job burnout research paper

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• Published: 19 February 2023

Big five model personality traits and job burnout: a systematic literature review

• Giacomo Angelini 1  

BMC Psychology volume  11 , Article number:  49 ( 2023 ) Cite this article

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Job burnout negatively contributes to individual well-being, enhancing public health costs due to turnover, absenteeism, and reduced job performance. Personality traits mainly explain why workers differ in experiencing burnout under the same stressful work conditions. The current systematic review was conducted with the PRISMA method and focused on the five-factor model to explain workers' burnout risk.

The databases used were Scopus, PubMed, ScienceDirect, and PsycINFO. Keywords used were: “Burnout,” “Job burnout,” “Work burnout,” “Personality,” and “Personality traits”.

The initial search identified 3320 papers, from which double and non-focused studies were excluded. From the 207 full texts reviewed, the studies included in this review were 83 papers. The findings show that higher levels of neuroticism (r from 0.10** to 0.642***; β from 0.16** to 0.587***) and lower agreeableness (r from − 0.12* to − 0.353***; β from − 0.08*** to − 0.523*), conscientiousness (r from -0.12* to -0.355***; β from − 0.09*** to − 0.300*), extraversion (r from − 0.034** to − 0.33***; β from − 0.06*** to − 0.31***), and openness (r from − 0.18*** to − 0.237**; β from − 0.092* to − 0.45*) are associated with higher levels of burnout.

Conclusions

The present review highlighted the relationship between personality traits and job burnout. Results showed that personality traits were closely related to workers’ burnout risk. There is still much to explore and how future research on job burnout should account for the personality factors.

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Introduction

Burnout: origin, evolution, and definition.

Since the 1970s, when most research in occupational health psychology was focused on industrial workers, studies on burnout have seen a substantial increase. Initially considered a syndrome exclusively linked to helping professions [ 1 , 2 , 3 , 4 ], burnout has been adopted by a broader range of human services professionals [ 5 , 6 ]. Job burnout’s construct has undergone considerable conceptual and methodological attention in the last fifty years. Nowadays, job burnout is considered a multidimensional construct closely referred to as repeated exposure to work-related stress (e.g., [ 7 ]). According to the original theoretical framework, job burnout is defined chiefly as referring to feelings of exhaustion and emotional fatigue, cynicism, negative attitudes toward work, and reduced professional efficacy [ 6 ].

While the relationship between socio-demographic, organizational, and occupational factors and burnout syndrome have received significant attention, the relationship between burnout and individual factors, such as personality, is less explored (for a meta-analysis, see [ 8 ]).

Therefore, it is interesting to investigate whether there is sufficiently convincing evidence to indicate that personality factors play a role in predictors of job burnout. Investigating to what extent personality factors predict job burnout could include a measure of these factors in the selection processes of workers. At the same time, it could also allow preventive actions to support all those at risk of job burnout. This literature review involved a search for cohort studies published since 1993, which used self-report measures of personality traits and job burnout and investigated the relationships between these variables.

Personality and job burnout

In the past, research on this issue has been chiefly haphazard and scattered ([ 9 , 10 ] for a meta-analysis; [ 11 ]). Indeed, personality has often been evaluated in terms of positive or negative affectivity (respectively, e.g., [ 12 , 13 ]), adopting the type A personality model (e.g., [ 14 ]), or the concept of psychological hardiness [ 15 ]. More recently, burnout research focused on the relationship between workers’ personalities measured by the Big Five personality model and their burnout syndrome [ 16 , 17 ]. More specifically, neuroticism (e.g., [ 18 , 19 ]) and extraversion personalities (e.g., [ 20 ]) were abundantly investigated in the scientific panorama (for review; [ 21 ]).

Personality traits according to the five-factor model (FFM)

Since the twentieth century, scholars and researchers have increasingly dedicated themselves to studying this topic, given the importance assumed by personality in the psychological panorama. One of the most famous and relevant approaches to the study of character is the five-factor model (FFM) of personality traits (often referred to as the “Big Five”) proposed by McCrae & Costa [ 22 , 23 ]. As a multidimensional set, personality traits include individuals’ emotions, cognition, and behavior patterns [ 23 – 26 ]. Furthermore, the FFM is the most robust and parsimonious model adopted to understand personality traits and behavior reciprocal relationships [ 27 ] due to two main reasons: its reliability across ages and cultures [ 28 , 29 ] and its stability over the years [ 30 ]. According to several scholars, the FFM consists of five personality traits: agreeableness, conscientiousness, extraversion, neuroticism, and openness [ 23 , 25 , 26 , 31 ]. Agreeableness refers to being cooperative, sympathetic, tolerant, and forgiving towards others, avoiding competition, conflict, pressuring, and using force [ 32 ]. Conscientiousness is reflected in being precise, organized, disciplined, abiding by principles and rules, and working hard to achieve success [ 33 ]. Extraversion is related to the quantity and intensity of individual social interaction characteristics. It is displayed through higher degrees of sociability, assertiveness, talkativeness, and self-confidence [ 32 ]. Neuroticism reflects people’s loss of emotional balance and impulse control. It is characterized by a prevalence of negative feelings and anxiety that are attempted to cope with through maladaptive coping strategies, such as delay or denial [ 29 , 34 ]. Openness is reflected in intellectual curiosity, open-mindedness, untraditionality and creativity, the preference for independence, novelty, and differences [ 33 , 35 ]. In the last thirty years, the Big Five model has been recognized as a primary representation of salient and non-pathological aspects of personality, the alteration of which contributes to the development of personality disorders [ 36 – 40 ], such as antisocial, borderline, and narcissistic personality disorders [ 41 ].

Although the role of the work environment as a predictor of burnout has been broadly documented (e.g., [ 5 , 6 , 11 ]), it cannot be neglected the effect that personality has on the development of this syndrome. Even reducing or eliminating stressors related to the work environment, some people may still experience high levels of burnout (e.g., [ 42 ]). For this reason, it is necessary to know the associations between personality traits and job burnout to identify the workers most prone to burnout and implement more risk-protection activities. Consequently, based on the literature presented above, this PRISMA review aimed to shed some light on the role that personality traits according to the Five Factors Model—Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness—play in the development of job burnout.

Protocol and registration

The systematic analysis of the relevant literature for this review followed procedures based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) process [ 43 – 45 ], a checklist of 27 items which together with a flow-chart (see Fig.  1 ) constitute the most rigorous guide to systematic reviews with or without meta-analysis. The systematic analysis of the relevant literature for this review followed procedures based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) process [ 43 – 45 ].

Diagram flow of information through the different phases of a systematic review

The PRISMA method intends to provide a checklist tool for creating systematic reviews of quality literature.

Eligibility criteria

The study was conducted by extensively searching articles published before June 30th, 2021 (time of research), limited to papers in journals published in English. Review articles, meta-analyses, book chapters, and conference proceedings were excluded. Articles investigating the relationship between personality traits and job burnout in any field of employment, except athletic and ecclesiastical, were included.

Information sources

The databases PsycINFO, PubMed, Scopus, and ScienceDirect, were used for the systematic search of relevant studies applying the following keywords:

* Burnout * AND * Personality *

* Burnout * AND * Personality traits *

* Job burnout * AND * Personality *

* Work burnout * AND * Personality *

* Job burnout * AND * Personality traits *

* Work burnout * AND * Personality traits *

The initial search identified 3320 papers. The details (title; author/s; year of publication; journal) of the documents identified for inclusion across all inquiries were placed in a separate excel document. After removing duplicates, reviewing titles, and reading abstracts (see Fig.  1 ), the papers were reduced to 207, of which full-text records were read. Studies selected in total for inclusion in this review were limited to the five dimensions of the Big Five Factor model [ 46 ] and were 83 papers.

Study selection

As shown by the Prisma Diagram flow (Fig.  1 ), a total of 83 studies were identified for inclusion in the review. Via the initial search process have been identified total of 3320 studies (Scopus, n = 1339; PubMed, n = 515; ScienceDirect, n = 181; PsycInfo, n = 1285). After excluding duplicates, the remaining studies were 1455 of these 1421 records analyzed, and 1195 were discarded. After reviewing the abstracts, these papers did not meet the criteria. Of the remaining 226 full texts, the 207 papers available were examined in more detail, and it emerged that 112 studies did not meet the inclusion criteria as described. Furthermore, to ensure that only studies that had received peer review and met certain quality indicators were included, the SCImago Journal Rank (SJR) was inspected. SCImago considers the reputation and quality of a journal on citations, based on four quartiles used to classify journals from the highest (Q1) to the lowest (Q4). As suggested by Peters and colleagues [ 47 ], SCImago represents a widely accepted measure of the quality of journals and reduces the possibility of including in systematic reviews papers that do not meet certain quality indices. Based on this, 12 papers were excluded. Finally, 83 studies were included in the systematic review that met the inclusion criteria. Of the articles included in the review, more than half (60%) are published in journals indexed as Q1. The others were in Q2 (28%), Q3 (5%), and finally Q4 (7%).

Study characteristics

Participants.

The included studies have involved 36,627 participants. Based on the inclusion criteria, all reviewed studies included (1) adult samples (18 years or older), (2) workers from the general population rather than clinical samples, (3) regardless of the type of work, and for most studies (4) more female participants than male (female, 57.79%; male, 42.21%). Six studies did not include participants’ demographic information [ 48 – 53 ]. The above percentages refer to the available data (n = 33,299).

The sample consisted of about 26% Teachers or Professors, 22% Nurses, 11% Physicians with various specializations, 10% Policemen, 10% Health professionals, 8% Clerks, of which about 5% worked with IT. Furthermore, the sample was made up of almost 3% Drivers, and less than 2% ICT Manager and Firefighters. Finally, about 9% of the sample carried out different types of jobs.

Countries of collecting data

The 83 articles included in this review have been published between 1993 and 2021 (see Fig.  2 ). In terms of geographic dispersion, more than half of the studies (n = 45; 54.21%) were conducted in Europe (France, Belgium, Bulgaria, Croatia, Germany, Greece, Italy, Netherland, Norway, Poland, Romania, Serbia, Spain, Sweden, Switzerland, and the UK). In contrast, the others were conducted either in America (n = 18; Canada, Jamaica, and the USA), Asia (n = 13; China, India, Iran, Israel, Jordan, and Singapore), Africa (n = 6; Nigeria, South Africa, and Turkey) and Oceania (n = 1; Australia).

Research records achieving the inclusion criteria from 1993 to June 30th, 2021

A summary of information about the general characteristics and main methodological properties of all included 83 studies is reported in Table 1 .

Concerning the key methodological features of studies, all studies reviewed involved empirical and quantitative research design. Most of the papers included (n = 73; 88%) in this review were cross-sectional and descriptive studies, except nine (11%) papers presenting longitudinal studies [ 50 , 54 – 61 ]. Furthermore, one paper (1%; [ 62 ]) presented two different studies within it, one cross-sectional and the other longitudinal.

Most of the studies, 84% (n = 70), assessed job burnout via the Maslach Burnout Inventory, both in the original version (MBI; [ 3 , 63 ]), and in the subsequent versions [ 64 , 65 ], or its adaptation [ 66 ]. The other studies, 16% (n = 13), used tools other than MBI, but which share with it the theoretical approach to job burnout and the dimensions of (emotional) exhaustion, depersonalization or cynicism, and reduced personal or professional accomplishment (see Table 1 ). Five papers used the Shirom-Melamed Burnout Measure (SMBM; [ 67 ]), four the Oldenburg burnout inventory (OLBI; [ 68 , 69 ]), one the Bergen Burnout Indicator (BBI; [ 70 ]), one the Brief Burnout Questionnaire (CBB; [ 71 ]), one the Burnout Measure [ 72 ] and one the Short Burnout Measure (SBM; [ 73 ]).

According to the Big Five model, the outcome of the analyzed studies was the correlational and regressive between work burnout and personality traits. The data of the models in which the personality traits mediated or moderated the relationships with other variables, which were not the study’s object, were not considered in this review. Concerning personality, all included studies were compatible with the "Big Five" model [ 74 , 75 ] and investigated traits of Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness.

In detail, about 28% (n = 23) of the studies used the NEO Five-Factor Inventory (NEO-FFI; [ 33 , 76 – 79 ]), 17% (n = 14) have used the Big Five Inventory (BFI; [ 31 , 75 , 80 – 83 ]), one of which is the 10-item version [ 84 ]. Yet, 10% (n = 8) used the Eysenck Personality Questionnaire (EPQ; [ 85 , 86 ]), with one study with the revised version [ 87 ], and four studies with the revised and short version [ 88 ]. Furthermore, 7% (n = 6) involved the International Personality Item Pool (IPIP; [ 89 , 90 ]), with two studies adopting the mini version [ 91 ], while another 7% (n = 6) involved the NEO-Personality Inventory (NEO-PI; [ 81 ]), with five studies adopting the revised version. About 5% (n = 4) has used the Ten-Item Personality Inventory (TIPI; [ 92 ]), 4% (n = 3) has used the Big Five mini markers scale [ 93 ], and 4% (n = 3) involved the Big Five Questionnaire (BFQ; [ 94 ]) Finally, about 2% (n = 2) has submitted the Five Factor Personality Inventory (FFPI; [ 95 ]), and 2% (n = 2) used the Mini Markers Inventory [ 93 ].

The remaining studies, about 14% (n = 12), used the following tools: the Basic Character Inventory (BCI; [ 96 ]), the Big Five factor markers [ 90 ], the Big Five measure-Short version [ 32 , 97 ], the Big Five Plus Two questionnaire-Short version [ 98 ], the Brief Big five Personality Scale [ 92 ], the Basic Traits Inventory (BTI; [ 99 ]), the Comprehensive Personality and Affect Scales (COPAS; [ 100 ]), the Eysenck Personality Inventory (EPI; [ 101 ]), the Freiburg Personality Inventory (FPI; [ 102 ]), the M5-120 Questionnaire [ 103 ], the Minimal Redundant Scales (MRS-30; [ 104 ][ 104 ]), and the Personality Characteristics Inventory (PCI; [ 105 , 106 ]).

All instruments included in the studies were in line with the “Big Five” domains [ 26 ], such as e.g., the NEO-FFI and the NEO-PI, widely used measures of the Big Five [ 81 ], the dimensions of the TIPI and the IPIP [ 89 , 92 ], or the factors of the EPQ and the EPI, compatible with the Big Five model [ 107 , 108 ].

Risk of bias in individual studies

Study design, sampling, and measurement bias were assessed regarding the evaluation risk of bias in each study. Table 2 summarizes the limits reported in each study. Where not registered, no limitations related to the study were referred by the authors of the original studies.

Study design bias

Although most of the studies (89%) have a cross-sectional design, this review reported in the table (see Table 2 ) this bias only on the studies that highlighted this as a weakness (50%). Cross-sectional methods are cheap to conduct, agile for both the researcher and the participant, and can give answers to many research questions [ 109 ]. At the same time, however, since it is a one-time measurement, it does not allow us to test dynamic and progressive effects to conclude the causal relationships among variables.

Three longitudinal studies reported a shortness [ 56 , 58 ] or longness [ 55 ] time-lag between the first and successive administrations. The time length between the study’s waves is an essential issue in longitudinal research methodology. The time interval between the first and following measurements should correspond with the underlying causal lag (e.g., [ 110 ]). If the time lag is too short, probably the antecedent variable does not affect the outcome variable. If, on the contrary, the time lag is too long, the effect of the antecedent variable may already have disappeared. In both cases, the possibility of detecting the impact of the antecedent variable on the outcome variable may decrease.

Furthermore, it is possible that in the period between the first and subsequent measurements, several events may occur affecting the outcome. Finally, the same participant in the sample could change the condition under study (to know more, [ 177 ]). Especially in work-related studies, employees may be subject to changes in context, needs, and working hours [ 178 ]. Despite this, longitudinal designs offer substantial advantages over cross-sectional methods in examining the causal links between the variables [ 177 ].

