The Relationship between Perfectionism, Personality Type A and Metacognition with Job Burnout in Staff of Ahvaz Jundishapur University of Medical Sciences ‎ ‎

INTRODUCTION

The foundation of a significant percentage of physical illnesses and psychological distresses is to withstand mental stress and inability to deal with it. Although the nature of many occupations is such that they lead to the psychological stress, most of the occupants of these jobs know how to deal with these kinds of stressful stimuli, and in spite of the stressful stimuli they face in their daily work, they have learned how to avoid the harmful effects of these stimuli. But some people do not have the ability or potential to cope with or escape from stressful stimuli and are constantly exposed to stressful stimuli. Most likely, these people are suffering from job burnout disorder [1, 2].

Job burnout is defined as an emotional analysis syndrome, depersonalization, and personal performance disorder. The issue of the analysis of personnel forces or job burnout is currently a common problem in all societies, so that according to the available statistics, out of every seven employed persons, one person suffers from burnout at the end of the day [3, 4].

The first problem of job burnout victims is that these people are suffering from physical burnout, their ability to work is low and they are often tired and unable. In addition, there are many physiological symptoms, such as frequent headaches, nausea, sleep disturbances, and changes in eating habits. Depression, feelings of helplessness, and the feeling of being trapped at work and occupation are part of the problem of these people. Although many efforts have been made so far to identify the factors affecting burnout, these factors have not been determined yet. One of the most important factors that can predict occupational burnout is perfectionism. Perfectionism is a set of very high standards for performance that comes with negative self-evaluations, criticisms, and blame [5].

The hard criteria for continuous evaluation and extreme forms of themselves, lead to abnormal reactions and feelings of worthlessness that can provide the basis for burnout in the individual. In fact, perfectionism is a permanent source of burnout. Because these people always require themselves to be flawless. Therefore, this expectation will affect their coping strategies against various occupational situations and often fail them. Appleton et al. [6] investigated the relationship between perfectionism and burnout. The results showed that socioeconomic perfectionism with three dimensions of job burnout has a positive relationship and self-oriented perfectionism has a negative relationship with burnout. Stoeber & Rennert [7] examined perfectionism among teachers and their relationship with burnout. The results of this study showed that positive perfectionism has a negative relationship with job burnout. Negative perfectionism is also positively correlated with burnout. Chen et al. [8] showed that positive perfectionism is negatively correlated with burnout, and negative perfectionism is positively correlated with burnout among athletes. Xu et al. [9] investigated the relationship between perfectionism, coping style and burnout among the staff of IT companies in China. The results of the research showed that there is a significant positive relationship between perfectionism and burnout.

Nowadays, researches are done in the field of burnout, and besides the perfectionism factor, they also consider the metacognitive factor as effective. According to Flavell [10], metacognition is a cognitive knowledge or process that participates in the evaluation, review, or control of cognition, and regulates cognitive function. When a person is armed with metacognition weapons, he or she can easily improve his or her performance with the planning and control of the task, reduce the burnout and tension of different situations, and improve his or her performance. Hajlu et al. [11] stated that there is a negative relationship between job burnout and Frost's perfectionism dimensions. Sabzepari [12] showed that perceived stress plays a mediator role between metacognition and job burnout, and metacognition is a better predictive than perfectionism for job burnout. The results of this study showed that perfectionism does not necessarily lead to stress and burnout, but, based on the path analysis, metacognition causes stress and burnout.

One of the other factors associated with burnout is the type of personality of individuals [13]. Types of personality determine the efficiency of mental talents and make it possible to describe human behavior in situations of life. These types should be considered as vocational and educational guidance, something that has often been neglected [14]. One of the behavioral patterns or personality styles that have been considered is a type A behavioral pattern. These individuals are highly competitive, naive, aggressive, hardworking, and less patient. They always feel a sense of urgency, and it is difficult for them to reach peace. They are angry about delaying their work or when confronted with those who believe they are inefficient. These people seem to have good self-esteem, but they are constantly in doubt. They require themselves to do more in a short time [13]. The results of the research by Mikaeli et al. [15] showed that positive perfectionism is negatively significantly correlated with burnout, and behavioral type A is positively and significantly correlated with burnout. But there was no relationship between negative perfectionism and burnout. Khakpour [13] also states that people with personality type A experience more burnout than those of type B and there is a significant relationship between the number of clients and burnout. The results of Ghorbanzadeh Shiroudi et al. [16] indicate that people with behavioral type A show more burnout symptoms and report more psychological distresses and more job dissatisfaction. Jamal [17] concluded that there is a positive relationship between behavioral type A and job burnout.

According to the said contents, the present study seeks to address the issue of job burnout with new dimensions, which has been neglected in previous studies. Therefore, the main question of the research is: Is there any relation between perfectionism, personality type A and meta-cognition with job burnout in the staffs of Ahvaz Jundishapur University of Medical Sciences?

