Module 5 Outline: Personal (Psychological and Social) Demands Contributing to Public Health Worker Burnout

In this module, we expand on the aspects of work that can be especially demanding for public health workers. Specifically, we focus on more personal demands that workers can experience psychologically and socially.
As in other modules, our goal is to help you recognize these types of demands. We also will share how they affect you and the people you supervise or manage.
After reviewing this module, you should be able to…
1. Identify and describe common psychological factors that public health workers can experience as demands.
2. Identify and describe common social factors that public health workers can experience as demands.
3. Explain how psychosocial demands can contribute to burnout.

As defined in earlier modules of this training, demands are events, circumstances, or pressures to which we need to respond. Resources are what we need to respond to demands.
In Module 4, we examined situational demands that are often not under the worker’s control.
Another important set of demands are those that are more personal, arising from our own thoughts and perceptions.
1. We want to be clear that these demands are more personal, but this does not mean that they are only a personal issue. As you will find with examples that will be provided throughout this module, supervisors and managers still have a responsibility and opportunity to recognize and respond to these personal demands. They affect us and the people with whom we work.
2. Psychologically oriented demands tend to be linked to our internal beliefs, perceptions and appraisals, or experiences.
  1. When we talk about psychological experiences, we mean cognitive/mental, emotional, and behavioral experiences. Our psychological experiences while working often help to explain a lot about the stress we experience. Some of the earliest research into stress helped clarify that two people can encounter the exact same situation and yet one will feel stress and the other may not (Lazarus, 1966; Folkman et al., 1986). More recent research has shown that different people may experience stress in different ways. For instance, some researchers say a stressor can feel like a challenge, hindrance, or threat (Cavanaugh et al., 2000; Tuckey et al., 2015).
  2. You can probably recognize that there are differences in how we react to stress. For instance, when we make a mistake at work some of us can rebound quicker than others. Similarly, when encountering criticism some individuals may feel more threatened by it.
1. Socially oriented personal demands result broadly from our interactions with other people.
  1. 1. This type of stressor can come from direct interactions with those you work with. This could be members of our work teams or people from the community you serve.
    2. We can also more generally experience stress from people’s interactions with one another at work, even when we’re not directly involved. For instance, some tension between two colleagues can create challenges for many.
    3. As we have illustrated on this slide, with a continuum ranging from psychological to social stressors, there are some beliefs and personal thoughts that fall closer to the psychological end. Our interactions with others tend to fall on the social end. Many other demands like appraisals of ourselves or comparisons fit somewhere in the middle, with social and psychological components.
There is a good bit of connection between our psychological and social experiences. As a result, it is common to see the term psychosocial used to describe these complex personal demands.
Defining the words we use to describe these types of demands can help. But more importantly, we want you to understand why and how these types of demands affect us. We also want to share what these demands “look like” so that you can recognize them and respond.

Connecting psychosocial demands to burnout is not always simple or straightforward.
The key is to realize that responding to all demands requires effort. Just as responding to physical work demands take effort from us and can wear us down, so can responding to psychosocial demands. This is true even if the resources we need to respond to psychosocial demands are different than physical demands.
1. 1. Mental effort – Psychosocial demands require mental effort by requiring focus and perseverance for critical thinking. These types of demands can also take up effort by simply distracting us or slowing our progress. Demands like self-doubt do this.
  2. Emotional effort – Some psychosocial demands require emotional effort from us. Anyone who has had to “put on a face” of calmness or positivity amid chaos can tell you that this acting can be exhausting. More broadly, psychosocial demands can generate negative emotions, which tend to harm productivity and focus (Ferreira et al., 2018). This sometimes results in self-undermining.
  3. Behavioral effort – Some psychosocial demands require us to respond in behavior. That can be related to emotional effort, like having to act professionally when faced with unfair or unkind treatment. As another example, interpersonal conflict may require practical effort like setting up a meeting to try to reach a resolution. So not only can a conflict eat away at our time if we are thinking or ruminating about it, resolving it also requires our time and attention.

