Perceived Stress and the Level of Burnout in Students of Helping Professions

The study is aimed at the clarification of the role of perceived stress in the process of developing burnout which belongs with the major research challenges in helping professions (Lloyd, King & Chenoweth, 2002). Research sample consisted of students of helping professions who completed the Maslach Burnout Inventory for students (MBI-SS) and Perceived Stress Scale and Emotional Habitual Subjective Well-being Scale. It was hypothesized that higher level of perceived stress would be linked with higher level of burnout. Burnout was expected to be correlated with frequent experiencing of negative emotions and less often experiencing of positive emotions. The side objective of the research was to examine the psychometric properties of the Slovak version of the MBI SS, which was translated from the original English version by Schaufeli et al. (2002). The interpretation of other results is discussed in the paper.


Problem of statement
One of the most frequent objects of psychological research is burnout phenomenon. The past 30 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work (Schaufeli, Leiter & Maslach, 2009;Maslach, Schaufeli & Leiter, 2001).
During this period many definitions of burnout have been created. The most known definition of burnout has been offered by Maslach & Jackson (1981), who defined burnout as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. But some researchers focus the intensity of emotional demands in occupations (Greenglass, Burke & Konarski, 2007) and others emphasize on long-term work stress (Maslach, Schaufeli, & Leiter, 2001). According to Cam and colleagues (2014) burnout describe as a chronic reaction to one's work and a negative affective response to prolonged impairing stress which is not immediately reversible after changes in tasks or the working conditions.
Recently, the work on burnout has expanded internationally. The original conception of burnout has been modified (Maslach, Schaufeli & Leiter, 2001) and new conceptual models have been created, for instance model which focus on engagement, the opposite of burnout.
At the same time significance of burnout phenomenon is being increasing not only for the human service professions, but for many others as well. Burnout is described as a crisis in one's relationship with work in general (Cam, Deniz, Kurnaz, 2014). For Maslach burnout is a question of the congruence between people and their jobs. It has been observed in people working with others (directly with patients, students, or clients), the blame for its development has been placed on excessive emotional burdens, and it has been rather well researched among various groups carrying out human service professions (Lloyd, King & Chenoweth, 2002).
And other new area of research burnout syndrome has become a university study (Parker & Salmela-Aro, 2011). Burnout among students refers to feeling exhausted because of study demands, having a cynical and detached attitude toward one's study, and feeling incompetent as a student (Schaufeli et al., 2002). Just university students of helping professions were identified as being at risk of experiencing stress and burnout (Schaufeli et al., 2002). Furthermore some researches show (Stoliker & Lafreniere, 2015) that burnout is related to certain states of stress, eg. perceived stress. This is explained by the fact that the impact that a stressful event has on an individual is partly determined by the perception of their stressfulness. This is referred to as perceived stress-the degree to which individuals consider situations in their life to be stressful. The high level of perceived stress can lead to a deployment of burnout (Lloyd, King, & Chenoweth, 2002).
At the end, stress and burnout significantly influence of subjective well-being (Chambel & Curral, 2005). In our research we focused mainly on detection of experiencing of positive and negative emotions (as emotional part of subjective well-being).

Purpose of study
The main aim of present study is to examine relations between stress and stress outcomesespecially burnout experienced by students of helping professions. We are not aware of a Slovak adaptation of known MBI-SS. Therefore we decided for additional aim to verify the internal structure of questionnaire and finding out reliability of this scale which assesses the burnout on the sample of Slovak university students. These are only the preliminary results. 3

Participants and procedures
A questionnaires were administered to a total sample of 256 students from just one university, aged 20 -25. Of this sample 85.7% (n=222) was female and 14.2% (n=37) was male; the mean age was 22.5 years (SD = 1.49). Sample consisted of psychology (41%, n=81), educational sciences (10%, n=64) and social work (8%, n=114) students. In this research, the scale is applied to 3th, 4th and 5th study year. Participants received informed content. Their participation was voluntary and anonymous. In none of analyzes gender differences were investigated because of unbalanced representation of women and men in the research sample.

