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Burnout, Social Support, and Copingat Work Among Social Workers,Psychologists, and NursesHasida Ben-Zur PhD a & Keren Michael PhD aa School of Social Work, University of Haifa, Haifa, 31905, Israel

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Burnout, Social Support, and Copingat Work Among Social Workers,

Psychologists, and Nurses:The Role of Challenge/Control Appraisals

Hasida Ben-Zur, PhDKeren Michael, PhD

ABSTRACT. The purpose of this study is twofold: (1) to comparestress appraisals, coping strategies, social resources, and burnout atwork between social workers, psychologists and nurses; and (2) to as-sess the effectiveness of appraisals and support in reducing burnout andenhancing effective coping strategies. Questionnaires containing assess-ments of work stress appraisals, coping strategies used to deal with prob-lems at work, and social support at work, as well as burnout measures ofexhaustion, depersonalization, and accomplishment were completed by249 female professionals (age range 25-61). No differences were ob-served between the three professions on most psychological measures,except for the depersonalization outcome of burnout, which was signifi-cantly lower among psychologists than among nurses or social workers.High challenge/control appraisal of the job was directly related to allburnout outcomes, contributing to less exhaustion and depersonalizationand to more personal accomplishment. The challenge/control appraisalwas also negatively associated with emotion-focused coping. By com-parison, the stress/load appraisal contributed to more exhaustion at

Hasida Ben-Zur is Professor, School of Social Work, University of Haifa, Haifa31905, Israel. Keren Michael is affiliated with the School of Social Work, Universityof Haifa, Haifa 31905, Israel (E-mail: [email protected]).

Address correspondence to: Hasida Ben-Zur, School of Social Work, University ofHaifa, Haifa 31905, Israel (E-mail: [email protected]).

Social Work in Health Care, Vol. 45(4) 2007Available online at http://swhc.haworthpress.com

© 2007 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J010v45n04_04 63

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work, while emotion-focused coping contributed to higher depersonal-ization. Social support was associated with higher challenge/control ap-praisal, with the latter mediating support effects on burnout. These datasuggest that the perception of challenge/control in one’s work may be animportant factor in preventing work burnout in the three professionstested in the study. doi:10.1300/J010v45n04_04 [Article copies available fora fee from The Haworth Document Delivery Service: 1-800-HAWORTH.E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2007 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Work stress appraisals, coping strategies, burnout, so-cial support

INTRODUCTION

Job Burnout in the Helping Professions

The present research investigates stress appraisals, coping, and burn-out among three kinds of professionals–social workers, psychologistsand nurses. Their work involves intensive encounters with people,and therefore, they may be vulnerable to burnout, first defined byFreudenberger (1980) as “a state of fatigue or frustration brought aboutby devotion to a cause, way of life or relationship that failed to producethe expected reward” (p. 13), and later by Maslach, Schaufeli, andLeiter (2001) as a “psychological syndrome in response to chronic in-terpersonal stressors on the job” (p. 399). There is agreement that jobburnout is the result of entering a job with high motivation and highcommitment but not getting positive results, or experiencing high disap-pointment (e.g., Pines, 1993). Winstanley and Whittington (2002) seeburnout as a dynamic process, related to stress and caused by a combi-nation of high workload and low coping resources.

Burnout is characterized by three dimensions: emotional exhaustion,depersonalization, and reduced personal accomplishment (e.g., Maslachet al., 2001), with emotional exhaustion constituting the stress dimen-sion of burnout, depersonalization the interpersonal context, and reducedaccomplishment the self-evaluation concept. Emotional exhaustion ischaracterized by a lack of energy and a feeling of being worn out. De-personalization refers to a negative approach to others and treating themas objects. Recently published research suggests that exhaustion leads

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to distancing oneself from work, so that depersonalization may be viewedas a type of avoidant coping mechanism used to cope with emotionalexhaustion (Maslach et al., 2001; Thoresen, Kaplan, Barsky,Warren, &de Chermont, 2003). Exhaustion and depersonalization, therefore, arestrongly related. The third component, personal accomplishment, refersto a high level of adequacy in relating to people and in job performance(Thoresen et al., 2003). Reduced accomplishment may be related to ex-haustion and depersonalization, but it may also develop as a result oflack of work-related resources, while exhaustion and depersonalizationresult from overload and conflict at work.

