Factorial validity and consistency of the Maslach Burnout Inventory among staff working with persons with intellectual disability and dementia

Background Burnout has been considered important to understanding the well‐being of workers in the intellectual disabilities (ID) field and the quality of services delivered to clients/consumers. However, little research has examined the psychometric properties and applicability to staff in ID services of one of the most widely used burnout measurements – the Human Services Survey version of the Maslach Burnout Inventory (MBI‐HSS). Methods Data were gathered using a mailed questionnaire comprising the MBI‐HSS and demographic information. The sample consisted of 435 staff delivering direct care and working in out‐of‐home community placements for persons with ID in New York state. The factorial structure of the scale was examined using confirmatory and exploratory factor analysis. Internal consistency estimates of reliability of the MBI‐HSS were determined using Cronbach's alpha. Results Confirmatory factor analysis supported the MBI‐HSS as an acceptable measure to evaluate burnout in ID services staff. However, the reliability statistics obtained for the Depersonalization (DP) sub‐scale was much lower than what has been reported in studies with other staff populations. An exploratory factor analysis suggested that a four‐factor solution, dividing the DP sub‐scale into two factors, provided a somewhat better fit for the sample. Conclusions The use of the MBI‐HHS as an instrument for measuring burnout among ID workers has its attraction but also its limitations. In particular, the DP sub‐scale should be used with caution because there appear to be wording issues for staff in ID settings that may lead to inconsistent responses.     

Burnout in direct care staff in intellectual disability services: a factor analytic study of the Maslach Burnout Inventory

Background There is gathering research interest in the well‐being of staff working in services for people with intellectual disability (ID), including the assessment of burnout and its correlates. However, no previous studies have considered the applicability of the main three dimensions of burnout to staff in ID services. Methods Data were analysed from two samples of staff (total n = 184) who participated in research studies that included completion of the Maslach Burnout Inventory (MBI). Results Nineteen of the MBI items loaded clearly onto factors closely resembling the three original subscales: emotional exhaustion, depersonalization and personal accomplishment. Internal consistency for the three MBI subscales was fair to good (range 0.68–0.87). Conclusions The original three MBI dimensions were found to be highly relevant to the present sample of staff. The analyses support the construct validity and reliability of the MBI for staff in ID services.     

Role clarity, perception of the organization and burnout amongst support workers in residential homes for people with intellectual disability: a comparison between a National Health Service trust and a charitable company

Changes in roles and responsibilities brought about by community care and the reorganization of the UK National Health Service (NHS) have resulted in higher levels of stress and insecurity amongst residential nursing staff working with people with intellectual disability. In the light of these organizational changes, questions have arisen about the relationship between role clarity, perception of the organization and occupational stress. A number of studies have investigated these issues amongst staff working with people with intellectual disability, although there have been few investigations in the UK. The present study examines the relationship between these variables in the context of the differences between the employees of an NHS trust and a charitable organization. The present study involved constructing a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). The results indicated that most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff. A within-service comparison of homes revealed differences amongst NHS trust and charity homes on sub-scales of the MBI. The results are discussed in the context of previous research and changes in working practices in the field.     

Psychometric properties of the Spanish self-report version of the Panic Disorder Severity Scale

Objective

The goal of the study was to assess the psychometric properties and the factor structure of the Spanish self-report version of the Panic Disorder Severity Scale (PDSS-SR).

Method

One hundred and twenty four patients meeting DSM-IV criteria for panic disorder were assessed with the Spanish PDSS-SR, the Anxiety Sensitivity Index-3 (ASI-3), the Sheehan Disability Inventory (SDI) and the Beck Depression Inventory-II (BDI-II). Cronbach's alpha was used to evaluate internal consistency. Pearson correlations were used to evaluate test-retest reliability, convergent and divergent validity. Sensitivity to change data was obtained for 91 patients that had completed a cognitive behavioural therapy. The factor structure was analysed using a confirmatory factor analysis (CFA).

Results

The Spanish PDSS-SR showed excellent internal consistency, good test-retest reliability and adequate convergent validity. Regarding divergent validity, the correlation with the BDI-II was larger than expected. The Spanish PDSS-SR was sensitive to change. Our CFA suggested a two-factor model for the scale.

Conclusions

The Spanish PDSS-SR has similar psychometric properties as the previous versions of the PDSS-SR and it can become a useful instrument to assess panic symptoms in clinical and research settings in Spanish-speaking countries.     

Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities

With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults – second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test–retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.     

