Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

Burnout and occupational participation among

dentists with teaching responsibilities in
universities

Meral Huri, Nilsun Bağiş, Hakan Eren, Onur Başibüyük, Sedef Şahin, Mutlu
Umaroğlu & Kaan Orhan

To cite this article: Meral Huri, Nilsun Bağiş, Hakan Eren, Onur Başibüyük, Sedef Şahin,
Mutlu Umaroğlu & Kaan Orhan (2016): Burnout and occupational participation among
dentists with teaching responsibilities in universities, Psychology, Health & Medicine, DOI:
10.1080/13548506.2016.1210177

To link to this article: http://dx.doi.org/10.1080/13548506.2016.1210177

Published online: 26 Jul 2016.

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Psychology, Health & Medicine, 2016
http://dx.doi.org/10.1080/13548506.2016.1210177

Burnout and occupational participation among dentists with

teaching responsibilities in universities
Meral Huria, Nilsun Bağişb, Hakan Erenc, Onur Başibüyüka, Sedef Şahina,
Mutlu Umaroğlud and Kaan Orhanc 
a
Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey;
b
Faculty of Dentistry, Department of Periodontology, Ankara University, Ankara, Turkey; cFaculty of Dentistry,
Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey; dFaculty of Medicine,
Department of Biostatistics, Hacettepe University, Ankara, Turkey

ABSTRACT ARTICLE HISTORY

The aim of this study was to investigate the levels of burnout and Received 10 January 2016
explore the relationships between burnout and occupational Accepted 30 June 2016
participation among dentists with teaching responsibilities. KEYWORDS
Canadian Occupational Performance Measure (COPM) was used to Burnout; dentistry;
evaluate occupational participation with questions on demographic occupational therapy
information among 155 dentists with teaching responsibilities.
Age, gender, years of experience, academic position were the
factors affecting level of burnout and occupational participation.
Occupational performance score was negatively correlated with
emotional exhausment (r = –.731) and depersonalization (r = –.693)
while positively correlated with personal accomplishment (r = .611).
Occupational satisfaction scores were negatively correlated with
emotional exhausment (r = –.631) and depersonalization (r = –.625)
while positively correlated with personal accomplishment (r = .614).
Occupational participation level can effect burnout among dentists
with teaching responsibilities. Further studies with a larger sample
are needed to investigate these preliminary results deeply.

1. Introduction
Burnout is an over stress syndrome characterized by loss of emotional exhaustion (EE), dep-
ersonalization (DE), and decreased sense of personal accomplishment (PA) (Basson, 2013;
Gorter & Freeman, 2011). Dentists with teaching responsibilities can experience increased
levels of burnout with respect to professional and educational overload, direct patient con-
tact, need of taking critical decisions and increased responsibilities (Bezuidenhout & Cilliers,
2011). Dentists tend to depression, anxiety, broken relationships, problematic alcohol use,
and suicidal ideation so dental care and education system with highly complex structure
is now undergoing changes such as reducing working hours and patient seen/day, pro-
gramme accreditation process to increase the quality of dental care (Basson, 2013; Gorter
& Freeman, 2011), etc.

CONTACT  Hakan Eren  heren@ankara.edu.tr

© 2016 Informa UK Limited, trading as Taylor & Francis Group
2    M. Huri et al.

Occupational participation is the capacity to choose, organize, and satisfactorily per-

form activities which are meaningful to oneself in the three core areas of daily living as
(1) self-care which can be defined as the activities to look after oneself such as grooming,
dressing or eating (2) leisure time activities which are needed to enjoy life such as reading,
art, sightseeing or sports, and (3) productivity activities which are contribution to survive
the social and economic fabric of the community and can be identified by level of occupa-
tional performance (OP) during activities daily living (ADL) and the individual satisfaction
level from the activity performance (Whiteford & Pereira, 2012). Recent studies support
that burnout may limit participation to ADL or limited participation to ADL may cause
burnout (Bakker, Demerouti, & Sanz-Vergel, 2014; Hakanen & Schaufeli, 2012; Kjellberg,
Kåhlin, Haglund, & Taylor, 2012).
The aim of this study was to evaluate the level of burnout and occupational participa-
tion and investigate the effects of demographic information on burnout and occupational
participation among dentists with teaching responsibilities.

