A systematic review including meta-analysis of work environment and burnout symptoms.
A systematic review including meta-analysis of work environment and burnout symptoms.
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DOI：
10.1186/s12889-017-4153-7
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发表时间：
2017-03-16
影响因子：
4.5
通讯作者：
Hall C
中科院分区：
文献类型：
--
作者：
Aronsson G;Theorell T;Grape T;Hammarström A;Hogstedt C;Marteinsdottir I;Skoog I;Träskman-Bendz L;Hall C
医疗和保险系统的从业人员和决策者需要了解工作暴露与职业倦怠之间的关系。许多职业倦怠的研究--无论是原创的还是评论的--都将他们的分析局限于情绪耗竭，或者没有报告关于玩世不恭、个人成就感或整体职业倦怠的结果。为了满足这一需求，我们进行了这项审查和荟萃分析，目的是提供系统分级的证据之间的关联工作条件和不久的将来发展的倦怠症状。筛选了广泛的工作暴露因素。入选标准为：1）1990-2013年在欧洲、北美、澳大利亚和新西兰进行的研究。2)前瞻性或可比病例对照设计。3)在基线时评估暴露（工作）和结局，并在1-5年后的随访期间至少再次评估。25篇文章符合预定义的相关性和质量标准。使用GRADE系统及其4级证据量表。在25项研究中，大多数研究关注的是情绪疲惫，较少的是愤世嫉俗，更少的是个人成就。中度强有力的证据（3级）得出结论，工作控制和减少情绪疲惫之间的关联，低工作场所的支持和增加情绪疲惫。有限的证据（2级）被发现之间的关联工作场所的公正，要求，高工作量，低报酬，低主管的支持，低同事的支持，工作不安全感和情绪衰竭的变化。愤世嫉俗与大多数这些工作因素有关。个人成就感的降低只与低回报有关。关于不良化学、生物和物理因素以及倦怠的质量足够高的前瞻性研究很少。虽然高水平的工作支持和工作场所的公平保护情绪耗竭，高要求，低工作控制，高工作负荷，低报酬和工作不安全性增加了发展枯竭的风险。我们的方法与广泛的工作接触因素分析有关的单独层面的倦怠扩大了知识的协会，证据以及研究需求。组织干预的潜力是说明的调查结果，倦怠症状的强烈影响，如工作要求，支持和施加控制的可能性的结构性因素。本文的在线版本（doi：10.1186/s12889-017-4153-7）包含补充材料，可供授权用户使用。
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. 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. 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. 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. The online version of this article (doi:10.1186/s12889-017-4153-7) contains supplementary material, which is available to authorized users.