This study is among only a few to investigate burnout in health care professionals working in units providing health services for inmates [37] and the first to characterize these workers according to MBI profiles. First, our results indicated that the most frequent profiles are ineffective and engagement, which comprised 71% of the sample. These findings are consistent with the profiles identified in a previous study among health care employees [12] but with a few differences, as the most prevalent MBI profile was ineffective rather than engagement in our sample. This ineffective profile reflects a psychological relationship with work that is not distressed but also not fully engaged, lacking the fulfilling qualities of engagement that are defined by “energy, involvement, and efficacy” [38]. The experience of being ineffective does not coincide with high exhaustion or high cynicism. Instead, it reflects a loss of confidence in one’s capabilities, perhaps as a result of work that feels tedious or an environment that offers little recognition for a job well done. It is a far more common experience among nurses or nursing auxiliaries in our sample. The ineffective profile clearly appears more negative than engagement but preferable to the distress inherent in the burnout, overextended, and disengaged conditions [12]. Our finding indicates a 7.8% prevalence of burnout, which is in line with previous studies when all three dimensions (EE, DP and PA) are severely abnormal in penitentiary settings [39] and consistent with the fact that the engaged profile is four times less common than the engaged profile among healthcare employees [38]. However, this result is well below the high burnout prevalence rates that have been previously reported among French health professionals, ranging from 28 to 73% [40–42]. Methodological differences could influence these reported burnout rates. There is real controversy in the literature regarding the tools to measure burnout and which dimensions of the MBI to include, with numerous studies using one [43–45], two [46, 47] or all three [7, 24] dimensions to classify burnout. With the ineffective profile, the overextended and disengaged profiles reflect transitional states towards burnout and thus represent cause for concern. Five percent of our participants met the classification for the disengaged profile, with high cynicism; this figure is below the proportion previously identified with this profile among health care providers [12]. Participants who identified as male were more likely to be classified with burnout and disengaged profiles than those who identified as female. Professionals who were concerned with a history of complaint procedures for aggression and who regularly experience verbal aggression were likely to experience a high level of cynicism. Professionals in units treating inmates are particularly exposed to intimidation, aggression and rebellion, facts known to lead to psychosocial risks [48]. One source of cynicism and therefore disengagement could be the transition from an idealistic world of a health care provider to the real world of threats and exposure to physical and verbal violence despite providing care. The 15.6% prevalence of the overextended profile is in line with the findings of Leiter et Maslach [12], and the prevalence of psychologists experiencing high levels of exhaustion in correctional settings is in line with the findings in previous work [49]. This result supports the needs for workload adjustments for professionals who are involved but very tired. Knowledge of these profiles can be useful when designing interventions focused on both people and job situations. At the organizational level, a sustainable workload and an increase in reward by providing more choice may be suggested for an overextended individual. An ineffective individual may benefit from more recognition and reward, and a disengaged individual will require a supportive work community and/or clear value and meaningful work. At the individual level, previous studies among workers experiencing challenging situations called for an emphasis on increasing resilience, which can be developed [47, 50]. Resilience is considered the ability to adapt successfully in the face of stress, trauma, adversity, tragedy, or significant threat [51]. Resiliency could help professionals sustain the capacity to not be disrupted by stress or threats and stay engaged at work as previously described [52]. As work-related stress is a public health concern and might play a role in the development of mental health problems in health care professionals [23], the high prevalence of anxiety and depression symptoms among the individuals with overextended and burnout profiles supports that a number of steps should be taken at the individual level to promote wellness. Early detection and prevention are needed to help counteract the stressors inherent in the workplace and the associated negative impact on mental health to maintain a high level of mental well-being in this demanding workplace.
Although there was no significant difference in the MBI profiles in regard to the care-level type, our research tended to show that professionals from the first level of care are more concerned with burnout, while those from the second and third levels of care are more concerned with an ineffective profile. For the second and third care levels, the findings emphasize the important role of esteem, recognition, and appropriate feedback to build engagement. Improvements in work environments in the first level of care, including having respectful working relationships with other service providers, being attentive to colleagues and anticipating the impact of one’s behaviour on others as well as clear targets, strategic leverage points and regular organizational assessments, could help to prevent burnout.
Several methodological limitations should be discussed. First, a small number of professionals were included in this study, which prevented us from using, for example, a multivariate polytomous logistic regression model. This could be a next step. Second, our findings might not be fully representative of professionals working in units for inmates and may not be generalizable to other groups, as professionals voluntarily decided to participate. Third, the data were collected using self-report questionnaires, which, although anonymous, may introduce bias specific to socially desirable responses. However, to our knowledge, this study is the first to assess the profiles among French professionals, and they are expected following the recommendations. This method of classification of participants according to MBI profiles is relatively recent in the MBI’s long history, and it is suggested that use of this approach could be helpful for the earlier recognition of individuals who may be at risk of developing burnout. Moreover, this is the first study to pay attention to professionals working among the three different levels of care in detention (ambulatory and part-time and full-time hospitalization). Furthermore, our results bring attention to interesting findings in that initiatives for professionals should include improvement in guidance of younger workers in units for inmates. Developing resources to facilitate exchanges with partnerships and to build a better work environment is essential, as these actions could afford mental health benefits.