Occupational Medicine 2020;70:45–51

Advance Access publication 20 December 2019 doi:10.1093/occmed/kqz160

Burnout and occupational stressors among

non-medical occupational health staff
Yukako Okuda1, Shinichi Iwasaki1, , Yasuhiko Deguchi1, Tomoko Nitta2, Tomoe Mitake1, Aya Sakaguchi1,
Akihiro Niki1 and Koki Inoue1
Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan,
1

Takarazukasanda Hospital, Hyogo, 669-1537, Japan.

2

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Correspondence to: Yukako Okuda, Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University,
1-4-3 Asahimachi Abeno-ku, Osaka 545-8585, Japan. Tel: +81-6-6645-3821; fax: +81-6-6636-0439; e-mail: m2079121@med.
osaka-cu.ac.jp

Background The work required to assist individuals in improving their mental health is stressful and known to be
associated with burnout. In Japanese companies, non-medical occupational health (OH) staff often
take the role of maintaining and improving workers’ mental health. However, few studies have exam-
ined burnout in this population.
Aims To assess the relationship between burnout and occupational stressors among non-medical OH
staff.
Methods We conducted a cross-sectional study of OH staff who had participated in mental health seminars
between 2016 and 2018. Occupational stressors were assessed using the Japanese version of the Job
Content Questionnaire. Burnout was assessed using the Japanese version of the Maslach Burnout
Inventory.
Results We administered the survey to 230 non-medical OH staff, of which 188 completed the question-
naire. According to a hierarchical multiple linear regression analysis, high job demands were asso-
ciated with greater emotional exhaustion, depersonalization and personal accomplishment. Greater
job control was associated only with higher personal accomplishment. Lower job support was asso-
ciated with greater emotional exhaustion and depersonalization.
Conclusions The present study found relationships between occupational stressors and burnout dimensions
among OH staff. To avoid burnout among non-medical OH staff, it is important to take measures
against occupational stressors, especially job demands and low levels of job support.
Key words Burnout; occupational health staff; occupational stressors.

Introduction also exposed to specific stressors such as the demanding

Burnout is defined as a prolonged response to chronic
emotional and interpersonal stressors. It comprises three
dimensions: emotional exhaustion, depersonalization and
reduced personal accomplishment [1].While initial studies
on burnout primarily focused on human service workers
(i.e. those who engage in ‘people work’) [2], those in many
other occupations can also suffer burnout [3]. Staff who
engage in mental healthcare work are particularly at risk
due to their high levels of stress. Mental healthcare staff
regularly engage in emotional work while caring for pa-
tients with mental illness and simultaneously striving to
deal with the stress inherent in other aspects of their work,
and they also require intense emotional involvement with
patients over prolonged periods. Mental health nurses are
relationships they have with patients, challenging inter-
actions with other mental health workers and the risk of
personal threats from violent patients as well as patient
suicide. In addition, they frequently suffer stress due to in-
adequate staffing, an excessive workload, poor leadership
and a lack of support [4]. For example, psychiatrists have
higher levels of emotional exhaustion and depersonaliza-
tion than physicians employed in general medical settings
[5]. Moreover, psychiatric nursing is considered a highly
stressful occupation [6], and exposure to occupational
stressors is associated with burnout [7].
In Japan, mental health work is undertaken not only
by nurses (including public health nurses) but also by
non-clinical workers who are collectively called occupa-
tional health (OH) staff [8]. These are non-medical staff

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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46  OCCUPATIONAL MEDICINE

Key learning points

What is already known about this subject:
• Occupations that involve assisting others with improving their mental health are known to lead to considerable
stress, which in turn is associated with a higher risk of burnout.
• Non-medical occupational health staff are often involved in providing mental health support in Japanese
companies.
What this study adds:
• Occupational stressors had different associations with the three dimensions of burnout among non-medical oc-
cupational health staff.
What impact this may have on practice or policy:
• Reducing job demands and encouraging support from co-workers and superiors may be important factors for

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preventing burnout among non-medical occupational health staff.