Sampling bias

About 29% of the studies (n = 24) reported the small samples as limitation. Among these, one study that had two different samples reported a small sample only in second one [ 62 ], while another study, in investigating differences, highlighted that certain groups have a relatively small sample size and reported this as a limitation [ 140 ]. Additionally, about 10% of the studies reported having received an inadequate response rate. About 18% of the studies reported a non-probabilistic sampling as a limitation, and 6% of studies examined reported having a gender-biased sample (male/female). Other studies (13%) reported collecting data in a single organization, country, or an imbalance among workers’ categories. Finally, three studies [ 154 , 168 , 170 ] reported a cultural or geographical bias. To sum up, studies’ limitations regarding the sample characteristics may significantly impact scores’ reliability [ 179 , 180 ]. Specifically, this research’s limits prevent to generalize the findings.

Measurement and response bias

Since inclusion evaluated burnout and personality traits through self-reports that respected the previously illustrated models, all the studies examined used self-report measures. Again, only 40% report this as a limitation. Using perceptual measures, one could be subject to the Common Method Bias (CMB; [ 181 ]). The CMB occurs when the estimated relationships among variables are biased due to a unique-measure method [ 182 ]. This bias may be due to several factors, including response trends due to social desirability, similar responses of respondents due to proximity and wording of items, and similarity in the conditions of time, medium, and place of measurements [ 183 – 185 ]. These variations in responses are artificially attributed to the instrument rather than to the basic predispositions of the participants [ 181 , 186 , 187 ]. Suppose the systematic method variance is not contained. In that case, it can result in an incorrect evaluation of the scale's reliability and convergent validity, inflating the reliability estimates of correlations [ 188 ] and distorting the estimates of the effects of the predictors in the regressions [ 184 ].

Furthermore, about 5% of studies reported using single-item measures. Personality characteristics were often measured through self-reports with single items and assessed through a Likert scale [ 189 ]. This type of assessment is susceptible to social desirability (SDR; [ 184 , 185 ]), i.e., the tendency to respond coherently with what others perceive as desirable [ 190 ]. Furthermore, this type of assessment is also susceptible to acquiescent responding (ACQ; [ 191 ]), i.e., the tendency to prefer positive scores on the Likert scale, regardless of the meaning of the item [ 192 ]. Response-style-induced errors can influence reliability estimates (e.g., [ 193 , 194 ]) and overestimate or underestimate the relationships between the variables examined [ 195 ]. Despite these response biases, widely documented in the literature [ 184 – 186 , 196 – 198 ], it appears that this bias is overstated in psychological research [ 185 ]. Indeed, self-reports would seem to be the most valid measurement method for evaluating personality factors because the same participant is the most suitable person to report their personality and level of burnout [ 42 ]. Other studies (10%) reported using a poor reliability scale: employing imprecise psychometric procedures in a study is likely to distort the outcome, therefore not allowing to make inferences about an individual and creating a response bias [ 199 ]. Finally, about 16% of the studies examined reported that the study did not review all the variables relating to the constructs investigated. Table 2 also identifies some specific limitations of the studies examined, such as, e.g., the comparison between non-numerically equivalent samples [ 174 ], the long compilation time required [ 165 ], and the lack of a control group [ 57 , 138 ]. Furthermore, some studies have used tools that evaluate only a total score of burnout [ 17 ] or personality [ 54 ] Finally, other studies have focused only on individual factors, leaving out job-related and organizational factors [ 147 ].

This systematic review was conducted to identify, categorize, and evaluate the studies investigating the relationship between job burnout and personality traits addressed to date. Specifically, the interest of this review was to explore the role of personality traits as individual factors related to job burnout. To do this, only studies that analyzed the direct relationship between personality traits and job burnout were included, leaving out all those studies that investigated additional variables that could in any way mediate or moderate this relationship.

Results of the studies included

Table 3 summarizes the results, the correlation and regression indices, and the power of significance of the studies included in this review.

The results of the included studies based on the five personality traits and the association with a dimension of job burnout are discussed below. The correlations between the personality trait and the size of the job burnout report first, while subsequently those of the regressions, presenting the cross-sectional studies first, which are most of them, and then also the longitudinal ones.

As seen previously, job burnout is a multidimensional construct that consists of the individual response to stressors at work [ 3 , 9 ]. The literature has long investigated the association between organizational and occupational factors and burnout. However, a recent meta-analysis shows that there is a bidirectional relationship between occupational stressors and burnout [ 200 ]. Because the research on individual factors has been less systematic, partial, and contradictory [ 113 ], this review aimed to synthesize research evidence about the role that FFM personality traits play in the development of job burnout. To do this, 83 independent studies that used different tools to assess both job burnout and personality traits while maintaining the same reference theory were identified. The most investigated personality traits were, in order, neuroticism, extraversion, agreeableness, conscientiousness, and openness to experience.

The present review extracted data from the reviewed studies, including (1) main characteristics of participants (including job type), (2) data collected country, (3) personality traits related to job burnout, (4) risk of bias in individual studies, and (5) methodological features of studies. As for the participants, all reviewed studies included (1) adult samples, (2) workers from the general population rather than clinical samples, (3) regardless of the type of work, and for most studies (4) more female participants than male. Based on these observations, future studies examining personality traits and work burnout should employ other samples (e.g., clinical samples) to enhance external validity.

This systematic review focused exclusively on personality traits and the relationship between them and job burnout. Results of the included studies confirmed a relationship between job burnout and the five distinct personality traits of the Big Five model [ 46 ] and that some of these were risk factors for job burnout (although not always in the same direction). A descriptive picture of the relationship between the five personality traits and job burnout will be discussed.

Agreeableness

A negative association between Agreeableness and job burnout was reported (range, r from − 0.12* to − 0.353***; β from − 0.08*** to − 0.523*). Longitudinal studies also suggest a role of Agreeableness as a protective factor of dimensions of Emotional Exhaustion, Depersonalization, and reduced Professional Accomplishment (EE; β, − 0.83*; β, − 0.48*; D; β, − 0.31*; PA; β, − 0.22*; rPA; β, − 0.28**). As seen previously, the Agreeableness trait has been described as a sense of cooperation, tolerance, and avoidance of conflict on problematic issues [ 32 ]. Agreeable individuals are warm, supportive, and good-natured [ 201 , 202 ], protecting them from feelings of frustration and emotional exhaustion [ 113 ]. Indeed, their tendency towards a positive understanding of others, coupled with interpersonal relationships based on feelings of affection and warmth [ 201 ], could protect them from developing job burnout and greater depersonalization [ 8 , 203 ]. Although most of the studies found a negative relationship between Agreeableness and job burnout, in some studies Agreeableness was positively correlated with Emotional exhaustion [ 159 ], and reduced Professional Accomplishment [ 50 , 62 ].

Conscientiousness

A negative association between Conscientiousness and job burnout was reported (range, r from − 0.12* to − 0.355***; β from − 0.09*** to − 0.300*). Longitudinal studies also suggest the role of Conscientiousness as a protective factor against Burnout (B; β, -0.21*). As seen previously, the Conscientiousness trait is reflected in precise, organized, and disciplined individuals who respect the rules and work hard to achieve success [ 33 ]. Their perseverance in work and success orientation would protect these people from developing emotional exhaustion [ 76 , 204 ] and poor personal accomplishment, as they are unlikely to perceive themselves as unproductive. Although most studies found a negative relationship between Conscientiousness and job burnout dimensions, some studies pointed out an unexpected inverse correlation between Conscientiousness and reduced Professional Accomplishment [ 60 , 62 , 143 , 159 , 166 ]. Furthermore, Conscientiousness was positively associated with Emotional exhaustion and Depersonalization [ 131 ]. This result would be due to the greater commitment and effort employed in their work, which would have greater levels of exhaustion and depersonalization [ 131 ]. Finally, another longitudinal study [ 56 ] attributes Conscientiousness as a negative predictor role for the dimensions of Personal/Professional Accomplishment. However, the authors do not provide reasons for this discordant result from the literature.

Extraversion

A negative association between Extraversion and job burnout was reported (range, r from − 0.034** to − 0.33***; β from − 0.06*** to − 0.31***). Longitudinal studies also suggest the role of Extraversion as a protective factor against burnout and its dimension of Exhaustion (B; β, − 0.16*; EE; β, − 0.26*). As seen previously, the Extraversion trait has been identified as the intensity of social interaction and the level of self-esteem of individuals [ 32 ]. People with higher levels of extraversion appear positive, cheerful, optimistic, and have more likely to experience positive emotions [ 206 ]. This positive view of their level of job-related self-efficacy [ 207 ], often associated with the interpersonal bonds they tend to create [ 208 ] can protect outgoing individuals from experiencing high levels of emotional exhaustion. On the contrary, introverted individuals tend to experience greater feelings of helplessness and lower levels of ambition [ 204 ], which instead results in a risk factor for job burnout. Although the negative association is the most frequent, some studies have found a directly proportional association between Burnout and Extraversion [ 54 ], Cynicism [ 127 , 173 ], and reduced Professional Accomplishment [ 50 , 60 , 62 , 143 , 146 , 159 ]. Again, the authors do not provide reasons for this discordant result from the literature.

Neuroticism

A positive association between Neuroticism and job burnout was reported (range, r from 0.10** to 0.642***; β from 0.16** to 0.587***). Longitudinal studies also suggest a role of Neuroticism as a predictor of Burnout and its extent of Exhaustion, while predicting a decrease in Professional Accomplishment (B; β, 0.21*; EE; β, 0.31***; β, 0.15**; β, 0.19**; PA; β, − 0.23**). As seen previously, it is possible to define Neuroticism as the inability of people to control their impulses and manage their emotional balance. Neurotic people experience a series of feelings of insecurity, anxiety, anger, and depression [ 25 , 76 , 204 ] that they try to manage through maladaptive coping strategies, such as delay or denial [ 29 , 34 ]. These characteristics of the personality trait of Neuroticism would interfere with job functioning and satisfaction, operating a negative "filter" that magnifies the impact of adverse events (see [ 209 ]) and constitutes a significant risk factor for job burnout [ 8 , 174 ]. Feelings of anxiety and nervousness could lead them more easily to experience higher levels of emotional exhaustion, and by focusing on more aspects of their work, they are more likely to manifest depersonalization. Although most studies report a positive association between Neuroticism and Burnout [ 164 ], Burnout [ 159 , 169 ], Depersonalization [ 133 , 159 ], and reduced Professional Accomplishment [ 60 , 62 , 126 ]. Ye and colleagues [ 164 ] tie this result to the Chinese cultural situation, whereby the observed greater sense of responsibility and discipline could reduce the effects of extroversion on job burnout. Farfán and colleagues [ 169 ], on the contrary, link this result to the tendency of the neurotic personality trait to use rationalization as a defense against job burnout. Unlike most of the studies included in this review, some results show a negative association between Neuroticism and Burnout [ 159 , 164 ], Emotional exhaustion, and Depersonalization [ 155 ]. Furthermore, a study indicates that Neuroticism is positively associated with reduced Personal/Professional Accomplishment [ 131 ]. Finally, in the longitudinal study by Armon and colleagues [ 54 ], Neuroticism even seems to protect against Emotional exhaustion. The authors explain the association over time of Neuroticism with job burnout as due to an underrepresentation in the measurement scales used or the moderating effect of gender on these associations [ 159 ].

A negative association between Openness and job burnout was reported (range, r from − 0.18*** to − 0.237**; β from − 0.092* to − 0.45*). Longitudinal studies have suggested the role of Openness as a protective factor of reduced Professional Accomplishment (rPA; β, 0.10*). As seen previously, individuals with high levels of Openness tend to be more intellectually curious about novelty and open-minded and have a predisposition to independence [ 35 , 76 , 202 ]. These characteristics protect individuals from experiencing discomfort, experiencing novelty and failures as opportunities [ 203 ], and protecting them from job burnout from emotional exhaustion. Conversely, when faced with stressors at work, less open individuals can adopt quick but suboptimal strategies, such as depersonalization [ 8 ]. Although most of the studies found a negative relationship between Openness and job burnout, five studies found a positive correlation between Openness and Emotional exhaustion [ 54 , 122 ] and Depersonalization [ 159 ], while negative with Personal/Professional Accomplishment [ 62 , 131 , 159 ]. The authors do not provide reasons for this discordant result from the literature. Other studies instead have found a positive association between Openness and all dimensions of Burnout [ 116 ]: Exhaustion [ 131 , 173 ], Depersonalization [ 131 ], and reduced Personal/Professional Accomplishment [ 142 ]. Finally, the longitudinal study by Ghorpade and colleagues [ 120 ] attributes Openness to the role of the positive predictor of Emotional exhaustion. According to the authors, this result could be attributed to the work of the professors (Professors) which, requiring a greater openness to listening to students' different problems and encouraging different positions in them, could increase emotional exhaustion.

The findings of most of the studies reviewed indicate that individuals who have higher levels of neuroticism and lower agreeableness, conscientiousness, extraversion, and openness to experience are more prone to experiencing job burnout. However, the few studies that show other results than this theoretical line cannot explain the conflicting results. Some authors adduce these results to a measurement bias (e.g., [ 159 ]) or sample characteristics (e.g., [ 120 ]) but fail to explain the reason for this relationship and believe that it is due to further variables to be explored.

Limitations

Although the literature review was conducted as rigorously as possible, the search strategy was limited to four scientific search engines. Furthermore, it was impossible to find all the relevant studies if the search terms were not mentioned in the articles' titles, abstracts, or keywords. Therefore, some related papers might be missed due to the selected terms. Furthermore, the search included only studies published in English, thus excluding relevant studies in other languages. Additionally, gray literature was not included in the study, and therefore, it may not have been considered essential data contained in non-peer-reviewed studies, unpublished theses, and dissertation studies. Furthermore, one of the exclusion criteria was the journal ranking of SCImago. Although this is a widely accepted and recognized measure to reduce the possibility of including in systematic reviews papers that do not meet certain quality indices [ 47 ], they may not have been considered relevant data. In addition, the Big Five model [ 46 ] was used as a conceptual model of reference to compare the results of the studies on job burnout. Studies that did not include the Big Five models or that explored the relationship between Burnout and personality disorders (e.g., Antisocial Personality Disorder, Narcissistic Personality Disorder, Borderline Personality Disorder, etc.) were therefore not examined in this study. Restricting studies to a single conceptual model of personality was necessary to focus the review, but at the same time, it limited our investigation. Furthermore, the heterogeneity of the study samples' work type, burnout measurement tools, and personality traits prevented comparing results across studies. Finally, despite precautions to reduce selection bias, confounding, and measurement bias, no studies have addressed reverse causality problems in the relationship between personality traits and burnout. Although the cross-sectional research design does not allow us to investigate the causal links between personality and burnout, an answer to the existence of this link is offered by the longitudinal studies included in the review. This type of study demonstrates that personality traits play a role in the development of burnout, but future research must investigate this relationship, especially with the help of longitudinal studies that can reduce the problems related to reverse causality.

The findings obtained in the present review highlight the importance of examining the role of personality traits in the development of job burnout syndrome. At the same time, it is possible to observe how scientific evidence places us in front of a picture that is not fully defined. In line with Guthier's meta-analysis [ 200 ], the findings of this review highlight the need for expanding job stress theories focusing more on the role that personality plays in burnout.

I am convinced of the value of this review in directing future empirical research on job burnout, especially in the light of new approaches to burnout as a multi-component factor (see [ 210 , 211 ]). Even more future research will have the task of encouraging the use of methodologies that evaluate personality traits in work contexts. An assessment of personality traits and continuous monitoring of occupational stress levels (e.g., [ 212 ]) could help identify the people who are most likely to develop burnout syndrome to prevent or limit its damage. Future research should improve understanding and intervention on burnout, too often limited by universal approaches that have neglected the uniqueness of the antecedents of burnout [ 213 ]. Some traits related to burnout predict work outcomes such as job performance, job satisfaction, and turnover [ 203 , 214 – 218 ]. It is, therefore, necessary to investigate the antecedents of Burnout to provide implications practices for jobs and organizations.

