Die verband tussen stres, streshanteringstrategieë en uitbranding by Suid-Afrikaanse kliniese en voorligtingsielkundiges

Jordaan, Ilse (2003-04)

Thesis (MA)--University of Stellenbosch, 2003.

Thesis

ENGLISH ABSTRACT: The primary aim of this study was to determine the relationship between stress (as manifested in anxiety and depression), coping strategies and burnout in South African clinical and counselling psychologists. The degrees of anxiety and depression, as well as the levels of burnout and types of coping strategies that psychologists used, were examined firstly. This was followed by an investigation into the coping strategies that correlated with anxiety and depression respectively. Stepwise multiple regression analyses were performed to complete this task. The relationship between anxiety and burnout, as well as between depression and burnout, were examined, using linear regression analyses. An investigation into the coping strategies that correlated with burnout was also performed, using stepwise multiple regression analyses. Finally, the influence of various biographical variables on burnout was determined, making use of linear regression analyses, t-tests, one-way analyses of variance and Tukey tests. The study was conducted with the aid of the internet, which involved the mailing of an explanatory letter to a stratified, randomly selected sample of a thousand psychologists, requesting the recipients to visit a web page and complete five questionnaires electronically. The test battery consisted of the following: A biographical questionnaire; the Beck Depression Inventory (BOl), which was used to determine the presence of depression; the Maslach Burnout Inventory (MBI), to examine the levels of burnout; the S-scale of the State-Trait Anxiety Inventory (STAl), which was used to measure anxiety; and the Brief Coping Orientations to Problems Experienced (Brief COPE), for the measurement of fourteen different coping strategies. A total of 238 registered psychologists (representing a response rate of 23.8%) participated in the study. Results indicated that 134 (56.3%) psychologists experienced above-average levels of anxiety, while 129 (54.2%) were at least mildly depressed. Regarding the three components of burnout, 72 (30.25%) and 64 (26.89%) experienced high and moderate levels of emotional exhaustion respectively, 49 (20.59%) and 65 (27.31%) experienced high and moderate levels of depersonalization respectively, while 68 (28.57%) and 84 (35.29%) reported strong and moderate feelings of reduced personal accomplishment respectively. Participants made use of all 14 coping strategies, as measured by the Brief COPE, but the coping strategy of active coping was used mostly, while behavioural disengagement was used the least. A combination of the coping strategies of self-blame, behavioural disengagement, denial, a lack of humour, self-distraction, a lack of acceptance of the reality of the stressful situation, venting and substance use, was a significant predictor of high levels of anxiety. A combination of substance use, self-blame, self-distraction, denial, and a lack of seeking instrumental support, contributed significantly to the prediction of depression. The participants' levels of anxiety and depression, respectively, were both significant predictors of burnout, as measured on all three MBI subscales. Emotional exhaustion was significantly predicted by the combination of behavioural disengagement, venting, a lack of humour, and active coping, while a combination of behavioural disengagement, a lack of positive reframing, venting, a lack of religious involvement, selfdistraction, the absence of emotional support seeking, and the absence of denial, significantly predicted depersonalization. The combination of a lack of the use of positive reinterpretation, selfdistraction, a lack of humour, self-blame, a lack of planning, seeking instrumental support, and behavioural disengagement, significantly predicted feelings of reduced personal accomplishment. Regarding biographical variables, the following results were obtained: Age was a significant predictor of emotional exhaustion and depersonalization, but not of feelings of reduced personal accomplishment. Male psychologists experienced significantly more emotional exhaustion and depersonalization than their female counterparts, but no significant difference between the sexes was found for reduced personal accomplishment. The number of hours per week spent in conducting psychotherapy with patients/clients was a significant positive predictor of emotional exhaustion, depersonalization and feelings of personal accomplishment. The number of years in practice only contributed significantly to the prediction of emotional exhaustion, but not to the prediction of depersonalization or feelings of reduced personal accomplishment. Participants who followed a psychodynamic therapeutic approach experienced significantly more emotional exhaustion than those who used a combination of cognitive behavioural therapy and personcentered therapy. When comparing the systemic and narrative approaches, the former contributed more significantly to feelings of reduced personal accomplishment in psychologists. No significant differences regarding scores on any of the three MBI subscales were found between participants who were married, divorced, or had never been married. Experiencing difficulties with the settlement of accounts by medical aid schemes was a significant predictor of burnout, with respect to all three MBI subscales. Having difficulties with bad debts, however, contributed significantly to the prediction of a decrease in depersonalization, but not to the prediction of emotional exhaustion or reduced personal accomplishment.

