INTRODUCTION

Burnout, or professional exhaustion, is a new phenomenon widely studied in the professions traditionally considered as "helping professions.” These types of professions, habitually and clearly feminized, are usually associated with teaching and the provision of care. Not in vain, the first reference to the syndrome derives from the analysis performed by a mental health nurse, who stated that she had a feeling of low morale and distance from her patients, verbalizing symptoms among which she highlighted exhaustion and demotivation ¹.

We can define burnout as a type of work stress, with recent a specific diagnostic label, whose essential element is the presence of emotional wear, which usually acts on prior or simultaneous job stress ². It is therefore a result of the chronic stress caused by the job and which causes the professional to become ill ³.

Maslach and Jackson postulated a three-dimensionality of the syndrome, as they considered that it included: 1) emotional exhaustion, or loss of emotional resources to cope with the job; (2) depersonalization, or development of negative attitudes, insensitivity and cynicism towards the recipients of the service provided; and 3) lack of personal fulfillment at work, such as the tendency to evaluate one's work negatively, with low professional self-esteem, which can occur among individuals working with people ⁴.

Social Work was born linked to medical science at the end of the nineteenth century and, to this day, it still maintains a close relationship with the field of health ⁵. The presence of social workers in the health field in Spain dates back to the 1950s and 1960s ⁶. Although most of this professional group works in the social services system, the second niche where it has the most representation in Spain is the health system ⁷.

Like other professional health groups such as nurses, social work is also performed by a clearly feminized population. Thus, according to the latest data collected at the state level, women make up 83% of those registered ⁸. It should also be noted that, in Spain, the tradition of informal (non-professionalized) care as the majority option in our society seems to be perpetuated. The latest disability survey by the National Statistical Institute states that 70% of dependent people are attended to only through informal assistance ⁹. This means that caregivers dedicate a large amount of time to the care of dependents, which may mean that the chances of developing overload increase ¹⁰, as well as the onset of physical or psychological problems that deteriorate caregivers' health ¹¹. In the light of these data, it seems appropriate to consider the analysis of these concomitant variables, more linked to the socio-family area but which involve adding more overload to the already overloaded family care (which is still a job), which often leads to burnout.

Concerning the burnout syndrome, research on the professional collective of social workers is scarce ¹². In the analysis of our reference framework, the Autonomous Community of Galicia, the research of Facal-Fondo ¹³stands out, although it only considers professionals of the social services system. Hence, it seems appropriate to study this construct and its associated variables within the framework of social health workers and to compare the data with other health professionals, especially with the collective of nurses.

MATERIAL AND METHODS

The study is descriptive, cross-sectional, and analytical and was carried out between March 2018 and January 2019 in the four provinces of the Autonomous Community of Galicia.

RESULTS

Descriptive characteristics of the sample

The main sociodemographic and professional characteristics of the population under study are presented in Table 1. As can be seen, the resulting final sample comprised 58 Social Work professionals, of whom 50 were women (86.2%) and 8 men (13.8%). This representation exceeds that identified at the state level. Their ages ranged between 23 and 63 years (M= 43.9, SD= 9.4).

Table 1: Socio-demographic and job characteristics of the sample 

Source: Research data.

Regarding marital status, more than half of the participants are married or living together as a sTable couple (53.4%), compared to 32.8% who are single. Concerning offspring, 62.1% have at least one child in their care.

Taking into account the job variables analyzed, the degree of contractual stability of the participants is surprising. Thus, more than three out of four (77.6%) state they have a permanent contract. This is consistent with the years of antiquity in the profession. Thus, one in three participants (36.2%) has been performing their professional activity for more than 20 years. The data could also indicate the scarce renewal of the workforce in recent years.

Finally, concerning the level of studies, more than half of the participants (56.9%) have only the basic qualification that entitles them to perform their professional activity (Social Assistance degree or diploma in Social Work). However, this can also be analyzed from the opposite direction, that is, 43.1% of the professionals carry out a continuous training process, extending their initial degree with higher studies such as Bachelor's, Master's or Doctorate degrees.

Burnout level of health workers

There is some consensus that burnout is a continuous variable that can manifest at a low degree (low scores in EE and D, but high in PF), moderate (average scores on all three subscales), or high (high scores in EE and D, but low in PF) ¹⁶. Based on these considerations, score ranges can be estimated, derived from different studies and research. The following are usually considered:

There are also studies that suggest combining scores to obtain a cut-off point from which to consider the syndrome clinically. Thus, a syndrome of burnout is considered to exist if the evaluated person obtains some of the following scores: more than 18 points on the scale of Emotional Exhaustion; more than 5 points on the scale of Depersonalization; 40 points on the scale of Personal Fulfillment at work ¹⁷. The diagnostic limits correspond to those listed in Table 2, including high and moderate risk.

Table 2: Estimation of degree of burnout, based on subscale scores 

Source: Research data.