Availability of data and materials

As this is a systematic review of the literature, this study indicates the information to obtain all data analyzed in the databases used. However, the datasets used during the current study remain available from the corresponding author upon reasonable request.

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Angelini, G. Big five model personality traits and job burnout: a systematic literature review. BMC Psychol 11 , 49 (2023). https://doi.org/10.1186/s40359-023-01056-y

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Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Nursing, Instituto Federal do Paraná, Londrina, Paraná, Brazil

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Pathological Sciences, Universidade Estadual de Londrina, Paraná, Brazil

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – review & editing

Affiliation Department of Public Health, Universidade Estadual de Londrina, Paraná, Brazil

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – review & editing

Roles Data curation, Formal analysis, Investigation, Project administration, Visualization, Writing – review & editing

Affiliation Department of Nursing, Universidade Estadual de Londrina, Paraná, Brazil

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Current address: Department of Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brazil

• Denise Albieri Jodas Salvagioni, 
• Francine Nesello Melanda, 
• Arthur Eumann Mesas, 
• Alberto Durán González, 
• Flávia Lopes Gabani, 
• Selma Maffei de Andrade

• Published: October 4, 2017
• https://doi.org/10.1371/journal.pone.0185781
• Reader Comments

Burnout is a syndrome that results from chronic stress at work, with several consequences to workers’ well-being and health. This systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies. The PubMed, Science Direct, PsycInfo, SciELO, LILACS and Web of Science databases were searched without language or date restrictions. The Transparent Reporting of Systematic Reviews and Meta-Analyses guidelines were followed. Prospective studies that analyzed burnout as the exposure condition were included. Among the 993 articles initially identified, 61 fulfilled the inclusion criteria, and 36 were analyzed because they met three criteria that must be followed in prospective studies. Burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. The psychological effects were insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders and psychological ill-health symptoms. Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were identified as professional outcomes. Conflicting findings were observed. In conclusion, several prospective and high-quality studies showed physical, psychological and occupational consequences of job burnout. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.

Citation: Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SMd (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS ONE 12(10): e0185781. https://doi.org/10.1371/journal.pone.0185781

Editor: Jacobus P. van Wouwe, TNO, NETHERLANDS

Received: June 16, 2017; Accepted: September 19, 2017; Published: October 4, 2017

Copyright: © 2017 Salvagioni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This work was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Working conditions have a well-known impact, either positive or negative, on employees’ health [ 1 ]. Adverse working conditions may lead to job burnout, a syndrome resulting from chronic stress at work that is characterized by overwhelming exhaustion, negative attitudes or a lack of commitment with clients and dissatisfaction with job performance. This process may lead to undesirable consequences for workers, their families, the work environment and the organizations [ 2 ]. From the psychosocial perspective, the following three dimensions of burnout have been described: a) emotional exhaustion, characterized by emotional depletion and loss of energy; b) depersonalization or cynicism, also described as dehumanization, detachment from work and clients and emotional hardening; and c) reduced personal accomplishment or inefficacy, that is, a feeling of personal or professional inadequacy as well as reduced productivity and coping skills [ 3 , 4 ].

Cross-sectional studies have shown associations between burnout and some health problems, such as increased alcohol consumption [ 5 ], sleep disorders [ 6 ] depression [ 7 ], sedentarism, obesity [ 8 ] and musculoskeletal pain [ 9 ]. However, well-conducted prospective studies are more appropriate for investigating the possible consequences of this syndrome, because these types of studies enable the identification of the temporal relationship between the exposure (burnout syndrome) and the outcomes (consequences).

We found only two systematic reviews that have investigated burnout and its possible consequences in working populations. One selected only studies published in English between 1988 and 2008, examined only job satisfaction and turnover intention among North-American psychotherapists and included only studies with a cross-sectional design [ 10 ]. The other focused on nurses and investigated the relationships of burnout, job satisfaction and general health in findings from 70 studies published in English between 1990 and 2012; the majority of these (68 studies) were also cross-sectional studies [ 11 ].

Therefore, this systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies.

Materials and methods

This study is a systematic review that followed the guidelines of the Transparent Reporting of Systematic Reviews and Meta-Analyses– S1 Appendix [ 12 ] (PROSPERO Register: CRD42015028047). We searched the PubMed (U.S. National Library of Medicine), Science Direct (Elsevier), PsycInfo (American Psychological Association), SciELO (Scientific Electronic Library Online), LILACS (Literature in the Health Sciences in Latin America and the Caribbean) and Web of Science databases through May 31, 2017, without restrictions on language or year of publication.

Search strategy

The following terms were used to identify publications on burnout with a prospective design: “burnout”, “longitudinal”, “prospective”, “cohort”, “case control”, “case-control”, “follow-up”, and “follow up”. These terms were combined with Boolean operators according to the rules of each database ( S2 Appendix ). To complement the database searches, we reviewed all the references of the selected articles and those of review articles.

Inclusion and exclusion criteria

The inclusion criteria were as follows: the study was an original study published in a journal with an editorial board and peer review; and the study was a prospective study investigating burnout as the exposure (independent variable) for the occurrence of physical, psychological or occupational consequences (dependent variables).

We excluded studies of non-working populations (i.e., studies with twins, patients and students, including medical, sports and high school students), editorials, commentaries, letters to editors, abstracts, literature reviews, qualitative studies, studies that reported only a cross-sectional analysis, trials, studies that reported research method or instrument validation, and follow-up studies that did not have a comparison group (unexposed to burnout) or treated burnout as an outcome (dependent variable).

Selection and extraction of the articles

The selection of the studies was performed independently by two of the authors using the following three steps: (a) analyzing the articles’ titles, (b) reading the abstracts, and (c) reading the full texts. At each step, if there were divergences, a third author was asked to judge, and the final decision was made by consensus or majority. After selection of the studies, the data of interest were registered in a standardized spreadsheet.

Evaluating the methodological quality of the studies

Although several tools for evaluating the susceptibility to bias in observational epidemiological studies are available, no consensus has been reached on a gold standard for this purpose [ 13 , 14 ]. Moreover, many of these tools have been criticized either because their validity and reliability have not been reported [ 15 , 16 ] or because of low agreement between reviewers and authors [ 17 ] or between reviewers [ 18 ]. Therefore, we analyzed several of these tools [ 19 – 22 ] as well as another tool related to adequate reporting of observational epidemiological studies [ 23 ]. Based on the conclusions of that analysis, we decided to follow the recommendations of epidemiology experts [ 24 , 25 ] for conducting sound and reliable prospective studies and only considered studies that met three central methodological criteria ( Fig 1 ) for internal validity. These criteria were related to the selection of participants (ensuring that those with the outcome already present at the baseline study were excluded), the attrition from the baseline study to the end of follow-up and adjustments for the main confounders.

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The first criterion was chosen because, in cohort studies, the exposed and unexposed groups are followed in order to compare the incidence (new cases) of the outcome in both groups; therefore, cases already present at baseline should be excluded [ 25 ]. However, we included studies that controlled for the outcome in the analysis of follow-up time. Additionally, changes in the levels of the outcome over time (from baseline to the end of the follow-up time) were considered incident events.

The response rate or loss to follow-up is another relevant aspect to be considered in epidemiological studies, as non-respondents or those lost to follow-up in a cohort study may differ in several characteristics from those who respond or are successfully observed during the time in which the study is conducted. These differences include whether the respondents were exposed to the hypothesized risk factor and whether they have a higher/lower risk of presenting the outcome at the end of the follow-up period [ 26 ]. Therefore, the second criterion was chosen to prevent the inclusion of studies that were susceptible to selection bias [ 24 , 26 ].

As we investigated consequences of burnout, the third criterion was chosen because age and/or health conditions are important factors that may confound the associations [ 24 ]. Therefore, only studies that reported minimal control for age or for health conditions were analyzed.

Data organization and presentation

The results are presented in tables according to the nature of the consequence: physical, psychological or occupational. When two types of consequences were reported by the same study, they were presented twice in their respective tables. The characteristics of the selected studies (authors, year of publication, country, cohort’s name, working population, follow-up period, burnout instrument, burnout measure, type of dependent variable and outcome measure) are presented in alphabetical order by the first authors’ surnames. The consequences were put in order according to their type and subtype (e.g., organic system), and the tables describe the final sample, the dependent variable (investigated consequence), the main significant and non-significant findings, and the control variables used in the analyses.

Search for and selection of studies

We identified 993 articles in the databases that were searched; 343 were duplicated. After reading the titles and abstracts, 529 were excluded. Among the 121 remaining articles, we excluded 63 after reading the full text. We then added three studies listed in the references of the selected studies, resulting in a final sample of 61 articles ( Fig 2 ).

https://doi.org/10.1371/journal.pone.0185781.g002

Methodological quality evaluation

Among the 61 selected studies [ 27 – 87 ], 36 met all three methodological quality criteria ( S3 Appendix ). The main characteristics of the articles that did not meet our predefined quality criteria can be viewed in S4 Appendix .

Characteristics of the included studies

From here on, only the characteristics and results of the 36 studies that met all three quality criteria will be presented ( Table 1 ) and discussed. All studies were prospective cohorts; 12 reported physical consequences, 10 reported psychological consequences and 12 reported occupational consequences. Two articles analyzed physical and psychological consequences.

https://doi.org/10.1371/journal.pone.0185781.t001

The studies were mainly conducted in Europe, particularly in Nordic countries (21 studies). The only other regions of the world in which the studies were conducted were Asia (Israel, China and Japan), South Africa and the United States. Several occupations were investigated, such as dentists, forest industry employees, nurses, teachers, human service workers and financial services′ employees. The Maslach Burnout Inventory (MBI) and the Shirom-Melamed Burnout Measure (SMBM) were the primary tools used to investigate burnout. Most authors treated burnout as a continuous variable, while some authors treated burnout as dichotomous and others divided it into three categories. The number of participants varied from 133 [ 62 ] to 10,062 [ 31 ]. Follow-up time ranged from one year for several outcomes [ 47 , 48 , 51 , 55 , 62 , 68 , 83 ] to 12 years for the outcome use of psychotropic and antidepressant medications [ 60 ]. With the exception of one study [ 32 ], all studies were published between the years 2005 and 2016. Only one study was not reported in English [ 47 ].

Physical consequences

The most frequently investigated physical outcomes were cardiovascular diseases (coronary heart disease (CHD) and hospitalization for cardiovascular diseases) and risk factors for these diseases (obesity, hyperlipidemia, type 2 diabetes, large waist circumference (WC), high body mass index (BMI), metabolic syndrome, hypertension, high triglycerides, low HDL cholesterol, high LDL cholesterol, and impaired fasting glucose) ( Table 2 ).

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Burnout was a significant predictor of hypercholesterolemia (total cholesterol ≥220 mg/dl) [ 59 ] and type 2 diabetes [ 65 ], independently of confounding variables. Burnout was also associated with low HDL cholesterol in a model adjusted for age; however, this association lost significance when additionally adjusted for alcohol consumption, smoking and physical activity [ 59 ].

Two studies confirmed a higher incidence of CHD among those exposed to burnout [ 32 , 77 ]. A significant association between burnout and hospitalizations due to cardiovascular diseases has also been observed in a cohort study of industrial employees that lasted 10 years [ 80 ].

Musculoskeletal disorders have been shown to be significantly associated with burnout. Increased levels of burnout during 18 months of follow-up were associated with an increased risk of developing musculoskeletal pain [ 36 ]. Workers with high burnout levels had more than twice the risk of developing musculoskeletal pain compared to those without burnout [ 66 ]. Burnout was also a risk factor for hospitalizations due to musculoskeletal disorders after adjusting for age and gender; however, this association lost significance after further adjustments by occupational status and physical environment at baseline [ 80 ].

One study found a relationship between burnout and changes in pain experiences. Burnout at T1 (baseline) or changes in burnout levels between T1 and T2 were important predictors of overall pain, neck-shoulder pain, back pain, and pain-related disability. However, pain in the entire body, pain intensity and pain frequency were not associated after adjustments [ 48 ]. Headache was an outcome of burnout investigated in two studies [ 48 , 58 ], but a significant association was found in only one study [ 58 ]. Both studies differed in the types of populations, measures of headache and control variables used in the analyses. The study that yielded a significant association was conducted among social workers in the US and measured headache through a general health questionnaire (PHQ) that contained 3 items related to headache (during the six previous months), resulting in scores ranging from 3 to 21; thus, headache was treated as a continuous variable. The analyses were adjusted for age, gender, field tenure and annual salary [ 58 ]. The other study investigated a random sample of Swedish women. Headache was assessed with a specific questionnaire on pain (several items) and was defined as pain during at least one month over the past three months; adjustments for the association between burnout and headache (incidence or increased ratings of intensity or frequency) were made for sociodemographic variables, work characteristics, smoking, psychological distress, physical health and basal pain parameters [ 48 ].

Some studies investigated burnout as a risk factor for prolonged fatigue [ 61 ], gastrointestinal issues, respiratory problems [ 58 ], severe injuries [ 31 ] and mortality below the age of 45 years [ 30 ]. All these consequences were significantly associated with burnout. However, burnout was not a significant predictor of mortality among those 45–65 years old [ 30 ].

Psychological consequences

Insomnia and depressive symptoms were the main investigated psychological consequences ( Table 3 ). Studies of 1,356 and 3,235 apparently healthy employees attending a center for a health examination showed burnout as a significant predictor of new cases of insomnia [ 33 ] and an increase in insomnia levels, respectively [ 35 ]. In these two studies [ 33 , 35 ], insomnia was assessed using a slightly modified version of the AIS-5, which is a 5-item tool that evaluates difficulties with sleep induction and maintenance by self-reporting with a total score ranging from 5 to 35. In one study, new cases of insomnia were defined dichotomously (yes/no) [ 33 ], whereas in the other study [ 35 ], insomnia was treated as a continuous variable (changes in the level of the total score). However, a study of 1,258 workers randomly selected from the general working population in Sweden that analyzed the dimensions of burnout (emotional exhaustion, cynicism, and professional efficacy) separately did not find an association with the incidence (new cases of insomnia) or persistence of insomnia (from the baseline study until one year later) [ 55 ]. In this study, the authors defined insomnia as self-reported problems with sleep three or more times per week during the past three months and difficulty in initiating or maintaining sleep for 30 minutes or more per night [ 55 ]. Similarly, a study of 146 social workers in the USA found that burnout was not a predictor of sleep disturbances [ 58 ]. Sleep disturbances in this study were assessed using the Physical Health Questionnaire–PHQ, which is a 4-item tool encompassing self-reported difficulty in falling asleep, awakenings during the night, nightmares and perception of a peaceful or undisturbed night’s sleep.