who belong to the personnel departments and have no
healthcare training and are not qualified as health staff.
Non-medical OH staff are charged with maintaining and
improving the mental health of workers in a given organ-
ization, which they often must perform alongside other
types of work (e.g. choosing people for jobs, dealing with
employees’ complaints or problems and so on). In many
cases, the scope of their work is too broad and the work-
load too high. Among their duties are: health promotion,
providing employees education on mental health, stress
awareness and coping methods; management of stress;
establishing consultation systems to connect with spe-
cialists; and supporting workers in being reinstated.
Given the scope of their duties, non-medical OH staff
must often engage in emotional labour, much like med-
ical mental health staff. However, compared with medical
staff, non-medical OH staff tend to have less knowledge
of mental health and have poorer coping methods, and
also have greater stigma regarding mental illness [9]. As
a result, they may be exposed to numerous occupational
stressors but lack the ability to adequately cope with
these stressors. Therefore, it is reasonable to assume that
they may have a higher risk of burnout.
The relationship between occupational stressors and
burnout has been extensively studied among medical
staff. However, this relationship has rarely been explored
among non-medical OH staff. Moreover, there is little in-
formation on the levels of the burnout dimensions in this
group. We, therefore, investigated levels of burnout (and
its dimensions) among non-medical OH staff and clari-
fied their relationship with occupational stressors. Based
on prior studies among mental health professionals, we
hypothesized that high levels of occupational stressors
would be associated with more severe burnout among
non-medical OH staff. Furthermore, we studied each di-
mension of burnout in relation to occupational stressors.
Methods
We used a cross-sectional design to examine the rela-
tionship between occupational stressors and burnout.
We distributed a self-report questionnaire to 263 OH
staff members whose work primarily involved mental
health and who were participating in mental health
seminars between 2016 and 2018. These seminars are
conducted in accordance with the curriculum pub-
lished by the Ministry of Health, Labour and Welfare,
and include mental health issues such as formulation of
mental health plans, response to mental illness, support
for returning to the workplace and improvement of the
workplace environment. Participants in these seminars
applied through a voluntary online application. They in-
clude both non-medical OH staff and medical OH staff
(including nurses, such as mental health nurses or public
health nurses) belonging to the company. A total of eight
such seminars were held during this period. Data from
33 medical OH staff were excluded from the analysis be-
cause we wanted to focus on non-medical OH staff in
this study. After participants with incomplete responses
were excluded (valid response rate 82%), 188 staff were
included in the analysis.
All participants gave informed consent to participate
as volunteers and understood that there was no penalty
for choosing not to participate. The study design was ap-
proved by the Human Subjects Review Committee of
Osaka City University (authorization number: 1409). All
data were stored only in our database. Participants’ em-
ployers did not have access to the data and did not know
who participated in the study.
The demographic variables measured were age, gender
and marital status (single or married). Work-related vari-
ables included months of experience and occupation.
The Job Content Questionnaire (JCQ) was designed
to measure work environment characteristics based on
the demand–control–support model [10,11]. In this
study, we used the Japanese version of the JCQ (JCQ-
J) to assess occupational stressors. The reliability and
validity of the JCQ-J for assessing job stressors among
Japanese employees are excellent [12]. The questionnaire
comprises four scales: job demand (5 items), job control
(9 items), supervisory support (4 items) and co-worker
support (4 items). The job demand items relate to the
 Y. OKUDA ET AL.: BURNOUT AND OCCUPATIONAL STRESSORS  47
speed of completing work, the degree of difficulty of the
work, the amount of work, the time given to complete the
work and the presence of conflicting demands. The job
control scale measures decision-making authority, task
variety and personal freedom on the job. The support
scales contain items evaluating support from supervisors
and co-workers. The items are rated on a four-point
Likert-type scale ranging from 1 (‘strongly disagree’) to
4 (‘strongly agree’). The item scores were weighted and
summed to create scale scores. The weights were set ac-
cording to the JCQ user’s guide [12]. A high job demand
score and low scores for the other three subscales were