Burnout is associated with caregiving and service occupations (Maslachet al., 2001) and occurs most often among such professionals as teach-ers, lawyers, physicians, nurses, social workers and psychotherapists(Pines, 1993). Burnout and stress among social workers are well docu-mented (e.g., Acker, 1999; Gilbar, 1998; Um & Harrison, 1998), withrecent research indicating that they experience emotional distress, highlevels of general anxiety and depression and high burnout as measuredby a perceived lack of personal accomplishment (Lloyd, King, &Chenoweth, 2002) in comparison with general occupational norms.Among school psychologists, 40% have shown levels of emotional ex-haustion higher than burnout norms (Mills & Huebner, 1998), and highlevels of burnout have been found for nurses as well (Buunk, Ybema,Van der Zee, Schaufeli, & Gibbons, 2001; Hiscott & Connop, 1990).

Most of the research on job burnout focuses on its antecedents in thejob environment, job and occupational characteristics, or organizationaloutcomes (Maslach et al., 2001), suggesting that role stressors such asrole conflict, role ambiguity and work overload are important factors inburnout (e.g., Zellars, Perrewe, & Hochwarter, 2000). Studies address-ing the issue of gender differences in burnout have reported contradic-tory results, showing no gender differences (e.g., Greenglass, Burke, &Ondrach, 1990); men experiencing more burnout than women (e.g.,Norvell, Hills, & Murrin, 1993); and women experiencing more burn-out than men (e.g., Hiscott & Connop, 1989). Other findings on genderdifferences in the context of work stressors have indicated that women,in comparison with men, faced a higher total workload (Frankenhaueser,1991), role overload (Barnett & Shen, 1997), and obstacles to achieve-ment in their workplace (Nelson & Burke, 2000; Williams, 1999).

Individual differences such as low hardiness, external locus of control,low self-esteem, neuroticism and Type A behavior pattern were found tobe related to burnout (Maslach et al., 2001). The Big Five personality

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model (McRae & Costa, 1990) was also tested in several studies(Piedmont, 1993; Zellars, Perrewe, & Hochwarter, 2000), with researchshowing certain positive associations between emotional exhaustion, de-personalization or reduced accomplishment with high levels of neurot-icism, and low levels of extraversion, agreeableness, conscientiousness,or openness. Negative affectivity (Iverson, Olekalns, & Erwin, 1998), ornegative affect measured as state or trait (Thoresen et al., 2003), has beenrelated positively to the exhaustion and depersonalization aspect of burn-out and negatively to the personal accomplishment aspect. On the basisof these findings, as well as the conceptualization of the term, the emo-tional exhaustion of burnout is considered a type of stress reaction. Stressand coping models thus provide the theoretical orientation of the presentresearch.

Models of Stress Appraisal, Coping, and Resources

The research followed the cognitive model of stress and coping (e.g.,Lazarus, 1999; Lazarus & Folkman, 1984). This model views stress asthe result of the perception that environmental demands exceed the per-son’s ability to cope with them. Hence, the ensuing feelings, thoughts,and actions of people during stressful encounters depend on their ap-praisals of the situation. In primary appraisal, the stressful situation isperceived as a loss, threat, or challenge, depending in part on individualdifferences emanating from past experience, demographic factors, per-sonal aspects, and social support systems. In secondary appraisal, theindividual assesses what he/she can do in order to solve the problem, re-move the threat, or correct the loss, with these assessments based onavailable resources, personal capability to cope, and strategies or meth-ods available for coping.

Coping represents the cognitive and behavioral efforts of individualsto manage stressful encounters (Lazarus & Folkman, 1984). These effortsresult in a variety of activities, classified according to problem-focused andemotion-focused modes, as differentiated by their function (Folkman &Lazarus, 1985; Lazarus & Folkman, 1984). Problem-focused coping in-cludes steps aimed at managing future danger or threat, reflected in theefforts the person invests to alter his/her interaction with the environment.Emotion-focused coping, by contrast, is aimed at reducing, preventing, ortolerating the emotional and physiological reactions that are characterizedas stressful.