2. Methods
2.1.  Study design and participants
This cross-sectional study was conducted to dentists with teaching responsibilities in
the Ankara University between February 2015 and August 2015. An a priori sample size
test of power was performed to identify the probability of detecting worthwhile clinical
effects. After informed consent was obtained from all the faculty members participants
were assigned randomly by an officer at a separate location who was not connected with
the study and who had prepared the random assignment schedule and concealed opaque
envelopes by using computer-generated random numbers. 155 dentists who were assigned
randomly sent an invitational letter with information about the study. They were asked
to fill in the demographic information and the evaluation tests individually. Independent
occupational therapists scored, coded, checked and last rechecked 25% of the results to
obtain a clean data. Inclusion criterias were being a dentist with teaching responsibility of
at least 1 year and having patient contact of at least 6 months while exclusion criterias were
having vacation more than 1 month/year, psychological problems or therapies (medication,
phycotherapy etc.) in last 6 months. Individual consent form was obtained. The local ethics
committee approved the study (Research no. 12-7/35).

3. Measures
Demographic information such as age, gender, marital status, professional status (academic
position) and years of experience were recorded; burnout was evaluated by Maslach Burnout
Inventory (MBI) and occupational participation was evaluated by COPM.

3.1. Burnout
Turkish version of MBI is a validated 22-item questionnaire using a 7-point scale from
‘0’ for never to ‘6’ for every (Ergin, 1993; Maslach, Jackson, & Leiter, 1996). MBI is a gold
 Psychology, Health & Medicine   3

standard evaluation tool for measuring burnout and has 3 subscales including EE, DE, and
PA. High scores on EE and DE and low scores on PA indicate burnout (Carswell et al., 2004).

3.2.  Occupational participation

Turkish verison of COMP was used (Bumin, Huri, & Kayihan, 2007). COMP is a semi-­
structured measure which evaluates clients’ self-perception about his/her occupational par-
ticipation and identify significant areas causing difficulties in ADL in the areas of self-care,
productivity, and leisure with performance and satisfaction subscores (Enemark Larsen &
Carlsson, 2012). The participant prioritizes most experienced 5 ADL problems and rates
each of them on an ordinal 10-point scale due to OP and occupational satisfaction (OS).
The mean scores for OP and OS were obtained by adding the scores of OP and OS over
and dividing them by the number of problems (Carswell et al., 2004; Eyssen et al., 2011).

3.3.  Statistical analyses

The results were analyzed by using SPSS version 20 (IBM SPSS, Chicago, IL, USA). Mean
and SD were calculated as descriptive statistics. Frequencies were expressed in percentages.
Pearson rank correlation was used for all analyzes. All the bivariate analysis of mean burnout
subscales and mean occupational participation scores with regard to independent variables
were done by unpaired t-test (t value; for gender, marital status and academic position)
and analysis of variance (ANOVA) (F- value; for age, speciality and years in profession).
Tukey’s HSD test was used for post hoc comparisons of ANOVA. Correlation analysis was
performed to determine the relationship among burnout and occupational participation
questionnaire. p < .05 indicates statistical significance.

4. Results
The response rate was 82% (155/189). Thirty-four dentists were excluded. Table 1 presents
the demographic information. Tables 2 and 3 present scores of MBI and COPM. 8% of
dentists were experienced significant burnout levels in all three subscales of burnout. 11%
possessed a DE and EE and 17% dentists possessed PA and EE. Approximately 36% of the
dentists surveyed with high level of EE.
Dentists under 36 years old showed high levels of burnout and low levels of occupational
participation (p < .05; Tables 2 and 3). Research asistants and 5–10 year in profession group
showed higher burnout and lower occupational participation (p < .05; Tables 2 and 3) but
they were not satisfied from their activity performance. Mean DE of male dentists were
significantly higher than females while EE of females were higher (p < .05; Tables 2 and 3).
Female dentists had better activity performance than males (p < .05; Tables 2 and 3), but
they were not satisfied with their activity performance. EE of single dentists was higher than
married dentists (p < .05; Table 2). Married dentists had higher OP than the single ones
(p < .05; Table 3) but they were not satisfied from their performance.
Table 4 presents the suggested possible correlations between burnout subscales and
occupational participation subscales. OP and OS scores were negatively correlated with
DE and EE while positively correlated with PA (Table 3).
4    M. Huri et al.

Table 1. Demographic information of the study group.