Table 3shows the data of the mean, standard deviation, maximum and minimum scores for each of the MBI-HSS theoretical scales for the 58 cases analyzed.

Table 3: Overall Results by Subscales 

Source: Research data.

In the EE dimension, the mean score for the population under study was 27.5. Based on the cut-off point, this global dimension score would be considered high. Dimension D reached an average global score of 8.3, which places this dimension at a moderate degree. The same is true of the PF dimension, which obtained a mean global score of 34.2. In any case, when analyzing the global scores of the three subscales, all three necessary indicators posited by Grajales to consider the presence of burnout are verified ¹⁷.

The prevalence data reveals high percentages, especially in the EE dimension, where more than half of the population under study obtained high scores. Similarly, the high prevalence in the D and PF dimensions (41.4% and 44.8%, respectively) shows that the studied population is at high risk.

Table 4: Prevalences in each of the subscales 

Source: Research data.

DISCUSSION

As previously noted in this study, not as much research on burnout has been carried out in the professional collective of social workers as in other social and health professions. This is particularly true if we focus explicitly on the discipline of social health work. The results suggest that social workers employed in the Public Health System have high burnout rates, reaching scores considered to be of high risk.

In relation to the territorial framework, the scores of this study are higher than those presented in 2012 by participants in an investigation of the same subject, although the professionals were social workers of the Galician Social Services.

When inspecting the organizational framework, social health workers have high scores in burnout, as do other health system professionals.

Different studies have found high levels of burnout among the medical staff ^{18 19-20}. The studies reviewed present indicators lower than those of this study. The difference in the EE dimension is especially surprising. Thus, in the reviewed studies of the medical group, high risk scores in this dimension ranged between 30.6% and 43.85%, whereas in our research, it reached 58.6%.

Another professional collective of the Health System where the phenomenon of burnout has been most analyzed is that of nurses. Multiple studies have been conducted in Spain on different types of services, such as mental health, primary care, or hospitalization ^{21 22 23 24}. However, the great heterogeneity in the results is noteworthy. In this regard, within the nurses' collective, it was noted that social support, resilience, and commitment coping strategies, and support (adaptive) are three tools for dealing with burnout ²⁵. Burnout has been linked to high levels of occupational stress and a negative perception of quality of life ²⁶. In addition, other studies show the need for greater concern from hospital service leaders and arousing nurses' awareness, as in most cases, they do not perceive the illness ²⁷.

With regard to social workers, it has been shown that the components of empathy can prevent or reduce burnout and secondary traumatic stress. It is therefore recommended that skills and empathy training be incorporated within their university training ²⁸. Similarly, as social work is a profession that frequently intervenes in traumatic problems, professionals should be trained in the development of self-care practices and strategies in order to avoid burnout ²⁹.

The results of recent research ^{12 30}is a distinguishing feature of the collectives of nurses and social workers, which, in the light of the scores, is also noted in this work. In Social Work, the burnout subscales point in the opposite direction from other professions such as Nursing. In general, in the case of nurses, burnout manifests first as depersonalization, then as emotional exhaustion and, finally, with decreased personal fulfillment. On the contrary, in the case of social workers, emotional exhaustion manifests first, and then reduced personal fulfillment with low depersonalization. As can be seen, in our study the high prevalence in emotional exhaustion is relevant, but the prevalence in the depersonalization subscale, which cannot be considered low, is surprising.

The high scores of our population are also conditioned by the years of working life. Readers are reminded that one out of three participants (36.2%) has been performing her professional activity for more than 20 years. Similarly, it seems crucial that, in a highly feminized group, some conditions are linked to the normative roles of women as the main providers of informal care in their family context. In this sense, 62.1% of the participants have at least one child in their care. This research has not examined this issue, but in future research, it is necessary to obtain information about the ancestors or descendants (elderly or disabled) of the people who provide support and care.

This study presents some limitations, the most significant of which are the following. On the one hand, we had no access to the total population of social workers (both registered and unregistered). Secondly, it would be of interest to conduct comparative analyses of direct scores in burnout in other professional categories that perform their professional activity within the same organization.

Diverse works carried out in many countries show that the continued care of people that requires high levels of emotional involvement causes significant harm to the professionals' physical and mental health ¹⁶. This highlights the need for further research into the working conditions of workers performing their activities within the Health System.

The results found in this research are relevant indicators for implementing improvements within the organization. Such changes should not be made without taking into account the normative roles of care that women traditionally play in our society, especially, in groups as highly feminized as nurses or health workers.

CONCLUSIONS

The Social Work professionals who carry out their professional activity in the Public Health System are mostly women. Also, among the characteristics of their work profile is the number of years of professional tenure and, therefore, the lack of incorporation into this system of recently qualified young population.

With regard to the level of burnout, as in other professional groups of helping relationships, social health workers have high scores in burnout. These data are confirmed in this research, where participants have even higher scores than other professional groups, especially in the emotional exhaustion dimension.