MATERIALS AND METHODS

In this correlational study, the study population included all staffs working in headquarter of Ahvaz Jundishapur University of Medical Sciences in 2020 (700 staffs). A sample of 248 people based on Morgan's formula was selected using simple random sampling. For data analysis, the Pearson correlation coefficient and multiple regression were used by the input and stepwise methods. The tools used in this study were:

The Perfectionist Questionnaire by Terry-Short et al. (1995)

This 40-item test was developed by Terry-Short et al. [18], in which 20 items are devoted to positive perfectionism and 20 other items are devoted to negative perfectionism, and each subject answers questions with a five-point scale (from a completely disagree to fully agree). The minimum score for each of the test scales is 20 and the maximum is 100. The Cronbach's alpha coefficient for the positive and negative perfectionism subscales has been reported to be 0.83 and 0.81, respectively. The correlation coefficient of the positive and negative perfectionism subscales with Hewitt’s perfectionism and Flett’s perfectionism were 0.46 and 0.53, respectively [18]. In another study, Cronbach's alpha of the questionnaire was 0.86 [19]. In the present study, the reliability coefficient of the perfectionism questionnaire and its subscales (positive perfectionism and negative perfectionism) using Cronbach's alpha were 0.83, 0.92 and 0.81, respectively, and using the Tensile method, they were 0.83, 0.79 and 0.67, respectively.

The Questionnaire of personality types A and B designed by Friedman and Rosenman (1974)
The Personality Types A and B questionnaire was designed by Friedman and Rosenmann in 1974. The questionnaire has 25 questions. Each question has 3 options (yes, no, I do not know). The personality type of each Individual is calculated based on the number of answers given to questions. If the number of "yes" answers is greater than 20, then the person has the A personality type, and if the number of "yes" answers is less than 5, the person has a B type personality. If the number of "yes" is between 13 and 20, the person is prone to type A and, if, between 5 and 13, the person has a type B personality. The validity of the questionnaire has been verified by its creators and has been used in many studies, including cardiac patients [20]. In another study, the reliability of the questionnaire was an alpha value of 89%. For validation of this questionnaire, formal validity was used and its reliability was 0.89 [21]. In the present study, the reliability coefficient of personality types A and B questionnaire using Cronbach's alpha was 0.74 and using the Tensile method, it was 0.58.

Wells & Cart-Wright Hatton metacognition questionnaire (2004)

Wells & Cart-Wright Hatton Beliefs and Cattery-Hatton [22] have a self-report scale of 30 items that assess individual differences in meta-cognition beliefs, judgments, and regulatory trends. The questionnaire consists of five subcategories of cognitive conflict, positive beliefs, cognitive self-consciousness, uncontrollability, and the risk of thoughts (or negative beliefs about uncontrollability and the risk of thoughts) and the need for control of thoughts. Each item is scored on the scale of the four Likert options (from “I do not agree” to “I agree very much”). In the Iranian sample, the Cronbach's alpha coefficient for the whole scale was 0.91, for the total scale it was 0.91, and for the subscales uncontrollability and the risk of thoughts (or negative beliefs about the uncontrollability and risk of thoughts), positive beliefs, cognitive conflicts, cognitive self-consciousness and the need for control thoughts have been reported to be 0.81, 0.86, 0.87, 0.80 and 0.71, respectively. Also, the test validity in Iran was 0.87% [23]. In the present study, the reliability of the meta-cognition questionnaire obtained using Cronbach's alpha was 0.84 and using the Tensile method was 0.69. In the present study, the reliability coefficient of the meta-cognitive questionnaire and its subscales (cognitive conflict, positive beliefs, cognitive self-consciousness, uncontrollability, and the risk of negative thoughts and the need to control thought) using Cronbach's alpha were 0.84, 0.81, 0.77, 0.74, 0.71 and 0.74, respectively, and using the Tensile method, they were 0.69, 0.77, 0.67, 0.74, 0.67 and 0.60, respectively.

Maslach & Jackson (1981) Burnout Inventory

This test was made by Maslach & Jackson [24]. The Inventory consists of 22 articles that measure emotional burnout, the performance of personality and depersonalization within the framework of professional activity. The reliability of this scale measured using Cronbach's alpha reported by Maslach and Jackson [25] was 0.83. Meanwhile, the reliability of three subscales was calculated between 0.72 and 0.89. Abolelall and Salameh [25] reported its reliability for three sub-tests on a sample of teachers between 0.71 and 0.84. Abedi [26] calculated the retest reliability coefficient and its reliability coefficient using Cronbach's alpha between 0.56 to 0.85 for different subtest tests. In the present study, the reliability coefficient of the burnout questionnaire and its subscales (emotional burnout, personal performance, and depersonalization) using Cronbach's alpha were 0.65, 0.85, 0.76 and 0.66, respectively, and using the Tensile method,  they were respectively 0.83, 0.87, 0.79, and 0.77.