Coping has been investigated in relation to stressful occurrences suchas the process of taking an exam (Folkman & Lazarus, 1985; Zeidner,


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1995), experiencing the Gulf war (e.g., Zeidner & Ben-Zur, 1993), orbeing treated for cancer (Ben-Zur, Gilbar, & Lev, 2001). Researchshows that problem-focused strategies are not correlated with stateof anxiety (e.g., Zeidner & Ben-Zur, 1993) but are found to be corre-lated with high achievement in examinations (e.g., Zeidner, 1995) andwith positive affect in coping with a social change (Ben-Zur, Yagil, &Oz, in press). In contrast, emotion-focused coping is highly correlatedwith psychological distress in various stressful situations (e.g., Ben-Zur, Gilbar, & Lev, 2001; Carver & Scheier, 1993; Zeidner, 1995;Zeidner & Ben-Zur, 1993).

Other stress and coping models have been developed that present asimilar view to the one posited by Lazarus and Folkman (1984) but em-phasize, in addition, the role of social and personal resources in copingwith stressful encounters (e.g., Hobfoll, 1989; Moos & Schaefer, 1993).Social support, one of the major resources, has been described along threeconstructs: support network resources, supportive behaviors or relation-ships, and the subjective appraisal of support (Hobfoll & Vaux, 1993).Various models have been proposed, including the direct effect model,which suggests that social support has a positive effect on well-being in-dependently of stress; and the basic buffer effect model, which assumesthat social support protects individuals from stress. Both models havebeen supported in empirical tests (e.g., Power, 1988). Furthermore, it hasbeen shown that people with more social resources tend to rely on prob-lem-focused coping (or approach coping) rather than on avoidance or ac-ceptance-resignation coping (e.g., Moos & Schaefer, 1993).

In the organizational and work context, demands have been found tobe related more to exhaustion, with resources related more to deperson-alization and accomplishment (Hobfoll & Freedy, 1993; Leiter, 1993).A meta-analysis of job burnout as a function of demands and resourcesshowed that demands such as role conflict/ambiguity and workload areindeed related to emotional exhaustion, but also to depersonalization(Lee & Ashforth, 1996). Resources were negatively correlated withemotional exhaustion and depersonalization, while the correlationswith personal accomplishment were weaker and few resources corre-lated with this dimension. An integrative cognitive model of stress, cop-ing, organizational demands, resources, and burnout (Leiter, 1991),tested on a sample of workers in a mental hospital, showed that controlcoping and coworker support were related to less burnout while escapistcoping, work overload, and interpersonal conflict were related to moreburnout. The model, however, did not include the component of chal-lenge appraisals, which is tested in the present study. Siefert, Jayaratne,


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and Chess (1991) investigated burnout and job satisfaction among so-cial workers as a function of nine job characteristics, including work-load and challenge, but excluding coping strategies, and found challengeto be negatively related to depersonalization and challenge and work-load to be positively correlated with accomplishment. A recent study(Winstanley & Whittington, 2002) examining burnout, client aggres-sion, and coping among general hospital staff showed burnout to behighly related to workplace aggression but not to coping strategies.However, the study did not include the components of appraisals or so-cial support in the context of job burnout.

Research Aims and Hypotheses

Our study focused on women’s burnout. Psychosocial risk factorsand stress have become increasingly more significant for workingwomen, in as much as women bear the main responsibility in the do-main of home and family, which adds to the risk of exhaustion (Perrons,1999), while they confront multiple and conflicting expectations fromtheir surroundings (Barnett & Shen, 1997). Additionally, women enterwork with higher expectations but receive fewer rewards as comparedwith men, and therefore, may experience high levels of occupationalburnout as indicated by a recently conducted study in Israel (Toker,Shirom, Shapira, Berliner, & Melamed, 2005). Thus, it becomes espe-cially important to investigate the roles of work appraisals, coping andsupport factors that can alleviate women’s burnout. The study aim istwofold: To examine the differences between social workers, psycholo-gists, and nurses in terms of work appraisals, coping, social support atwork and burnout indicators; and to assess the associations betweenthese variables. The following hypotheses were postulated:

H1: High burnout will be associated negatively with social supportat work, challenge/control appraisals, and problem-focused cop-ing, and positively with stress/load and emotion-focused coping.