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Depressive symptoms were a psychological consequence that was investigated with different measurement tools, different numbers of participants and different follow-up times. Burnout was found to be a significant predictor of depressive symptoms among 2,555 dentists in a follow-up study lasting three years and a mediator between job strain and depressive symptoms [ 27 ]. In 18 months of follow-up, burnout also predicted an increase in depressive symptoms in a study of almost 5,000 apparently healthy workers attending a center for routine heath examinations in Israel [ 37 ]. Additionally, in a three-wave study conducted between the years 2003 and 2009, an increase in job burnout from T1 to T2 was found to predict an increase in depressive symptoms from T2 to T3 in 1,632 Israeli workers attending the same health center, although this increase was attenuated by high physical activity levels [ 78 ]. However, burnout did not predict depressive symptoms in a study of 627 French school teachers that did not exclude those with depressive symptoms at baseline but controlled for this outcome in the follow-up analysis [ 38 ]. In all studies selected in our review, depressive symptoms were assessed with scales typically used in epidemiological studies to screen for possible clinical depression. An increased risk of antidepressant use, mainly among men, was also demonstrated by a study [ 63 ] that used records of the Danish national prescription registry, which contains data on all prescription medications purchased at pharmacies in Denmark. Men with high levels of burnout had an increase of 5.17% per year in the risk of entering antidepressant treatment compared to men with intermediate levels of burnout; this association was stronger for men than that observed for women (an increase of 0.96% per year). Similar results were found in a Finnish study that aimed to evaluate whether changes in burnout levels over a four-year period predicted the use of psychotropic and antidepressant medications in the following eight years. The authors noted that inconsistencies among the levels of the subdimensions of burnout at baseline, such as high emotional exhaustion and low cynicism or vice versa, as well as change toward burnout in four years, were predictors of psychotropic and antidepressant treatment [ 60 ].

Burnout was also a predictor of hospital admissions due to mental disorders over a 10-year period among Finnish forest industry employees [ 80 ]. Among employees from the financial sector, burnout was a risk factor for psychological ill-health symptoms and a mediator between work overload and these symptoms [ 44 ].

Occupational consequences

Job satisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were the investigated outcomes ( Table 4 ). Job dissatisfaction was an occupational consequence explored in two studies with relatively small samples (n≤316). Emotional exhaustion was found to be a predictor of job dissatisfaction in both studies [ 47 , 62 ], while depersonalization was found to be significantly associated in just one [ 47 ], which did not identify an association with professional efficacy.

https://doi.org/10.1371/journal.pone.0185781.t004

Burnout was prospectively associated with sickness absence days and sickness absence spells. Workers with worse levels of burnout (those ranked in the highest quartile of the scale score) were absent from work, on average, 13.6 days per year, in comparison with those classified in the lowest quartile (5.4 days). An increase in the burnout score predicted increases of 21% and 9% in sickness absence days and sickness absence spells, respectively, even after adjustments for sociodemographic, work and health conditions [ 39 ]. An increase in absence duration (defined as the number of sick-leave days between T1 and T2) was an occupational consequence among workers with high levels of burnout [ 71 ].

The high and medium levels of burnout were associated with long-term sickness absence (>2 weeks) after adjustments for sociodemographic characteristics and health-related lifestyle. When psychosocial characteristics were added in the statistical model for adjustments, the effects of high and medium levels of work burnout were attenuated, although the results were still significant [ 40 ].

In a study that grouped the exhaustion and cynicism dimensions of burnout (ExCy), Hallsten et al. [ 51 ] observed a twofold risk of long-term sickness absence (>60 consecutive days) among those classified as high ExCy after adjustments. Burnout was also a predictor of both long-term sickness absence leaves (≥42 consecutive days) [ 68 ] and sick-leave absences (≥3 days) due to mental or behavioral problems [ 79 ]. Sick leaves due to musculoskeletal disorders of ≥3 days were a consequence of burnout [ 79 ], but no association was identified for long-term sickness absences due to these disorders (≥42 consecutive days) [ 68 ]. Additionally, burnout was a significant risk factor for sick-leave absences due to diseases of the circulatory and respiratory systems but not for diseases of the digestive system [ 79 ].

A study of 3,125 Finnish forest industry employees found that burnout significantly predicted new disability pensions during a 4-year follow-up period, even after adjustments for age, gender, marital status, occupational status, sector, mental disorders and physical illness. The same pattern of association was found, after all adjustments, for the burnout syndrome subdimensions of cynicism (in both genders) and emotional exhaustion (in men) [ 28 ]. These investigators, in a subsequent follow-up study [ 29 ] that lasted eight years and included 7,810 employees of the same forest industry, found that workers with severe burnout had a greater likelihood of receiving a new disability pension (15%) compared to those with mild (8%) or no burnout (5%). After adjustments for several confounders and chronic illness at baseline, severe burnout and severe emotional exhaustion significantly predicted a new disability pension. However, when analyzing causes of disabilities according to the presence of burnout and its subdimensions, only exhaustion significantly predicted new pensions for mental or other miscellaneous diseases, after all adjustments [ 29 ].

Job burnout prospectively affected the perception of job demands and job resources among Chinese workers [ 83 ]. A study of nurses revealed that both emotional exhaustion and depersonalization had effects on future perception of high job demands and that emotional exhaustion predicted presenteeism [ 45 ].

The investigated and statistically significant consequences of burnout are shown in Fig 3 .

https://doi.org/10.1371/journal.pone.0185781.g003

To the best of our knowledge, this is the first comprehensive systematic review of the prospective effects of job burnout. This review provides relevant evidence of the physical, psychological and occupational consequences of this syndrome to workers. No limits were defined for the literature search, such as language or time of publication. Selection and methodological evaluation of the articles were performed independently by two authors and followed PRISMA guidelines [ 12 ]. To guarantee a higher quality of evidence, we defined minimal criteria that should be followed when prospective studies are conducted in order to avoid selection bias or other types of bias [ 13 , 19 , 23 – 26 ]. Nevertheless, a meta-analysis could not be performed due to the heterogeneity of the studies, mainly regarding measures of burnout or outcomes that were analyzed in more than one study (e.g., depressive symptoms or absenteeism). Therefore, we were not able to assess publication bias with statistical procedures, because the results of the included articles could not be analyzed using meta-analysis methods. We cannot rule out the possibility that some of the excluded studies are also of high methodological quality but were not included because they did not report exclusion of the outcome at baseline or they failed to report adjustments. Finally, studies with students were not included in our review, although undergraduate and graduate medical students in particular may experience many of the stressors and consequences of professional burnout [ 88 ]. We found only one study that longitudinally analyzed burnout as a potential risk factor for ill health among medical students; burnout (depersonalization and a low sense of personal accomplishment) was a predictor of suicidal intention over the following one year, whereas recovery from burnout reduced the risk of this outcome [ 88 ]. This serious and life-threatening outcome may also occur in working populations experiencing burnout.

The majority of the cohort studies selected for this review was from Nordic countries. This may be due to the availability of reliable registries on health and social benefits in these countries [ 8 , 28 – 31 , 40 , 63 , 68 ], which make it possible to identify employees, link records and therefore conduct studies of large sample sizes. It is important to note that the political and economic situation in these countries favors better work and health conditions. Therefore, there is still room for research in low- and middle-income countries, where work conditions and access to healthcare are less favorable. In such regions, for instance, workers may not have the option of choosing their job or may not be able to quit their job for survival reasons. In addition, low- and middle-income countries generally do not have well-structured health services or state-of-the-art technologies, and the quality of assistance may be less than optimal, all of which can affect the health of the population.

Among the physical consequences of burnout that were prospectively investigated, cardiovascular diseases and pain stood out. Cardiovascular diseases were also more frequently reported as causes of absenteeism by workers with burnout in a study classified under occupational consequences. As burnout follows a state of chronic stress, it has been suggested that the biological mechanisms resulting from prolonged stress may deteriorate physical health. One hypothesis is that the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis become exhausted due to burnout. This results in overactivation of vital functions (e.g., heart rate and blood pressure) and damage to metabolism and the immune system [ 89 ]. According to Melamed et al. [ 90 ], potential mechanisms linking burnout to cardiovascular diseases include its associations with components of metabolic syndrome, dysregulation of the HPA axis, inflammation, sleep disorders, reduced immunity, changes in blood coagulation, changes in fibrinolysis, and adoption of poor health behaviors, such as smoking and lack of physical activity. In fact, cumulative work stress has been shown to be associated with the incidence of cardiovascular events, and this relationship was mediated by both the direct effects of neuroendocrine mechanisms and the indirect effects of unhealthy behaviors, particularly poor diet and low physical activity [ 91 ].

Impaired immune function in individuals with burnout may increase their susceptibility to infectious diseases such as flu-like illnesses, the common cold and gastroenteritis [ 67 ], which is in line with the results observed for respiratory infections and gastroenteritis in one study included in this review [ 58 ]. In addition, burnout was a predictor of musculoskeletal pain, although the pathophysiological pathways linking these conditions remain unclear [ 66 ]. The findings regarding the longitudinal relationship between burnout and headaches were not consistent, one study detected a significant association [ 58 ], whereas the other study did not [ 48 ]. This divergence may be due to the different methodologies used and may be mainly related to the previous timeframe in which headache was investigated (six months vs three months) and the definition of headache used, among other factors. Moreover, the type of headache was not investigated (tension headache, acute or chronic headache, migraine) in either study. In epidemiological studies, the case definition of headache can be problematic [ 92 ], particularly tension-type headaches, which are the most common type. This issue may result in different rates of incidence or prevalence [ 92 ] and can impact on the investigated associations. However, there is evidence that psychological stress, which is closely related to burnout and pain, is a contributing factor to headache [ 93 ], and several mechanisms linking stress to headache have been proposed, such as sympathetic hyperactivity [ 94 ]. Workers under recurrent or prolonged stress may also more frequently engage in unhealthy behaviors, such as a poor or rich diet, a lack of physical exercise and alcohol abuse. When combined with sleep disorders, these unhealthy behaviors may lead to a myriad of other consequences [ 35 , 59 ], such as obesity [ 8 ] and diabetes [ 65 ].

Burnout significantly predicted depressive symptoms or antidepressant treatment in the majority of the studies that investigated psychological consequences, and these relationships were stronger for the subdimensions emotional exhaustion and depersonalization. Some authors have recently renewed debate on the overlap between burnout and depression, as they found that these conditions were highly correlated with each other, therefore advocating that burnout should be considered a depressive syndrome [ 95 ]. However, Maslach and Leiter [ 4 ] have argued that there are problems with this analysis since the instruments used for measuring burnout and depression are both dominated by fatigue. They concluded that it is not surprising that they would overlap. Moreover, studies on the discriminant validity of burnout and depression [ 96 , 97 ] have demonstrated that these conditions are distinct constructs. In the present review, studies that detected associations between burnout and depressive symptoms either excluded those affected by this outcome at baseline or controlled for these symptoms, which favors the argument that these are indeed distinct conditions.

The results regarding the incidence of sleep problems following burnout were not consistent in our review. Insomnia or changes in insomnia levels were found to be consequences of burnout in two studies with apparently healthy employees attending a center for periodic health examinations in Israel [ 33 , 35 ] but not in a study with a random sample of employed individuals taken from the general population of the Örebro County, Sweden [ 55 ]. Another study with social workers in the state of California, USA, also did not find that burnout was a risk factor for sleep disturbances, although the final sample of this study was relatively small (n = 146) [ 58 ]. These differences may be due to the varying methodologies of the studies, with different tools used to measure burnout or sleep disturbances. Moreover, the studies with Israeli workers excluded people with cardiovascular diseases, diabetes, those who had suffered a stroke or a mental crisis and those taking antidepressants or antipsychotic medication [ 33 , 35 ], which are conditions usually related to burnout or sleep problems and thus increased internal validity. Conversely, the Swedish study included employees regardless of their health statuses, perhaps thereby increasing external validity, although reducing internal validity [ 55 ]. More longitudinal studies with both internal and external validity are needed to explore the incidence of sleep problems among burned out workers. Measuring sleep disturbances with objective measures, such as actigraphy or polysomnography, is also important [ 98 ].

Burnout can also trigger presenteeism [ 45 ] and absenteeism [ 39 , 40 , 51 , 68 , 79 ]. While absenteeism means absence from work, presenteeism represents a phenomenon when people come to work even when sick, leading to a loss of productivity. In a vicious circle, as a consequence of health problems caused by burnout, workers may not reach the desirable performance at work, which in turn may lead to increasing levels of emotional exhaustion [ 86 , 99 ]. The worker’s weakened health along with his/her diminished functional capacity may lead to absenteeism, a great cause of concern for the worker and the organizations that has both social and economic consequences. For the individual, absenteeism or presenteeism due to health problems may represent the beginning of a process of social decline involving job loss and even permanent exclusion from the labor market. For organizations, absenteeism means a loss of manpower, additional expenses associated with temporary workers and a decrease in productivity [ 39 ]. In this review, we observed that workers who experienced medium or high levels of burnout were at higher risk of short or long-term sickness absences. In addition to absenteeism, there is evidence that burnout also increased the risk of future disability pension [ 28 , 29 ].

In our review, we focused on the longitudinal relationships between burnout and physical, psychological and occupational outcomes and we highlighted some of the complex mechanisms involved in this process. Some of these mechanisms have been investigated in several studies on the antecedents and outcomes of burnout, most of which have adopted the theoretical framework of the job demands-resources (JD-R) model [ 100 ]. This model posits that work demands (e.g., high workload and time pressure) leads to negative outcomes via burnout (stress process), whereas work resources (e.g., autonomy and peers’ support) via work engagement contribute to positive outcomes (motivational process) [ 101 , 102 ]. Studies have shown that burnout is more stable than engagement over time [ 103 , 104 ]. More recently, leadership was integrated into the JD-R model to examine its relationships with a variety of demands, resources and outcomes. The authors found that leadership had a direct effect on the investigated outcomes (employability, performance, commitment and performance behavior) and an indirect effect on burnout and engagement by reducing demands and increasing job resources [ 102 ]. Reports have suggested that both the level of demands and the types of demands (challenge or hindrance) can impact the work-related well-being of employees, as revealed in a study in which job resources (support from colleagues, performance feedback, supervisor coaching and opportunities for development) fostered workers’ well-being (positive affectivity and work engagement) specifically under high-challenge demand conditions but not under hindrance demands [ 105 ]. There is also an ongoing debate about the concept of engagement regarding its relationship with burnout (i.e., if engagement is the opposite of burnout or if they are distinct constructs) [ 4 , 106 ]. In a recent meta-analytic study, Goering et al. [ 106 ] showed that burnout and engagement seemed to be distinct constructs when antecedents (resources, challenge demands and hindrance demands) were analyzed; however, the pattern was less clear for consequences (performance, turnover intention, job satisfaction, organization commitment and indicators of physical health). Burnout and engagement seem to act as opposites for turnover intention and task performance; however, due to the large heterogeneity of effect sizes in the population with distributions ranging from positive to negative values, the authors concluded that several boundary conditions (moderators) might exist, many of which probably had not been investigated to date. These aforementioned aspects in connection with the results of our review suggest the need to more deeply investigate the process leading from burnout to health or occupational outcomes, especially by incorporating factors that may confound the relationship and analyzing the role of possible mediators that can change the pattern of associations (e.g., moderating the relationships). As shown in our review, the majority of studies had only two waves. Considering the dynamics and the complexity of the relationship between variables, knowledge could be extended by studies with multiple waves to try to capture changes in work conditions, burnout, engagement and the incidence of diverse outcomes [ 27 , 44 , 49 ].

In summary, the present systematic review based on well-conducted and well-reported studies shows that cardiovascular diseases, musculoskeletal pain, depressive symptoms, psychotropic and antidepressant treatment, job dissatisfaction and absenteeism are consistent effects of burnout. Conflicting findings were observed for headache and insomnia. Other consequences were found in only one study; therefore, there is still a need to investigate these relationships with burnout in longitudinal studies. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.