Values and Psychological Acceptance as Correlates of Burnout in Support Staff Working With Adults With Intellectual Disabilities

There is growing evidence that acceptance and mindfulness interventions for support staff in intellectual disability (ID) services can have beneficial mental health outcomes for staff themselves and individuals with ID. However, there are few data focusing on the relevance of related psychological processes for support staff well-being. The purpose of this research was to contribute to the evidence base and to introduce a new measure of staff values in ID services: the Support Staff Values Questionnaire (SSVQ-ID). Fifty-nine support staff completed a measure of psychological acceptance (the Acceptance and Action Questionnaire), the SSVQ-ID, and the Maslach Burnout Inventory. The acceptance and values measures had good internal consistency and statistically significant associations with dimensions of burnout. The results suggest that further research on acceptance and mindfulness process variables is warranted along with interventions designed to increase support staff resilience, especially when working with clients with dual diagnosis.     

The Resident Choice Scale: a measure to assess opportunities for self-determination in residential settings

Background A 26‐item Resident Choice Scale was designed to assess service practices for promoting resident choice. Method The staff working with 560 UK/Irish adults with intellectual disability were interviewed. Specific examples of practices promoting resident choice were requested and independently rated by the interviewer. Results The interrater reliability of Resident Choice items was found to be acceptable (subsample n = 50). The psychometric properties of the Resident Choice Scale total score and scores on eight subscales were also acceptable. Consistently strong associations were found between greater resident choice and greater resident ability and, to a lesser extent, fewer resident challenging behaviours. Few associations were found between resident choice and autism or mental health problems. Even when controlling for resident ability and challenging behaviour, consistent associations were found between greater resident choice and the concurrent variables of greater community presence, fewer institutional practices, and greater user self‐reported satisfaction (subsample n = 50). Conclusions Taken together, this pattern of results indicates that the Resident Choice Scale shows promise as a measure of the environmental opportunities available for adults with intellectual disability to exercise self‐determination. Areas for future research testing the reliability and validity of the Resident Choice Scale are outlined.     

Psychometric properties of the Social Phobia and Anxiety Inventory for Children using a non-American population-based sample

Although previous studies have examined the factor structure of the SPAI-C, adequate factor analytic methodology has not been employed. This study explored the psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C), using a non-American population-based sample of older children and young adolescents 11-14 years of age. Initially an exploratory factor analysis was conducted followed 1 year later by a confirmatory factor analysis. Five factors labeled Assertiveness, Public Performance, Physical/Cognitive Symptoms, Social Encounter, and Avoidance were retained and confirmed. The Public Performance and Assertiveness factors were the most stable and consistent factors or traits of social anxiety over a 1-year period. Results revealed adequate concurrent validity, internal consistency and moderate 12-month test-retest reliability of the SPAI-C total scale. The SPAI-C was found to assess levels of both social anxiety and social anxiety disorder according to DSM-IV criteria. Findings suggest that the SPAI-C is applicable in clinical treatment studies designed to assess sensitivity to change in various aspects of social anxiety disorder.     

Elevated diurnal salivary cortisol in nurses is associated with burnout but not with vital exhaustion

Studies on HPA axis regulation in burnout revealed heterogeneous results, possibly due to different psychometric and endocrine measurements, heterogeneous samples or small sample sizes. In the present study, the relationship between salivary cortisol during the day (four time points: 0700 h, 1130 h, 1730 h, and 2000 h) and burnout as well as vital exhaustion was investigated in a large sample of 279 nurses. Burnout was measured using the Maslach Burnout Inventory (MBI), which includes scales for emotional exhaustion, depersonalization, and personal accomplishment. A burnout criterion was assumed to be fulfilled, when any of the MBI scales was above the norm. Subjects with two burnout criterions fulfilled (N = 18) were characterized by a higher cortisol release over the day compared to those reporting only one criterion (N = 77) or no burnout (N = 181) (ANOVA, p = .015). On the other hand, subjects who reported high levels of vital exhaustion did not differ from those who did not report signs of vital exhaustion. These findings provide further evidence for HPA axis dysregulation in burnout.     

Psychometric properties of the revised Developmental Behaviour Checklist scales in Dutch children with intellectual disability

The present study assessed the reliability and validity of the revised scales of the Developmental Behaviour Checklist (DBC) in a Dutch sample of children with intellectual disability (ID). The psychometric properties of the parent and teacher versions of the DBC were assessed in various subsamples derived from a sample of 1057 Dutch children (age range = 6–18 years) with ID or borderline intellectual functioning. Good test–retest reliability was shown both for the parent and teacher versions. Moderate inter‐parent agreement and high one‐year stability was found for the scale scores. Construct validity was satisfactory, although limited by high informant variance. The DBC scales showed good criterion‐related validity, as indicated by significant mean differences between referred and non‐referred children, and between children with and without a corresponding DSM‐IV diagnosis. The reliability and validity of the revised DBC scales are satisfactory, and the checklist is recommended for clinical and research purposes.     

