Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

Is mindfulness associated with stress and burnout among mental health professionals in Singapore? Suyi Yang, Pamela Meredith & Asaduzzaman Khan To cite this article: Suyi Yang, Pamela Meredith & Asaduzzaman Khan (2016): Is mindfulness associated with stress and burnout among mental health professionals in Singapore?, Psychology, Health & Medicine, DOI: 10.1080/13548506.2016.1220595 To link to this article: http://dx.doi.org/10.1080/13548506.2016.1220595

Published online: 19 Aug 2016.

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Date: 21 August 2016, At: 17:24

Psychology, Health & Medicine, 2016 http://dx.doi.org/10.1080/13548506.2016.1220595

Is mindfulness associated with stress and burnout among mental health professionals in Singapore? Suyi Yanga,b  , Pamela Mereditha and Asaduzzaman Khana a

School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; Department of Occupational Therapy, Institute of Mental Health, Singapore, Singapore

b

ABSTRACT

High levels of stress and burnout have been reported among mental health professionals worldwide, including Singapore, with concerning potential implications for the quality of patient care. Mindfulness has been associated with decreased stress and burnout; however, associations between mindfulness, stress, and burnout have not been examined in Singapore. The aim of this study was to investigate whether mindfulness is associated with stress and burnout among healthcare professionals working in a mental health setting in Singapore. A total of 224 Singaporean mental health professionals completed a cross-sectional survey which included measures of: mindfulness (observe, describe, act with awareness, non-judge, and non-react), stress, and burnout (exhaustion and disengagement). Using multiple regression, significant negative associations were found between each of the mindfulness facets and: stress, exhaustion, and disengagement, while controlling for years of experience. Of the five mindfulness facets, act with awareness demonstrated the strongest negative association with all three variables. This study showed that mental health professionals in Singapore who have higher levels of mindfulness also have lower levels stress and burnout (disengagement and exhaustion). Future longitudinal research is warranted to better understand the directionality of these associations, with implications for the development of interventions aimed to reduce stress and burnout within this population.

ARTICLE HISTORY

Received 26 October 2015 Accepted 1 August 2016 KEYWORDS

Burnout; healthcare professionals; mindfulness; mental health; stress

Introduction Evidence of high levels of stress and burnout among mental health professionals has emerged from both Western and Asian countries (Acker, 2012; Hamaideh, 2011; Rossi et al., 2012; Yang, Meredith, & Khan, 2015). In a survey conducted by Lloyd and King (2004), with 304 mental health professionals in Australia, 57% experienced emotional exhaustion, while 33% experienced depersonalization, which is an attempt to emotionally withdraw from work and which may result in a cynical attitude towards their clients (Maslach, Schaufeli, & Leiter, 2001).

CONTACT  Suyi Yang 

[email protected]

© 2016 Informa UK Limited, trading as Taylor & Francis Group

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  S. Yang et al.

In the only available Singaporean study, Yang et al. (2015) surveyed 220 mental health professionals, revealing higher levels of stress and burnout compared to studies of adults in various (non-mental health-related) professions in Western countries. High levels of stress and burnout have, in turn, been associated with decreased work engagement (Poulsen et al., 2014), and diminished service quality (Aiken et al., 2012) in healthcare professionals. Given this information, there is a need for an evidence-based approach to address this issue. Studies have shown that mindfulness (i.e. the ability to pay attention to the present moment in a non-judgmental manner, Kabat-Zinn, 1991) is associated with stress and burnout (Di Benedetto & Swadling, 2014; Hou, Wong, Lo, Mak, & Ma, 2013) and that training in mindfulness has the potential to reduce stress and burnout among healthcare professionals (Escuriex & Labbé, 2011). Baer, Smith, Hopkins, Krietemeyer, and Toney (2006) proposed that mindfulness can be conceptualized as a set of five facets: (1) observe (noticing internal and external experiences) (2) describe (labeling emotions), (3) act with awareness (attending to tasks at hand), (4) non-react (not reacting to thoughts and feelings), and (5) non-judge (being non-judgemental towards thoughts and feelings). In examining associations between these mindfulness facets and related constructs in their sample of 881 students, Baer et al. (2006) reported that three of the facets (act with awareness, non-judge, and non-react) were associated with lower psychological symptom levels measured using the brief symptom inventory. In another study with 230 Chinese adults in Hong Kong, Hou et al. (2013) reported negative associations between all five mindfulness facets and stress. While a small number of studies have examined these associations in other populations (e.g. students and community adults), we are aware of only one study in which mindfulness and burnout were examined among mental health professionals. Di Benedetto and Swadling (2014), in their survey with 167 psychologists in Australia, reported a strong negative correlation between these constructs. An extensive literature review revealed no studies investigating the association between mindfulness, stress, and burnout in Singapore. As Singapore’s healthcare professionals are predominantly of Asian origins (Zhang, 2002), the associations between these constructs might be different to those of their Western counterparts. As noted earlier, Singapore mental health professionals are experiencing high levels of stress and burnout which, in turn, have been associated with decreased work engagement and service quality. Understanding these relationships is important to inform future research that might consider the potential of mindfulness interventions to reduce stress and burnout in this population. The aim of the present study is to investigate how the five mindfulness facets are associated with stress and burnout among mental healthcare professionals in Singapore, while adjusting for demographic factors.