Supporting information

S1 appendix. prisma checklist..

https://doi.org/10.1371/journal.pone.0185781.s001

S2 Appendix. Search strategy.

https://doi.org/10.1371/journal.pone.0185781.s002

S3 Appendix. Assessment of quality in cohort studies about burnout consequences.

https://doi.org/10.1371/journal.pone.0185781.s003

S4 Appendix. Characteristics of the 25 articles not included in this systematic review.

https://doi.org/10.1371/journal.pone.0185781.s004

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I won’t make the same mistake again: burnout history and job preferences

• Original Paper
• Published: 23 January 2024
• Volume 37 , article number  2 , ( 2024 )

Cite this article

• Philippe Sterkens 1 ,
• Stijn Baert   ORCID: orcid.org/0000-0002-1660-5165 1 , 2 , 3 ,
• Eline Moens 1 ,
• Joey Wuyts 1 &
• Eva Derous 4  

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The burnout literature has focused on the determinants of burnout, whereas its careers consequences remain understudied. Therefore, we investigate whether recently burned-out individuals differ in job preferences from non-burned-out workers. We link these differences in preferences with (1) perceptions of job demands and resources, as well as (2) the weighting of such perceptions. To this end, a sample of 582 employees varying in their history of burnout judged job offers with manipulated characteristics in terms of their willingness to apply as well as perceived job demands and resources. We find that recently burned-out employees appreciate possibilities to telework and fixed feedback relatively more, while being relatively less attracted to learning opportunities. These findings can be partially explained by differences in the jobs’ perceived resources.

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Data availability.

The data that support the findings of this study are available from the corresponding author upon request.

Policy-capturing, factorial survey experiment and conjoint analysis are all very closely related traditions of vignette techniques that are used in the social sciences (Aguinis and Bradley 2014 ; Weijters et al. 2021 ).

To construct an ecologically valid set of vacancies for participants to rate, we allowed full-time jobs to appear in 50% of the vignettes because full-time jobs are still more common than part-time jobs. The remaining half of the vignettes consisted of 25% half-time jobs and 25% 4/5ths jobs.

In the analyses including control variables, up to 10 participants were excluded from the sample because they failed to provide data for all control variables.

An additional screening question was included that asked whether the participant was currently ‘employed’ ( n  = 582), ‘unemployed’ ( n  = 80) or ‘self-employed’ ( n  = 7). Only participants who answered ‘employed’ were allowed to continue the survey and could provide their informed consent to study participation.

An article revising the psychological capital scale was published on 3 March 2021 (Dudasova et al. 2021 ). Because we sent out our survey on 9 March 2021, we were unable to implement the revised scale before rolling out the survey.

The significance of other terms did change after adding control variables in addition to the interactions. However, this is not unexpected, given that these terms now represent very specific reference categories. Moreover, analysing the wage variable via a continuous variable instead of dummy-variables did not change our conclusions.

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Sterkens, P., Baert, S., Moens, E. et al. I won’t make the same mistake again: burnout history and job preferences. J Popul Econ 37 , 2 (2024). https://doi.org/10.1007/s00148-024-00980-6

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ORIGINAL RESEARCH article

The impact of job burnout on employees’ safety behavior against the covid-19 pandemic: the mediating role of psychological contract.

• 1 Institute for Human Resource Management, Zhejiang University of Finance and Economics, Hangzhou, China
• 2 School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou, China

Employee safety behavior is critical for occupational health in work environments threatened by the COVID-19 pandemic. Meanwhile, the widespread and increasingly serious job burnout of employees is a complex and difficult problem for enterprises to handle during any epidemic. Therefore, it is helpful to identify and discuss job burnout and other main psychological factors that affect safety behavior to find appropriate solutions. Using the PLS-SEM method, the study explored the relationship between job burnout and safety behavior against the epidemic, as well as the mediating role of psychological contract. According to the local guidelines for controlling COVID-19, this study revised the safety behavior scale. Data were collected by structured questionnaires in May to July 2020 from Chinese employees ( N = 353) who resumed their work after the outbreak of the pandemic. The findings confirmed that job burnout has a negative impact on safety behavior, and psychological contract play a partial mediating role in mitigating the negative impact. Specifically, the transaction dimension and relationship dimension of psychological contract negatively affected safety behavior while the development dimension of the psychological contract was not directly related to safety behavior. It is suggested that enterprises should take effective measures to reduce employees’ job burnout and implement flexible psychological contract management and intervention, so as to effectively improve the performance of work safety behavior. Based on the multidimensional model, the findings of this study shed light on promoting safety behavior to prevent the spread of epidemics.

Introduction

With the worldwide spread of the COVID-19 pandemic and the dramatic economic policy response, the issues of restarting production have been rapidly brought to the fore. Many countries have stressed the need to restart much-needed business activities in response to the economic downturn brought about by the pandemic as the global economy seeks to develop smoothly and rapidly. However, this will undoubtedly lead to a large number of employees facing a high-risk and high mental stress ( Rodríguez-Rey et al., 2020 ).

Therefore, it is helpful to identify and discuss the main psychological factors that affect safety behavior to find appropriate solutions ( Canet-Juric et al., 2020 ). Because job burnout will affect the mental health and work behavior of employees, this has raised concerns not only for the possible aggravation of job burnout, but also for safety behavior performance during epidemics ( Du and Liu, 2020 ; Gómez-Salgado et al., 2020 ).

In June 2020, China effectively contained the rapid expansion of COVID-19 cases. Prevention and control emergency response levels had been downgraded in all regions. The government emphasized that to do a good job of normalizing prevention and control, it is necessary to improve the detection ability, implement precise prevention and control, and ensure the resumption of work in an all-around way. With the gradual resumption of work and production, the rate of returning to work in large and medium-sized enterprises has reached 94%, close to the normal level in previous years.

During the same period, the epidemic situation in some countries entered the stage of a plateau or decline, and epidemic prevention measures such as “city closure” adopted by European countries have begun to show the effects. Many countries are also aware of the need to restart much-needed business activities. However, enterprises in various countries are also faced with the dual pressure of carrying out difficult daily production activities and seriously preventing epidemic situations.

China has accumulated unique experience in dealing with this dual pressure. All the enterprises that have resumed working in China have undertaken the major responsibility of their own epidemic prevention and attached great importance to it in their daily management. It is suggested that the enterprises that start operating again should establish good epidemic prevention work plans and epidemic prevention emergency plans, reserve necessary epidemic prevention materials, conduct epidemic prevention publicity and education, and determine and supervise the epidemic prevention responsibilities of each employee. According to the relevant epidemic prevention regulations of China, the enterprises involved in resuming work bear an important responsibility for the prevention of the epidemic. If any enterprise cannot control the epidemic situation in their workplace, it will be asked by the local health authorities to immediately stop work and the local health authorities will assist in handling the issue. Then, the enterprises involved cannot start work again for at least 2 weeks.

Against this background, many Chinese enterprises of all sizes have taken extensive measures to ensure that the health of their employees is not endangered. They suggested that employees should do the following their work and lives: conduct daily self-health monitoring; wear a mask when working and do not touch the inside and outside surfaces of the mask with your hands when you remove it; keep their office areas and rest areas tidy and clean their work stations, including their desks, armrests, seats, etc., at least once a day; take staggered meals and talk less when eating; avoid participating in gathering activities, and do not go to crowded or poorly ventilated places, such as restaurants, shopping malls, etc.; and wash your hands immediately after touching public facilities or others’ objects in the workplace.

To keep their jobs in the economic downturn, most Chinese workers who resumed work began their daily work under the threat of COVID-19. They cautiously abided by various epidemic prevention regulations and suffered more physical and mental pressure than usual. This will undoubtedly aggravate the job burnout of employees and expand the risk of the epidemic spreading, which will be a serious threat to the safety of employees, enterprises and societal health. Therefore, employee participation in safety behavior is of great significance for maintaining workplace safety and reducing the risk of COVID-19.

This paper establishes a theoretical model based on the PLS-SEM method and uses the relevant survey data of Chinese employees to study the relationship between job burnout and safety behavior in an epidemic environment and the impact of psychological contract on this relationship. The purpose of this study is to determine the mechanism of individual and organizational psychological factors influencing employees’ safety behavior and to provide a theoretical basis for improving employees’ safety behavior against COVID-19. In view of Chinese unique practice and experience in controlling the spread of COVID-19 and resuming production, the conclusions of this study will not only enrich the relevant theoretical system, but also provide beneficial management ideas and practical references for occupational health and safety management in other countries.

Theoretical Analysis and Research Hypothesis

Safety behavior.

Safety behavior has two dimensions: safety compliance and safety participation ( Griffin and Neal, 2000 ). Safety compliance refers to the behavior of employees to ensure safety at work, such as complying with safety regulations and safety instructions. Safety participation is a kind of voluntary safety behavior beyond personal responsibility. For example, it includes proposing suggestions to improve safety and actively correcting the unsafe behaviors of colleagues.

Some literatures have studied of safety behavior from the perspective of personal characteristics. It was found that self-efficacy has a significant positive impact on safety compliance behavior and safety participation behavior, and perceived supervisor support positively moderates the relationship between self-efficacy and safety behavior ( Zhang et al., 2018 ). Moreover, self-efficacy, safety attitude, safety awareness, safety knowledge and other factors are correlated with safety participation behavior and safety obedience behavior, among which self-efficacy has the greatest influence on safety participation behavior, and safety awareness has the greatest influence on safety obedience behavior ( Zeng and Yang, 2016 ). Some previous studies have found that organizational behavior can affect employees’ safety behavior more widely ( Wang et al., 2015 ). The results of an empirical study showed that the safety climate, work pressure, risk perception and safety management are significantly related to safety participation behavior and safety compliance behavior. Among them, the safety climate has the greatest impact on safety participation behavior, and risk perception has the least impact on safety compliance behavior ( Wang and Yang, 2017 ).

Generally, safety behavior research is aimed at high-risk behaviors in some industries, such as the mining, transportation, smelting and chemical industries. Employee safety citizenship behavior is very important for workplace safety in high-risk industries. Wang et al. (2020) stated that it is necessary for managers to encourage employees’ safe citizenship behavior and to deal with stressful situations by strengthening safety trust intervention measures. To explore the safety behavior path, a theoretical model that was a function of both human resource management and psychological security was built for miners’ safety behavior ( Wang et al., 2017 ). The results showed that psychological security has an obvious adjustment effect on safety behavior. In addition, the level of sense of psychological safety slowly increases the positive influence of safety compliance behavior and accelerates the reduction of the negative impact of safety participation behavior. The results also showed that wages, education and training have direct impacts on the psychological safety and safety compliance behavior of employees. From the perspective of interpersonal relationships, constructed a theoretical model of the relationship between the quality of employee relationships and the influence of safety behavior that takes job involvement as the mediating variable ( Wang and Lu, 2019 ). The results showed that all dimensions of employee relationship quality in coal mining enterprises have a significant positive impact on safety compliance and participation behavior, among which satisfaction and trust have the most significant impacts. All dimensions of employee relationship quality have a positive impact on employee engagement, but the impacts of trust and commitment are obvious. Job involvement has a positive impact on safety compliance and participation behavior. Job involvement is a mediating variable between employee relationship quality and safety behavior. Construction workers are occupational groups with high risk and extreme mental stress, and their psychological capital will affect their mental health, job performance and safety behavior. He et al. (2019) found that the self-efficacy dimension of psychological capital has a positive impact on safety compliance and safety participation, and the resilience dimension has a positive impact on safety participation. In addition, communication competence plays a mediating role between the hope and optimism dimensions of psychological capital and safety participation.

In short, the concern and management of employees’ safety behavior in enterprises can effectively improve employees’ safety behavior and reduce the risk of harm. Safety behavior, as an action of employees that directly affects the workplace and their own safety at work, is the last link to determine the safety of enterprises, and will inevitably be influenced by many factors. However, when COVID-19 may threaten the production and service of enterprises for a long time, employees should always be alert to the threat of epidemic situation while ensuring normal work, which may lead to anxiety, depression, etc., and thus affect safety behavior. Therefore, under the background of epidemic prevention, it is particularly important to continuously improve employees’ safety behavior, and it is also necessary to explore whether there are certain antecedents that will affect employees’ safety behavior in epidemic prevention.

Job Burnout and Safety Behavior

Job burnout is mainly reflectes in emotional exhaustion, depersonalization and low personal accomplishment, which will undoubtedly affect the personal behavioral effect of work. Resource conservation theory points out that employees who are burnout will consume more existing resources to adjust the fatigue, and if the resource consumption can’t be replenished in time, employees will fall into a vicious circle of insufficient resource supply, and employees will lack enough energy to work seriously, and even express their dissatisfaction through some negative attitudes or behaviors at work. Job burnout could result in a number of dysfunctional attitudes affecting individual employee behavior and organizational performance, including depression, negative orientations toward colleagues, reduced job performance, organizational commitment and job satisfaction ( Kalliath, 2003 ; Swider and Zimmerman, 2010 ). Numerous studies have examined the common phenomenon and consequences of job burnout in the modern workplace ( Jia, 2015 ; Liu et al., 2016 ; Sun et al., 2020 ). Therefore, what is the impact of job burnout in the workplace, and how does it specifically affect employee safety behavior?

Workplace stressors can lead to job burnout, and job burnout is a kind of psychological reaction to long-term exposure to stressors. Organizational change in the changing environment may form new work stressors, which will lead to negative health consequences for employees ( Day et al., 2017 ; White et al., 2020 ). Chen and Ye (2020) constructed a conceptual model of young employees’ job burnout to clarify the influencing factors and structural dimensions of young employees’ job burnout. The conceptual model described the action paths of a combination of job burnout factors, revealed that the mismatch between individual factors and job situational factors is the root cause of job burnout. The occurrence or existence of factors that negatively affect the work environment and increase work pressure, and this will aggravate job burnout and affect the job performance of employees ( Singh and Singh, 2018 ). Taking 120 nursing staff members as the research object, Li (2013) compared the influence of different degrees of job burnout on work efficiency. The results showed that the nursing quality, patient satisfaction and nurse satisfaction of the mild burnout group were significantly higher than those of the moderate burnout group and high burnout group, and nursing defects were significantly lower in the mild burnout group than those of the moderate burnout and high burnout groups. Furthermore, it was found that job burnout also affects employee safety behavior. Workload, management style and lack of work control have significant effects on psychological stress ( Hao and Ye, 2020 ). Psychological stress also affects the safety compliance and safety participation of employees. Further research showed that psychological stress plays a significant mediating role in the relationship between job antecedents and safety compliance and safety participation ( Wong and Chan, 2020 ).

In summary, job burnout has a negative impact on job engagement, work efficiency, safety compliance and safety participation. The current epidemic situation caused by COVID-19 is a serious threat to people’s health and life safety, which will undoubtedly increase the mental and physical burdens of employees, aggravate job burnout, and have adverse effects on mood and health, as well as negatively affect employees’ work behavior. Therefore, the following hypothesis was proposed:

H1: Job burnout negatively affects employees’ safety behavior during the COVID-19.

Job Burnout and Psychological Contract

Job burnout not only affects the behavior of employees, but it also dynamically affects their work emotions. It also affects the various beliefs regarding the responsibilities and obligations of employees and organizations ( Conway and Briner, 2002 ; Huang et al., 2014 ). Job burnout will reduce work ability and increase turnover intention, and work ability and turnover intention will affect job burnout. Turnover intention is positively correlated with emotional exhaustion and depersonalization of job burnout and negatively correlated with low personal accomplishment ( Li et al., 2019 ). There is a significant negative effect of job stress on job engagement, and job burnout has a greater indirect impact on job engagement ( Chambel and Oliveira-Cruz, 2010 ). Gao and Liu (2018) found that job burnout has a negative impact on job embedding and that subjective wellbeing has an intermediary role between them. Klein et al. (2020) found that there is a high correlation between work stressors and job burnout.

The concept of psychological contract emphasizes the existence and restriction of unwritten contracts and joint commitment between employers and employees. Most of the existing researches divided psychological contract into three dimensions: transaction, relationship and development. Transaction dimension emphasizes that employees expect economic returns such as salary and welfare, which is the comparative basic contract level; relationship dimension means that employees expect a good working atmosphere and harmonious interpersonal relationships in the organization, and they hope to be satisfied in the aspects of spiritual belonging and social interaction; development dimension is that employees want to get the promotion of positions, the promotion of professionalism or a bigger and better career development space, etc., which is a higher-level contractual pursuit. Because the three dimensions of psychological contract are generally progressive and have little relevance, they are generally discussed separately in research. However, besides the influence of the organization, the generation of psychological contract will also be influenced by the employees’ own emotions and state, and the job burnout caused by the high pressure of epidemic and severe situation during COVID-19 may make employees feel that the degree of achievement of psychological contract is not high, and even make employees neglect their attention to psychological contract. Supported by the above, the following were hypothesized:

H2a: Job burnout negatively affects the transaction dimension of psychological contract during COVID-19.