The Spanish validation of an Eating Disorders Symptom Impact Scale (EDSIS) among caregivers

The aim of this study was to examine the psychometric properties of the Spanish version of the Eating Disorders Symptom Impact Scale (EDSIS-S), which is designed to evaluate an eating disorders-specific caregiving experience. A cross-sectional study was conducted among 187 Spanish caregivers of relatives with an eating disorder. Measures included the Experience of Caregiving Inventory (ECI) and General Health Questionnaire (GHQ-12). Socio-demographic variables of the carers and clinical variables of the patients were collected. Results supported the factorial structure, reliability and convergent validity of the instrument and the instrument was acceptable for assessing the eating disorders-specific experience of caregiving in Spain. Almost all of the factor loadings were >0.40. Cronbach’s alpha coefficients were mostly superior to 0.70. The EDSIS-S instrument has good psychometric properties and is similar to the original in terms of validity and reliability. Further examination of the factor structure of this instrument among adult samples is indicated. From a clinical perspective, the EDSIS allows for tailoring caregiver interventions to address the specific impact of symptoms on individual carers.     

Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale

OBJECTIVE: To assess the psychometric properties of the Spanish version of the Hospital Anxiety and Depression Scale(HADS). METHOD: We administered HADS to 685 participants (256 controls and 429 patients with five different diagnoses). The reliability of the instrument was assessed by a test-retest study. Construct validity studies were carried out through item-subscale correlation and factor analysis for the whole group and by each of the five different diagnoses. Three instruments were used as external criteria to assess concurrent validity. RESULTS: HADS test-retest reliability presented correlation coefficients above 0.85. The internal consistency was high, with a Cronbach's alpha of 0.86 (anxiety) and 0.86 (depression). Factor analysis showed a clear two-factor structure for all groups. The results showed high concurrent validity with the Beck Depression Inventory and State-Trait Anxiety Inventory and with the mental domains of the Short-Form Health Survey. CONCLUSION: The Spanish version of the HADS demonstrated good reliability and validity when used in medical patients.     

Initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID)

Individuals with an intellectual disability often require intensive services to promote their social participation to the fullest extent. As such, measuring satisfaction with these services appears essential to enhance the quality of life of individuals with an intellectual disability and to improve service delivery within agencies. Thus, the purpose of the study was to conduct an initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID), a 15-item questionnaire designed to assess service satisfaction. To examine the structure, reliability, and validity of the BASSPID, we interviewed 98 individuals with an intellectual disability and 23 parents. Overall, the BASSPID contained one scale, which had strong content and convergent validity as well as items easily understandable for individuals with an intellectual disability. Furthermore, the questionnaire had good internal consistency and adequate test-retest reliability. However, parents generally overestimated the perceived satisfaction of their child. The study suggests that the BASSPID may be useful to assess the satisfaction of individuals with an intellectual disability, but more research is needed to examine its potential impact on improving service quality.     

Acceptability and psychometric properties of the Structured Clinical interview for Anorexic‐Bulimic Spectrum (SCI‐ABS)

In this study we evaluated the psychometric properties of the Structured Clinical Interview for the Anorexic‐Bulimic Spectrum (SCI‐ABS), including internal consistency, concurrent validity, discriminant validity and test–retest reliability. We also determine acceptability and feasibility of administration of the interview. The SCI‐ABS was designed to assess typical and atypical symptoms, behaviours and temperament traits pertaining to eating disorders. The interview included 134 items grouped into nine domains, four of which were divided into subdomains. Data were collected from 372 subjects: 55 psychiatric patients with any eating disorder according to DSM‐IV criteria, 118 university students, 141 subjects working out in a gym, and 65 obstetrical patients. Concurrent validity of the instrument was assessed against the Eating Attitude Test (EAT) and the Eating Disorder Inventory (EDI). Thirty‐five subjects were also recruited to study the test–retest reliability and 25 women with any eating disorder were administered both the self‐report and the interview formats of the SCI‐ABS. Internal consistency of domains and subdomains was good. Mean domain and subdomain scores were significantly higher in patients with eating disorders, supporting the discriminant validity of the instrument. Correlation with EAT and EDI indicated good concurrent validity. Test–retest reliability was excellent and the agreement between the interview and self‐report formats was satisfactory. Copyright © 2000 Whurr Publishers Ltd.     

Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities

Background Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well‐defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. Methods A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV‐TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS‐III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub‐scales were computed to assess differentiation between the scales. Mean sub‐scale scores were compared between different DSM‐IV‐TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. Results The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub‐scale inter‐correlations showed there is a degree of differentiation between the sub‐scales. Discriminant validity was shown for the sub‐scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine‐factor model as reported in previous studies. Conclusions As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID.     