H2: A. problem-focused coping will be associated positively withchallenge/control appraisals and social support, and negativelywith stress/load.

B. Emotion-focused coping will be associated negatively withchallenge/control appraisals and social support, and positively withstress/load.


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H3: Challenge/control appraisals will be associated positivelywith social support, whereas stress/load appraisals will be associ-ated negatively with social support.

METHOD

Sample

The sample consisted of 249 participants: 55.8% social workers,20.5% psychologists, and 23.7% nurses. All the participants werewomen, average age 41.66 (SD = 8.57, range = 25-61). Most were mar-ried (72.7%) and the others were single (14.5%), divorced (9.6%), orwidowed (2.4%). Most were born in Israel (74.7%) and the rest in Eu-rope/U.S. (16.1%) and Asia/Africa (4.4%). Economic status was rated2.74 on average (SD = 0.81) on a 5-point scale (1 = Very good; 5 = Verybad). An inspection of the responses to a question about field of special-ization revealed a high proportion of specialization in family, child, ad-olescent, and developmental fields (35.5%), followed by community(17.4%), mental (12.8%), elderly and rehabilitation (11.2%), general(8.3%), clinical (7.9%), and corrections or addictions (7.0%).

Instruments

The study included the following inventories (see psychometric datain Table 1):

1. Demographic data. This questionnaire included information onage, gender, education, family status, number of children, place oforigin and place of work.

2. Appraisals. Using Bjorck and Klewicki’s (1997) appraisal scales,the participants were asked to assess their work on the followingfour scales (1 = Low; 9 = High): stress, load, challenge, and con-trol. Factor analysis with Varimax rotation showed two factors,one loaded highly on stress and load and the other on challengeand control. Hence, the two factors were used to construct twoappraisal scales: stress/load and challenge/control, which wereuncorrelated (r = 0.02).

3. Coping strategies. The use of coping strategies was tested by theshort Hebrew version of the COPE scale (Carver, Scheier, &Weintraub, 1989), which includes 15 coping strategies, each


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strategy represented by the sum of two items as translated fromthe original scale (Zeidner & Ben-Zur, 1993; Ben-Zur & Zeidner,1995). Respondents were asked to indicate the extent to whicheach of the 15 strategies was used in coping with problems atwork. Responses were rated on a four-point scale, ranging from0 = Not at all to 3 = Great extent (and transformed into a 1-4 scalein accord with Carver, Scheier, and Weintraub, 1989). Based onfactor analysis, Zeidner and Ben-Zur (1993) and Ben-Zur andZeidner (1995) reported two factors, termed problem-focused andemotion-focused. A factor analysis in the present study showed asimilar structure of two factors, which formed the basis for twoscales: a problem-focused scale, loaded on active coping, plan-ning, suppression of competing activities, instrumental and emo-tional support, and positive reinterpretation (alpha = 0.70); and anemotion-focused scale, loaded on mental and behavioural dis-engagement, denial, ventilation, acceptance, alcohol use, and hu-mour (alpha = 0.67; restraint and religion loaded less than 0.40 oneach of the two factors and therefore were not included). The twocoping scales were unrelated (r = 0.03).

4. Social support at work. This characteristic was assessed by fouritems taken from the Multidimensional Scale of Perceived SocialSupport (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988), used inits Hebrew form (Stetman, 1995). The original instrument assessesperceived social support from three sources: family, friends, andsignificant other (four items for each subscale), using a 1-7 ratingscale, from “Very strongly disagree” to “Very strongly agree.” Thealpha levels of the individual subscales are highly satisfactory(0.85, 0.87, and 0.91, respectively). The reliability of the total is0.88, validated by showing negative correlations between the sub-scales and measures of anxiety and depression (Zimet, Dahlem,Zimet, & Farley, 1988). The instructions for rating the four itemsused in the present study referred to social support from colleaguesat work.