considered to indicate more stressors. The Cronbach’s
alpha coefficients of the scales were as follows: 0.73 for
job demand, 0.68 for job control, 0.92 for supervisor
support and 0.85 for co-worker support.
Burnout level was assessed using the Japanese ver-
sion of the Maslach Burnout Inventory (MBI) [13–15].
The MBI is arguably the most widely used instrument
for assessing burnout [1]. Its Japanese version, which
was developed by Kubo, has been found to have good
reliability [15]. The MBI comprises three subscales:
emotional exhaustion, depersonalization and reduced
personal accomplishment. Exhaustion is both the cen-
tral quality of burnout and its most obvious manifest-
ation. Depersonalization refers to a negative, callous or
excessively detached response to various aspects of the
job. Both exhaustion and depersonalization interfere
with personal accomplishment: that is, it is difficult to
gain a sense of accomplishment when feeling exhausted
or when helping people to whom one is indifferent [1].
The scale contains 17 items, each rated on a 5-point
Likert-type scale ranging from ‘always yes’ to ‘no’. The
personal accomplishment items were reverse scored as
reduced personal accomplishment. Higher scores on
the emotional exhaustion, depersonalization subscales
and reduced personal accomplishment subscale in-
dicated a greater tendency towards burnout [13,14].
The Cronbach’s alpha coefficient of each subscale
was as follows: 0.73 for emotional exhaustion, 0.68
for depersonalization and 0.92 for reduced personal
accomplishment.
The independent t-test was used to evaluate differ-
ences in age by gender. Neither the JCQ-J, the MBI
scores nor months of work experience were normally
distributed; therefore, the Mann–Whitney U-test was
used to identify differences in these scores by gender.
The significance of differences in marital status and
gender was evaluated by the chi-square test. The correl-
ations between the JCQ-J and MBI were analyzed using
Spearman’s rank correlation coefficient. As demographic
variables such as gender and age are related to burnout,
we performed hierarchical multiple linear regression ana-
lysis to determine whether occupational stress explained
a significant proportion of the variance in each dimen-
sion of burnout. Gender, age, marital status and months
of work experience were entered in step 1, and JCQ-J
scales were entered in step 2, with controls for the vari-
ables from step 1. The regression analysis was conducted
in line with the National Institute for Occupational
Safety and Health stress model [16]. Differences were
considered significant at P < 0.05. All statistical analyses
were conducted using SPSS Statistics v24.0 software
(IBM Corp., Armonk, NY, USA).
Results
Table 1 shows the participants’ characteristics and de-
scriptive results of the JCQ-J and MBI. The average age
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of the sample was 47.4 (age range: 22–72  years, SD =
9.3) years, and 112 (60%) participants were men and 76
(40%) were women. The t-test, Mann–Whitney U-test
and chi-square test results indicated that age, marital
status, job demand, job control and supervisory support
significantly differed by gender.
Table 2 shows Spearman’s correlations between the
MBI subscales and JCQ-J scales. Emotional exhaustion
had moderate negative correlations with supervisory
support (r  =  −0.44; P < 0.001) and co-worker support
(r = −0.43; P < 0.001). The same was true for deperson-
alization (r = −0.48, r = −0.45; P < 0.001, respectively).
Table 3 shows the results of the hierarchical multiple
linear regression analysis. For emotional exhaustion, in
steps 1 and 2, age was a significant predictor, and older
age predicted lower emotional exhaustion. In step 2, oc-
cupational stressors accounted for an additional 30% of
the variance (F = 10.2, P < 0.01), with higher job de-
mand predicting a higher level of emotional exhaustion
and higher supervisory and co-worker support predicting
lower emotional exhaustion. For depersonalization, step
1 of the model revealed no significant predictors. In step
2, the occupational stressors accounted for an additional
34% of the variance (F = 10.41, P < 0.01), with higher
job demand having a significant positive effect on de-
personalization and higher supervisory and co-worker
support having significant negative effects on deperson-
alization. Finally, for personal accomplishment, step 1
revealed no significant predictors, while step 2 revealed
that the occupational stressors accounted for an add-
itional 19% of the variance (F = 4.94, P < 0.01). Higher
job demands and job control predicted higher levels of
personal accomplishment.
Discussion
We examined the relationship between occupational
stressors and burnout in non-medical OH staff. Results
indicated that occupational stressors estimated by the
JCQ-J had different associations with each of the di-
mensions of burnout. Higher job demands scores were
associated with higher emotional exhaustion, higher
48  OCCUPATIONAL MEDICINE