Maslach Burnout Inventory -Student Survey (MBI-SS)
One of the most known measurement tool about burnout among students is the Maslach Burnout Inventory-Student Survey (MBI-SS) (Schaufel et al., 2002). This scale has not been adapted for the Slovak students yet. This questionnaire consists of 15 items that constitute three scales: exhaustion (EX; 5 items), cynicism (CY; 4 items), and efficacy (EF; 6 items). Exhaustion refers to the extent to which the student feels physically and/or mentally drained. Cynicism refers to the extent to which the student feels pessimistic towards their studies.. All items are scored on a 7-point frequency rating scale ranging from 1 (never) to 7 (all time). Items from the exhaustion and cynicism dimensions were scored normally while the items from the efficacy dimension were scored inversely. Higher scores on the MBI SS represent higher levels of burn out. The Cronbach's alpha coefficients for internal consistency of the original scale had values ranging from .74 to .80 for exhaustion, .79 to .86 for cynicism, and .67 to .76 for the efficacy (Schaufeli et al., 2002). In our Slovak version for university students was Cronbach's alpha calculated as .82 for exhaustion, .84 for cynicism and .76 for efficacy.

Perceived stress scale (PSS)
Assessment of stress was performed with the Perceived Stress Scale (PSS; Cohen, Kamarck & Mermelstein, 1983). This scale is self-report measure and this version consists of 10 items of which 4 are positively formulated and 6 are negatively formulated. The PSS measures the degree to which individuals perceived their daily life as being stressful during the last month with a 5-point Likert scale (1= never and 5= very often). Higher scores on the PSS represent higher levels of perceived stress. Cohen and colleagues (1983) found out good internal consistency reliability (α= .84 to .86) of the scale. In our version for Slovak participants was Cronbach's alpha calculated as .73.

Emotional habitual subjective well-being scales (SEHP)
Instrument which assess positive and negative state of mind (as parts of subjective well-being) was Emotional habitual subjective well-being Scale (SEHP, Džuka, Dalbert, 2002). The questionnaire consists of two components: negative (6 negative emotions -anger, shame, sadness, fear, guilt, pain max score=36) and positive (4 positive emotions -joy, happiness, pleasure, energy, max. score=24). The task of participants is to indicate the frequency of experiencing 10 emotions or physical states. All items are scored on a 6-point frequency rating scale ranging from 1 (almost always, 2=very often, 3=often, 4=sometimes, 5=rarely, 6=almost never). Higher scores on the SEHP represents lower frequency of experienced emotions. This is the opposite direction than in the other questionnaires. The Cronbach's alpha coefficients for internal consistency of the original scale had values .74 and .77 for scale of negative state of mind and scale of positive state of mind, respectively (Džuka, Dalbert, 4 2002). In our research was Cronbach's alpha calculated as .71 for positive state of mind and .69 for negative state of mind.

Statistical analyses
Data were analyzed using SPSS 20.0. Reliability of all questionnaires was tested in terms of internal consistency (Cronbach α). Relations between burnout, perceived stress and subjective well-being were determined by correlations analysis (Pearson correlations). To verified internal structure of MBI-SS bivariate correlation analyses (Pearson correlations) were computed.

Students' perceived stress, level of burnout and subjective well-being
Descriptive statistics (means, standard deviations) and internal consistency (α) for all measures are presented in Table 1. The mean score of PSS for the sample (n=256) was 28.47 (SD= 6.42; min=10, max=50). Data were analyzed by the items. The average response on a scale reached a value of 2.84 (2=almost never, 3=sometimes, 4=fairly often). These values showed that students perceive only a moderate level of stress. Top score was recorded by students of helping professions in following items: item No.7 "In the last month, how often have you been able to control irritations in your life?" (M=3.58; SD= .83), in item No. 4 "How often have you felt confident about your ability to handle your personal problems?" (M=3.47; SD= .88) and in item No.3 "How often have you felt nervous and "stressed?" (M=3.39; SD= .98). Score of items No.7 and No.4 had been transformed before the analysis. These values showed that students often are not able to control irritations and at the same time they don't feel confident in coping their personal problems and finally they often feel stressed. Note; EX 1= I feel used up at the end of a day at university; EX 5= I feel tired when I get up in the morning and I have to face another day at the university; EX 1= I feel emotionally drained by my studies; EF 11 R= I believe that I make an effective contribution to the classes that I attend; EF 15 R= During class I feel confident that I am effective in getting things done (R=score of item had been transformed).
The mean score of MBI SS for the sample (n=256) was 50.26 (SD=15.69; min=15, max=105). The average scale response reached a value of 3.35 (SD= .72) for whole questionnaire (3=a few times a month; 4=every week). These values showed that students experiencing moderate levels of burnout. Specifically the average response on a scale of exhaustion was 3.61 (SD= .81), of cynicism was 3.03 (SD= .92) and of efficacy was 3.34 (SD= .96). It means that the highest value reached exhaustion, followed by efficacy and the lowest value reached a level of cynicism. Overview of the highest average scale values responses are presented in Table 2. In general, students most often experience exhaustion.
Analysis of the Emotional habitual subjective well-being Scales SEHP led to a result that the participants experienced more positive state of mind than negative which is showed by the average scale response (scale range 1=almost always to 6=almost never). The average scale value of the positive state of mind was 2.95 (SD= .73) and of the negative state of mind was 4.31 (SD= .84).

