Mindfulness, stress and burnout among mental health professionals in Singapore

Abstract

International literature suggests that mental health professionals are experiencing high levelsof stress and burnout. This is of concern as high levels of stress and burnout in healthcareprofessionals are associated with staff health concerns, decreased patient satisfaction, andhigh staff turnover rates. A growing body of research has shown that mindfulness is effectivein reducing stress and burnout in health professionals in western countries. However, theextent of stress and burnout, and the effectiveness of mindfulness interventions in reducingstress and burnout experienced by mental health professionals in Singapore, were unknown.To address these gaps in the literature, there were two primary aims of this thesis: (1) toinvestigate the extent of stress and burnout in healthcare professionals working in a mentalhealth setting in Singapore, and (2) to examine the effectiveness of a mindfulnessintervention in promoting mindfulness and compassion and reducing stress and burnoutamong mental health professionals in Singapore. A sequential two-phase research design wasadopted to address these aims. Phase one was a cross-sectional survey study addressing thefirst aim, while Phase two was a prospective study addressing the second aim. In addition,there were three secondary aims: (1) to investigate the psychometric properties of the FiveFacets Mindfulness Questionnaire (FFMQ), (2) to examine the associations betweenmindfulness, stress, and burnout among mental health professionals in Singapore, and (3) toexamine the relationships between amount of time engaged in both formal and informalhomework practice and change in mindfulness and stress levels after the mindfulnessintervention. The first and second secondary aims were addressed in the Phase one study,while the third secondary aim was addressed in the Phase two study.In the Phase one study, a cross-sectional survey which included the PSS (Perceived StressScale), OLBI (Oldenburg Burnout Inventory), and FFMQ (Five Facets MindfulnessQuestionnaire), was conducted. A total of 260 Singaporean mental health professionalsconsisting of psychiatrists/ doctors, allied health professionals, case managers, pharmacists,researchers, or nurses completed the survey. Findings from this study showed that healthcareprofessionals working in a mental health setting in Singapore were experiencing higher levelsof stress and burnout compared to healthy adults in other countries. Mental healthprofessionals below the age of 25, those with less than five years’ experience, and those withthe lowest annual income, reported the highest levels of stress and burnout. No significant associations were found between other demographic or work situation variables with stressand burnout. All of the mindfulness facets were negatively associated with stress andburnout. In addition, the FFMQ was found to have a five-factor structure consistent with theoriginal measure, and demonstrated excellent internal consistency and adequate constructvalidity, in our sample of Singaporean mental health professionals.In the Phase two study, 37 mental health professionals participated in a prospective study inwhich they participated in a mindfulness program. This program consisted of six two-hoursessions offered once a week over six weeks, and instructors used a range of mindfulnesstechniques to teach participants to cultivate compassionate and non-judgemental attitudestowards their inner experiences. Five self-report questionnaires: FFMQ, SCS-SF (SelfcompassionScale-Short Form), CS (Compassion Scale), PSS, and OLBI, were used asoutcome measures. Data were collected at three stages: pre- and post-intervention, and threemonths follow-up.Findings revealed that participants reported significant improvements in levels ofmindfulness, self-compassion and compassion for others, and a significant reduction of stress,after the six-week mindfulness program. Changes in mindfulness and self-compassion levelswere maintained three months after the mindfulness program. In contrast, there was nosignificant change in the subscales for burnout, measured pre-post intervention or threemonths later. In addition, findings showed that the amount of time participants engaged informal meditation home practice during the intervention period was positively associatedwith the reduction of stress levels post-intervention.Overall, our results suggest that mental health professionals in Singapore are experiencingrelatively high levels of stress and burnout, and that a six-week mindfulness program has thepotential to improve their mindfulness and compassion levels, and reduce their stress levels.However, future adequately powered experimental studies in Singapore are warranted tosupplement the findings of the current study. More research is also required to identify thebest approach to reducing stress and burnout, and how doing so might contribute to improvedwork engagement, staff retention, and quality of care in mental health practice in Singapore.