Methods Participants A total of 224 mental health professionals participated in this study (see Table 1 for demographic details).

Psychology, Health & Medicine 

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Table 1. Socio-demographics characteristics of participants, N = 224. Variable Profession  Nurse  Occupational therapist  Doctor/psychiatrist  Social worker  Case manager  Psychologist/counselor  Others Age group  35 Ethnicity  Chinese  Malay  Indian  Others Gender  Male  Female Marital status  Single  Married  Others Education level  Diploma  Degree  Post-graduate Income level  S$50 K Year of experience  20

n

%

84 35 27 24 23 14 17

37.5 15.6 12.1 10.7 10.2 6.3 7.6

17 65 48 89

7.8 29.7 21.9 40.6

159 15 28 17

72.6 6.8 12.8 7.8

62 157

28.3 71.7

106 104 9

48.4 47.5 4.1

28 123 67

12.8 56.4 30.7

25 113 79

11.5 52.1 36.4

84 63 42 35

37.5 28.1 18.8 15.6

Procedure Ethical approvals for this study were obtained in August 2013. Data were collected using both online and printed versions of the survey. A total of 210 online, and 50 printed, surveys were returned (N = 260); however, 36 submissions were incomplete, resulting in N = 224. Measures Perceived stress scale (Cohen, Kamarck, & Mermelstein, 1983) The perceived stress scale (PSS) is a 10-item self-report questionnaire measuring perception of stress over the last month. Items were rated using a 5-point Likert scale (0 = never, to 4 = very often). An example item is ‘In the last month, how often have you felt that you were unable to control the important thing in your life?’

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Oldenburg burnout inventory (Demerouti & Halbesleben, 2005) The Oldenburg burnout inventory (OLBI) is a 16-item self-report questionnaire which consists of two subscales: exhaustion and disengagement from work. Items were rated using a 4-point Likert scale (0 = never, to 4 = very often). An example item is: ‘There are days when I feel tired before I arrive at work.’ Five facets mindfulness questionnaire (Baer et al., 2008) The Five facets mindfulness questionnaire (FFMQ) is a 39-item self-report measure of the five facets of mindfulness. Items were rated using a 5-point Likert scale (1 = never or very rarely true, to 5 = very often or always true). An example item is: ‘I’m easily distracted.’ Data analysis Descriptive statistics were calculated for all variables. Fifteen regression analyses were conducted to examine the relationships between mindfulness and both stress and burnout when controlling for relevant demographic variables. T-tests and ANOVAs were used to identify demographic variables and working situations that were significantly associated with the dependent variables. Age, years of experience, and income levels were associated with stress, exhaustion, and disengagement. As all three variables were all highly correlated, only years of experience was employed as the control variable in all regression models. In each regression model, one of the five mindfulness facets served as the independent variable, with stress, exhaustion, or disengagement as the respective dependent variable. For each regression model, multicollinearity, homoscedasticity, outliers, and normality of residuals were examined. Based on this process, assumptions were met in all but one model (non-react and disengagement). Thus, disengagement was transformed using the square root function, remedying the issue. A Bonferroni adjustment with a significance level of p 20 Describe R2 F statistic

−1.18 −1.09 −3.01** −6.86*** .23 F(4,216) = 15.40***

0.731 −1.85 −1.27 −4.91*** .13 F(4,218) = 7.98***

1.89 −1.06 −0.77 −5.80*** .16 F(4,214) = 10.28***

Years of experience (≤5 years) 6–10 11–20 >20 Act with awareness R2 F statistic

−1.86 0.31 −0.43 −10.28*** .36 F(4,220) = 30.94***

0.38 −0.84 0.67 −7.11*** .22 F(4,218) = 14.80***

1.36 −0.05 1.21 −7.65*** .24 F(4,217) = 16.73***

Years of experience (≤5 years) 6–10 11–20 >20 Non-judge R2 F statistic

−2.23* −1.52 −3.51*** −7.09*** .23 F(4,219) = 16.30***

−0.04 −2.12* −1.60 −3.98*** .10 F(4,218) = 5.85***

0.91 −1.42 −1.17 −4.57*** .12 F(4,213)***

Years of experience (≤5 years) 6–10 11–20 >20 Non-react R2 F statistic

−1.40 −1.12 −2.79** −8.67*** .30 F(4,217) = 22.85***

0.44 −2.0* −1.26 −3.97*** 0.10 F(4,218) = 5.82***

1.46 −1.44 −0.48 −5.08*** .14 F(4,209) = 8.06***

p ≤ .05; **p ≤ .01; ***p ≤ .001.

*

When compared with the other four facets, act with awareness demonstrated the strongest negative association with stress (β = −.60, 95% CI = [−5.95, −4.04], p 

Is mindfulness associated with stress and burnout among mental health professionals in Singapore?

High levels of stress and burnout have been reported among mental health professionals worldwide, including Singapore, with concerning potential impli...
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