5. Burnout. Burnout was measured by an abbreviated version(Iverson, Olekalns, & Erwin, 1998) of the Burnout scale (Maslachand Jackson, 1981). The scale contains nine items, rated on a 1-5rating scale (1 = No agreement to 5 = Total agreement), and exam-ines emotional exhaustion, depersonalization, and a sense of per-sonal accomplishment. A factor analysis revealed a three-factorstructure that accords with the three dimensions described above.The correlation between exhaustion and depersonalization was


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positive (r = 0.33, p < 0.01), while the correlations between thesetwo dimensions and accomplishment were lower (�0.13 [p <0.05] and �0.20 [p < 0.01], respectively), as found by Maslach,Schaufeli, and Leiter (2001).

Procedure

The self-report inventories were distributed by graduate students attheir place of work, or among social workers, psychologists, and nursesemployed by other organizations. The respondents were told that the in-ventory assessed work-specific attitudes and feelings; it was to be com-pleted anonymously, and returned personally to the graduate students.The students were instructed to collect data from women social workers(50%), psychologists (25%), and nurses (25%). The proportion of so-cial workers was purposely kept double that of the other two profes-sions to allow for a test of the associations between the study variablesin this particular group. The participants’ response rate was 75.9% (328questionnaires were distributed and 249 questionnaires were returned).

RESULTS

The data for the main demographic variables, which show that thenurses participating in the study were older than either the socialworkers or psychologists, and that nurses worked longer hours thanthe psychologists are presented in Table 2. More social workers and


TABLE 1. Psychometric Properties of the Study Variables

Variable M SD Alpha

AppraisalsStress/load 5.36 1.35 0.88Challenge/control 5.44 1.09 0.48

Problem-focused coping 6.81 0.70 0.70Emotion-focused coping 4.05 0.80 0.67Social support at work 5.48 1.21 0.91Burnout measures

Exhaustion 2.75 0.87 0.83Depersonalization 1.74 0.77 0.82Accomplishment 3.97 0.63 0.63

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psychologists were Israeli born in comparison with nurses, while morenurses and psychologists were married in comparison with social work-ers. In addition, a higher proportion of nurses had a larger number ofyears of work experience in comparison with psychologists or socialworkers, a variable that was highly correlated with age (r = 0.70). Age,number of working hours, and origin were used in the following analy-ses as control variables.

The means of the burnout indicators for the three sample groups,showed significant differences for the depersonalization subscale only,with social workers and nurses rating higher than psychologists on thisscale (Table 3). An Analysis of Covariance (ANCOVA) using age, num-ber of working hours and origin as covariates showed significant resultsfor this scale (F[2,222] = 4.15, p < 0.05). None of the other variables,that is, coping, appraisals, or support differed significantly among thethree groups.

The Pearson correlations among the research variables showed thatchallenge/control is the most potent variable in its associations with burn-out (Table 3): It is negatively correlated with exhaustion and deperson-alization and positively correlated with accomplishment. Stress/load and


TABLE 2. Means (SDs) and Percentages of Demographic Variables of theThree Groups: Social Workers, Nurses, and Psychologists

Variable Group

Social Workers Nurses Psychologists Statistical Test

Demographic variablesOrigin (Israel) 83.6 56.9 78.0 14.83**,1

Family status (married) 70.5 72.9 81.6 0.321

M (SD) M (SD) M (SD) F (df)Age 40.20 (8.41)a 41.29 (8.06)a 45.44 (8.39)b 7.98** (2,240)Working hours (per week) 34.98 (8.72)a 33.17 (8.38)ab 37.62 (6.79)b 3.88* (2,233)Reported economic situation 2.79 (0.85) 2.71 (0.73) 2.64 (0.79) � 1Burnout measures

Exhaustion 2.79 (0.82) 2.83 (1.03) 2.54 (0.79) 1.94Depersonalization 1.81 (0.80)a 1.82 (0.83)a 1.46 (0.50)b 4.48** (2,244)Accomplishment 3.94 (0.62) 3.91 (0.66) 4.11 (0.62) 1.84

1Chi-square.*p � 0.05 **p � 0.01.Reported economic situation: 1 = Very bad, 5 = Very good.Note: Means with the same superscript letter do not differ significantly (p = 0.05) in a Scheffe test.

