraining courses.
In a study carried out between the workload resulted from case-load size and work hours per week with burnout, the findings showed that there was a relationship between the number of visiting the patients and job burnout. Furthermore, a part of the working hour of SLPs is dedicated to treating the patients and the rest of working hours are spent for the activities such as preparation for session therapy, report writing, planning, providing a timetable for patients, administrative tasks, counseling for families, and commuting. Therefore, it seems that the number of visits of the patients compared with working hours is the important risk factor for job burnout. Additionally, this finding is consistent with studies of Miller & Potter (1982), Goldberg (1993), Pezzei and Oratio (1991), Potter & Lagace (1995), Blood and et al., (2002), Due (2016), Caesar and Nelson (2008) and Ratliff (2017) (13, 15, 16, 18, 20, 31-33).
One of the most important features of a job is income, which causes satisfaction for everybody. In fact, income is considered as one of the external factors of a burnout (16). The results of Rahimi, Foroushani, and Naseh’s studies, which were conducted on SLPs and occupational therapists, were consistent with the results of this study (25). However, the findings of Hale et al., (24) and Potter and Lagace’s studies (18) on SLPs and also Mozayan’s study on the occupational therapists (12) were not consistent with this study. The reason of inconsistency in findings of this study compared with the other studies in Iran indicated that there was no insurance support for therapists; thus, the financial problems could be a concern for them.
It seems that participation in workshops and retraining courses develops the clinical` skills and makes some changes in the individual’s attitude, which leads to reduce the job burnout. Unfortunately, there is no study about the relationship of retraining courses with burnout on SLPs. The only study, which was found on job burnout in Iran, was the relationship of retraining courses and job burnout, which was conducted on the occupational therapists by Mozayan et al. and was not consistent to this study (12).
This study showed that age, sex, marital status, education level, number of children, work experience; working hours per week, place of visiting the patients, treatment field, the second job, and the executive responsibility had no significant relationship with burnout. Mozayan’s findings showed a consistency in all the above factors in this study except in work experience [12]. Furthermore, the results of the studies done by Kaegi et al., and Hale et al., like this study, reported the lack of relationship between burnout, age, and work experience (19, 24). However, the studies carried out by Potter & Lagace, and Sliwinski et al., were opposed to this study (11, 18).
Studies done by Maslach et al., (2001) and Carlotto & Palazzor (2006) did not show any relationship between gender and burnout (34, 35), however, Potter & Lagace (1995) suggested that men compared with women, due to having more responsibility and social stress, had more job burnout.
The results of Goldberg’s study (1993) showed that there was a significant relationship between the executive responsible for SLPs and job burnout; however, it was not consistent with this study. The study of Potter & Lagace, like the current study indicated that there was no relationship between work domain and burnout (11, 15).
4.1. Limitation
In this study, the subjects were restricted to only the SLPs who participated in the 13th Iranian national congress of speech and language pathology and we did not have any access to all the Iranian SLPs. Thus, the results of this study cannot be overgeneralized to all of them. Work place in which SLPs work can affect the amount of job burnout. Hence, it is suggested that the effects of the work place are investigated on the amount of their job burnout in future studies.
4.2. Conclusion
This is the first study conducted on Iranian SLPs to investigate the job burnout and the related risk factors. The results of this study help the SLPs and the officials to be aware of job burnout causes, and help them find the preventive ways to reduce it.
The results showed that most of the SLPs had the mild and moderate job burnout. In fact, burnout has a direct relationship with job stress resulted from case load size. Also, it has an inverse relationship with the level of income and retraining courses.
As the burnout influences the quality of treatment services, it is advised that the health providers pay more attention to SLPs in future policy making. Also, steps to be taken to reduce the job stressors including to increase the financial and mental supports, to provide welfare needs, to hold the job retraining courses or to publish the journals, and also to decrease the case-load size resulted from visiting the number of patients.