Results of correlation analysis
Firstly we assumed that respondents' perceived stress would be positively correlated with burnout and both constructs would be negatively correlated with experiencing of negative emotions (because the scale of SEHP is the other way round) and positively correlated with experiencing of positive emotions. Overview of the results of correlations is presented in Table 3. Note: MBI-SS = Maslach Burnout Inventory-Student Survey; MBI-EX = Maslach Burnout Inventory-Student Survey -Exhaustion; MBI-CY= Maslach Burnout Inventory-Student Survey -Cynicism; MBI-EF = Maslach Burnout Inventory-Student Survey -Efficacy; PSS = Perceived Stress Scale; SEHP-pozit = Emotional habitual subjective well-being Scale-positive component; SEHP-negat= Emotional habitual subjective well-being Scale-negative component; * p < .05. **; p < .01* Burnout correlated positively with perceived stress (r = .441; p < .05), positive state of mindfrequency of experiencing positive emotions (r = .307; p < .05) and correlated negatively with negative state of mind -frequency of experiencing negative emotions (r = .366; p < .05). In such a case higher level of burnout is related to higher experiencing of negative emotions and lower experiencing of positive emotions. Each components of MBI-SS correlated positively with perceived stress, positive state of mind and correlated negatively with negative state of mind (Table 3). It means that higher level of exhaustion, cynicism and reduced efficacy is related to higher frequency of experiencing negative emotions and lower frequency of experiencing positive emotions. Our research assumptions were confirmed.

Results of verification of internal structure of Slovak version of MBI-SS
The last step of the data analysis was verification of the internal structure of MBI-SS because this questionnaire has not been adapted to the Slovak students yet. These are only the preliminary results. We used exploratory factor analysis with Varimax orthogonal rotation. Based on a Screen test we extracted the three strongest factors. Together, they explain 59.1% of the variance of the measured variables.
Two items (No.8 "I feel burned out from my studies" and No. 13 "In my opinion, I am a good student") had a value lower than the criterion value (under .3). These items were removed. The final number of scale items is 13. The analysis showed that the MBI-SS had a 3-factor structure as the original version by Schaufeli et al. (2002).

Discussion
The main prediction of present study, that burnout experienced by Slovak students of helping professions associated with perceived stress and subjective well-being, was supported. Findings of present study that higher level of burnout linked with higher level of perceived stress correspond with results of other researches (Stoliker & Lafreniere, 2015;Chambel & Curral, 2005). According to authors, stress is something that university students are bound to experience during their educational career and perceived stress was found out to have a negative influence on students' subjective wellbeing. This was confirmed in our study too, because the second research result was that each components of burnout and perceived stress correlated with frequent experiencing of negative emotions and less often experiencing of positive emotions (as a components of subjective well-being). In detail, higher levels of burnout were related to more frequent negative emotional state (feelings of anger, shame, sadness, fear, guilt, pain) and less frequent positive emotional state (feelings of joy, happiness, pleasure, energy) and higher levels of perceived stress. Our findings are supportive of theoretical definitions of compassion fatigue (Figley, 2002;Stamm, 2010).
Based on the results of present study we can conclude that the participants of our research experiencing moderate levels of burnout and perceive stress, experiencing more positive state of mind than negative and that almost all participants reported more often positive than negative emotions.
The last step of research analysis was verification of Slovak version of MBI-SS. The three factor structure of the questionnaire was explored. In the main results of our research supported Three-Factor Models of the MBI-SS (Schaufeli et al., 2002). In Slovak version of MBI-SS were 2 items deleted. Evidence for internal consistency of Slovak version of instrument was determined through the Cronbach's alpha for reliability. Preliminary results of ongoing research showed that Slovak translation of the MBI-SS is reliable (in terms of internal consistency).
Limitations of the present study: Research sample was non-representative of the population of university students in helping professions. Therefore, results reported in the paper cannot be generalized. The important information is that the results of verification of Slovak version of MBI-SS are only preliminary.