Cite this asPerrotta G, Marciano A, Fabiano G (2023) Perrotta-Marciano Burnout Risk Interview 1 (BORI-1): The new clinical interview to investigate burnout risk in public and private workplaces. Arch Community Med Public Health 9(4): 066-069. DOI: 10.17352/2455-5479.000205
Copyright License© 2023 Perrotta G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Starting from the general concept of "burnout", thus describing the lack of energy, fatigue, and unproductivity at work that a person develops in the workplace, the present paper defines the specific characteristics of the syndrome and related contexts and then proposes a new psychometric instrument (Perrotta-Marciano Burnout Risk Interview 1, BORI-1), in the interview version, capable of assessing and graduating the risk of the same, to intervene promptly in borderline situations that could degenerate into injurious and self-injurious acts. The interview aims to analyze the risk of burnout in individuals who work in both the private and public sectors and who for reasons of service may be put under pressure, even if they have passed the medical and psychiatric examination. It is therefore proposed as a tool for investigation, prevention, and clinical evaluation of burnout syndrome in its clinical signs, thus bridging the critical issues noted in the current psychometric instruments dedicated to the subject under consideration.
The term "burnout" literally means ‘exhaustion’, thus describing the lack of energy, fatigue, and unproductivity at work that a person develops in the workplace. It first took on the connotations of clinical syndrome when psychologist Herbert Freudenberger defined it as a condition of psychophysical depletion that would wear a person down due to chronic exposure to interpersonal stresses in the workplace, with the manifestation of physical, emotional, and behavioural symptoms  .
Freudenberger, drawing on the studies of Maslach and Cherniss that focused on defining the characteristics of burnout among social and healthcare workers, laid the groundwork for a series of insights in other areas as well, such as the military, social welfare, and work in general [2,3].
The World Health Organization, in the International Classification of Diseases-11 (ICD-11), defines burnout as "a state of vital exhaustion due to work-related stress"; however, not all authors agree on this definition, such as Borgogni and Council, who differentiate the burnout syndrome from work-related stress. According to these authors, burnout has more emotional aspects than physical ones, since this syndrome is grafted onto a work situation that has become chronic over time; moreover, the impairment of interpersonal relationships is seen as a symptom and not a cause. In this sense, other authors also stress the importance of differential diagnoses for burnout. Burnout, in the ICD-11, has the code "QD85" and is characterized by four symptoms: feeling mentally and/or physically drained; progressive mental distancing from the workplace; cynicism related to one's workplace and colleagues; and reduced professional effectiveness [4-6].
It was to be the American psychiatrist Maslach, the world's leading expert in the field of burnout, and in agreement with other researchers who introduced the 3 main dimensions of this syndrome: a) Emotional Exhaustion (EE), in which the extent to which the subject perceives the demands as excessive compared to the psychophysical resources available is investigated (the subject's difficulty in recovering energy is also captured in this dimension); b) Depersonalization and cynicism (DP), in which it is investigated how well the subject exhibits these characteristics (this dimension favours if elevated emotional detachment, thus avoiding demands and/or disappointment); c) Ineffectiveness and unsatisfactory work accomplishment (PA), in which it is investigated how much the person may experience feelings of inadequacy that undermine self-esteem. It was also investigated how, certain aspects of personality may predispose the subject to develop burnout: specifically, it was seen that subjects prone to depression are more likely to experience the dimension of Emotional Exhaustion (EE) while the dimension of Depersonalization and Cynicism (DP) is related exclusively to the characteristics of the work environment [7,8].
To test, therefore, for the presence of burnout, as a syndrome, four different aspects must be analyzed: 1) the characteristics of the work environment and job; 2) the subjective perception of stress; 3) the level of job satisfaction; and 4) the consequences in the burnout sufferer. The presence or absence of this syndrome, therefore, can only be verified through batteries of tests .
Concerning the work environment, six objective characteristics were identified that relate to the work itself: workload, decision autonomy, rewards, sense of belonging, fairness, and values . Concerning the work environment and the climate experienced within it, some very toxic aspects were identified such as an inadequate workplace, unresolved conflicts between colleagues, the absence of mutual support, the presence of destructive social behaviours, and work-life balance i.e., the balance between work commitment and available free time .
The analysis of these aspects is assessed through the use of specific standardized psychometric instruments. For example, to analyze organizational aspects and stress perception, Griffiths' Work Organization Assessment Questionnaire (WOAQ) test and the Occupational Stress Indicator are used. For the analysis of moderate factors and the effects of burnout, the most popular tool is the Maslach Burnout Inventory (MBI) which is based precisely on the EE, DP, and PA dimensions. This questionnaire consists of 22 items divided into 3 main dimensions: EE (9 items), DP (5 items), and PA (8 items). Another functional instrument is the 14-item Shirom-Melamed-Burnout-Measurament (SMBM), which measures levels of physical fatigue (FF, 6 items), cognitive fatigue (SC, 5 items), and emotional exhaustion (EE, 3 items) [12-16]. During the pandemic, these psychometric instruments proved to be very useful, although they showed some structural and functional shortcomings, such as the defect in the relationship between the effectiveness of the data obtained and the actual psychopathological condition of the subject with regard to psychophysical health risk and the actual risk of burnout related to suicidal tendencies [17,18].
To address these deficiencies [17,18], a questionnaire (Perrotta-Marciano Burnout Risk Interview - 1, BORI-1) has been developed and is being administered for validation, that intends to address the critical issues identified. The test (Table 1) is structured into 6 sections, for a total of 50 items, described as follows and taking the most widely used psychometric tests as a reference model, paying more attention to the issue of risk [19-21].
The scoring involves the partial calculation of sub-sections B-C-D-E-F indicating specifics in the areas of neurotic symptoms (B), dramatic symptoms (C), psychotic symptoms (D), negative consequences in the work environment (E) and suicidal tendency (F), and an overall calculation measuring the risk of burnout in current time and space. Responses to Section a are instrumental in framing the personal context of the respondent and therefore have no scoring to be done. Scoring thresholds are calibrated based on the study protocol being applied, in a representative population sample; studies are ongoing, and are detailed here:
The overall total score of all 35/50 items can be a minimum of 0 and a maximum of 240, distributed as follows: from 0 to 36 burnout risk is considered absent and insignificant, from 37 to 72 is considered low (and limited), from 73 to 123 is considered medium (and significant), from 124-174 is considered high (and marked), and from 175 to 240 is considered high (and critical); clinical intervention is suggested as early as a score of 124/240 or higher, even against the opinion of the subject under investigation.
The proposed “Perrotta-Marciano Burnout Risk Interview - 1 (BORI-1)” addresses the need to investigate burnout risk, paying particular attention to symptomatic manifestation and suicidal tendencies. To validate this psychometric instrument, a study is being conducted with a representative population sample that will demonstrate its ability to be valid, efficient, and effective concerning its goals and objectives.
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