Chronic Interpersonal Stressors Research Articles

Measuring Burnout: A Validation Study of The Oldenburg Burnout Inventory for The Sri-Lankan IT Sector

Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. WHO defines burnout as an “occupational phenomenon” and is included in the 11th revision of the International Classification of Diseases (ICD-11). Research reveals the existence of this burnout phenomenon across a range of occupations, such as healthcare professionals, teachers, athletes, pilots, IT professionals etc. A study conducted by Yerbo, a mental wellbeing platform revealed that 2 in 5 of the workers in the IT industry show a high risk of burnout. At present, there are few tools available to measure burnout. After the Maslach Burnout Inventory (MBI), the Oldenburg Burnout Inventory (OLBI) is considered the most widely used measure of burnout and is also freely available. The current study is aimed at determining the measurement validity of the OLBI in the local context based on IT professionals. To determine the content validity of the OLBI, an expert panel was employed. In order to examine the construct validity and concurrent criterion validity, a questionnaire-based study was conducted among 161 (n = 161) randomly chosen IT professionals. MBI and DASS-21 were used to explore the convergent and divergent validity of the OLBI. Four items were deemed not essential to measure burnout based on content validation. The MTMM analysis revealed adequate evidence of the existence of both convergent and divergent validity of the OLBI. The current study was able to provide evidence of content, concurrent criterion and construct related validity of the OLBI in the Sri Lankan context based on IT professionals. These findings suggest that OLBI can be used as a reasonable tool to measure burnout among IT professionals in Sri Lanka. Availability of such a tool will undoubtedly help organizations in ensuring their workforce is healthy and productive. KEYWORDS: Occupational burnout, Content validity, Construct validity, Criterion validity, Oldenburg Burnout Inventory, Multi Trait Multi Method Matrix

Cortisol’s diurnal rhythm indexes the neurobiological impact of child adversity in adolescence

Adverse early life experiences, such as child maltreatment, shapes hypothalamic-pituitary-adrenal (HPA) activity. The impact of social context is often probed through laboratory stress reactivity, yet child maltreatment is a severe form of chronic stress that recalibrates even stable or relatively inflexible stress systems such as cortisol’s diurnal rhythm. This study was designed to determine how different social contexts, which place divergent demands on children, shape cortisol’s diurnal rhythm. Participants include 120 adolescents (9–14 years), including 42 youth with substantiated child physical abuse. Up to 32 saliva samples were obtained in the laboratory, on days youth stayed home, and on school days. A 3-level hierarchical linear model examined cortisol within each day and extracted the diurnal rhythm at level 1; across days at level 2; and between-individual differences in cortisol and its rhythm at level 3. While cortisol’s diurnal rhythm was flattened when youth were in the novel laboratory context, the impact of maltreatment was observed within the home context such that maltreated children had persistently flattened diurnal rhythms. The effect of maltreatment overlapped with current chronic interpersonal family stress. Results are consistent with the idea that maltreatment exerts a robust, detrimental impact on the HPA axis and are interpreted in the context of less flexibility and rhythmicity. The HPA axis adapts by encoding signifiers of relevant harsh or unpredictable environments, and the extreme stress of physical abuse in the family setting may be one of these environments which calibrates the developing child’s stress responsive system, even throughout a developmental stage in which the family takes on diminishing importance.

Characterizing Life Stress Exposure Among Sexual Minority Adolescents: Temporality, Content, And Mediating Role in Mental Health Disparities.

Though sexual minority adolescents face a wide array of deleterious stressors, few studies have examined the role of specific types of stress exposure (i.e., chronic vs. episodic, interpersonal vs. non-interpersonal) on mental health disparities. This study utilizes a contextual threat-based assessment to (a) compare levels of stress exposure types between sexual minority and non-sexual minority adolescents, and (b) examine stress type as a mediator between sexual orientation and two outcomes: depressive symptoms and emotion dysregulation. Data comes from a longitudinal sample (14-17years-old, N = 241; 17.6% sexual minority; 54% assigned female at birth; 73.9% White), with two time-points (T1 and T2) utilized. Sexual minority adolescents reported higher chronic interpersonal stress, but no differences in non-interpersonal chronic or episodic stress, relative to non-sexual minority adolescents. Chronic interpersonal stress exposure mediated the link between membership in an oppressed group (i.e., sexual minority teens) and the primary outcomes (emotion dysregulation and depressive symptoms) at both T1 and T2. Findings demonstrate the utility of contextual threat-based assessments within sexual minority research.