Now that we have reviewed, broadly, what personal psychosocial demands are and how they affect us, we will get into some more practical examples. These will help you better recognize and respond to these risks for burnout.
We cannot explore every possible psychosocial demand here. However, we can highlight some specific examples public health workers are likely to experience.
Looking back at our earlier visual of the continuum of example stressors, ranging from more psychological to more social, we will start demands that are beliefs, falling on the psychological end. We will end the section with more socially oriented demands from interactions, with the appraisals, comparisons, and a few other demands falling somewhere in between.
1. Self-doubt – One of the most personal demands we run into is our own evaluation of ourselves. Our beliefs about our ability to complete work (i.e., self-doubt or low self-efficacy) can be a potent personal and psychological demand.
  1. High levels of self-doubt, such as the popularized “imposter syndrome”, can be related to a number of concerning outcomes. This includes stress and burnout (Bravata et al., 2020) and sometimes self-undermining behaviors. For instance, if you doubt your abilities, you may procrastinate on your work or be slow to ask for feedback that could help you make progress, creating additional demands from slowed work time.
2. Perceived work overload or underload – how we perceive the suitability or appropriateness of our workload is another commonly experienced stressor.
  1. Workloads that seem to be insurmountable can be a main source of stress for public health workers, especially in times of crisis response. On the other hand, public health workers who must carry out roles that are not their passion or not using their expertise can also experience stress.
  2. This demand can be tricky for leaders to manage because its effects are linked to the objective workload (noted in Module 4) and workers’ perceptions of that workload. A workload that seems objectively reasonable by a supervisor may feel over- or underwhelming to a worker. And to be clear, from a worker health perspective, there is absolutely a limit on how much work we should expect of workers. We cannot overburden a worker and excuse it as just a perceptual problem if they feel overloaded.
  3. Also problematic, some workers who are overloaded do not admit it or do not clearly perceive it. Some work cultures can make busy feel like the norm and being overloaded just a part of the job. Driven workers can often perceive high demands as a challenge to overcome. And perceiving demands as a challenge is a good thing for performance and motivation! But studies find that too many challenge stressors still relate to more burnout (Mazzola et al., 2019). There is a point where feeling challenged can be too much of a good thing and can have negative effects on our well-being and work ability (e.g., Schilbach et al., 2021).
  4. Feeling overloaded can also come from perceived constraints, which are objectively or subjectively experienced barriers to getting our work done. For example, lacking information or necessary practical resources such as staff or specialized software. Workers can also feel constrained by policies, procedures, or workload delegation. This may be all too familiar for public health workers tasked to “do more with less”.
  5. Feeling overloaded can also come from perceived ambiguity. Workers may not know what needs to be done, how their performance will be evaluated, or even whom they can turn to for support. Public health work already comes with some level of unpredictability, so reducing avoidable ambiguity is important.
  6. Supervisors who want to reduce burnout should:
    1. Actively monitor workloads;
    2. Actively monitor workers’ feelings about those workloads; and
    3. Reduce ambiguity where possible.

The next few demands fall in that “in between” territory where they are psychologically oriented, but also influenced by our social environment.
1. Perceived expectations – stress experiences can occur from the expectations we perceive for how we should think, feel, and act. Expectations can come from us and others (e.g., general public, supervisors, peers).
  1. Very high or unrealistic expectations can be an aspect of our personality. Traits like perfectionism or achievement striving are often very helpful and valued in work settings. Unfortunately, these traits can be harmful when they lead us to:
    1. evaluate ourselves too harshly,
    2. be overly critical when we make mistakes, or
    3. feel excessive pressure (DiBartolo et al., 2007).
  2. Public health workers care a lot about the work they do and have a deep desire to help their communities. They may be prone to these types of high (sometimes unmeetable) self-expectations.
  3. Even workers who are not perfectionists by nature can struggle with feeling they cannot meet the expectations of others or that others expect them to be perfect. This can similarly relate to symptoms of burnout (Childs & Stoeber, 2012).
  4. For public health workers, expectations can also come from their communities. For example, during the COVID-19 pandemic, there was an increase in widespread desire for on-demand surveillance data (e.g., case counts). This triggered more demands around data gathering, interactive dashboards, etc. that workers had to manage
2. Social comparison – Our expectations often come from comparing ourselves to others in our social networks. Comparisons are not always a bad thing – they can help us gather helpful information or even motivate us. However, comparisons often act as demands when:
  1. they threaten our sense of self-worth,
  2. lead to unreasonable expectations,
  3. generate a sense of inequity (Wemken et al., 2021) or simply distract us from what we should be doing.
  4. simply distract us from what we should be doing.
3. Comparisons that trigger feelings of inequity are particularly important to watch for among public health workers. They often will make sure the job gets done, even if one or more coworkers are not pulling their weight. Although the work may get done, the consequences for the people doing the work may be seriously negative.
4. Role conflict occurs for all of us when we feel that managing the demands in one of our life roles makes managing the demands in another role more difficult or maybe even impossible (e.g., Kahn et al., 1964).
  1. 1. 1. For instance, supervisors can feel conflict in meeting the needs of their workers and their superiors.
      2. An often-studied example of this type of conflict occurs between one’s work roles and non-work roles (e.g., spouse, friend, parent). During the height of the COVID-19 pandemic, many public health workers had to adapt to long or odd work hours that interfered with their personal life.
      3. Very high or unrealistic expectations can be an aspect of our personality. Traits like perfectionism or achievement striving are often very helpful and valued in work settings. Unfortunately, these traits can be harmful when they lead us to:
        
        evaluate ourselves too harshly,
        
        be overly critical when we make mistakes, or
        
        feel excessive pressure (DiBartolo et al., 2007).
5. A strong supervisor will be able to help workers better manage expectations, comparisons, and conflict. Providing clear expectations and feedback are critical. Good leaders also recognize that the expectations, comparisons, and role conflicts affecting us and our burnout levels do not all come from work. Thinking about supporting workers as a whole person can be one of the most important things a supervisor can do to reduce burnout.