The intellectual disability version of the very short form of the physical self-inventory (PSI-VS-ID): cross-validation and measurement invariance across gender, weight, age and intellectual disability level

Recently Maïano, Bégarie, Morin, and Ninot (2009) developed and validated an intellectual disability (ID) version of the very short form of the physical self-inventory (PSI-VS-ID). In a recent review of the various physical self-concept instruments Marsh and Cheng (in press) noted that the short and very short versions of the French PSI represent an important contribution to applied research but that further research was needed to investigate the robustness of their psychometric properties in new and diversified samples. Thus, this study is specifically designed to investigate the robustness of the PSI-VS-ID psychometric properties in a new independent sample of 248 adolescents and young adults with ID. In particular, tests of measurement invariance were conducted across the present sample and the original sample from Maïano et al. (2009) study in order to more precisely assess the degree of replication of the results. Overall, results from a series of confirmatory factor analyses of the PSI-VS-ID provided support for its: (i) factorial validity and reliability; (ii) factorial invariance across gender and weight status; (iii) partial (strict or strong) factorial invariance across age, ID level and samples; and (iv) latent mean differences across gender, weight status and ID level groups.     

Job burnout amongst the institutional caregivers working with individuals with intellectual and developmental disabilities: Utilization of the Chinese version of the Copenhagen Burnout Inventory survey

Burnout has been considered important to understand the well-being of people who work with individuals with intellectual disabilities (ID) and developmental disabilities (DD). To identify personal and workplace characteristics associated with burnout, this study aimed to utilize the Chinese version of the Copenhagen Burnout Inventory to provide a burnout profile of caregivers who served individuals with ID/DD and evaluate the potential factors associated with burnout in this group. A purposive sampling method and a self-administered structured questionnaire were employed to recruit 276 caregivers from 4 different disability institutions for study participation. The results revealed that the average personal burnout score (PBS) and work-related burnout score (WBS) were 44.0 (SD = 16.8) and 34.2 (SD = 15.9). These burnout scores were higher compared with general full time employees in Taiwan. The results showed that that 17.8% of the staff were moderately burnt out (PBS score: 50–70), and 7.6% of the staff were in the highest exhausted level (PBS score ≧ 70) of PBS. With regard to the WBS score, 20.7% were moderately burnt out (PBS score: 50–70), and 5.1% of the staff were in the highest exhausted level (WBS score ≧ 70). Finally, a multiple regression analysis reported that the factors of self-report health status and WBS significantly predicted higher respondent PBS (R² = 0.642). The study highlights the need to improve the psychological health and well-being of the caregivers who work with individuals with ID/DD and the need for the institutions to strengthen supportive healthy working environments to decrease staff burnout.     

Burnout in the general population

Background Burnout is a chronic stress syndrome which develops gradually as a consequence of prolonged stress situation. Socio-demographic factors related to job-related burnout have not been studied in the whole population. We investigated the relative differences in the level of burnout between groups based on various socio-demographic factors in the population-based Finnish sample. Methods The nationally representative sample comprised 3,424 employees aged 30–64 years. Burnout was assessed with the Maslach Burnout Inventory–General Survey. The socio-demographic factors of interest were gender, age, education, type of employment, work experience, socio-economic status (SES), working time, and marital status. Results Only small differences in burnout were found between the different population groups. As a three-dimensional syndrome, burnout was associated with age. In contrast to what has been consistently reported so far, mostly among human service work and in non-representative studies, burnout seemed to increase somewhat with age. Among women, burnout was also related to education, SES, and work experience, and among men, to marital status. Conclusions Burnout can evolve in all kinds of vocational groups. It seems that age does not generally protect against burnout. A low education level and low social status carry a possible risk of burnout for women, and being single, divorced, or widowed carry a possible risk of burnout for men.     

The development and psychometric properties of the Sensory Processing Scale Inventory: A report measure of sensory modulation

Background Sensory irregularities are commonly seen across developmental and intellectual disability groups. Identifying patterns of dysfunction within these clinical groups facilitates the development of appropriate intervention strategies. Thus, we evaluated the psychometric properties of the new Sensory Processing (SP) Scale Inventory rating scale.

Method Parents of children 4–18 years with and without sensory challenges completed the SP Scale Inventory. Item, domain, and subscale analyses were conducted to evaluate internal reliability, discriminant validity, and construct validity of the scale.

Results Items with adequate reliability and discriminant validity, a high frequency of endorsement by the clinical sample, and clear factor representation were retained. Reduced subscales demonstrated strong reliability and validity. Factor analysis verified the previously proposed sensory modulation subtypes.

Conclusions The new SP Scale Inventory appears to be a clinically useful parent rating scale to characterise patterns of sensory modulation in children with an intellectual or developmental disability.     

Occupational burnout and medically certified sickness absence: a population-based study of Finnish employees

OBJECTIVE: Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. METHODS: A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. RESULTS: The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. CONCLUSIONS: Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.