RELATIONSHIP BETWEEN GENDER, STUDY DURATION AND BURNOUT AMONG MEDICAL STUDENTS

Background: Burnout is a psychological syndrome as a response that arises due to chronic interpersonal stressors at work. Burnout in medical students has a negative impact mentally and physically.Aims: This study aims to determine the relationship between gender and study duration with burnout in medical students.Method: This study was conducted using an analytical observational method with a cross-sectional study approach using MBI-SS. The population for this study is composed of medical students at the Faculty of Medicine at Universitas Sebelas Maret, specifically those from the classes of 2019-2021. Samples were selected randomly using a stratified random sampling method. The sample size was 247 students. The data were then analyzed using SPSS 22 for Windows.Result: The results of the analysis showed that there was no significant difference in the level of burnout based on gender with p-value of 0.786, but there was a significant difference in the level of burnout based on the study duration with p-value of 0.044, which the third-year students rank highest in MBI-SS score.Conclusion: The results of this study indicate that there is no significant relationship between gender and burnout levels but there is a significant relationship between study period and burnout levels. These results indicate that the longer the study duration, the higher the burnout level of students.

Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents

BackgroundChronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms. MethodsThis study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period. ResultsIn partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress. LimitationsStudy limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective. ConclusionsMore targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.

Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder

BackgroundOffspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up.MethodsFamilies having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index—4th Edition, the Behaviour Assessment Scales for Children—2nd Edition, and the UCLA Life Stress Interview.ResultsFamilies having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found.ConclusionsThe findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.

Burnout syndrome among health care workers in Hungary – a literature review

Burnout is recognised as an occupational hazard and prolonged response to chronic interpersonal stressors at work in various people-centred professions, with higher prevalence among health care workers. The main objective of this research was the integrative review of the literature on burnout syndrome in Hungarian health care workers. Twelve (12) studies found in PubMed database were included in the research and a number of important conclusions have been summarized about burnout syndrome among employees of the Hungarian health care system. Also, as important conclusion it has been highlighted, that recognising, preventing, and treating burnout and depression among health care workers should be one of the priorities of the health care in Hungary.

Promoting a sense of belonging, engagement, and collegiality to reduce burnout: a mixed methods study among undergraduate medical students in a non-Western, Asian context

BackgroundBurnout is a psychological condition induced by work-related chronic interpersonal stressors. Interventions creating a sense of belonging and collegiality have been proposed as approaches for alleviating burnout. The current study aimed to: (1) explore the relationships between burnout, sense of belonging (relatedness with others), and work engagement; and (2) identify the key elements perceived by undergraduate medical students as positively contributing to collegiality, engagement, and a sense of belonging, in an undergraduate medical training setting.MethodsAn exploratory sequential mixed-methods design using questionnaires and semi-structured individual interviews collected quantitative and qualitative data among undergraduate medical students at Mahidol University, Thailand. The Maslach Burnout Inventory-Student Survey questionnaire was used to measure burnout. The Basic Psychological Need Satisfaction at Work Scale (BPNSS-21) and the Utrecht Work Engagement Scale-Student Version (UWESS-9) measured students’ basic psychological needs satisfaction at work and work engagement, respectively. Descriptive statistical analysis and confirmatory factor analysis were performed on BPNSS-21 and UWESS-9 data. Spearman’s correlation coefficient was used to identify the correlation between burnout and other factors. Twenty undergraduate medical students participated in the qualitative study. Qualitative analysis was conducted iteratively using constant comparison and the standard principles of primary, secondary, and tertiary coding for thematic analysis.ResultsThai versions of the BPNSS-21 and UWESS-9 showed an acceptable fit for the Thai cultural context. Burnout had significant weak inverse associations with engagement (r = − 0.39, p < 0.005) and basic psychological needs satisfaction (r = − 0.37, p < 0.005). Sense of belonging had a significant weak inverse relationship with burnout (r = − 0.25, p < 0.005). The main themes emerging from qualitative analysis were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills.ConclusionsSense of belonging, engagement, and collegiality were related to burnout. The key features for promoting collegiality, the sense of belonging, and engagement were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills.