Table 1.  Demographic variables, Job Content Questionnaire (JCQ) scores and Maslach Burnout Inventory (MBI) scores by gender

Mean ± SD

Range Total Female Male P

Number 188 76 (40%) 112 (60%)

Age (22–72) 47.4 ± 9.3 45.5 ± 9.4 48.6 ± 9.1 *
Marital status **
 Single 48 29 19
 Married 140 47 93
Months of work experience 123 ± 113 125 ± 102 123 ± 121
JCQ scores
  Job demand (12–48) 31.8 ± 6.1 29.9 ± 4.6 33.2 ± 6.7 **

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  Job control (24–96) 71.3 ± 8.5 69.1 ± 7.2 72.9 ± 8.9 **
  Supervisory support (4–16) 11.2 ± 2.6 10.5 ± 2.8 11.6 ± 2.4 **
  Co-worker support (4–16) 11.4 ± 2.1 11.5 ± 2.0 11.4 ± 2.2
MBI scores
  Emotional exhaustion (5–25) 12.4 ± 4.7 12.6 ± 4.3 12.3 ± 4.9
 Depersonalization (6–30) 11.9 ± 4.9 11.9 ± 4.9 11.9 ± 4.9
  Reduced personal accomplishment (6–30) 19.9 ± 4.5 20.0 ± 4.3 19.8 ± 4.6

*P < 0.05, **P < 0.01.

Table 2.  Spearman correlations between Job Content Questionnaire (JCQ) scores and Maslach Burnout Inventory (MBI) scores

1 2 3 4 5 6

1. Job demand –
2. Job control 0.09 –
3. Supervisory support −0.09 0.30*** –
4. Co-worker support −0.23** 0.24** 0.62** –
5. Emotional exhaustion 0.36*** −0.15* −0.44*** −0.43** –
6. Depersonalization 0.27*** −0.18* −0.48** −0.45** 0.68** –
7. Reduced personal accomplishment −0.15* −0.39*** −0.17* −0.18* 0.16* 0.16*

*P < 0.05, **P < 0.01, ***P < 0.001.

depersonalization and increased personal accomplish-
ment scores on the MBI. Higher job control scores were
associated with increased personal accomplishment and
higher supervisory and co-worker supports were associ-
ated with lower emotional exhaustion and depersonaliza-
tion. Although we hypothesized that higher occupational
stressors (i.e. high job demands, low job control and low
social support) would be associated with more severe
burnout, the results of this study showed that occupa-
tional stressors were associated with each burnout di-
mension independently and with different patterns.
The strengths and limitations of this study are dis-
cussed below. This study is among the first to explore the
association between occupational stressors and burnout
among non-medical OH staff in Japan. Therefore, our
findings can provide suggestions for reducing risk of
burnout among non-medical OH staff. However, use of
self-report questionnaires and selection bias limits the
generalizability of the findings. The selection bias derives
from the fact that OH staff who voluntarily participate in
mental health seminars might have higher awareness of
mental health than the general population of OH staff.
Furthermore, the causal relationship between occupa-
tional stressors and burnout could not be determined
because of the cross-sectional nature of the study design.
Longitudinal studies with a larger sample and the use of
diagnostic interviews for burnout should be conducted
to confirm our conclusions.
Regarding the risk of burnout, a study with Japanese
consultation support specialists showed the prevalence
of high-risk burnout. Tao and Kubo, who created the
Japanese version of the MBI used in this study, defined
the criteria for a high-risk group on each dimension [17].
Using these criteria, consultation support specialists had
a risk of 2% on emotional exhaustion, 0% on deperson-
alization and 3% on reduced personal accomplishment
[18]. When these criteria were applied to the prevalence
of high-risk burnout in our study (data not shown),
prevalence rates were 2% on emotional exhaustion,
7% on depersonalization and 8% on reduced personal
 Y. OKUDA ET AL.: BURNOUT AND OCCUPATIONAL STRESSORS  49

Table 3.  Hierarchical multiple linear regression analysis of Job Content Questionnaire (JCQ) scores and Maslach Burnout Inventory
(MBI) scores

Emotional exhaustion Depersonalization Reduced personal

accomplishment

Step 1 Step 2 Step 1 Step 2 Step 1 Step 2

β β β β β β

Gender −0.03 0.02 −0.03 −0.03 0.06 −0.07

Age −0.21* −0.15* −0.13 −0.07 −0.07 −0.01
Married −0.08 0.00 −0.01 0.05 0.04 0.01
Months of work experience 0.05 0.01 0.02 −0.01 −0.08 −0.04

