Burnout and Its Relationship to Psychological Distress and Job Satisfaction among Academicians and Non-Academicians in Malaysia

The purpose of this study was to ascertain the prevalence of burnout and its associated risk factors among the University staff, involving both academicians and non-academicians and relate these to their job satisfaction. A cross-sectional study was conducted among the university staff involving both academicians and non-academicians. The participants were emailed the questionnaires through their university email and alternative email addresses. They were asked to complete questionnaires on their sociodemographic and work details, Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21) and Job Satisfaction Scale (JSS). Among the 411 participants who participated, 53% were academicians (n = 216). Academicians demonstrated greater burnout levels and psychological distress when compared to non-academicians. Correlational analyses indicated a moderate to high correlation between psychological distress and burnout due to work, personal and client where higher burnout was associated with higher psychological distress. Non-academicians demonstrated greater job satisfaction levels when compared to academicians. Correlational analyses indicated a high correlation between job satisfaction and burnout due to work, with higher burnout levels associated with lower job satisfaction among staff. This study showed that academicians suffer from high levels of burnout in aspects of personal, work and client-related matters, and this has contributed to higher psychological distress among them and significantly affect their job satisfaction.


Introduction
Burnout syndrome can be conceptualized in several ways. It is seen as an inability to cope with the emotional stress at the workplace and more likely to happen with persistent stress rather than with occasional stressful events (Felton, 1998). Burnout occurs when the coping mechanisms used fail to cope with external demands, and this leads to emotional exhaustion, which then leads to a vicious cycle of depersonalization, decreased personal accomplishment and an increasing level of emotional exhaustion (Maslach, Schaufeli & Leiter, 2001). Factors contributing to job burnout are multifactorial. Discrepancies in an employee's personal, physical, psychological and social factors and organizational environment may lead to burnout in employees especially when it is persistent (Cassitto, 2003). at risk of depression and anxiety. Psychological distress such as depression and anxiety as a result of burnout syndrome will lead to more deterioration in terms of psychological and physical health as well as work performance (Reevy & Deason, 2014).
Job-related burnout may not only cause deterioration in psychological and physical health, it can also lead to poor professional functioning and low job satisfaction. Job satisfaction is the positive perception of an individual towards his or her work where factors such as pay, promotion, working conditions, leadership, social relationships and the job itself were found to influence the level of job satisfaction of an individual at the workplace (Okwaraji & Aguwa, 2015). Job satisfaction has been found to be closely related to burnout. Burnout was associated with poor coping strategies and negatively associated with better self-efficacy and job satisfaction and to good physical and stable mental health (Tamini & Kord, 2011) In Malaysia, academic and non-academic personnel have been under pressure over the years to meet with the increasing demands to be internationally recognized academically and in the field of research, generate income for the university, and they were expected to meet the key performance indicators set by the university in administrative duties as well. (Mukosolu et al., 2015). To achieve these standards, the university academic staff need to work harder to bring sufficient output such as producing high impact publications, application of research grants and supervision of students. Meanwhile, the non-academic staff were forced to work harder to provide high standard administrative service by reducing the amount of manpower and resources (Mukosolu et al., 2015).
Burnout is an increasing problem and negatively impacts on an individual's job satisfaction and physical and mental health. This problem needs to be addressed to maintain an individual's healthy physical and mental health as well as maintaining the integrity of the university as an organization. Therefore, this study aims to ascertain the prevalence of burnout among the university staff and its relationship to job satisfaction and psychological distress.

Methods
A cross-sectional study was conducted among the Universiti Teknologi MARA (UITM) staff involving both academicians and non-academicians. UITM is one of the largest University in Malaysia, and it has campuses in every state in Malaysia. Universiti Teknologi MARA has 17000 staff which comprised of both academicians and non-academicians. All staff working at the University were asked to participate. To determine the sample size needed for the study, authors used sample size table proposed by (Krejcie & Morgan, 1970), which required a minimum of 376 participants in order to achieve a good statistical power. The participants were emailed the questionnaires through their university email and alternative email addresses. They were asked to complete questionnaires on their sociodemographic and work details, Copenhagen Burnout Inventory (CBI), Job Satisfaction Survey (JSS) and Depression, Anxiety and Stress Scale (DASS-21). The staff received a cover letter prior to the answering the questionnaires reassuring them about anonymity, confidentiality, and that published results were solely for scientific purpose. Ethical approval was obtained from the University's Research Ethics Committee (REC/422/17).

