Karl Bang Christensen

The Copenhagen Burnout Inventory: A new tool for the assessment of burnout

Abstract So far, the large majority of studies on burnout in the international literature have employed the Maslach Burnout Inventory (MBI). In this paper we criticize the MBI on a number of points and present a new tool for the measurement of burnout: the Copenhagen Burnout Inventory (CBI). The CBI consists of three scales measuring personal burnout, work-related burnout, and client-related burnout, for use in different domains. On the basis of an ongoing prospective study of burnout in employees in the human service sector, the PUMA study (Project on Burnout, Motivation and Job Satisfaction; N=1914 at baseline), we analysed the validity and reliability of the CBI. All three scales were found to have very high internal reliability, and non-response rates were small. The scales differentiated well between occupational groups in the human service sector, and the expected pattern with regard to correlations with other measures of fatigue and psychological well-being was found. Furthermore, the three scales predicted future sickness absence, sleep problems, use of pain-killers, and intention to quit. Analyses of changes over time showed that substantial proportions of the employees changed with regard to burnout levels. It is concluded that the analyses indicate very satisfactory reliability and validity for the CBI instrument. The CBI is being used in a number of countries and translations into eight languages are available.

Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark

Abstract Objectives To examine the effects of physical work environment on long term sickness absence and to investigate interaction between physical and psychosocial risk factors. Design and setting Prospective cohort study of long term sickness absence among employees in Denmark. Participants 5357 employees interviewed in 2000 about their physical work environment, and various covariates were followed for 18 months in a national sickness absence register. Outcome measurements Cox regression analysis was performed to assess risk estimates for physical risk factors in the work environment and onset of long term sickness absence, defined as receiving sickness absence compensation for eight consecutive weeks or more. Results 348 participants (6.9%) developed long term sickness absence during follow-up. Of these, 194 (55.7%) were women and 154 (44.3%) were men. For both female and male employees, risk of onset of long term sickness absence was increased by extreme bending or twisting of the neck or back, working mainly standing or squatting, lifting or carrying loads, and pushing or pulling loads. Significant interactions were found for three combinations of physical and psychosocial work environment risk factors among female employees (P<0.05). Conclusion Uncomfortable working positions, lifting or carrying loads, and pushing or pulling loads increased the risk of onset of long term sickness absence. The study shows a potential for reducing long term sickness absence through modifying work postures straining the neck and back, reducing the risk of work done standing or walking, and reducing the risk associated with handling loads. Dealing with psychosocial stressors simultaneously may improve physical intervention efforts further for female employees.

Psychosocial work environment exposures as risk factors for long-term sickness absence among danish employees : Results from DWECS/DREAM

Objective:This study examines effects of psychosocial risk factors on long-term sickness absence, and investigates possible interactions between psychosocial and physical work environment risk factors. Methods:A total of 5357 employees were interviewed in 2000 regarding work environment and followed up during the proceeding 1.5 years regarding onset of long-term sickness absence. Results:Long-term sickness absence among female employees was associated with role conflict, low reward, and poor management quality. Demands for hiding emotions and high emotional demands predicted long-term sickness absence among men. No significant interactions between psychosocial and physical exposures were found for female or male employees. Conclusions:The study suggests a potential for reducing long-term sickness absence through interventions targeted toward reducing role conflict, and improving reward and management quality among female employees, and through reducing emotional demands and demands for hiding emotions among male employees.

Psychosocial work characteristics as predictors for burnout: findings from 3-year follow up of the PUMA Study.

Objective: The objective of this study was to investigate the impact of psychosocial work characteristics on burnout. Methods: A total of 1772 participants in different human service sector organizations were eligible for the cross-sectional analyses (baseline) and 952 for the prospective analyses. We measured 14 psychosocial work characteristics and three types of burnout. Linear regression models were used for analyzing associations between psychosocial work characteristics at baseline and burnout at baseline and at 3 years of follow up. Results: Low possibilities for development, high meaning of work, low predictability, high quality of leadership, low role clarity, and high role conflicts predicted burnout at 3 years of follow up after the psychosocial work characteristics were adjusted for each other, potential confounders, and burnout level at baseline. Conclusion: Psychosocial work characteristics were prospectively associated with burnout, suggesting that improving the psychosocial work environment may reduce future burnout in human service work.

Using administrative sickness absence data as a marker of future disability pension : the prospective DREAM study of Danish private sector employees

Objectives: The aim of this study was to examine duration of sickness absence as a risk marker for future disability pension among all private sector employees in Denmark 1998–2004. Methods: All private sector employees receiving sickness absence compensation from the municipality in 1998, a total of 225 056 persons (39.2% women 61.8% men, age range 18–65, mean age 37.2), were followed in a national register to determine granted disability pension during the period 1 January 2001 through 31 December 2004. The authors excluded pensions in 1999 and 2000 to determine the status of sickness absence duration as an early risk marker. Results: 5694 persons (2.5%) received disability pension during follow-up, more men (53.4%) than women (46.6%). There was a strong graded association between increasing length of absence and increasing risk of future disability pension. Significant differences were found between the younger and older age strata: men below 40 experiencing more than 26 weeks of sickness absence had a 16-fold risk of disability pension. The corresponding figure for men 40 years or older was approximately 7. For women, the corresponding figures were 12.6 and 6.7 respectively. Conclusion: The findings suggest that administratively collected data on sickness absence compensation are an important predictor of disability pension among private sector employees. The use of information on sick leave may improve the effectiveness of early interventions by policy makers, case managing authorities, employers and physicians.