H2b: Job burnout negatively affects the relationship dimension of psychological contract during COVID-19.

H2c: Job burnout negatively affects the development dimension of psychological contract during COVID-19.

Psychological Contract and Safety Behavior

Zhang and Li (2006) used the psychological contract framework to explore the fulfillment of the psychological contract and its consequences for organizational citizenship behavior. The analysis found that affective commitment plays a critical role in mediating psychological contract fulfillment, organizational citizenship behavior, etc. Zhang and Li (2017) found that the violation of psychological contract has a significant negative predictive effect on safety compliance behavior and safety participation behavior, and perceived organizational support plays a moderating role in the relationships between psychological contract violations and safety compliance behavior and safety participation behavior. Psychological security refers to the employees’ shared belief that the organization is a safe environment for members to express themselves without fear, embarrassment and punishment or other negative consequences in relation to their wellbeing, self-image and status ( Edmondson, 1999 ). The sense of belonging, related to an individual’s experience of participating in a system or environment, makes people feel that they are an integral part of the environment or system. This concept embodies the sense of being valued, needed or accepted by a group, system or environment. Trust in organizational security has no direct and significant effect on security participation behavior ( Conway and Coyle-Shapiro, 2012 ; Newaz et al., 2019 ), but psychological security and sense of belonging can mediate the relationship between trust in organizational security and security participation behavior ( Liu et al., 2020 ).

Wang and Dong (2014) divided the formation process of psychological contract into three stages, including production, performance and realization; and established a relationship model between psychological contract and safety behavior. Enterprises could cultivate the safety behavior of employees by designing reasonable incentive mechanisms, conducting regular communication at the level of psychological contract and creating a safe and fair organizational atmosphere. According to the social exchange theory and the resource conservation theory, if the enterprise can guarantee the achievement of employees’ psychological contract, then employees will feel that they have been valued and given preferential treatment, and will have a sense of satisfaction and belonging psychologically. For the purpose of repaying the organization, they will abide by the regulations of the organization and take positive actions for the development of the organization, and they will also feel that they have more external and internal resources to work hard. In the environment of epidemic prevention, the achievement of employees’ psychological contract can make employees show more active safety behaviors to maintain the smooth operation of the organization, which is beneficial to the safety of production and service of enterprises. Supported by the above, the following were hypothesized:

H3a: The transaction dimension of psychological contract positively affects employees’ safety behavior during the COVID-19.

H3b: The relationship dimension of psychological contract positively affects employees’ safety behavior during the COVID-19.

H3c: The development dimension of psychological contract positively affects employees’ safety behavior during the COVID-19.

Based on the above theoretical combing and research hypothesis, this study puts forward a research model of the relationship between related research variables under the epidemic background, as shown in Figure 1 .

Figure 1. Research hypothesis model diagram.

Methodology

Questionnaire design and collection.

Demographic variables such as gender, age, educational background, the nature of the enterprise, industry, position, working years and time of starting work after the outbreak of COVID-19 in 2020 were selected as control variables. Questionnaire items of job burnout, psychological contract and safe behavior are all based on maturity scale. The job burnout scale developed by Li and Shi (2003) has been proven to have high reliability and validity. The reliability of each dimension of the original scale was above 0.8. This study used this scale for investigation, there are 15 items in the whole scale. Nine of them adopt positive scoring, such as “I believe that I can effectively complete the work”; and the other 6 items adopt the reverse scoring method, such as “Too much work makes me feel stressed.” Based on the psychological contract scale proposed by Chinese scholars ( Zhang and Li, 2006 ; Sha, 2020 ), measured the variable in three dimensions, and the reliability of each dimension of the original scale was above 0.8. The scale consists of 13 items, all of which have positive scores. For example, “The company provides stable job security for employees.”

The scale of safe behavior referred to the scales used by Neal et al. (2000) , discussed the items of the scale with three safety experts and two human resource management experts, and modified some items according to the requirements of COVID-19 epidemic prevention. It is subdivided into safety compliance behavior and safety participation behavior. The former includes the first to the fourth measurement items, and the latter includes the fifth to the ninth measurement items ( Table 1 ).

Table 1. Safety behavior scale.

In this study, all items of three core variables were measured on a five-point Likert scale ranging from “1 = strongly disagree” to “5 = strongly agree.” From May to July in 2020, an anonymous questionnaire survey was conducted among enterprise employees who have returned to work in 17 cities of 6 provinces in China. Because the epidemic situation in China was basically controlled at this stage, and more effective methods of prevention and control of the epidemic situation in COVID-19 were found, the questionnaire collected can better reflect the situation of prevention and control of COVID-19 in most Chinese enterprises at that time. However, as the overall situation of prevention and control is still severe, researchers are affected by the prevention and control policies, and can’t visit enterprises too much. The questionnaire is collected mainly online and supplemented by offline. In this study, a total of 406 questionnaires were distributed, and finally 373 questionnaires were returned. After eliminating invalid questionnaires such as incomplete filling and identical filling contents, a total of 353 valid questionnaires were obtained for analysis.

Statistical Methods

Because the purpose of this study is to explore the predictive ability of job burnout for prevention behavior through psychological contract and to provide theoretical guidance for the prevention of COVID-19, this study conducts exploratory research rather than pursuing the best model parameter estimation results. Compared with the covariance-based structural equation model, which has been widely accepted by researchers, the Partial Least Squares Structural Equation Model (PLS -SEM) has the advantages of being suitable for exploratory research to analyze complex models, extract orthogonal factors with zero correlation factors and predict dependent variables conveniently and flexibly ( Sarstedt et al., 2014 ; Xiao, 2018 ). Therefore, this study uses Smart PLS 2.0 to construct the PLS-SEM to test the hypotheses proposed above ( Davcik, 2014 ). It can directly obtain the R 2 and explain the variance of the dependent variables to the maximum extent so as to enhance the accuracy of the exploratory research and data analysis.

In this paper, SPSS version 22 was used for the descriptive statistical analysis, group analysis and the common method bias, and the reliability and validity of the samples were analyzed by Smart PLS 2.0. Finally, the main effect and intermediary effect of this study were tested.

Sample Analysis

Firstly, several important demographic variables are analyzed and summarized. Regarding the gender distribution, there were 155 males (43.9%) and 198 females (56.1%). The gender distribution is relatively balanced, which is in line with the high employment rate of Chinese women. Among the age groups, the most concentrated age group is from 21 to 50 years old, accounting for 94.6%, which showed that middle-aged and young people are the main employment groups during the epidemic. Because most of the subjects are front-line workers, few managers and technicians, most of the subjects have a low level of education. The specific data are shown in Table 2 .

Table 2. Demographic analysis ( N = 353).

The research also discusses the influence of demographic variables such as age, gender, enterprise nature and working years on the research variables in groups. The results show that there are significant differences in job burnout among employees of different ages, and three dimensions of psychological contract in working years. Other demographic variables have no significant influence on the research variables.

The significant P -value of age on job burnout is 0.012. The job burnout of employees aged 51 and above is significantly different from other age groups, and the order from high to low is 21–30 years old, 20 years old and below, 31–40 years old and 41–50 years old. It can be seen that in the process of epidemic prevention, older employees are more prone to job burnout than younger. Because faced with the great pressure of epidemic prevention, it will inevitably consume more physical and mental energy, and older employees can’t have enough energy and physical strength to adjust like young employees, which will easily lead to job burnout. The significant P -values of working years on transaction dimension, relationship dimension and development dimension are 0.035, 0.006 and 0.000, respectively. Employees who working more than 10 years are significantly different from other seniority levels, among which employees with 6–10 years have the largest gap, followed by less than 1 year and 1–5 years. This is also in line with the development process that employees’ psychological contracts gradually increase to the peak after they enter the organization, and then they are no longer full of expectations for the organizational contracts.

Reliability and Validity Analysis

The common method bias of data will lead to a false relationship between research constructs. Harman’s single factor method suggested that after exploratory factor analysis, if the variance explanation of the first factor was more than 50%, the common method bias problem is not serious. In this study, SPSS 22.0 is used to conduct the overall exploratory factor analysis on the data of all items. The variance explained by the first factor was 47.577%, which was less than 50%, indicating that CMB was within the acceptable range.

The reliability of the questionnaire is mainly used to test the internal consistency of the results of the questionnaire measurement. In this paper, Cronbach’s alpha coefficient was used to measure the internal structure of the scale and the consistency of the measurement items. Cronbach’s alpha coefficient is acceptable as long as it reaches 0.70, 0.70–0.98 indicating high reliability, and below 0.35 indicating low reliability, which must be rejected. Then, the Kaiser-Meyer-Olkin (KMO) value is performed to determine whether the scale is suitable for factor analysis. When KMO value is greater than 0.9, it is very suitable; 0.7–0.8 means acceptable; below 0.6 is not suitable.

In this paper, the items of the safe behavior scale were reformed based on the epidemic situation, so the scale was specially tested. The results show that KMO = 0.912 and sig. = 0.00, which mean that the reliability of this scale is very high and very suitable for factor analysis. Then, we obtained the factor loading matrix of the scale after rotation, found that there are two factors in the safety behavior with clear structure, as shown in Table 3 .

Table 3. Factor load matrix after rotation: safety behavior scale.

According to Table 3 , factor 1 is the safety compliance dimension of safety behavior, including Q1, Q2, Q3, Q4, and Q5, although Q5 was originally assigned to factor 2; and factor 2 is the safety participation dimension of safety behavior, including Q6, Q7, Q8, and Q9. The loads of the two factors are greater than 0.5, and the cumulative variance that is explained by the factors is 70.059%, which verifies the two-dimensional division method of safety behavior adopted in this paper.

However, Davcik stated that the evaluation of Cronbach’s alpha coefficient is based on an impossible premise, that is, the reliability of all items is tau-equivalent; therefore, he suggested that researchers use the composite reliability (C.R.) instead, C.R. = (Σλ) 2 /((Σλ 2 ) + Σδ). In general, the value of C.R. should be greater than 0.7 ( Hair et al., 2010 ). Table 4 shows the C.R., standardized path load (β) of the reflection index and average variance extracted (AVE) of all latent variables. AVE is used to measure validity, the formula is AVE = (Σλ 2 )/n. The table shows that the standardized path load of all external models is greater than 0.7, and the C.R. is greater than 0.8; therefore, the reliability of the questionnaire is relatively ideal.

Table 4. SEM analysis ( N = 353).

The convergent validity of latent variables can be evaluated by their factor loading, AVE and C.R. ( Hair et al., 2010 ; Shiau and Luo, 2013 ). It can be seen from Table 4 that all the factor loadings in this study are greater than 0.7; each AVE of these facets is greater than the recommended threshold value of 0.5; and each C.R. is greater than 0.8. Therefore, the convergent validity was supported by the test.

Hair et al. (2012 , 2013) suggests that there are two steps to test the discriminative validity of the model: first, test the cross loadings of the observed variables; second, the AVE square root of the latent variable in the first-order model is compared with its correlation coefficient with other latent variables. The results can be seen in Tables 5 , 6 .

Table 5. Cross loading of variables ( N = 353).

Table 6. Correlation coefficient and AVE square root between variables ( N = 353).

As shown in Table 5 , the reflected index loads of all latent variables are greater than the value when they interact with other latent variables. It can be preliminarily concluded that there is an ideal differentiation between the latent variables.

As shown in Table 6 , the values on the diagonals in the table are greater than the absolute values on the corresponding horizontal and vertical columns. Therefore, it can be considered that each latent variable has good discriminant validity. From the statistical results in Table 6 , it also can be seen that there is a significant correlation between the variables and their dimensions, which is pairwise correlation. Among them, job burnout has a significant negative correlation with the three dimensions of psychological contract and safety behavior, while the three dimensions of psychological contract have a significant positive correlation with safety behavior.

Structural Model

This study used the path weighting scheme to estimate the standardized path coefficient of the model because the path weighting scheme can obtain the highest explanatory power. The coefficient of determination ( R 2 ) of safety behavior is 0.415. The analysis results of the path coefficient are shown in Table 7 .

Table 7. Standardized path coefficient ( N = 353).

First, the path coefficients of job burnout to the transaction dimension, relationship dimension, development dimension and safety behavior are significantly negative; therefore, H1, H2a, H2b, and H2c were verified. Second, the path coefficients of the transaction dimension and relationship dimension to safety behavior are positive and significant at the 0.01 significance level while the path coefficient of the development dimension to safety behavior is not significant. Therefore, H3a and H3b were verified, and H3c was not.

According to the previous path estimation results, only the significance of each path coefficient can be obtained. Whether the three dimensions of psychological contract can effectively mediate the effect of job burnout on COVID-19 safety behavior can be further tested. First, the effect of the development dimension on safety behavior is not significant, so the mediating effect of the development dimension on safety behavior and job burnout is not significant. Second, in other paths, whether the transaction dimension and relationship dimension effectively mediate the effect of job burnout and safety behavior cannot be concluded only by observing the above path coefficients, but rather they should be evaluated via calculations. According to the intermediary effect test process proposed by Zhao et al. (2010) , PLS-SEM was used to analyze the output results, and the results are as follows: (1) The indirect effect of the transaction dimension on safety behavior (−0.614 * 0.178 = −0.109, t = 2.754) reached a significant level, indicating that there is a mediating effect; and the direct effect of job burnout on safety behavior was −0.288 ( t = 4.949), reaching a significant level (see Figure 2 ), which indicating that there is a partial mediating effect. Because −0.614 * 0.178 * −0.288 > 0, it is a competitive intermediary effect. (2) The indirect effect of the relationship dimension on safety behavior (−0.547 *0.199 = −0.109, t = 2.778) is significant, which means that there is a mediating effect; and the direct effect of job burnout on safety behavior is −0.288 ( t = 4.949), indicating that there is a partial mediating effect. Since −0.547 *0.199 * −0.288 > 0, it also indicates that it is a competitive intermediary effect. The specific data are shown in Table 8 .

Figure 2. Influence path coefficient. N =353; N.S. is not significant at the significance level of 0.5; ** and *** are significant at the significance level of 0.01 and 0.001, respectively.

Table 8. Results of mediating effect ( N = 353).

Under the specific background that COVID-19 mercilessly threatens people, the relationship among job burnout, psychological contract (transaction dimension, relationship dimension, and development dimension) and safety behavior was studied using the PLS-SEM. The χ 2 /df value of the structural equation model is 3.291 < 5, RMSEA value is 0.067 < 0.08, GFI = 0.876, CFI = 0.903, the values of IFI and TLI are all greater than 0.9. According to the output index of the model fitting, the fitting degree of the models is not very good, but overall, it is still in an acceptable range. The applicability and effectiveness of the job burnout—psychological contract—safety behavior model in the Chinese context was verified. The final causal model is shown in Figure 2 .

According to the result of Figure 2 , the main conclusions of this study are as follows: job burnout affects epidemic prevention safety behavior, and it is significant at 0.001 level, with an estimated value is −0.288. Job burnout negatively affects three dimensions of psychological contract: transaction dimension, relationship dimension and development dimension. The significance level is above 0.001, and its estimated values are −0.614, −0.547, and −0.548 respectively. The three dimensions of psychological contract have positive influence on epidemic prevention safety behavior, with estimated values of 0.178, 0.199, and 0.144 respectively. The significance level of transaction dimension and relationship dimension on epidemic prevention safety behavior is 0.005, but the development dimension has no significant influence on epidemic prevention safety behavior. Moreover, the transaction dimension and relationship dimension of psychological contract play a partial mediating role between job burnout and safe behavior, while the development dimension has no mediating role.