N %
Age group (years)
 ≤25 41 26.5
 26–35 51 32.9
 36–45 19 12.3
 46–55 11 7.1
 56–65 33 21.3
Gender
 Female 81 52.3
 Male 74 47.7
Marital status
 Married 80 51.6
 Single 75 48.4
Professional status
 Assistant 81 52.2
 Specialist 74 48.7
Speciality
 Oral and maxillofacial surgery 21 13.5
 Oral and maxillofacial radiology  11 7.1
  Restorative dentistry 16 10.3
 Endodontics 17 11.0
 Orthodontics 15 9.7
  Pediatric dentisty 21 13.5
 Periodontology 24 15.5
 Prosthodontics 30 19.4
Years in profession (years)
 1–5 61 39.4
 5–10 20 12.9
 10+ 74 47.7

5. Discussion
The results have provided evidence that dentists with teaching responsibilities can be con-
sidered to be at risk of burnout. This result is similar to the results of Al-Mobeeriek and
Al-Mobeeriek (2011) and Singh, Aulak, Mangat, and Aulak (2016) with high level of EE
while contrast with the results of Gorter and Freeman (2011) with low level of EE.
Moreover, the results suggest possible correlations that support occupational partic-
ipation of dentists with burnout were decreased in terms of OP and OS. OP was nega-
tively correlated with EE, DE and positively correlated with PA indicating that increase in
occupational participation may help decreasing EE, DE and increasing PA which help to
reduce burnout. Additionally, negative correlations between OS and EE, DE and positive
correlations between OS and PA indicate that increasing satisfaction level from the activi-
ties can help decreasing EE, DE and increasing PA which may help reduce burnout. So not
only increasing the activity performance but also increasing the satisfaction level from the
participated activity can help reduce burnout among dentists with teaching resposibilities.
According to authors knowledge, this study is the first study to show the relationships
between occupational participation and burnout. Our results supported by the recent lit-
erature which defend that occupational engagement can support the barriers to reduce
burnout (Al-Mobeeriek & Al-Mobeeriek, 2011; Atalayin, Balkis, Tezel, Onal, & Kayrak,
2015; Singh et al., 2016).
A secondary aim of this study was to investigate the affects of demographic informa-
tion on burnout and occupational participation. Consistent with the literature, the results
indicated that age, gender, marital status, professional status and years of experience affect
 Psychology, Health & Medicine   5

Table 2. Mean MBI subscale scores by demographic information.

Burnout
Demographic information Emotional exhaustion Depersonalization Personal accomplisment
Age group (years)
 ≤25 24.95 (4.98) 17.04 (13.39) 21.41 (4.78)
 26–35 23.21 (4.98) 15.00 (17.76) 22.58 (5.25)
 36–45 22.78 (5.49) 14.63 (14.57) 30.63 (6.80)
 46–55 22.72 (4.10) 13.27 (13.81) 30.45 (4.00)
 56–65 20.45 (9.18) 13.54 (5.63) 30.24 (7.47)
F = 4.51; p = .002 F = 5.15; p = .003 F = 3.52; p = .002
Gender
 Female 24.65 (5.01) 12.21 (2.14) 29.42 (5.01)
 Male 20.28 (7.34) 16.90 (3.42) 28.47 (6.66)
t = 3.52; p = .002 t = 2.43; p = 0003 t = .016; p = .974
Marital status
 Married 20.32(5.23) 13.21(3.51) 27.42(4.51)
 Single 23.24(3.12) 13.35 (2.62) 28.32(4.24)
t = 2.33; p = 0001 t = 1.41; p = .919 t = 1.69; p = .781
Speciality
 OMS* 24.23 (6.67) 14.57 (2.76) 28.47 (5.98)
 OMR** 22.63(6.31) 16.09 (4.20) 29.09 (7.48)
  Restorative Dentistry 22.18 (6.35) 14.87 (2.80) 30.68 (6.01)
 Endodontics 24.82 (6.61) 15.64 (3.56) 30.05 (6.48)
 Orthodontics 21.93 (6.47) 14.00 (2.75) 31.00 (4.88)
  Pediatric Dentisty 23.23 (6.67) 14.85 (5.17) 26.47 (5.06)
 Periodontology 21.79 (5.22) 14.70 (4.54) 28.95 (3.96)
 Prosthodontics 23.66 (6.28) 15.76 (3.72) 28.46 (6.73)
F = 1.31; p = .83 F = 1.41; p = .79 F = 2.61; p = .81
Academic Position
  Research assistant 22.31 (4.21) 16.83 (314) 28.51 (3.21)
 Academic staff 19.23 (3.53) 13.32 (2.41) 27.84 (4.24)
t = 3.72; p = 0824 t = 3.21; p = 0831 t = 1.34; p = 0763
Years in profession (years)
 1–5 18.85 (5.06) 13.86 (3.73) 29.49 (4.71)
 5–10 24.50 (5.45) 16.80 (2.72) 29.35 (5.90)
 10+ 19.16 (7.23) 13.91 (3.55) 28.71 (6.57)
F = 4.21; p = .001 F = 2.42; p = .003 F = 13.21; p = .728
Notes. Data are means and standart deviation (SD); OMS* = Oral and Maxillofacial Surgery; OMR**= Oral and Maxillofacial
Radiology.