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social support at work were negatively related to exhaustion. Social sup-port and problem-focused coping were negatively related to depersonal-ization and positively related to accomplishment, while emotion-focusedcoping showed the opposite patterns. Thus, the first hypothesis whichpredicted a negative correlation between high burnout and support atwork, challenge/control appraisals and problem-focused coping, and apositive correlation with stress/load and emotion-focused coping, waslargely supported, although not all the burnout indicators showed thehypothesized direction for stress/load appraisals and for coping.

The second hypothesis was partially confirmed, as problem-focusedcoping was positively correlated with challenge/control appraisals and so-cial support, and emotion-focused coping was negatively correlatedwith these variables. Only the stress/load appraisals did not show thepredicted associations with coping and support (see Table 3). The thirdhypothesis was confirmed for challenge/control appraisals, which werepositively correlated with social support, but stress/load appraisals didnot show any relationship with social support, as was hypothesized.

The regressions applied to the burnout indicators are presented in Ta-ble 4. The group variable was tested by creating two dummy variables(Group 1: social workers = 1, psychologists and nurses = 0; Group 2: socialworkers and nurses = 1, psychologists = 0). As can be seen in Table 4,the variables in the final regressions explained 35%, 30%, and 28% of thevariance for exhaustion, depersonalization, and accomplishment, respec-tively, with challenge/control being the most potent variable in contrib-uting to burnout. The appraisal of stress/load contributed to exhaustion


TABLE 3. Pearson Correlations of Social Support, Appraisals, Coping, andBurnout Measures

Variable Social Supportat Work

Challenge/Control

Stress/Load Problem-Focused Coping

Emotion-Focused Coping

Challenge/control 0.45***

Stress/load 0.09 0.02

Problem-focused 0.28** 0.32*** 0.14

Emotion-focused �0.18* �0.28*** �0.03 0.03

Exhaustion �0.17* �0.35*** 0.45*** �0.04 0.15

Depersonalization �0.37*** �0.48*** 0.07 �0.21** 0.29***

Accomplishment 0.32*** 0.50*** 0.12 0.29*** �0.18*

*p � 0.01, **p � 0.001, ***p � 0.0001.

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only, while of the coping-burnout associations only emotion-focusedcoping was proven to contribute independently to depersonalization. Therationale for analyzing social workers with the two other occupationalgroups was based on the finding of minimal group effects on any of themeasures. Using the dummy variables, the regression analyses still testedthe effect of group on burnout, while controlling for demographic andresearch variables. Furthermore, a repetition of the correlational and re-gression analyses on the social worker group alone revealed results thatwere practically the same in terms of the effects of social support, apprais-als, and coping on burnout.

The results in Table 4 suggest that the effects of social support, whilesignificant for depersonalization and accomplishment, disappear in the


TABLE 4. Hierarchical Regressions of Burnout Outcomes on DemographicVariables, Two Dummy Variables, Social Support, Appraisals, and CopingStrategies at Work

Variable ExhaustionBeta

DepersonalizationBeta

AccomplishmentBeta

Step 1Age �0.00 �0.07 �0.00Number of working

hours0.03 0.13 0.04

Origin 0.04 �0.00 �0.01Dummy1 �0.10 0.00 0.01Dummy2 0.14 0.12 0.06R2 0.05 0.08* 0.03

Step 2Social support �0.02 �0.13 0.12R2 (R2 change) 0.07 (0.02) 0.18** (0.10**) 0.14** (0.11**)

Step 3Challenge/control �0.34** �0.31** 0.38**Stress/load 0.45** 0.06 0.06R2 (R2 change) 0.35** (0.28**) 0.28** (0.10**) 0.27** (0.13**)

Step 4Problem-focused coping �0.01 �0.09 0.12Emotion-focused coping 0.04 0.17* �0.04R2 (R2 change) 0.35** (0.00) 0.30** (0.02) 0.28** (0.01)

*p � 0.01, **p � 0.001.Note: Dummy1: social workers = 1, nurses and psychologists = 0; Dummy2: social workers and nurses = 1, psychologists = 0;Origin: Israel = 1, Other = 2; all regression coefficients are based on Step 4. For Step 1: df = 5,222, Step 2: df = 6,220, Step 3:df = 8,218, Step 4: df = 10,214.

