Burnout Subtypes and Absence of Self-Compassion in Primary Healthcare Professionals: A Cross-Sectional Study

BackgroundPrimary healthcare professionals report high levels of distress and burnout. A new model of burnout has been developed to differentiate three clinical subtypes: ‘frenetic’, ‘underchallenged’ and ‘worn-out’. The aim of this study was to confirm the validity and reliability of the burnout subtype model in Spanish primary healthcare professionals, and to assess the explanatory power of the self-compassion construct as a possible protective factor.MethodThe study employed a cross-sectional design. A sample of n = 440 Spanish primary healthcare professionals (214 general practitioners, 184 nurses, 42 medical residents) completed the Burnout Clinical Subtype Questionnaire (BCSQ-36), the Maslach Burnout Inventory General Survey (MBI-GS), the Self-Compassion Scale (SCS), the Utrecht Work Engagement Scale (UWES) and the Positive and Negative Affect Schedule (PANAS). The factor structure of the BCSQ-36 was estimated using confirmatory factor analysis (CFA) by the unweighted least squares method from polychoric correlations. Internal consistency (R) was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the BCSQ-36 and the other constructs were analysed using Spearman’s r and multiple linear regression models.ResultsThe structure of the BCSQ-36 fit the data well, with adequate CFA indices for all the burnout subtypes. Reliability was adequate for all the scales and sub-scales (R≥0.75). Self-judgement was the self-compassion factor that explained the frenetic subtype (Beta = 0.36; pConclusionsThe typological definition of burnout through the BCSQ-36 showed good structure and appropriate internal consistence in Spanish primary healthcare professionals. The negative self-compassion dimensions seem to play a relevant role in explaining the burnout profiles in this population, and they should be considered when designing specific treatments and interventions tailored to the specific vulnerability of each subtype.

背景
基层医疗从业人员普遍报告存在较高水平的心理痛苦与职业倦怠。现有研究已提出职业倦怠的新型分型模型，可将其划分为三种临床亚型：狂热型（frenetic）、低挑战型（underchallenged）与耗竭型（worn-out）。本研究旨在验证职业倦怠亚型模型在西班牙基层医疗从业人员中的效度与信度，并评估自我同情（self-compassion）这一构念作为潜在保护因素的解释力。

方法
本研究采用横断面研究设计。共纳入440名西班牙基层医疗从业人员，其中包括214名全科医师、184名护士与42名住院医师，所有受试者均完成了以下量表的填写：职业倦怠临床亚型问卷（Burnout Clinical Subtype Questionnaire，BCSQ-36）、马氏职业倦怠量表通用版（Maslach Burnout Inventory General Survey，MBI-GS）、自我同情量表（Self-Compassion Scale，SCS）、乌得勒支工作投入量表（Utrecht Work Engagement Scale，UWES）以及正负性情感量表（Positive and Negative Affect Schedule，PANAS）。本研究基于多列相关系数，采用不加权最小二乘法，通过验证性因子分析（confirmatory factor analysis，CFA）估算BCSQ-36的因子结构。本研究通过计算潜在真实变量与观测变量间的相关系数平方值，评估量表的内部一致性（R）。采用斯皮尔曼秩相关（Spearman’s r）与多重线性回归模型，分析BCSQ-36与其他构念之间的关联。

结果
BCSQ-36的因子结构与数据拟合良好，所有职业倦怠亚型的验证性因子分析指标均达标。所有量表及子量表的信度均符合要求（R≥0.75）。自我评判（self-judgement）作为自我同情的维度，可有效预测狂热型亚型（Beta=0.36；p）。

结论
基于BCSQ-36的职业倦怠分型模型在西班牙基层医疗从业人员中展现出良好的因子结构与内部一致性。自我同情的负性维度在解释该群体的职业倦怠特征中发挥了重要作用，因此在针对各亚型的特定易感性设计专属治疗与干预方案时，应将此类维度纳入考量。