level of burnout. Dentists under 36 years of age showed higher level of burnout and lower
level of OP and OS (Al-Mobeeriek & Al-Mobeeriek, 2011; Jin, Jeong, Kim, Choi, & Song,
2015). Moreover, research assistants and dentists with 5–10 years of experience (mostly
research assistants) tended to have high levels of burnout and low levels of OP and OS
(Al-Mobeeriek & Al-Mobeeriek, 2011).
Results of age and years of experience showed that increased burnout and low levels of
occupational participation are common during early years of profession and they are com-
mon findings among medical residents, junior nurses and junior physiotherapists (Chou, Li,
& Hu, 2014; Divaris, Polychronopoulou, Taoufik, Katsaros, & Eliades, 2012). It is thought
that learning process of health care practitioners is hard and can limit the life-work balance
and the time interested in meaningful activities which can affect occupational participation
negatively.
Females showed higher level of burnout with high level of EE while males reported high
level of DE. These results are in agreement with the studies that defend Dutch, Turkish and
US female academic dentists have higher EE while male academic dentists have higher DE
(Al-Mobeeriek & Al-Mobeeriek, 2011; Gorter & Freeman, 2011; Singh et al., 2016).
6    M. Huri et al.

Table 3. Mean COPM (occupational participation) subscales by demographic information.

Occupational participation
Demographic information Performance score Satisfaction score
Age group (years)
 ≤25 5.30(1.57) 4.92(1.86)
 26–35 5.80(1.65) 5.68(1.95)
 36–45 6.07(2.40) 6.07(2.79)
 46–55 7.90(1.84) 6.21(2.27)
 56–65 6.36(1.91) 6.03(2.21)
F = 3.71; p = 0.001 F = 2.63; p = 0.002
Gender
 Female 7.69(1.73) 4.43(2.03)
 Male 5.38(1.89) 7.12(2.29)
t = 3.74; p = 0.003 t = .4.62; p = 0.004
Marital status
 Married 6.91(1.32) 4.36(1.40)
 Single 4.36(1.29) 6.12(2.06)
t = 2.51; p = .001 t = 3.64; p = .002
Speciality
 OMS* 5.33(1.90) 5.09(2.22)
 OMR** 4.45(2.18) 4.45(2.23)
  Restorative dentistry 5.95(1.59) 6.06(1.80)
 Endodontics 5.76(2.47) 5.52(3.05)
 Orthodontics 6.48(1.65) 6.28(2.24)
  Pediatric dentisty 5.25(1.05) 4.92(1.53)
 Periodontology 5.73(1.11) 5.09(1.70)
 Prosthodontics 5.34(2.09) 5.08(2.26)
F = 1.32; p = .73 F = 2.41; p = .72
Academic position
  Research assistant 5.23(2.41) 4.31(3.52)
 Academic staff 7.32(1.24 7.54(2.47)
t = 2.41; p = .002 t = 3.62; p = .003
Years in profession (years)
 1–5 7.41(1.61) 6.08(1.87)
 5–10 3.36(1.60) 3.41(2.04)
 10+ 6.43(1.98) 5.75(2.33)
F = 2.64; p = .002 F = 4.12; p = .001

Table 4. Relationships between burnout and occupational participation among the study group.
Emotional Depersonali- Personal Performance Satisfaction
exhaustion zation accomplisment score score
Emotional exhaus- 1
tion
Depersonalization .766* 1
Personal accom- –.705* .–651* 1
plishmnet
Performance score –.731* –.693* .611* 1
Satisfaction score –.631* –.625* .614* .933* 1
*Significant at the .001 level (2-tailed).

Consistent with the literature, single dentists showed higher EE, lower OS but OS levels
were higher than the married dentists (Gorter & Freeman, 2011; Jin et al., 2015; Singh et al.,
2016). It is thought that married dentists can be stable or in a better emotional condition
with better OP but their OS was lower than the single ones that indicating married dentists
have problems on fulfilling their life.
Most of the dentists did not get or open the invitation letter and could not participate to
study. Nevertheless, the response rate was sufficient. Although, the study was cross-sectional;
 Psychology, Health & Medicine   7

because of using a sample from one university, the results cannot be generalized. Besides,
the fact that several dentistry specialties have been included; different internal, external and
organizational factors for each specialty made the analyze difficult.
The results of the study highlight the importance of creating a life with high level of OP
and high level of OS. Using strategies to enhance activity participation and increased level of
participating behaviorally, cognitively, and physically meaningful and purposeful activities
may help prevent dentists with teaching responsibilities from burnout.

Disclosure statement
No potential conflict of interest was reported by the authors.

ORCID
Kaan Orhan   http://orcid.org/0000-0001-6768-0176

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