Discussion and Conclusion

First, as shown in Figure 2 , in the process of preventing and controlling COVID-19 in enterprises, job burnout accounted for 37.7, 29.9, and 30% of the three dimensions of psychological contract, namely, the transaction dimension, relationship dimension and development dimension, respectively. Job burnout is partially mediated by psychological contract, as well as directly influenced, and its explanatory ability to epidemiological prevention safety behavior is 46.3%. It is confirmed that job burnout negatively affects employees’ safety behavior in the process of preventing and controlling COVID-19 and producing, and psychological contract can play a part of intermediary role to alleviate this negative impact.

Second, during COVID-19, the severe situation of epidemic prevention and the unrelenting characteristics will increase the psychological pressure of employees, and it is easy for employees to get tired. Job burnout in this environment may cause employees to ignore some safety and epidemic prevention norms, thus showing behaviors that are not conducive to enterprise safety. These negative effects can easily cause human errors in work, relax the compliance with safety behavior standards, and eventually decrease the enterprise epidemic prevention effect. Therefore, the problem of job burnout during the epidemic period should be paid more attention and addressed better than usual.

Third, in the process of preventing COVID-19 in enterprises, the relationship dimension of psychological contract has the greatest mediating effect among the three dimensions, which indicates that in a public health crisis, the most important thing for a company is to treat each employee sincerely and respect employees. The transaction dimension is also very influential, which proves that if the company can provide competitive compensation and a safe working environment, it can also promote the safety behavior of employees in the process of epidemic prevention. In contrast, the development dimension usually focuses more on personal long-term growth and career development, training and promotion opportunities; therefore, it has no obvious relationship with the short-term epidemic prevention and emergency response behavior of employees. Thus, we should give full play to the positive role of psychological contract during the epidemic period. By improving the quality of the communication between leaders and subordinates in the company’s epidemic prevention management, organizations can provide effective situational support to reduce employees’ job burnout.

Significance and Future Research

Based on the principles of applied psychology and the concept of safety behavior, this study constructed a theoretical framework and applied it to epidemic prevention and production safety, and the results provided occupational health countermeasures for enterprises to reduce the occurrence of epidemics.

This study makes several contributions. First, based on the unprecedented COVID-19 epidemic prevention background, we established a research model to observe and improve the safety behavior of employees. Second, according to the specific prevention and control behavior related to the epidemic, this study improved the existing safety behavior scale and provided a reference tool for similar research in the future. Third, studying the adverse effect of job burnout on employees’ safety behavior helps to understand the psychological mechanism of individual safety behavior. It is found that there are different impacts of the subdimensions of psychological contract on safety behavior, which indicate the complexity of the interactions among job burnout, psychological contract and safety behavior and highlights the necessity of multidimensional psychological contract intervention. Finally, the mediating role of psychological contract between job burnout and safety behavior provides the opportunity to better explain the psychological behavior process and reduce the risk of workplace epidemics.

More importantly, the research reported in this paper enriches the current body of knowledge by examining the impacts of job burnout on employees’ safety behavior and the mediating role of psychological contract. It provides theoretical guidance and practical suggestions for enterprises to establish appropriate strategies when a public health crisis occurs in the workplace.

However, there are some deficiencies in this study. First, since our cross-sectional study is based on survey data during a large-scale infectious disaster, the conclusions need to be confirmed by prospective cohort studies. Therefore, we suggest that a longitudinal design should be used in future studies to evaluate the research findings. Second, the universality of the conclusion needs further demonstration. Our investigation is limited to the specific period of China, and the revision of the safety behavior scale only referred to the epidemic prevention behavior of Chinese enterprises. In order to test the universality of the proposed model and the improved scale, future research should use employees from other countries and regions as samples for comparative analysis. Third, our model only studies the relationship between finite variables. Therefore, future research can study more variables in the context of public health safety and establish a variety of models involving multiple variables such as workplace epidemic risk, emotional stressors, organizational intervention, and proactive and prosocial safety behavior. Finally, since the three dimensions of psychological contract represent employees’ job pursuit and expectation at different levels respectively, this study adopts the way of sub-dimensions to make assumptions about this variable. Future research can explore the overall role of this variable to test the universality of the intermediary role of psychological contract under similar research background. And future research may focus on how the mental state of employees changes over time and how it affects safety behavior in epidemic prevention. Based on this dynamic relationship, safety management can promote flexible safety measures to elevate safety performance in the workplace.

We must admit that widespread and increasingly serious job burnout is a complex and difficult problem for enterprises to address during any epidemic. This study explored the safety behavior mechanism of COVID-19 under the influence of two important psychological factors. The results of this study show that job burnout will negatively affect the work of employees and increase the possibility of unsafe behaviors among employees, which will have adverse impacts on the safety status of employees. However, in the process of preventing and controlling COVID-19 in enterprises, psychological contract can weaken the potential for unsafe behaviors by employees due to job burnout. If the organization attaches importance to the establishment of emotional trust and effectively connects employees with the organization, it can ensure the conscious and good implementation of epidemic prevention and safety behavior.

In order to address COVID-19 or other similar public health crises, enterprises can provide material resources and social support for employees to alleviate their job burnout. For example, different support projects and activities can be carried out to alleviate the negative emotions of employees, form an organizational atmosphere of humanistic care, and improve employees’ positive work emotions. This helps them to build a sense of trust and belonging at work and to better perform safe behavior.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Author Contributions

HL, YD, and HZ conceived the idea, designed the study, and prepared the first draft and revised it. HZ and YD collected and analyzed the data. HL collected data and edited the original manuscript. All authors have approved the final version.

This research was funded by the National-sponsored Funding Program for Social Sciences of China (Grant No. 18BGL198).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords : job burnout, psychological contract, safety behavior, COVID-19, epidemic prevention

Citation: Liu H, Du Y and Zhou H (2022) The Impact of Job Burnout on Employees’ Safety Behavior Against the COVID-19 Pandemic: The Mediating Role of Psychological Contract. Front. Psychol. 13:618877. doi: 10.3389/fpsyg.2022.618877

Received: 18 October 2020; Accepted: 12 January 2022; Published: 24 February 2022.

Reviewed by:

Copyright © 2022 Liu, Du and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Huiwen Zhou, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Self-care can’t fix employee burnout, burnout is not an individual problem but an organizational one, which calls for changes in a workplace's structures, policies, and norms..

Imagine: It’s Monday morning and your alarm goes off. You hit snooze three times, desperate to extend the weekend. Finally, you open your eyes and, when you get up, you feel as though you’re pushing against a huge amount of weight. You just woke up, but you already feel exhausted. With just enough time to guzzle down some coffee, you pull out your phone to survey your to-do list for the day, but it only reminds you of how unproductive you’ve felt lately.

According to a 2020 survey , it’s likely an estimated 42% of you reading this don’t have to imagine that scenario, because you’re living it. You’re experiencing work-related burnout.

And you’re not alone. I mean that literally, not metaphorically. If you are experiencing burnout in your workplace, there are likely other colleagues feeling similarly. Although burnout can feel very isolating, the fact that it tends to operate in multiples—across many people, teams, departments—makes it an organizational issue.

Burnout is not an individual problem requiring personal coping mechanisms. It’s a structural one that demands organizational change.

Understanding burnout

Burnout is a form of chronic stress. The most basic definition of stress is our biological and psychological response to a demand for change.

For example, perhaps you’re working on completing a report—and a colleague walks in and asks you to proofread something they’re working on. If you have the mental and physical resources to respond to the request, then you typically would not experience an adverse stress response. But if your report is due in 15 minutes, your response to that demand will likely be quite different, triggering a stress response, as the body shifts resources to face a threat. The adrenal glands release adrenaline and cortisol, which speeds up our breathing and heart, dilates blood vessels, and pumps sugar energy into the bloodstream.

Stress becomes chronic when we experience it over an extended period of time (over the course of months or even years) or repeatedly (say, on a weekly basis). The result, burnout, tends to manifest itself along three criteria : emotional exhaustion, cynicism, and reduced productivity.

In the work I do with organizations focused on improving employee well-being, stress often comes up as an issue. We’ve observed in our organizational well-being research that clients with higher employee stress tend to have lower employee well-being in areas like psychological safety, belonging, and esteem.

Organizations typically respond to employee stress with “helpful” individual-level tips for employees, like breathing exercises or gratitude practices. While there’s certainly nothing wrong with trying to build our resilience or develop coping mechanisms to manage stress, these steps rarely address the root causes of the burnout.

That’s because job-related burnout is structural, rooted in the context of the organizational environment, specifically the organization’s systems, policies, procedures, and norms. According to a 2020 paper, “ Job Burnout: A General Literature Review ,” burnout can result from one or more of the following causes: workload, lack of job control, and lack of an effective performance management system. Each of these is rooted in the organization, not the individual.

At Yes Wellbeing Works , we explored each of these dimensions of burnout through employee focus groups. Here’s what we’ve discovered about each one—and what employers can do to address them.

1. Workload

“Because everyone on my team works seven days a week to keep up, it’s become the norm,” said one focus group participant. “So much so that when I try not to work on Sunday, I look and feel like I’m not a team player.”

How could that norm not result in burnout? Why is this team experiencing so much work that they feel they have to work seven days a week, every week? Here are some questions for managers to ask:

• Do the cognitive demands of the work exceed the amount of time allocated to complete it? Or is the process to complete the work arduous and repetitive? Then that is likely a work design problem. In other words, how are internal processes, procedures, and performance goals set? What’s not being considered?
• Is the team understaffed? Did someone resign—and was the workload of that person just redistributed instead of triaged for only the most important tasks until they were replaced? If so, then that may be an organizational design problem. What is the structure of the team? How are roles defined? Which tasks drive the organizational impact of each role?
• Is the team being asked to do more with less people in order to increase profits (private sector) or retain limited financial resources (non-profit)? This tracks with a challenge with the organization’s financial strategy. What is the organization’s strategy to maximize financial resources? Does that strategy ask too much of employees?

These can be hard problems for organizations to solve—but the important thing to understand is that none of them have to do with any one employee.

2. Lack of job control

“When a key process is changed, we are never consulted, yet we are the ones who have the most experience actually doing the work,” said another focus-group participant. “Then there’s all these problems that come up due to the change that we could have prevented if asked in advance.”

Adult professionals tend to work best when they can work autonomously . When that need is met, they report higher levels of overall well-being and productivity. That’s because having control over how you do your job expands the possible solutions you can use to manage work demands and solve problems. Lack of control contracts those possibilities, potentially making the job harder and causing stress.

Feelings of job control relate to the extent to which employees believe they can make decisions about how they approach their work or have influence over decisions about their work. For example, while many employees in American organizations are classified as full-time exempt employees, who are paid for their output, they can sometimes be managed as though they are paid by the hour. That would be an example of restricted job control.

Some jobs do require repetitive action and regimented processes for completion, as in the manufacturing space. Even in that case, however, there are almost certainly opportunities for feedback and control. In almost all cases, managers decide how much control employees have over their work. The collective behaviors of managers in an organization combine to form the organization’s management system—the people policies, procedures, and behaviors used to achieve the goals of the organization.

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When the management system is designed to primarily serve managers and not the employees, more restrictive forms of management can prevail, limiting job control, stifling creativity, and inducing more stress. Conversely, employee-centric management—an approach based on the individual employee—encourages job control through skill building, growth opportunities, and trust.

3. Lack of an effective performance management system

“If you’re doing a good job, it’s quiet. If you’re not doing a good job, it’s not quiet. We only get feedback in crisis.”

A performance management system goes beyond the annual performance review. Performance management systems are a set of internal tools and procedures that help align organizational outcomes with employee performance. Organizations set (or forget) performance management systems, not employees.

These systems consist of clearly articulated job descriptions, where roles and expectations are spelled out; if not, employees have to invest extra energy to figure out what their contribution should be in the organization. Every employee also needs ways to give and receive feedback regularly throughout the year, as well as a system for rewards and recognition of performance that can have a positive impact on their well-being, the opposite effect of burnout.

In most organizations, the decisions that drive burnout are accepted as fact, best practices, or norms. That’s what’s sneaky about structure—it can have a huge impact without ever being critically analyzed. While individual-level coping mechanisms can perhaps extend the bandwidth of employees ever so slightly, they cannot address the systemic forces that often drive employee burnout. And, let’s be honest, resiliency shouldn’t have to be a permanent professional strategy.

So what should we do?

If you’re an individual employee reading this, then my advice is always to, yes, try to take care of yourself—and if your organization isn’t addressing the issues driving burnout, then it may be time to look for other employment opportunities.

If you’re an organizational leader who has the authority to change the pattern of employee stress in your organization, then commit to taking and catalyzing action internally. We can no longer view employee stress as an individual issue or indicative of someone’s capacity to “cut it.”; that is not a view supported by research. Yes, individual personality factors and personal support resources can make burnout more likely—but that cannot explain the epidemic of employee stress we are currently experiencing, which ranges from 42% to 79% depending on the source.

The bottom line is this: Before you blame yourself or an employee for burning out, first take a hard look at workload, job control, and the performance management system. It’s likely the structure is broken, not the people—and if you don’t fix the structure, you can burn out even more of your people.

About the Author

Shanna B. Tiayon

Shanna B. Tiayon, Ph.D. , also known as “The Wellbeing Dr.,” is a writer, speaker, and trainer working in the area of well-being. Currently, Shanna is the owner of WellbeingWorks , LLC, a boutique well-being firm bringing together the best interdisciplinary knowledge in the areas of social psychology, human resources, research, and training design.

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• Yonsei Med J
• v.59(2); 2018 Mar 1

Emotional Labor and Burnout: A Review of the Literature

Da-yee jeung.

1 Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

2 Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

Changsoo Kim

3 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Sei-Jin Chang

This literature review was conducted to investigate the association between emotional labor and burnout and to explore the role of personality in this relationship. The results of this review indicate that emotional labor is a job stressor that leads to burnout. Further examination of personality traits, such as self-efficacy and type A behavior pattern, is needed to understand the relationships between emotional labor and health outcomes, such as burnout, psychological distress, and depression. The results also emphasized the importance of stress management programs to reduce the adverse outcomes of emotional labor, as well as coping repertories to strengthen the personal potential suitable to organizational goals. Moreover, enhancing employees' capacities and competence and encouraging a positive personality through behavior modification are also necessary.

INTRODUCTION

Job stress is now a much-discussed topic and has drawn the focus of popular media. It can lead to negative physiological, psychological, and behavioral responses among employees. 1 , 2 , 3 With the expansion of service industries, emotional labor has emerged as a new job stressor. When employees regulate or suppress their emotions in exchange for wages, they are considered to be performing emotional labor.

The service industry plays a crucial role in today's world economies. Indeed, service activities now exceed approximately 70% of the gross domestic product (GDP) in the United States, as well as in European countries. 4 Thus, emotional labor is likely to be common among most employees across several vocational fields, not just those that entail services to the public. Morris and Feldman 5 indicated that the significance of emotional labor has been acknowledged in a variety of occupations. Today, most organizations manage or regulate employees' emotions in order to accomplish their organizational goals. These regulations and requirements have been found to be more prevalent in jobs that demand constant interactions with customers or clients.

This literature review was performed to demonstrate the association between emotional labor and burnout and to investigate the role of personality traits, such as self-efficacy and type A behavior pattern (TABP), in this relationship.

DEFINITIONS OF EMOTIONAL LABOR

Beginning with the work by Hochschild, 6 literature on emotional labor has grown immensely in the last three decades. 7 , 8 The term “emotional labor” is appropriate only when emotional work is exchanged for something, such as wages or some other type of valued compensation. Wharton 9 remarked that such work is not only performed for wages, but also under the control of others. However, despite remarkable progress in academic research on emotional labor, some important questions remain unsolved.

