Burnout Syndrome at Work by Doctors Employed at Emergency Center of Clinical Center of Serbia A

Burnout Syndrome at Work by Doctors Employed at Emergency Center of Clinical Center of Serbia A Aleksandra M. Bukumiroviċ1, Sanja D. Totić-Poznanović2,7, Ljiljana N. Marković-Denić3, Zoran M. Bukumirić4, Aleksandra N. Vlačić5, Vladimir S. Radak1, Ratko M. Lasica6,7, Ana D. Šijački1,7 A 1 Center for Research, Education and Human Resources, Clinical Center of Serbia, Belgrade, Serbia 2 Clinic for psychiatry, Clinical Center of Serbia, Belgrade, Serbia 3 Institute of Epidemiology, Medical Faculty University of Belgrade, Belgrade, Serbia 4 Institute for Medical Statistics and Informatics, Medical Faculty University of Belgrade, Belgrade, Serbia 5 Department of Biomedicine, Ministry of Health of the Republic of Serbia, Belgrade, Serbia 6 Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia 7 Medical Faculty University of Belgrade, Belgrade, Serbia


INTRODUCTION
Th e term burnout is an expression from the 1970th originated by the American psychologist Freudenberger [1,2].Th e term is used in order to describe the consequences of stress and high ideals of people who worked in the "helper" professions [3].According to Maslash, one of the leading experts in this area, burnout syndrome is a reaction to chronic emotional and cynicism (negative or overly personal reaction to diff erent aspects of the job) and ineffi ciency [4].Maslash fi rst published Burnout Syndrome Questionnaire called Maslach Burnout Inventory (MBI), which is still in use [4].
A large number of research have imposed the need to look at this phenomenon in other profi les, not just those from the socalled helpless -service activities, as initially [3,5].It has been shown that the occurrence of this syndrome can be invoked by workers of all professions, employed in administrative aff airs as well as workers in productive activities [6,7] and can be recognized even before employment: in students as so-called "student burnout syndrome" [7,8].Etiopathogenesis of the burnout syndrome is complex but is generally considered to be extended "negative stress" as key factor in its formation, whereby the characteristics of individuals and the impossibility of successful overcoming also play an important role.Other important pathogenic factors can be identifi ed as "slavery to daily routine" or "disappointment due to excessive expectations" [3,7].Vuković et al 2017, pointed out negative correlation between work environment and effi ciency satisfaction of healthcare professionals, and job pressure due to anxiety and chronic stress presence at work [9].Burnout has long been defi ned as a state of progressive loss of idealism, energy, and meaning of their work.Workers perceive it as a reaction to chronic sources of stress at work, with already defi ned stages in its evolution (enthusiasm, stagnation, frustration, apathy).As a medi-cal condition burnout has not yet been clearly defi ned [3,5,10].Recognizing this condition is a need in the society and is refl ected in the European Union's Decree on Health and Safety at Work, whose provisions may also apply to psychosocial characteristics of work (89/391/ EEC) [11].

AIM
Th e aim of this study was to assess the relation of sociodemographic variables with the presence of burnout in the study population of physicians.

METHODS
Burnout syndrome manifests itself diff erently, occurs more frequently in emergency and complex medical interventions and leads to discontent at the workplace, especially in young doctors without experience and with great ambitions.Th e greater the degree of expressed exhaustion syndrome with doctors without specialization, families and bad fi nancial situation.Th is paper is part of a non-commercial, retrospective, epidemiological study in the period May-June 2017 and February-March 2018 at the Emergency Center of the Clinical Center of Serbia (EC CCS).Terms used in consideration of specialist is a qualifi ed physician with a completed specialization; community life is considered to life in any type of community, whether married or in a domestic partnership, family affi liation occurs if the respondent contributes to the community's fi nances For the purpose of this research, a specially designed questionnaire was used which, in addition to the sociodemographic and economic characteristics of the examinees, observes certain behavioral characteristics [12] and a questionnaire for the assessment of burnout syndrome at work for employees in direct contact with people: the Maslach Burn-out Inventory-Human Services Survey (MBI-HSS) [12].MBI-HSS examines the psychological eff ects of three levels of burnout syndrome (low / moderate / high): emotional exhaustion, depersonalization and personal (non) realization [13,14].Th e rights to use the questionnaire were purchased in Serbian.

Statistical methods
From descriptive statistical methods were used measures of central tendency (mean, median), a measure of variability (standard deviation) and the relative numbers (frequency, percent).Methods for testing statistical hypotheses were used: Cronbach α reliability, Fisher Exact Probability Test or Pearson's chi-squared test, Kruskal-Wallis test and Spearman's coeffi cient of rank correlation.Statistical hypotheses were tested at the level of statistical signifi cance (alpha level) of 0.05.

Description of the population
In accordance with good clinical practice, physicians-respondents gave signed consent and fi lled in the questionnaire by themselves.76 diff erent specialists answered correctly to the examination, male 38 (50.0%) and female the same number.Th e age structure of the respondents in the most representative category (35-44 years) was 31 (40.8%).Respondents involved in the research live most oft en in a community (married or domestic partnership) 40 (52.6%) of respondents and 37 (48.7%) had children.Th e fi nancial burden of the whole family fell to 35 (46.1%) respondents.Th e more respondents had 6-20 years of service.In Figure 1 we showed the distribution of respondents according to the degree of education.