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overall regression, implying that either appraisals or coping mediate itseffects on burnout. The mediating effects of appraisals and coping wereinvestigated using Baron and Kenny’s (1986) guidelines. Tests of ap-praisal strategies as mediators showed significance only for the chal-lenge/control appraisals. The regressions of burnout on social support,and the combined effects of social support and challenge/control ap-praisals on burnout, therefore, are presented in Table 5. The regressionof challenge/control on social support was also highly significant:F(1,244) = 62.22, p < 0.0001, B = 0.50, SE = 0.06, beta = 0.45, t = 7.88.Mediation tests using the Sobel test revealed values of 4.19, 4.92, and5.22 for exhaustion, depersonalization and accomplishment, respec-tively (p < 0.0001). As can be seen in Table 5, challenge/control ap-praisals mediated the effects of social support on all indicators ofburnout. The same tests using coping as a mediator, however, failed toshow significant effects. Thus, the appraisal of challenge/control mayconstitute a mediator of social support on burnout. In contrast, copingstrategies did not prove to be strong mediators of the effects of apprais-als on burnout, and as Table 4 shows, the effects of appraisals remainstrong even when coping strategies are included in the regression.

Finally, tests of appraisals as moderators of the effects of social supporton burnout, or coping strategies as moderators of the effects of eitherchallenge/control or stress/load appraisals on burnout, were done by mul-tiplying the appropriate variable scores and conducting regression analysesin which the two variables and their multiplication were tested in eachanalysis. These tests showed only one case in which emotion-focusedcoping moderated the effects of challenge/control on depersonalization(R2 = 0.27, F[3,240] = 29.12, p < 0.0001; the betas were for emotion-fo-cused coping 0.73 (p = 0.01), for challenge/control �0.11 [n.s.], and forthe emotion-focused coping by challenge/control interaction �0.58 [p= 0.03]. The means of depersonalization for high challenge/controlwere 1.48 and 1.50 for low and high emotion-focused coping, respectively,while for low challenge/control they were 1.71 and 2.17, respectively.Thus, the combination of low challenge/control and high emotion-focusedcoping leads to the highest level of depersonalization.

DISCUSSION

The present study aimed to compare participants from three care pro-fessions on work stress appraisals, coping strategies and resources, and


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burnout, and to assess the associations between these psychologicalvariables. It should be noted that the professionals were not sampledrandomly and therefore the findings only apply to the pool of partici-pants tested in this study. The comparisons among social workers,psychologists, and nurses showed very few differences, with only de-personalization scoring somewhat higher for the nurses and socialworkers than for the psychologists. This effect, however, was verysmall–accounting for only about 3.5% of the variance, and in the regres-sion analyses was non-significant. It may be concluded, therefore, thatin the present study, very few differences were observed among the threeprofessions regarding levels of burnout, patterns of coping with prob-lems, appraisals of challenge and load, and the availability of socialsupport.

The appraisals of challenge/control variable proved to be the mostpotent factor in the study: it was related negatively with exhaustion anddepersonalization, while being positively associated with accomplish-ment, associations that held even when other variables were taken intoaccount. The results pertaining to the second appraisal dimension–namely stress/load–were less strong: this variable was related to ex-haustion only, as already found for demands in other studies (e.g.,Hobfoll & Freedy, 1993; Leiter, 1993). These findings conform gener-ally to the cognitive theory of stress and coping (e.g., Lazarus, 1999;Lazarus & Folkman, 1984) which emphasizes the appraisals of the situ-ation as important determinants of outcomes such as distress (e.g.,Moos & Schaefer, 1993) and well-being assessed by positive and nega-tive affect (e.g., Ben-Zur, Yagil, & Oz, in press). However, the presentstudy highlights the importance of challenge/control appraisals, in thework context of the care professionals tested, as being more importantthan appraisals of load or stress at work. Moreover, challenge/controlproved to be a strong mediator of social support on burnout, to the ex-tent that the effect of social support practically disappeared, or wasgreatly reduced, when these appraisals were included in the analysis.