We will wrap up our examples by focusing on demands that lean most toward the social side of the continuum we have been discussing in this module.
1. Emotional labor occurs when someone must display a set of emotions seen as “appropriate” or consistent with one’s job requirements (Grandey et al., 2013).
  1. Emotional labor may come into play for certain public health roles more than others. However, all public health workers have probably had to display a sense of calmness and confidence, when they are truly feeling overwhelmed by uncertainty. This is especially true during crisis and emergency response situations. For extended or ongoing crisis situations, as has been the case with the COVID-19 pandemic, this acting can be extremely draining for the worker and associated with higher levels of burnout (Kim, 2022, Roh et al., 2016).
2. Interpersonal conflict is not always bad thing. Conflict can be important and productive. But some forms of conflict or social tensions are more clearly problematic. Interpersonal mistreatment can come from many different sources (e.g., co-workers, community members, other outsiders who may be in the work environment). It can take many different forms, ranging from some mild rudeness to harassment or aggression.
  1. Even seemingly mild forms of mistreatment such as passive aggressive comments, excluding someone from social groups, or making a derogatory joke can have serious impacts on worker’s well-being (Cortina et al., 2017).
  2. Incivility and other mistreatment at work more often affects those with less power (for example, those belonging to disadvantaged groups). Incivility is sometimes seen as a form of “modern discrimination” (Cortina et al., 2011) because these seemingly mild acts may be tolerated more than overtly hostile behaviors.
    1. Supervisors must be aware of and proactive in addressing this type of mistreatment of marginalized groups. It directly harms public health goals of having a diverse and engaged workforce.
  3. Many public health roles can involve several risk factors for aggression and other forms of mistreatment from those outside the organization. For instance, making decisions that affect other people’s lives or exercising control over others’ behaviors (LeBlanc & Kelloway, 2002).
    1. Studies show that concerns about mistreatment in this community increased during the COVID-19 pandemic, a time when public health leaders had to make decisions that affected people’s lives, like mask mandates (Ward et al., 2022).
    2. One survey of local health departments found that 57% of departments reported some experience of harassment during 2020. 36% of job departures by public health officials coincided with reports of harassment (Ward et al., 2021).
  4. The impact of mistreatment on a public health worker may vary depending on their past experience. For instance, previous trauma could magnify a reaction, or experience managing conflict could minimize the impact. Regardless, these negative interactions can be emotionally very difficult without corresponding resources.

Putting it all together, public health workers experience demands like having to act a certain way on the job. They may have to interact with other people who are rude, discourteous, or flat out aggressive.
1. Some of these demands are unavoidable or difficult to control. But, as we will learn in later modules, there are many actions a supervisor can take to quickly and firmly condemn mistreatment in the workplace. There are many resources employers can provide to reduce strains and burnout related to social demands.
Regardless of whether a demand is easy to identify in our tangible environment or whether it is a thought that we cannot get out of our head, responding to or managing it requires effort and sometimes other resources.
Those critical resources will be the topic of our conversation in the next two modules.
Here is a quick reminder of the other content covered in this training course. We hope you are finding this information to be helpful and that you will take the time to review additional modules.

References

Bravata, D. M., Watts, S. A., Keefer, A. L., Madhusudhan, D. K., Taylor, K. T., Clark, D. M., . . . Hagg, H. K. (2020). Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review. Journal of General Internal Medicine, 35(4), 1252-1275. https://doi.org/10.1007/s11606-019-05364-1

Buunk, A. P., Zurriaga, R., & Peiro, J. M. (2010). Social comparison as a predictor of changes in burnout among nurses. Anxiety, Stress & Coping, 23(2), 181-194. https://doi.org/10.1080/10615800902971521

Cavanaugh, M. A., Boswell, W. R., Roehling, M. V., & Boudreau, J. W. (2000). An empirical examination of self-reported work stress among U.S. managers. Journal of Applied Psychology, 85(1), 65-74. https://doi.org/10.1037/0021-9010.85.1.65

Childs, J. H., & Stoeber, J. (2012). Do you want me to be perfect? Two longitudinal studies on socially prescribed perfectionism, stress and burnout in the workplace. Work & Stress, 26(4), 347-364. https://doi.org/10.1080/02678373.2012.737547