Burnout as a predictor of self‐reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study

Aim: To investigate whether burnout predicts sickness absence days and sickness absence spells in human service workers. Method: A total of 824 participants from an ongoing prospective study in different human service sector organisations were eligible for the three year follow up analysis. Burnout was measured with the work related burnout scale of the Copenhagen Burnout Inventory. Sickness absence was measured with self-reported number of days and spells during the last 12 months before the baseline and the follow up survey. A Poisson regression model with a scale parameter was used to account for over dispersion. A linear regression model was used for analysing changes in burnout and absence between baseline and follow up. Results: Burnout was prospectively associated with both sickness absence days and sickness absence spells per year. Differences in sickness absence days varied from a mean of 5.4 days per year in the lowest quartile of the work related burnout scale to a mean of 13.6 in the highest quartile. An increase of one standard deviation on the work related burnout scale predicted an increase of 21% in sickness absence days per year (rate ratio 1.21, 95% CI 1.11 to 1.32) after adjusting for gender, age, organisation, socioeconomic status, lifestyle factors, family status, having children under 7 years of age, and prevalence of diseases. Regarding sickness absence spells, an increase of one standard deviation on the work related burnout scale predicted an increase of 9% per year (rate ratio 1.09, 95% CI 1.02 to 1.17). Changes in burnout level from baseline to follow up were positively associated with changes in sickness absence days (estimate 1.94 days/year, SE 0.63) and sickness absence spell (estimate 0.34 spells/year, SE 0.08). Conclusion: The findings indicate that burnout predicts sickness absence. Reducing burnout is likely to reduce sickness absence.

Success or failure? Interpreting and understanding the impact of interventions in four similar worksites

Abstract While many studies of interventions have focused on their content and immediate effects, less research has focused on the processes that may explain these effects. The purpose of this study was to show how process evaluation can be used to interpret the results of an intervention study in four industrial canteens in Denmark. Two canteens acted as intervention groups and two as comparison groups. Effects were measured by surveys before and after interventions, and observations and interviews were conducted to provide an in-depth understanding of processes. Analyses were conducted based on the responses from 118 employees. Results showed, contrary to expectations, improvements in working conditions and well-being in one intervention group and in one comparison group, whereas no improvements were found in the two remaining groups. Data from the process evaluation enabled a meaningful interpretation of these results, raising the possibility programme failure rather than theory failure, and thereby constituting an example of how process evaluation can shed light over the factors that may influence outcomes in controlled intervention studies.

The distinction between work pace and working hours in the measurement of quantitative demands at work

During recent years many researchers have criticized the widely used scales on psychological job demands. For instance, they comment that in most cases different types of demand seem to be mixed in one measure. In this paper we analyse the scale on quantitative job demands in the recently developed Copenhagen Psychosocial Questionnaire (COPSOQ), with special emphasis on Differential Item Functioning (DIF). DIF refers to basic differences between groups of respondents, which may affect how they respond to questionnaire items. The data material for our study comprised a representative sample of Danish employees. The respondents were categorized into 32 specific jobs according to the International Standard Classification of Occupations (ISCO 1968). We analysed DIF with respect to the respondents’ jobs with logistic regression analyses. These analyses showed that the items used in the original demand scale functioned very differently for different jobs in the population. The conclusion is that scales on quantitative demands are very sensitive to the choice of specific items. If many items on fast work pace and tempo are included in a scale, a number of blue-collar jobs will be identified as high-demand jobs. If, on the other hand, many questions on long working hours and overtime are included, the use of the scale will result in an entirely different picture. This issue has so far received little attention in occupational health psychology. The results have wide theoretical and methodological implications for research on quantitative job demands.

Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one-year randomized controlled trial

This study investigated effects of physical exercise on musculoskeletal pain symptoms in all regions of the body, as well as on other musculoskeletal pain in association with neck pain. A single blind randomized controlled trial testing a one-year exercise intervention was performed among 549 office workers; specific neck/shoulder resistance training, all-round physical exercise, or a reference intervention. Pain symptoms were determined by questionnaire screening of twelve selected body regions. Case individuals were identified for each body region as those reporting pain intensities at baseline of 3 or more (scale of 0-9) during the last three months. For neck cases specifically, the additional number of pain regions was counted. Intensity of pain decreased significantly more in the neck, low back, right elbow and right hand in cases of the two exercise groups compared with the reference group (P<0.0001-0.05). The additional number of pain regions in neck cases decreased in the two exercise groups only (P<0.01-0.05). In individuals with no or minor pain at baseline, development of pain was minor in all three groups. In conclusion, both specific resistance training and all-round physical exercise for office workers caused better effects than a reference intervention in relieving musculoskeletal pain symptoms in exposed regions of the upper body.

The contribution of the psychosocial work environment to sickness absence in human service workers: Results of a 3-year follow-up study

Abstract We investigated to what extent psychosocial work characteristics predict sickness absence in a cohort of 890 human service professionals (84% women), followed-up for 3 years. We measured 16 different psychosocial work characteristics at baseline and analysed their associations with number of sickness absence days at follow-up using multivariate Poisson regression. In addition, we computed a psychosocial work environment index, summarizing eight psychosocial scales. Participants with exposure to violence and threats, high emotional demands, high demands for hiding emotions, low influence at work, low meaning of work, low quality of management, and role conflicts had an increased number of sickness absence days at follow-up, after adjustment for numerous confounders. Adjusting for sickness absence history caused little change in most effect estimates. Scoring in the most adverse quartile of the psychosocial work environment index was associated with a 71% increase in sickness absence days. Improving the psychosocial work environment index and eliminating exposure to violence and threats would have prevented 32% of all sickness absence days in the study population. In particular we found that exposure to violence was a strong predictor of absence. This study shows that a wide range of psychosocial work characteristics contribute to sickness absence in human service workers. Improving the psychosocial work environment might help to reduce sickness absence in this population.