Exploring Pediatric Nurses' Perspectives on Their Work Environment, Work Attitudes, and Experience of Burnout: What Really Matters?

BackgroundPediatric nurses care for some of the most vulnerable patients in our healthcare system and are vulnerable to the impact of the stress of their work on their well-being. Burnout is a potential response to chronic interpersonal stressors and a negative work outcome linked to personal and professional consequences. A thorough understanding of the experience and factors associated with burnout in this population is an important part of developing interventions to mitigate or prevent this workplace outcome. Therefore, our study objectives were to: (1) explain and expand our understanding of pediatric critical care nurses experience of burnout in relation to their work environment and work engagement; (2) provide recommendations for nursing administrators to improve nurses’ work environment, work attitudes, and work outcomes.MethodsA convenience sample of pediatric critical care nurses from a large pediatric quaternary care hospital in Ontario, Canada were invited to participate in this second phase of a sequential explanatory mixed-methods study. Semi-structured interviews were conducted, with and main themes and subthemes distilled through the method of interpretive description.ResultsA total of 18 PICU/CCCU/NICU nurses participated. Derived themes included the experience and identification of burnout, including its prevalence and elusiveness. Their experiences of quality of work-life included themes such as compensation, emotional support at work, respect, their professional identity, and spill over into home life. They discussed components of work engagement, including the work itself, investment into their growth and development, and the meaning of their work. The self-care subthemes included the importance of preparation and recovery, and the use of physical and mental separation as a preservation strategy. The participants’ recommendations for strategies to mitigate burnout were also summarized.ConclusionBurnout is a complex and regularly occurring experience for pediatric critical care nurses. Although the experience may be difficult to self-identify, the impacts on the individuals are profound. Further research and organizational support are needed to test practical and evidence-based interventions to improve the well-being of this population.

Early-life adversity and risk for depression and anxiety: The role of interpersonal support.

Early-life adversity is a major risk factor for psychopathology, but not all who experience adversity develop psychopathology. The current study evaluated whether the links between child and adolescent adversity and depression and anxiety were described by general benefits and/or buffering effects of interpersonal support. Data from 456 adolescents oversampled on neuroticism over a 5-year period were examined in a series of discrete-time survival analyses to predict subsequent disorder onsets. Models examined linear, quadratic, and interactive effects of interpersonal support over time, as measured by chronic interpersonal stress interview ratings. Results did not support buffering effects of interpersonal support against either child or adolescent adversity in predicting depression or anxiety. However, there was support for the general benefits model of interpersonal support as evidenced by follow-up analyses of significant quadratic effects of interpersonal support, demonstrating that higher interpersonal support led to decreased likelihood of depression and anxiety onsets. Secondary analyses demonstrated that effects of interpersonal support remained after accounting for baseline depression and anxiety diagnoses. Further, quadratic effects were driven by social domains as opposed to familial domains when considering child adversity. Implications for interventions and randomized controlled prevention trials regarding interpersonal relationships are discussed.

Dampak Kelelahan Mental (Burnout) Terhadap Kinerja Karyawan PT. Duta Merpati Indonesia

Burnout is a psychological syndrome that arises as a prolonged response to chronic interpersonal stressors from work. Burnout can be a serious problem for companies or organizations and individuals which will affect productivity, quality, job satisfaction and employee performance. This study aims to understand the burnout (mental fatigue) that is often experienced by employees and the factors that cause it. So that this research can be a reference for readers who experience or want to know burnout. This research was conducted with a qualitative descriptive research method based on the results of observations and interviews with resource persons in the field and continued the results of previous research. The type of sample used in this research is simple random sampling. The sample in this study were employees and employees of PT. Duta Merpati Indonesia who found a double job desk (holding more than one task and responsibility). This study shows the impact of mental fatigue experienced by employees due to carrying out several different tasks and responsibilities. These include decreased loyalty, decreased productivity, and job discomfort. Mental fatigue occurs because of the severe stress experienced by a person in carrying out activities, resulting in a feeling of reluctance or not being motivated to carry out activities that are usually done.