Cortina, L. M., Kabat-Farr, D., Leskinen, E. A., Huerta, M., & Magley, V. J. (2011). Selective Incivility as Modern Discrimination in Organizations. Journal of Management, 39(6), 1579-1605. https://doi.org/10.1177/0149206311418835

Cortina, L. M., Kabat-Farr, D., Magley, V. J., & Nelson, K. (2017). Researching rudeness: The past, present, and future of the science of incivility. Journal of Occupational Health Psychology, 22(3), 299-313. https://doi.org/10.1037/ocp0000089

DiBartolo, P. M., Li, C. Y., & Frost, R. O. (2007). How Do the Dimensions of Perfectionism Relate to Mental Health? Cognitive Therapy and Research, 32(3), 401-417. https://doi.org/10.1007/s10608-007-9157-7

Ferreira, A. I., da Costa Ferreira, P., Cooper, C. L., & Oliveira, D. (2018). How daily negative affect and emotional exhaustion correlates with work engagement and presenteeism-constrained productivity. International Journal of Stress Management, 26(3), 261-271. https://doi.org/10.1037/str0000114

Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992-1003. https://doi.org/10.1037//0022-3514.50.5.992

Gallus, J. A., Bunk, J. A., Matthews, R. A., Barnes-Farrell, J. L., & Magley, V. J. (2014). An eye for an eye? Exploring the relationship between workplace incivility experiences and perpetration. Journal of Occupational Health Psychology, 19(2), 143-154. https://doi.org/10.1037/a0035931

Grandey, Diefendorff, J., & Rupp, D. (2013). Bringing emotional labor into focus: A review and integration of three research lenses. In Emotional labor in the 21st century: Diverse perspectives on the psychology of emotion regulation at work. Routledge Academic.

Kahn, R. L., Wolfe, D. M., Quinn, R. P., Snoek, J. D., & Rosenthal, R. A. (1964). Occupational stress: Studies in role conflict and ambiguity. New York: Wiley

Kim, M. N., Yoo, Y. S., Cho, O. H., & Hwang, K. H. (2022). Emotional Labor and Burnout of Public Health Nurses during the COVID-19 Pandemic: Mediating Effects of Perceived Health Status and Perceived Organizational Support. International Journal of Environmental Research and Public Health, 19(1). https://doi.org/10.3390/ijerph19010549

Lazarus, R. S. (1966). Psychological stress and the coping process. New York, NY: McGraw-Hill.

LeBlanc, M. M., & Kelloway, E. K. (2002). Predictors and outcomes of workplace violence and aggression. Journal of Applied Psychology, 87(3), 444-453. https://doi.org/10.1037/0021-9010.87.3.444

Mazzola, J. J., & Disselhorst, R. (2019). Should we be “challenging” employees?: A critical review and meta‐analysis of the challenge‐hindrance model of stress. Journal of Organizational Behavior, 40(8), 949-961. https://doi.org/10.1002/job.2412

Roh, C. Y., Moon, M. J., Yang, S. B., & Jung, K. (2016). Linking Emotional Labor, Public Service Motivation, and Job Satisfaction: Social Workers in Health Care Settings. Social Work in Public Health, 31(2), 43-57. https://doi.org/10.1080/19371918.2015.1087904

Schilbach, M., Baethge, A., & Rigotti, T. (2021). Do challenge and hindrance job demands prepare employees to demonstrate resilience? Journal of Occupational Health Psychology, 26(3), 155–174. https://doi.org/10.1037/ocp0000282

Schlotz, W., Yim, I. S., Zoccola, P. M., Jansen, L., & Schulz, P. (2011). The Perceived Stress Reactivity Scale: measurement invariance, stability, and validity in three countries. Psychological Assessment, 23(1), 80-94. https://doi.org/10.1037/a0021148

Tuckey, M. R., Searle, B. J., Boyd, C. M., Winefield, A. H., & Winefield, H. R. (2015). Hindrances are not threats: advancing the multidimensionality of work stress. Journal of Occupational Health Psychology, 20(2), 131-147. https://doi.org/10.1037/a0038280

Ward, J. A., Stone, E. M., Mui, P., & Resnick, B. (2022). Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020January 2021. American Journal of Public Health, 112(5), 736-746. https://doi.org/10.2105/AJPH.2021.306649

Wemken, G., Janurek, J., Junker, N. M., & Hausser, J. A. (2021). The impact of social comparisons of job demands and job control on well-being. Applied Psychology: Health and Well-Being, 13(2), 419-436. https://doi.org/10.1111/aphw.12257

Module 5 Outline: Personal (Psychological and Social) Demands Contributing to Public Health Worker Burnout

Follow NIOSH

NIOSH Homepage