1) Copenhagen Burnout Inventory
Copenhagen Burnout Inventory (CBI), is a self-rated inventory measuring the degree to which people see a connection between their fatigue and their client-related work. (Kristensen et al., 2005). It consists of 19 items and comprises three sub-dimensions that arepersonal burnout, work-related burnout, and client-related burnout. The CBI has been translated and validated in other languages, including to the local language -Malay language. The Malay version was translated and validated for our population, and it has a good face and construct validity with a high internal consistency (Andrew Chin et al., 2018). The reliability of the scale for this study is 0.94. High scores (≥50%) indicated a high level of burnout. Moderate burnout is indicated with the scores of 50-74, high burnout 75-99 and severe burnout is considered when the score is 100 (Creedy et al., 2017).

2) Job Satisfaction Survey (JSS)
The JSS is a self-rated scale to measure job satisfaction (Spector, 1985). The scale consists of 36 items assessing total job satisfaction using nine subscales (each consisting of 4 items). These subscales include pay, promotion, fringe benefits, contingent rewards, supervision, co-workers, operating procedures, nature of work and communication. Respondents rate the positive and negative features of their jobs ranging from 1 (disagree very much) to (6 agree very much). Higher scores on the JSS indicate higher levels of job satisfaction. The Malay version has been translated and validated (Chin-Siang et al., 2014;Ibrahim et al., 2014). The reliability of the scale for this study is 0.62.

3) The Depression, Anxiety and Stress Scale -21 Items (DASS-21)
DASS-21 is a set of three self-report scales designed to measure the emotional states of depression, anxiety and stress. Each of the three DASS-21 scales contains seven items, divided into subscales with similar content. The Malay language version of DASS-21 had well-documented reliability with Cronbach's alpha values of 0.95 in this study. It has been validated on various Malaysian samples, including clinical and non-clinical populations, and therefore is a valid instrument for use in a Malaysia population (Ramli et al., 2009).

Statistical Analyses
The statistical analysis was carried out using the Statistical Package for Social Sciences Software Version 24 (IBM Corp. Released, 2015). All descriptive and inferential statistics were generated using the software.

Results
Table 1 describes the sociodemographic profile of UiTM staff responding to this study. There were 411 participants in this study, of which 259 were academicians. Results of the t-test show a statistically significant mean difference in burnout in all domains (personal, work, client) between the group (Table 2). Academicians demonstrated greater burnout levels when compared to non-academicians in regard to personal matters (t 409 = 4.40, p < .001), work matters (t 409 = 3.32, p < .05) and client matters (t 409 = 3.61, p < .001).   Table 4 showed a statistically significant mean difference in job satisfaction between the group. Non-academicians demonstrated greater job satisfaction levels when compared to academicians (t 409 = -2.94, p < 0.05). Correlational analyses were used to examine the relationship between psychological distress and burnout among staff (Table 5). Results indicated moderate to high correlation between psychological distress and burnout due to work, personal and client. Higher burnout was associated with higher psychological distress. Correlational analyses were used to examine the relationship between job satisfaction and burnout among staff (Table 6). Results indicated a high correlation between job satisfaction and burnout due to work, with higher burnout levels associated with lower job satisfaction.