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Job demand 0.31** 0.16* −0.17*
Job control −0.04 −0.05 −0.36**
Supervisory support −0.22* −0.28** −0.03
Co-worker support −0.21* −0.30** −0.14
R 0.23 0.59 0.13 0.60 0.14 0.46
R2 0.05 0.35 0.02 0.36 0.02 0.21
R2 change score 0.05 0.30 0.02 0.34 0.02 0.19
F 2.21 10.02** 0.66 10.41** 0.72 4.94**

Step 1: adjusted for gender, age, marital status (reference category: single) and months of work experience.
Step 2: adjusted for occupational stressors and job strain ratio.
*P < 0.05, **P < 0.01.

accomplishment, which were higher than those reported
by Hatano [18].
Higher JCQ-J job demands scores were associated
with higher emotional exhaustion and depersonaliza-
tion scores on the MBI. Emotional exhaustion and de-
personalization are considered the core dimensions of
burnout [19]; there is a general consensus that both of
these dimensions must be included in the measurement
of burnout [20]. An increase in job demands was sig-
nificantly related to both greater emotional exhaustion
and depersonalization among care providers in oncology
wards [21], in a study of nurses [22] and in volunteer
ambulance officers [23]. Findings were the same in our
study. It is therefore assumed that the relationship be-
tween job demands and the two core burnout dimen-
sions is strong regardless of occupation.
Non-medical OH staff who received more support
from co-workers and supervisors experienced less emo-
tional exhaustion and depersonalization. One study in-
dicated that support from a supervisor buffered against
emotional exhaustion and depersonalization, which
were both aggravated by organizational change-related
stressors among Canadian healthcare staff [24]. Thus, to
prevent burnout among non-medical OH staff, we need
to focus on reducing job demands and increasing sup-
port from co-workers and supervisors, which in turn may
improve the two core dimensions of burnout.
Non-medical OH staff who reported higher job con-
trol scores tended to have greater personal accomplish-
ment scores as well. However, few previous studies have
explored job control and personal accomplishment
individually, which makes comparison difficult. However,
when high job control occurs in conjunction with high
job demands, it is hypothesized that if employees are able
to deal with these demands, they receive protection from
excessive stressors, which fosters feelings of learning and
mastery, and leads to positive states, such as personal ac-
complishment [25]. Therefore, job control might buffer
against burnout among non-medical OH staff.
When the associations between these occupational
stressors and the three dimensions of burnout are taken
together, results of this study showed that higher job de-
mand is associated with more severe scores on the core
dimensions of burnout (emotional exhaustion and de-
personalization), and higher social support (supervisory
and co-worker support) has an opposite association with
these core dimensions and thus might serve as a buffer
effect on the severity of burnout. Further, higher job de-
mand and higher job control were associated with in-
creased personal accomplishment. A state of having high
job demand and high job control simultaneously is called
an active job state in Karasek’s job demand–control
model. This state is hypothesized to lead employees to
positive states, such as motivation and personal accom-
plishment [25]. This combination may increase personal
accomplishment in non-medical OH staff.
The current findings provide suggestions for inter-
ventions. Interventions targeting burnout can be cat-
egorized into person-directed and organization-directed.
Person-directed interventions include participating in
psychological workshops such as mindfulness [26] and
stress management training [27]. Attending seminars or
50  OCCUPATIONAL MEDICINE
training regarding mental health designed to develop an
understanding of mental health might assist in preventing
burnout. The majority of organization-directed interven-
tions involve workload or schedule changes designed
to prevent burnout. In 2019, the Japanese parliament
enacted a Work Style Reform law aimed at drastically
changing the way people work [28]. This law includes
implementing a cap on overtime work to redress long
working hours. This will help to prevent work-related
illnesses including burnout. The effectiveness of com-
bining several interventions such as fostering communi-
cation aimed at increasing social support or cultivating
a sense of teamwork and job control was also reported
[29]. A psychoeducational strategy designed to improve
work engagement as a company-level intervention is ef-
fective in preventing burnout because work engagement
is introduced as an antipode of burnout and is negatively
related to job strain and burnout [30].
The present study found relationships between occu-
pational stressors and the dimensions of burnout among
non-medical OH staff. These results are encouraging be-
cause they suggest that job interventions focusing on the
reduction of occupational stressors might be effective in
preventing burnout.
Acknowledgement
We would like to thank all participants for their contributions.
Funding
None declared.
Competing interests
None declared.
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