Prevalence of burnout and its associated factors among nurses at a governmental hospital in Jouf region in Saudi Arabia

Background: Burnout is a psychological syndrome that progresses as a prolonged response to chronic interpersonal stressors related to the job. Thus, this study aimed to assess the prevalence of burnout among nursing staff, explore its causes, and find a relationship or difference between the demographic data and the prevalence of burnout among nurses at Al Qurayyat General Hospital, Saudi Arabia. Methods: This study was a descriptive, cross-sectional survey conducted among nurses of Al Qurayyat General Hospital. The study was conducted using Maslach Burnout Inventory to assess the prevalence of burnout. A convenience sampling method was used to recruit the nurses and their demographic details were collected. Results: In this study, 290 nurses participated, of which 191 (65.9%) participants were available, and the data of 90 (34.1%) participants were missing. More than one-half of the nurses were non-Saudi (74.3%) and 181 were females (94.8%). Around 62.3% had high emotional exhaustion (EE), 35.2% had high depersonalization, and 57.1% had low personal accomplishment. There was a significant correlation between marital status and the EE domain (p = 0.04). Conclusion: There was a high level of burnout among nurses of Al Qurayyat General Hospital. Marital status was the only factor that affected the EE domain. It is necessary to assess burnout among nurses as it has significant negative effects on the quality of care provided by nurses.

STRESS AND BURNOUT SYNDROME AMONG MOROCCAN MEDICAL STUDENTS: A CROSS-SECTIONAL STUDY

Background:Christina Maslach and colleagues define burnout as a psychological syndrome in response to chronic interpersonal stressors on the job which is further characterized by its three dimensions of exhaustion, depersonalization, and a decreased sense of accomplishment. Burnout and stress are symptomatically similar, with burnout attributed specifically to occupational or academic stressors. Both can cause seriousconsequences on studenthealth, professionalism, and patient care. There are few studies evaluating the level of stress and burnoutsyndrome among medical students in Morocco.The aim of this study was to assess the prevalence and levels of burnout syndrome to identify associated factors as well as the level of stress among a group of medical students in Morocco. Method: Our study was descriptive andcross-sectional. It focused on 5th grade level medical students and was carried out during the month of November 2014. Data was collected through a self-administered questionnaire based on volunteering. Results:The study was conducted in a total of 178 fifth-year medical students. The response rate was 97.2% (n = 173). The mean age was 22.2 years (SD = 0.87 years) with a female predominance (74%). The average daily working hours were 8.33 hours (SD= 2.74) and the average daily hours of sleep was 7 hours (SD= 1.1). The majority of students (96.5%) were single.The prevalence of burnout, based on Maslach Burnout Inventory, was 49% (n = 87) of students.The prevalence of high emotional exhaustion was 44%, high depersonalization was 33.3% and high burnout score for personal accomplishment accounted for 64 %.We found a positive correlation between the number of working hours and the burnout score (r = 0.341, p &lt;0.001) as well as the stress score (r=0.3, p=0.009). We also found a negative correlation between the number of hours of sleep and the Burnout score (r = -0.215, p = 0.019).Clearly, this study provides an idea for necessity to plan specific interventions to reduce student stress and avoid burnout.

Neurophysiological Responses to Interpersonal Emotional Images: Associations with Symptoms of Depression and Social Anxiety.

Affective neuroscience research using electrocortical event-related potentials has provided valuable insights on alterations in emotion processing in internalizing disorders. However, internalizing disorders are accompanied by additional impairments in social cognition and functioning, and most extant research examines neural responses to broad categories of emotional scenes or faces presented irrespective of context. Examining neural reactivity specifically to interpersonal emotional scenes may more precisely capture and disentangle processes involved in depression and social anxiety, two highly comorbid forms of psychopathology. The current study validated a novel set of positive and threatening interpersonal emotional stimuli in a sample of emerging adults (N = 114) who completed a modified emotional interrupt paradigm while electroencephalogram and behavioral data were recorded. Participant ratings of valence and arousal supported the validity of the emotional images. Consistent with prior research, sustained neurophysiological processing indexed by the late positive potential (LPP) was observed for interpersonal emotional images, especially positive, compared with neutral images. Elevated LPP reactivity to both positive and threatening interpersonal images moderated the effects of chronic interpersonal stress on social anxiety symptoms, such that enhanced LPP reactivity in conjunction with higher levels of chronic interpersonal stress was associated with elevated social anxiety symptoms. These results were unique to social anxiety symptoms and not symptoms of depression, suggesting sustained neural processing of interpersonal stimuli may differentiate social anxiety from depression. Future research on emotional reactivity specifically within the interpersonal domain is needed to inform our understanding of developmental pathways to internalizing psychopathology.