Previous research has demonstrated that emotional labor contributes to negative attitudes, behaviors, and poor health of the employee. 5 , 6 To highlight its constituting components, comprehensive definition and a theoretical model have been performed, which are expected to explain negative outcomes, such as individual stress and adverse health outcomes. There are various conceptualizations of emotional labor as a strategic model, 6 a job characteristics model, 5 and a mixed model proposed by Grandey. 10

Hochschild 6 defined emotional labor as “the management of feelings to create a publicly observable facial and bodily display (p. 7).” According to this perspective, managing emotions is recognized as one way for employees to achieve organizational norms or goals. Ashforth and Humphrey 11 defined emotional labor as “the act of displaying appropriate emotions, with the goal to engage in a form of impression management for the organization (p. 90).” They proposed that emotional labor should be positively associated with task effectiveness, provided that the clients perceive the expression as sincere. They also suggested that if employees are not expressing genuine emotions, emotional labor may not become detrimental for them by creating a need to distinguish from their own emotions.

Morris and Feldman 5 defined emotional labor as the “effort, planning, and control needed to express organizationally desired emotion during interpersonal transactions (p. 987).” This definition includes the organizational expectations for employees concerning their interactions with the clients, as well as the internal state of tension or conflict that occurs when employees have to display fake emotions, which is known as emotional dissonance. Grandey 10 defined emotional labor as the process of managing emotions such that they are suitable to organizational or professional display rules. This conceptualization assumes that some organizations or professions have their own limited or typical set of emotions that are to be displayed while interacting with clients.

HEALTH CONSEQUENCES OF EMOTIONAL LABOR

These approaches indicate that emotions are being managed and regulated in the workplace to meet an organization's display rules, and suggest either individual or organizational outcomes of emotional labor. For example, Schaubroeck and Jones 12 found that emotional labor was more likely to elicit symptoms of ill-health among employees who identified less, or were less involved, with their jobs. Several studies of emotional labor in particular occupations have documented that it can be exhausting, be considered as stressful, and increase the risk of psychological distress and symptoms of depression. 9 , 13 , 14 Hochschild 6 and other researchers have proposed that emotional labor is stressful and may lead to burnout.

Emotional labor has been linked to various job-related negative behaviors and adverse health outcomes, such as job dissatisfaction, loss of memory, depersonalization, job stress, hypertension, heart disease, emotional exhaustion, and burnout, 8 and has even been shown to exacerbate cancer. 15 For example, Zapf 8 revealed that emotional labor in combination with organizational problems, was related to burnout.

In addition to the negative effects of emotional labor, it is well known that emotional labor itself is closely related to workplace violence. Employees working in service sectors are more likely to be exposed to occupational violence from their clients while performing their duties, compared to those of other industries, such as manufacturing, and those who engage in white-collar jobs. Client violence is very common in today's modern industrialized society and includes client-, patient-, customer-, and prisoner-initiated violence. 16 In Western countries, high risk jobs of client violence were found to be “caring jobs,” such as police; firefighters; teachers; and welfare, health care, and social security workers. 16 Approximately 10% of health care workers in the United Kingdom had reported a minor injury, while 16% of them had been verbally abused. 17 In the United States, 46–100% of health care providers are estimated to have been assaulted while performing their duties. 18 Accordingly, when researchers try to examine the relationship between emotional labor and its negative consequences, such as health problems and work disabilities, it is recommended that the combined effects of emotional labor and workplace violence including verbal abuse from the clients be considered.

Burnout research has its roots in service industry sectors, such as caregiving, in which the core aspect of the job is the relationship between provider and recipient. 19 Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. 20 Maslach and Jackson 21 defined it as “a syndrome of emotional exhaustion and cynicism that occur frequently among individuals who do ‘people-work’ of some kind (p. 99).” In contrast to the approach proposed by Maslach, et al., 19 other researchers have argued that job burnout might be reduced to a single common experience, namely exhaustion. 22 Studies of psychological burnout have been conducted in several countries, including Norway, 23 Israel, 24 , 25 , 26 Canada, 27 the United States, 28 and Korea, 29 and have produced remarkably similar findings.

BURNOUT AND HEALTH OUTCOMES

Burnout from work-related demands or tension is of utmost concern for organizations because they incur high costs in the form of negative outcomes. 30 Burnout is a negative emotional reaction to one's job that results from prolonged exposure to a stressful work environment. 19 , 31 It is a state of exhaustion and emotional depletion that is dysfunctional for the employee and leads to absenteeism, turnover, and reduced job performance. 32 , 33 , 34 Moreover, these effects are particularly problematic for health care professionals, whose lower job performance can also have an adverse effect on their patients' health. 35

The importance of burnout is suggested by its relationship with such outcomes as decreased job performance and physical/mental health problems. 36 According to the conservation of resources (COR) theory, burnout occurs over prolonged periods of having few resources, which causes other resources to become compromised as well. 37 Unfortunately, the extent to which employees engage in the regulation of their emotions is related to stress-induced physiological arousal, 38 , 39 , 40 as well as with job strain, which are manifested in the form of poor work attitudes and burnout. 12 , 41 , 42 , 43 , 44 , 45 However, the specific mechanisms to understand the relationship between emotional labor and stress outcomes have not yet been clarified.

Several studies on the relationships between emotional labor and burnout have been based on “the dissonance theory of emotional labor.” According to this theory, emotional dissonance is considered a cornerstone of emotional labor. 46 It is conceptualized as a conflict between felt and displayed emotions, encompassing both potential and actually manifested emotions. 47 Morris and Feldman 5 found that employees gradually begin to experience burnout when their capacity for emotional dissonance is exhausted as a result of emotional labor. Zapf 8 also suggested that emotional dissonance is found to be positively associated with burnout.

In particular, employees are depleted of energy and become fatigued if they are continuously exposed to situations requiring emotional regulation (e.g., adherence to excessive display rules). As a coping strategy with this emotional exhaustion, they may demonstrate negative and cynical attitudes toward others and express dehumanizing and indifferent responses, which, in turn, can result in poor productivity and, finally, in a negative evaluation of themselves. 48 Burnout manifests differently depending on the job, although it appears to be much more common among workers involved in customer service than among those in the manufacturing industry. 49 Taken together, these findings suggest that greater attention should be paid to burnout among caregivers, given their high degree of emotional labor. 50 Indeed, it is especially important, given that the effects of burnout span beyond individual members and can affect entire organizations. In other words, burnout is inimical to the productivity and efficiency of the organization, thereby increasing turnover, facilitating negative job attitudes, and decreasing performance. 28 , 51 , 52 While there is a growing body of evidence that emotional labor can be stressful and lead to burnout symptoms, research has not sufficiently addressed the differing factors of emotional labor as predictors of burnout.

BURNOUT AS A NEGATIVE CONSEQUENCE OF EMOTIONAL LABOR

Due to global competition and the spread of the service sector, today's world of work is rapidly changing. 53 This transformation leads to increasing mental workloads and demands. 54 Although previous literature has revealed that burnout can occur both within and outside human service sectors, 55 caregiving service professionals are more likely to face a relatively higher risk of burnout. 56 The occupational perspective regards occupational grouping as being relevant in and of itself, meaning that workers employed in “high emotional labor” jobs 6 and “high burnout” jobs 48 report higher levels of stress than those in other jobs.

It has been generally assumed that there is something unique about “caregiving” professions that make their jobs more likely to feel burnout. 28 , 57 , 58 , 59 Interactions with clients that are frequent and long-lasting have been regarded as antecedents to burnout. 48 Researchers have documented differences in the dimensions of burnout for various service and caregiving professions, 60 and have developed taxonomies of “high-burnout” jobs based on the frequency of interactions 48 and the emotional control needed while interacting with clients.

The literature on emotional labor is focused on customer service, where interactions are less spontaneously “emotional” despite the necessity of high levels of emotional management or regulation to maintain positive relationships to customers. 6 , 61 Hochschild 6 proposed a list of “emotional labor jobs” that involve frequent customer contact and control over the emotional displays of the employees by their organization. However, comparing the occupations on Hochschild's list to non-emotional labor jobs has not been very useful in determining stress and burnout. 12 , 14 , 62 Employees in the “high emotional labor” grouping do not feel higher levels of emotional exhaustion than those in the “low emotional labor” grouping. This finding could be attributed to the fact that emotional labor is not a dichotomous variable; there may be a wide range of emotional labor demands with many jobs having some level of these demands. 5 , 45

High levels of job demand may contribute to numerous stress reactions, such as burnout and depression, which may finally result in absenteeism, work disability, and turnover. 63 For, example, Jeung, et al. 64 reported that sub factors of emotional labor are positively related to burnout. These results indicate that conflicts and tensions occurring in the process of interactions with clients, and experiencing emotional dissonance are more likely to increase the risk of burnout. In addition, a shortage of supportive and protective systems in the organization also contributes to job burnout.

Emotional demand and regulation are more common in the human and public service occupations wherein customers constantly demand attention. 65 People who are frequently faced with other people are more likely to feel burnout. 66

REASONINGS FOR THE EFFECTS OF EMOTIONAL LABOR ON BURNOUT

Some mechanisms provide theoretical explanations about whether emotional labor contributes to burnout. 42 According to the COR theory, 67 when individual resources are threatened or lost, these losses cause anxiety and distress, thereby increasing physiological arousal and health problems. 68 Experiencing interpersonal stressors is recognized as one of the most threatening sources of stress, posing a threat to self-image and resulting in increased cortisol response and perceived distress than other stressors. 69 Previous research has reported that employees are likely to respond to angry or rude customers by suppressing genuine emotion. 70 Such frequent self-regulatory efforts may lead to a loss of resources. First, the inauthenticity of faking expressions, or surface acting, 42 reduces one's self-worth and self-efficacy. Such acts of strategic modification of one's emotions, thoughts, and behaviors require cognitive effort. 8 This reduction of resources may play a crucial role in enhancing the stressful situation. Moreover, the loss of resources due to cognitive effort is more likely to contribute to strained or impaired well-being. 71 Second, suppressing emotions requires energy resources, as exhibited by increased physiological arousal, higher levels of glucose, and decreased motivation. 72 Consequently, continuous exposure to stress due to excessive emotional demands might activate the stress system, including the hypothalamic pituitary adrenal axis and the sympathetic nervous system. Furthermore, excessive and long-lasting emotional demands could contribute to depression or anxiety and behavioral problems, such as alcohol abuse or physical inactivity. 73 Third, suppressing genuine emotions results not in actually showing or directly changing those feelings, but in fewer social connections with others, 38 which consequently reduces social resources.

A second explanation for the mechanisms of the causal relationship between emotional labor and burnout has focused on emotional acting: surface acting. Surface acting is more likely to cause emotional exhaustion due to the effort required to fake or suppress negative emotions. 41 Surface acting consistently produces emotional exhaustion that results in diminished well-being. 74 Research suggests that surface acting is likely to deplete energy, as it involves long-lasting internal tension between one's displayed (suppressed) and true feelings, which in turn causes emotional dissonance. According to the person-centered concept of authenticity, conforming to external expectations leads to self-alienation and compromised feelings of authentic living. 75 Empirical research has revealed that accepting external influences and acting against one's internal emotions has a significant association with anxiety, stress, and diminished subjective and psychological wellness. 75 The continuous experience of emotional dissonance is more likely to increase the risk of high levels of psychological effort, thereby leading to loss of resources. 76 , 77 and finally resulting in burnout. Surface acting involves displaying inauthentic emotions that can produce negative responses from others. Scott and Barnes 78 examined the relationship of emotional labor with work withdrawal, and they found that surface acting is significantly associated with negative effects and work withdrawal.

Overall, research has documented that faking or suppressing one's genuine emotions is linked to stress, resource depletion, 72 and burnout. 79

RELATIONSHIP BETWEEN PERSONALITY TRAITS AND BURNOUT

Experiencing frequent and chronic job stress, combined with a low sense of efficacy for managing job demands and lack of social support when faced with difficult situations and environments, is more likely to increase risk of burnout. 80 , 81 Indeed, over the last two decades, several studies have demonstrated that individual differences may play an important role in developing burnout. Several systematic reviews and meta-analytical studies examining the predictors of burnout emphasized the role of some individual characteristics. 82 , 83 , 84 Jeung, et al. 64 revealed positive associations between the three sub-factors of emotional labor and TABP to burnout, and a negative association between self-efficacy and burnout among Korean dental hygienists. A growing body of research is proposing that self-efficacy and TABP operate as personal modifiers against job burnout caused by emotion regulation.

Although much research on burnout has concentrated on working environments, personality traits were also found to play a pivotal role in the development of job burnout. 19 Recently, several investigations have documented that job autonomy, organizational climate, and some personality traits play significant roles as modifiers or mediators in the relationship between emotional labor and job burnout. 85 Numerous works have emphasized the importance of personality traits; they have stressed the personal experience of emotional labor over time and identified personality traits as moderators.

Unfortunately, research on job stress has ignored the role of individual differences in the stress process. One personal characteristic that is likely to play an crucial role in the relationships among work stress, work control, and employee adaptation is self-efficacy. 86 Beyond the environmental factors influencing burnout, it is also important to consider individual and self-regulatory factors that result in useful resources.

Self-efficacy refers to an individual's belief in his or her capability to organize and execute a course of action needed to meet the demands of a situation, 87 and it refers to judgments that employees make concerning their ability to do what is needed to successfully conduct their jobs. 88 As expected, work control and autonomy decreased the adverse effects of job stress on outcome measures only for employees who recognized themselves as having high levels of self-efficacy in the work place.

Workers who have high levels of self-efficacy believe they have the potential for mastering stressors more effectively than those with lower self-efficacy. A range of self-efficacy levels is likely to be associated with variance in employees' reactions because self-efficacy affects the choice of coping behaviors and the level of persistence in overcoming job-related barriers and stressors. 89 Most research studies have emphasized the individual perceptions of one's social capital, such as self-efficacy and job autonomy, which can reduce or buffer against the tension of emotional labor. 77 , 90

Behavior patterns as a protective factor have long been implicated as a health risk factor. People with TABP as conceptualized by Friedman and Rosenman 91 are described as “impulsive, competitive, aggressive, impatient, and more susceptible to developing the symptoms of coronary heart disease.” Consequently, these individuals are less likely to have a possibility of coping with job stress. Numerous studies have reported a significant relationship between job strain and a linear combination of TABP and job characteristics. Froggatt and Cotton 92 revealed that type A individuals experience more stress when their work load increases, and Choo 93 found a positive relationship between job stress and TABP. Fisher, 94 however, did not find a moderating effect of TABP on the relationship of role stress to job satisfaction and performance.

Nevertheless, little is known as to why people with TABP are more susceptible to adverse health outcomes. Abush and Burkhead 95 analyzed the relationship between TABP, perceived job characteristics, and feelings of job tension, and they found a significant relationship between job tension and a linear combination of TABP and job characteristics. Thus, research shows that the tendency to experience burnout cannot be separated from personality or behavior pattern. 96

The results of this review suggest that emotional labor, as a new job stressor in modern society, leads to burnout and that an examination of some personality traits, such as self-efficacy and TABP, is needed to understand the relationship between emotional labor and its consequences, such as burnout. These results also emphasize the importance of stress management programs to reduce the adverse outcomes caused by emotional labor and of coping repertories to promote the personal potential suitable to organizational goals and norms. Moreover, enhancing individual capacities and encouraging a healthy personality through behavior modifications are required. Furthermore, legislation at the state level is needed for the protection of negative impacts caused by emotional labor.

ACKNOWLEDGEMENTS

This research was supported by the Fire Fighting Safety & 119 Rescue Technology Research and Development Program funded by National Fire Agency (“MPSS-2015-80”).

The authors have no financial conflicts of interest.