When compared with cognitive appraisals, the effects of problem- andemotion-focused coping in relation to burnout were weaker. While thesevariables correlated with depersonalization and accomplishment, their ef-fect was much lower in the overall regression analysis, showing an asso-ciation only between emotion-focused coping and depersonalization. Thedata regarding problem-focused coping replicate many other research re-sults which show no associations, or only weak associations, betweenproblem-focused coping and outcomes (e.g., Penley, Tomaka, & Wiebe,2002). The weak data regarding emotion-focused coping, are surprising.


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However, one result suggested that emotion-focused coping may moder-ate the association between challenge/control and depersonalization.Thus, the combination of a high level of emotion-focused coping and alow level of challenge/control is the most negative in terms of deperson-alization, which may be especially problematic for the professionalstested whose main objective is to aid and support clients.

The effect of social support in relation to burnout was significanton the correlational level but disappeared in the overall regression anal-ysis. Similar weak/non-significant findings were observed in severalother studies (Burke & Greenglass, 1996; Koniarek & Dudek, 1996;Rafferty, Friend, & Landsbergis, 2001) and may be explained by thedifferential measures and associations found in the research on socialsupport and burnout. Notably, the present study referred only to sup-port from coworkers, while other research (Baruch-Feldman, Brondolo,Ben-Dayan, & Schwartz, 2002; Peeters & Le-Blanc, 2001; Rafferty,Friend, & Landsbergis, 2001) found varied effects of social supportwhen assessing different sources (e.g., family, work colleagues, superi-ors at work) or investigating different kinds of support functions (e.g.,listening, technical support, technical challenge, emotional challenge,sharing social reality; Pines, Ben-Ari, Utasi, & Larson, 2002; Zellars &Perrewe, 2001).

The present findings were obtained from Israeli women in thecaregiving and service professions. In the area of coping with stress, acomparison of research on the use of coping strategies by Israelis andAmericans shows a high similarity between the present study results aswell as other Israeli studies (Ben-Zur, Gilbar, & Lev, 2001; Ben-Zur,Yagil, & Oz, in press; Ben-Zur & Zeidner, 1995), and the coping datacollected in the United States by Carver, Scheier, and Weintraub (1989).In both cultures, problem-focused coping was favored over emotion-focused coping strategies. In contrast, in cross-cultural comparisonsIsraeli professionals showed relatively lower levels of burnout thantheir American counterparts (Pines, 2004), or participants from othernationalities (e.g., Savicki, 2002). This finding is especially prominentin light of the fact that the political, social, and economic uncertaintiesin Israel are much higher, the working conditions are worse and less re-warding, and the confrontation of death and injury of soldiers and civil-ians is much more frequent than in the United States. According to theexistential perspective (Pines, 2004), however, precisely because of thissituation, Israeli professionals may find a greater sense of significancein their life than the same professionals in the United States, and there-fore may experience less burnout. Nevertheless, the present study


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showed that high challenge and control appraisals were related to lessexhaustion and depersonalization, and more accomplishment, evenwithin this specific Israeli environment, attesting to the significance ofthese variables in Israeli women’s occupational burnout.

In sum, among the professionals from the three care professionstested, the perception of challenge/control in their work was the mostimportant dimension. The study did not use a representative sampleand, therefore, the results apply to the sample tested. Future researchshould focus on repeating the study with representative samples fromthe care professions. Other studies may proceed by testing the sourcesof challenge and control appraisals, and social support, and their effectson employees’ well-being.

The present study has implications for education, supervision, andjob training in the health care professions. Professionals should acquireboth information and skills on effective coping strategies in order tomanage problems and conflicts at their work successfully. The focusshould be on applying various ways of appraising work situations aschallenging and controllable rather than stressful or overloaded.

Received: 07/06/06Accepted for Publication: 08/11/06

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