The Interplay of Chronic Interpersonal Stress and Rumination on Nonsuicidal Self-Injury in Youth.

Nonsuicidal self-injury (NSSI) describes deliberate self-destructive behaviors without the intention to die. Little is known about what factors contribute to NSSI especially among youth. The current study tested two conceptual models for how chronic interpersonal stress and rumination may contribute to NSSI engagement across 18months in a community sample of youth: (1) a mediation pathway based on the Emotional Cascade Model (i.e., stress contributes to rumination and then to subsequent NSSI), and (2) a moderation model based on the cognitive vulnerability-stress framework (i.e., rumination moderates the relation between stress and NSSI). 516 youth aged 7-16 (Mage = 12.0; 56% female; 90% Non-Hispanic or Non-Latinx) reported on ongoing interpersonal stress occurring between T1-T2 (every 6months from T1 to 12months) via the Youth Life Stress Interview, rumination via the Children's Response Styles Questionnaire (at T1 and 18months later, T2), and NSSI engagement every six months from 18 to 36months (T2-T3) via the Self-Injurious Thoughts and Behaviors Interview. Interpersonal stress predicted later rumination (b = .43, p < .01), rumination forecasted later NSSI occurrence (OR = 1.06, p < .01), and mediation was supported via a significant indirect effect of interpersonal stress on NSSI through rumination (b = .03, 95% CI = .01, .07). Rumination did not significantly moderate the relation between stress and NSSI. The prospective relation between chronic interpersonal stress and NSSI engagement was partly explained by rumination, aligning with the Emotional Cascade Model's prediction that rumination contributes to NSSI. Youth may conduct NSSI to interrupt rumination elicited by chronic interpersonal stress.

Abstract PD12-02: Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism

Abstract Background: Depression in cancer patients predicts lower survival, and early identification of individuals at highest risk for depression is needed. In the general population, depression is higher in contexts of both childhood adversity and chronic interpersonal stress, but their collective influence on depressive outcomes in the first year after breast cancer diagnosis is unknown. Genetic polymorphisms related to socioemotional functioning (e.g., the serotonin transporter) may moderate the associations among childhood adversity, chronic interpersonal stress, and depressive outcomes, specifying which women are most at risk. Methods: 460 women with invasive breast cancer were assessed for depressive symptoms and major depressive episodes (MDEs) seven times across one year. Associations between depressive symptoms and childhood adversity, chronic interpersonal stress, and the 5-HTTLPR polymorphism were examined. We used multilevel modeling for predicting longitudinal depressive symptoms, logistic regression for predicting any MDEs over the year, and multinomial logistic regression for predicting odds of belonging to Low/Recovery/High depressive symptom trajectory classes (Stanton et al., 2015). Models controlled for known sociodemographic and clinical confounding variables such as age, ethnicity, SES, cancer stage, treatments received, medical comorbidities, history of depression, and neuroticism. Results: Higher chronic interpersonal stress predicted greater depressive symptoms at study entry (b=4.56, 95% CI [2.60,6.52]), greater odds for belonging to a High vs. Low depressive trajectory class (OR=3.16, [1.53, 6.51]), and greater odds of having an MDE (OR=2.28, [1.10, 4.73]). 5-HTTLPR moderated the influence of chronic interpersonal stress on depressive symptoms over time (b=0.24, [0.06,0.41]), with no decline in symptoms for SS genotype women under high chronic interpersonal stress vs. significant improvement in symptoms despite high chronic interpersonal stress for LL/LS genotype women. There were no significant effects of childhood adversity on depressive outcomes considered. Conclusion: Women with greater chronic interpersonal stress are at risk for high, unremitting depressive symptom trajectories and MDEs in the first year after invasive breast cancer diagnosis. Unchanged depressive symptoms across the year were most pronounced for women bearing the SS allele of the 5-HTTLPR polymorphism. Women with high chronic interpersonal stress and the SS genotype may benefit from early intervention to prevent depression after breast cancer diagnosis. Citation Format: Jacqueline HJ Kim, Steve W Cole, Karen L Weihs, Annette L Stanton. Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-02.