Discussion
This study aimed to investigate burnout, psychological distress and job satisfaction among academic and non-academic staff in a public university in Malaysia. The prevalence of stress was 5%, depression 10.9% and anxiety 22.8% in this study which was much lower compared to a previous local study which reported stress 22%, depression 35.4% and anxiety 52.9% using the same screening tool DASS-21 (Noor & Ismail, 2016). The main difference was the previous study was conducted among academicians only in a Malaysian research university (MRU) which generally has higher key performance indicators (KPI). In contrast, our study setting was the largest non-research university in Malaysia. A different study done among 250 academicians in a Turkish university found that the prevalence of anxiety was 49.2% (Akç ay et al., 2018). There were other studies done, but those studies focused on job stress or occupational stress using different tools. In a study conducted in 9 state universities in South India found that 74% of university teachers experienced a moderate to a high level of occupational stress using the Occupational Stress Rating Scale (Reddy & Poornima, 2012). Another study by (Shen et al., 2014) which investigated occupational stress using the Effort Reward Imbalance Model found that the rate was 22.3% and prevalence of depressive symptoms was 58.9% using Centre for Epidemiologic Studies Depression Scale (CESD).
Highest level of burnout was found in the personal domain, 57.2% followed by the work and client domains. The personal domain in the Copenhagen Burnout Inventory (CBI) refers to the degree of physical and psychological fatigue and exhaustion experienced by a person. This domain can compare individual regardless of their occupational status (Kristensen et al., 2005). (Kozak et al., 2013) found that five psychosocial factors strongly associated with personal burnout were emotional demands, work-privacy conflict, role conflict, job insecurity and feedback at work. This study found that burnout was higher in academicians compared to non-academicians. The finding is contradictory to another study done in among practicing dentists from both academic and non-academic hospitals in Riyadh and Eastern Province, Saudi Arabia (Al-Mobeeriek, & Al-Mobeeriek, 2011). Most of the previous studies done did not include non-academic staff in the university (Barkhuizen et al., 2014;Chen et al., 2014). A systematic review by Watts & Robertson (2011) revealed that staff exposure to a high number of students, especially tuition of postgraduates, strongly predicts the experience of burnout. Other predictors are younger age, male higher in depersonalization score, and female scored higher on the emotional exhaustion dimension. A study by Yao et al. (2015) found that the most significant predictors of burnout prevention were the love of the teaching profession and work acknowledgement from a direct supervisor. Non-academicians mainly comprised of administrative staff who has different job scope. They do not have teaching and research responsibilities. A study among university administrative staff found a low level of burnout linked with high professional self-esteem and lower emotional exhaustion and depersonalization (Tricas Moreno et al., 2010).
Academicians were found to have higher psychological distress in this study. Our finding was similar to a national survey conducted in Australian universities by Winefield et al. (2003) involving 8700 participants. However, the study used the General Health Questionnaire (GHQ-12) to measure psychological distress. Another study found that the level of psychological distress was 40% among university employees, but there was no difference in the prevalence of psychological distress between job categories (Biron et al., 2008).
Job satisfaction was found to be lower among the academicians in this study. A study found that the academic staff of a local university have moderate job satisfaction (Noordin & Jusoff, 2009). In a different study which compared academic staff in public and private universities found that academicians in private universities were more satisfied with their pay, supervision, and promotional opportunities. On the other hand, academicians in the public sector were more satisfied with co-workers behaviour and job security (Khalid et al., 2011). A study done by Huda et al. (2004) found a high prevalence of job dissatisfaction (42.6%) among medical lecturers. The associated factors were decision authority and psychological job demands. However, another study in Turkey found that the job satisfaction level of the academicians was moderately high (Toker, 2011). In non-academic staff, interpersonal skills and job competency have a different impact on different dimensions of job satisfaction (Jung & Shin, 2015). Being young and unmarried were found to be associated with higher job satisfaction among non-academic staff (Yapa et al., 2013).
Further analysis suggests that there was moderate to a high correlation between burnout and psychological distress. A similar finding was reported in a study done in South India involving nine state universities. There was a positive relationship between occupational stress and burnout among university teachers (Reddy & Poornima, 2012). The authors explained that organizational inefficiency, high staff turnover, absenteeism due to illness, reduced quality and quantity of practice, increased healthcare costs, and reduced job satisfaction were effects of occupational stress. A study by Zhong et al. (2009) showed that burnout was a mediator among job stress, the occurrence and exacerbation of depressive symptoms and poor physical health. There was a negative correlation between burnout and job satisfaction. This is similar to the finding from a study done by Yoleri & Bostanci (2012) where job satisfaction was found to be inversely correlated with emotional exhaustion, one of the components in the Maslach Burnout Inventory. Other studies conducted among academics also found job satisfaction to be a strong predictor of burnout (Bilge, 2006;Coetzee et al., 2019).

Conclusion
This study showed that academicians as compared to non-academicians suffer from high levels of burnout in aspects of personal, work and client-related matters and this has contributed to higher psychological distress among them and greatly affects their job satisfaction.