Occupational stress, burnout and reduced psychological well-being among Australian dentists : a multi-method study extending the job demand-control-support model to incorporate coping

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NO FULL TEXT AVAILABLE. This thesis contains 3rd party copyright material. ----- The transactional theory of stress provides the theoretical background for the present study. This theory proposes that stress is not a factor or variable that resides in the individual or the environment, but is a dynamic process that consists of several components (Lazarus & Folkman 1984). A highly regarded transactional model of workplace stress (Kompier, 2003) is the Job Demand-Control-Support (JDCS) model (Johnson & Hall 1988; Karasek & Theorell 1990). In this model the variables job demands, job control and social support are used to establish the connection between a person and their job and the collective relations between people. While the model has good predictive validity (Perrewe & Zellars, 1999) it does not take account of individual differences in susceptibility to stressors. Hence the present study uses coping in addition to the key JDCS variables to examine the stressor-strain relationship among Australian dentists. In the present study, strain is conceptualised by two similar but distinct constructs. The first construct, burnout, is a psychological syndrome that involves a prolonged response to stressors in the workplace. The second construct, reduced psychological well-being, considers the inability of an individual to carry out their normal healthy functions. The research was conducted in two phases. The first phase entailed the qualitative component of the research program. Eighteen dentists predominately from private practice in two Australian states participated in semi-structured interviews. The aim of the first phase was to identify the chronic sources of work stress commonly experienced by Australian dentists. Phase One also sought to determine the extent to which the stressors identified were consistent with how stressors had been conceptualised and operationalised in the literature. In Phase Two, a multi-measure survey was developed, piloted and distributed to a census (n = 3,886) of Australian Dental Association NSW Branch members in October 2010. The survey yielded a response rate of 26.9 per cent (n = 1,046). Although many of the scales, such as the Job Content Questionnaire (Karasek et al. 1985) had been validated extensively, less was known about Cooper et al.’s (1988) Work Stress Inventory for Dentists (WSID) or how each of the scales would perform in the Australian dental context. Explanatory and confirmatory factor analyses were used to assess the uni-dimensionality of the scales and to determine the items that best captured the dimensions of each construct. Structural equation modelling was used to assess the validity of the constructs and test the hypothesised relationships. The findings from Phase One of the study indicate that Australian dentists were subject to a variety of job-specific stressors. Many of these stressors were consistent with the stressors conceptualised in the WSID, such as time and scheduling pressures. Stressors relating to the business side of dentistry were the most notable disparity. Phase Two findings indicate that psychological job demands had the greatest impact either directly or indirectly through job control, social support or coping on burnout and reduced psychological well-being. While job-specific stressors in the form of time and scheduling pressures were found to have a direct relationship with emotional exhaustion as well as an indirect relationship through job control. Further, a direct relationship between the fragility of the dentist patient relationship and both depersonalisation and reduced psychological well-being was established. Business process stressors were found to have a direct relationship with dentists’ sense of personal accomplishment. Social support and coping were found to jointly buffer the impact of psychological job demands on reduced personal accomplishment. Reduced psychological well-being was found to have a direct relationship with emotional exhaustion as well as reduced personal accomplishment, while the burnout dimensions depersonalisation and reduced personal accomplishment were found to precede emotional exhaustion. Consistent with Lazarus’ transactional theory of stress, these findings suggest that stress is a dynamic process that consists of several components. The study highlights the importance of examining the complex inter-relationships of the key determinants of the JDCS model in addition to coping on burnout and reduced psychological well-being thus filling a gap in the established literature. Limitations of the study are discussed and future research recommendations are provided, as are the practical and theoretical implications. The implications for theoretical advancement include the formulation of a model using objectively measurable constructs that can be directly tested and modified or rejected.
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