Reciprocal effects of neuroticism and life stress in adolescence

Background: Stressful life experiences and personality can influence one another. Personality may contribute to the amount and type of stress individuals experience, which is referred to as a selection effect. Life stress may also impact one's personality, which is referred to as a socialization effect. It was hypothesized that neuroticism would predict increased chronic and episodic stress (selection effect) and that chronic and episodic stress would predict increased neuroticism (socialization effect).Methods: The current study investigated selection and socialization effects of neuroticism and life stress over a three-year period in 627 adolescents. Life stress data were examined in terms of duration (chronic versus episodic) and type (interpersonal versus non-interpersonal). Episodic stress data were examined as dependent or independent.Results: The results from ten cross-lagged panel models provided some evidence for significant selection and socialization effects depending on stress type. Over three years, we observed that neuroticism increases interpersonal chronic stress and non-interpersonal stressful events (selection effects) and that dependent non-interpersonal stressful events and chronic stress increase neuroticism (socialization effects).Limitations: Study limitations include a lack of a lifespan perspective and a statistical approach that does not differentiate between- from within-person variance.Conclusions: Findings suggest the value of attending to stress response as well as targeting neuroticism in prevention and intervention approaches in adolescents.

Annual Research Review: Social relationships and the immune system during development.

A child's social relationships serve critical functions during development. The interface between a child's social world and their immune system, particularly innate immunity, which helped children survive in the face of infections, nutritional scarcity, and violence throughout human history, is the focus of this Annual Research Review. This article reviews the state of research on social relationships and innate immune inflammation during childhood. Warmth and rejection in childhood social relationships, as well as physical trauma and unpredictable social environments, were not consistently related to circulating inflammatory markers such as interleukin-6 and C-reactive protein during childhood. Instead, links between social environments and inflammation were observed in studies that focus on children with greater background risk factors, such as low family socioeconomic status, family history of mood disorders, or presence of chronic interpersonal stressors combined with acute episodic stressors. In addition, studies on worse childhood social environments and greater inflammation in adulthood were more consistent. Warmth and rejection in the social environment may be related to sensitivity of immune cells to the anti-inflammatory actions of glucocorticoids, though this is primarily observed in adolescent women at risk for depression. Additional mechanistic evidence suggests that greater warmth and less rejection are related to processes that regulate inflammation, including greater expression of the glucocorticoid receptor gene and lower expression of genes that are responsive to the pro-inflammatory transcription factor NF-kappa B. The article concludes by discussing implications of the interface between a child's social relationships and inflammation for mental health and other recent (on evolutionary timescales) health threats, as well as recommendations for future research, and recommendations for researchers interested in integrating inflammatory measures in developmental research.

Letter to a New Nurse

Letter to a New Nurse

Beyond the Maslach burnout inventory: addressing emergency medicine burnout with Maslach's full theory.

Burnout, a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job, remains a substantial problem for emergency physicians, leading to decreased quality of care and attrition from the workforce. The majority of prior work on burnout in emergency medicine has focused on individualized solutions, which have demonstrated modest efficacy for ameliorating burnout. However, recent studies suggest that burnout in medicine is primarily caused by workplace factors (eg, unmanageable workloads, unreasonable time pressures) and therefore requires solutions at an organizational level. In her decades of research across industries, Christina Maslach identified 6 domains of organizations that can either promote engagement or lead to burnout. In this article, we apply Maslach's 6 domains to emergency medicine to provide a systematic framework for alleviating burnout and promoting engagement among emergency physicians. By considering the domains of workload, reward, control, fairness, community, and value congruence, emergency medicine leaders can develop and deploy more effective interventions aimed at improving the experience and longevity of physicians across our specialty.