AFRIKAANSE OPSOMMING: Die primêre doelstelling van hierdie studie was om ondersoek in te stel na die verband tussen stres (soos gemanifesteer in angs en depressie), streshanteringstrategieë en uitbranding by Suid- Afrikaanse kliniese en voorligtingsielkundiges. Die mate van angs en depressie, asook die vlakke van uitbranding en tipes streshanteringstrategieë wat sielkundiges gebruik het, is eerstens vasgestel. Vervolgens is die streshanteringstrategieë wat verband hou met angs en depressie onderskeidelik, met behulp van stapsgewyse meervoudige regressie-analises bepaal. Die verband tussen angs en uitbranding, asook tussen depressie en uitbranding, is met behulp van lineêre regressie-analises ondersoek. Verder is die streshanteringstrategieë wat verband hou met uitbranding deur middel van stapsgewyse meervoudige regressie-analises bepaal. Laastens is die invloed van, verskeie biografiese veranderlikes op uitbranding deur middel van lineêre regressieanalises, t-toetse, eenrigting-variansie-analises en Tukey-toetse ondersoek. Die studie is met behulp van die internet uitgevoer, wat behels het dat elke lid van 'n gestratifiseerde, ewekansig-geselekteerde steekproef van 'n duisend geregistreerde kliniese en voorligtingsielkundiges 'n brief per pos ontvang het, met die versoek om 'n webbladsy te besoek en vyf vraelyste daarop te voltooi. Die toetsbattery het bestaan uit die volgende: 'n biografiese vraelys; die Beck Depression Inventory (BDI), wat gebruik is om die teenwoordigheid van depressie by die deelnemers vas te stel; die Maslach Burnout Inventory (MBI), om die vlakke van uitbranding te ondersoek; die S-skaal van die State-Trait Anxiety Inventory (STAl), vir die meting van angs; asook die Brief Coping Orientations to Problems Experienced (Brief COPE), wat gebruik is om te bepaal in watter mate deelnemers 14 streshanteringstrategieë gebruik het. 'n Totaal van 238 geregistreerde sielkundiges (wat 'n responskoers van 23.8% verteenwoordig) het aan die studie deelgeneem. Die resultate het aangedui dat 134 (56.3%) sielkundiges bogemiddelde angsvlakke ervaar het, terwyl 129 (54.2%) minstens tot 'n ligte mate depressief was. Wat die drie komponente van uitbranding betref, het 72 (30.25%) hoë en 64 (26.89%) matige vlakke van emosionele uitputting ervaar, 49 (20.59%) en 65 (27.31%) het onderskeidelik hoë en matige vlakke van depersonalisasie ervaar, terwyl 68 (28.57%) en 84 (35.29%) onderskeidelik sterk en matige gevoelens van verminderde persoonlike bekwaamheid gerapporteer het. Die deelnemers het van al 14 Brief COPE-streshanteringstrategieë gebruik gemaak, terwyl die meeste van aktiewe streshantering en die minste van losmakingsgedrag gebruik gemaak het. 'n Kombinasie van die streshanteringstrategieë van selfblamering, losmakingsgedrag, ontkenning, 'n gebrek aan humor, self-afleiding, 'n gebrek aan aanvaarding van die realiteit van die stresvolle situasie, emosionele ontlading en substansgebruik, was 'n beduidende voorspeller van hoë angsvlakke. Die gesamentlike gebruik van substansgebruik, selfblamering, self-afleiding, ontkenning en die afwesigheid van instrumentele ondersteuningsoeke, was 'n beduidende voorspeller van depressiewe simptomatologie. Die deelnemers se angs- en depressievlakke onderskeidelik, was albei beduidende voorspellers van uitbranding ten opsigte van al drie die subskale van die MBI. Die streshanteringstrategieë wat emosionele uitputting beduidend voorspel het, was 'n kombinasie van losmakingsgedrag, emosionele ontlading, 'n gebrek aan humor en die gebruik van aktiewe streshanteringsmetodes. Depersonalisasie is beduidend voorspel deur die gesamentlike voorkoms van losmakingsgedrag, 'n gebrek aan positiewe herformulering, emosionele ontlading, 'n gebrek aan geloofsbeoefening, self-afleiding, die afwesigheid van emosionele ondersteuningsoeke en die afwesigheid van ontkenning. Die gesamentlike voorkoms van 'n gebrek aan positiewe herformulering, self-afleiding, 'n gebrek aan humor, selfblamering, 'n gebrek aan beplanning, instrumentele ondersteuningsoeke en losmakingsgedrag, was beduidende voorspellers van verminderde persoonlike bekwaamheid. Wat die biografiese veranderlikes betref, is die volgende resultate vir die totale steekproef verkry: Ouderdom was 'n beduidende voorspeller van emosionele uitputting en depersonalisasie, maar nie van verminderde persoonlike bekwaamheid nie. Manlike sielkundiges het beduidend meer emosionele uitputting en depersonalisasie ervaar as hulle vroulike kollegas, maar geen beduidende verskil tussen die geslagte is ten opsigte van verminderde persoonlike bekwaamheid bevind nie. Die aantal ure wat per week aan psigoterapeutiese werk met pasiënte/kliënte bestee is, was 'n beduidende positiewe voorspeller van emosionele uitputting, depersonalisasie en gevoelens van persoonlike bekwaamheid. Die aantal jare wat sielkundiges reeds gepraktiseer het, was slegs 'n beduidende voorspeller van emosionele uitputting, maar nie van depersonalisasie en gevoelens van verminderde persoonlike bekwaamheid nie. Sielkundiges wat 'n psigodinamiese terapeutiese benadering toegepas het, het beduidend meer emosionele uitputting ervaar as diegene wat 'n kombinasie van kognitiewe gedragsterapie en persoonsgesentreerde terapie gebruik het. In vergelyking met 'n narratiewe benadering, het die toepassing van 'n sisteembenadering tot beduidend minder gevoelens van persoonlike bekwaamheid by sielkundiges gelei. Geen beduidende verskille ten opsigte van sielkundiges wat getroud, geskei of nooit getroud was, is ten opsigte van enige van die drie MBI-subskaaltellings gevind nie. Die ervaring van probleme met die vereffening van rekeninge deur mediese fondse was 'n beduidende voorspeller van uitbranding ten opsigte van al drie die MBI-subskale. Die ervaring van probleme met oninbare skulde was egter 'n beduidende voorspeller van 'n afname in depersonalisasie, maar nie van emosionele uitputting of verminderde persoonlike bekwaamheid nie.

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