Survey Analysis -Maslach Burnout Inventory MBI-HSS
Th e reliability of the MBI-HS instrument was good, the questionnaire had an adequate level of internal consistency (Cronbach α = 0.832).Th e depersonalization median was 4 (0-20), personal accomplishment median was 38.50 (0-48) and emotional exhaustion median was 32 .
Th e low level of depersonalization of most respondents by 75%, depersonalization was equally present in both genders.Th ere was a statistically signifi cant negative correlation between the working life and the degree of depression (rs = -0.333;p = 0.028).Respondents with less years of service had a higher degree of www.hophonline.orgBoth genders showed a high degree of lack of personal achievements 38 (50.0%) respondents, female 21 (55.3%)slightly higher than male respondents 17 (44.7%).Th e largest percentage of respondents found themselves in the category of 35-44 years and had a high degree of lack of sense of personal achievement (Figure 2).Respondents involved in a community-based, married or domestic partnership, study had the most commonly inferior degree of personal achievement 16 (48.5%),while those not had a low and high degree of personal achievement 9 (47%).
High emotional exhaustion was present in 65 (85.5%),showed non-signifi cant difference in the degree of emotional exhaustion in relation to gender (p = 0.155).All age ranges had an equally high degree of emotional exhaustion.In the youngest range, as many as 94.7% of respondents have a high level of emotional exhaustion similar to those in the 35-44 age group of 90.3%.A signifi cant diff erence (p = 0.042) was observed in respondents who do not had children, to be subjected to higher emotional exhaustion.

DISCUSSION
DMBI is the most commonly used instrument for testing burnout, instrument is designed for scientifi c purposes but is oft en used in practice [14].According to the author MBI-HSS syndrome observed in three separate aspects of depersonalization, emotional exhaustion and lack of personal achievements, the same is not provided to connect them in a common score [15].Th e purpose of this study was to evaluate the association of socio-demographic variables with the presence of the burning syndrome in the examined population of the physician to analyze some of the risk factors related to the work that could cause burning syndrome, which was done using the MBI-HSS questionnaire for which rights of use are purchased in Serbian language.In general, our results are similar to studies conducted in the US, Spain and Brazil [13,16,17].
Th e "Emotional Exhaustion" scale possesses an adequate level of internal consistency (Cronbach α = 0.728) and the "Depersonalization" scale of the MBI questionnaire possesses an adequate level of internal consistency (Cronbach α = 0.836) and in relation to the values of other studies [18]."Burnout" is measured through three scales of the Maslash Burning Questionnaire (MBI)."Burnout" is manifested through depersonalization, lack of personal achievement and emotional exhaustion.In the study, the highest percentage of respondents showed a low degree of depersonalization of 69.2%, a high degree of personal accomplishment present in 24 (46%) respondents and high levels of emotional exhaustion accounted for as much as 81%.Th ere is statistically signifi cant weak negative correlation between age and degree of depersonalization (rs = -0.284;p = 0.041).Younger subjects have a higher degree of depersonalization.Th e majority of respondents live in a community 33 (63.46%), and almost equally exposed to low depersonalization 23 (69.7%) as those living alone (68.4%).More than half of the respondents live in the community, with their families and children, so half of the cost of living, both family and personal, are on the burden of the respondents.Th e family provides great

Level of emotional excaution
Low Moderate High support and understanding and hence the preventive role and mechanism for overcoming stress [18].Th ere is a statistically signifi cant weak negative correlation between the years of service and the degree of depersonalization.Respondents with a shorter service have a higher degree of depersonalization.Contemporary work is based on gender equality and as expected there is no statistically signifi cant diff erence in the degree of lack personal accomplishment in relation to gender.In both genders occurs high degree of defi ciency of personal accomplishment 38 (50.0%), but 21 (55.3%)female respondents slightly higher than male respondents 17 (44.7%).Half of the respondents were very dissatisfi ed with personal achievement, the highest percentage of respondents being in the category of 35-44 years and having a high level of lack of personal accomplishment.High emotional exhaustion is present in both genders, although the diff erence between them is not a signifi cant diff erence in the degree of emotional exhaustion compared to the gender (p = 0.155), greater is the number of females (35) being emotionally exhausted compared to the male (30).Th e relationship between gender and emotional exhaustion is signifi cant in a larger number of authors [19,20], while the Pico put forward a similar situation as in our study [21].All age groups have a high level of emotional exhaustion, a signifi cant diff erence (p = 0.042) was observed in subjects with or without children who are underweight for more emotional exhaustion.

CONCLUSION
1.More than half of the respondents live in community, with their family and have children.2. Younger respondents have a higher level of psychological quality of life and have a higher degree of quality of life in social relationships.3. Respondents with children show a lower degree of emotional exhaustion.4. Younger respondents have a higher degree of depression.
Based on the results of this study and literature, the burning syndrome is a medical condition, a psychological disorder that required to be followed through a multidisciplinary approach with modernly educated teams.In the future is expected that business tasks will be complicated so that personality

Figure 1 .
Figure 1.Distribution of respondents by level of education

Figure 2 .
Figure 2. Distribution of emotional exhaustion of respondents in relation to years of work experience

Table 1 .
Distribution of respondents by level of education Distribution