RESULTS

The sample number was 248, of which 150 were male and 98 were female. Also, 184 members were married and 64 were single. The age of majority )52.8%( was between 31-40 years old and the age of minority (1.6%) was over 50 years old. The highest number (59.3%) had a bachelor's degree and the lowest (9.7%) had an associate degree.

In the perfectionism variable, the mean and standard deviation in the components of positive perfectionism, and negative perfectionism was 129.74±15.93, 74.12±13.51, and 55.61±10.24, respectively. In the variable personality type A, the mean and standard deviation was 19.63±3.73. In the variable metacognitive, the mean and standard deviation in the components of cognitive conflict, positive beliefs, self-consciousness, uncontrollability and the risk of thoughts, and the need to control thoughts was 66.08±11.23, 11.47±3.85, 12.21±3.64, 13.18±2.96, 6.10±1.93, and 7.05±2.13, respectively. In the variable job burnout, the mean and standard deviation in the components of emotional exhaustion, the emotional exhaustion, the performance, and in depersonalization was 58.30±15.98, 17.52±9.85, 31.45±7.92, and 9.33 ±5.26, respectively.

Correlation coefficients between research variables are listed in Table 1. As Table 1 shows, there is no significant relationship between perfectionism and job burnout (p = 0.787; r = 0.017). There is a significant negative relationship between perfectionism in the components of positive perfectionism and burnout of employees. Also, there is a positive significant relationship between perfectionism in the components of negative perfectionism and job burnout of employees. There is a significant positive correlation between personality type A and job burnout (p = 0.047; r = 0.126). There was no significant relationship between metacognition and burnout of employees (p = 0.175; r = 0.086). There is a significant relationship between metacognition in the components of cognitive conflict, cognitive self-consciousness and uncontrollability, and the risk of negative thoughts and job burnout of employees. There is also a negative relationship between metacognition in the components of positive beliefs and the need to control thoughts and job burnout of employees.

Table 1. Correlation coefficients between research variables

The results of multivariable regression analysis by input method and step by step are listed in Table 2. As shown in Table 2, the predicted regression of employees' burnout on perfectionism, personality type A, and metacognition is not statistically significant (p <0.05; F = 2.17). The variable A of personality type A with a beta coefficient of 0.58 can predict positively and significantly the burnout. Also, the value of R² indicates that 0.02% of the variance in employees' job burnout is explained by the variables mentioned. The results of stepwise regression analysis also show that only the variable personality A type predicts employee burnout.

Table 2. Results of regression analysis by input and stepwise method.

DISCUSSION AND CONCLUSION

The aim of this study was to investigate the relationship between perfectionism, personality type A and metacognition with burnout in personnel of Ahvaz Jundishapur University of Medical Sciences. As shown in the results section, in order to investigate the research hypotheses, the Pearson correlation coefficient and multiple regression were used by the input and stepwise methods.

The results show that there is no significant relationship between perfectionism and job burnout among employees. Also, there is a significant negative correlation between perfectionism in the components of positive perfectionism and job burnout of employees. The existence of a negative relationship between positive perfectionism and job burnout has been confirmed in several studies [6-8]. In explaining this finding, it can be said that people working in the Ahvaz Jundishapur University of medical sciences think that they are the guarantors of the health of the community. They consider themselves a supporter of the health of the people of the community. They are proud of their job and this job has a great deal of value to them. This great vision and ambition make them able to resist the difficulties of the workplace and oppose the problems, which gives them the power of hope and gives them a new life to deal with the problems. On the other hand, these people make most of their power and effort in the practice of their duties. As a result, they are always striving to achieve the above goals and gain positive results, and gradually develop positive psychological areas such as self-respect and self-confidence, and features such as realism, the acceptance of personal limitations, flexibility and a sense of satisfaction and the pleasure from the personal performance. This leads them to increase the pleasure and improve job performance that can be as variables that are inconsistent with job burnout.

Furthermore, there is a significant relationship between perfectionism in the components of the negative perfectionism and burnout of employees. In other words, the increase in perfectionism in the component of the negative perfectionism of employees has been accompanied by an increase in their job burnout. The results of the study indicate that negative perfectionism has a positive correlation with job burnout. These findings are in line with the results of previous research [6-8]. Negative perfectionism refers to the cognition and behaviors that attempt to achieve high-level goals and avoid and escape from negative results, and at this time, fear of failure is observed [27]. Medicine and related affairs have a kind of sanctity in the minds, and the implicit meaning of helping people's health lies in it, which can affect the results. People working in medical science, for this reason, have great ideas in mind. They consider themselves as the guarantors of the health of society’s people and always try to save lives and fear that their negligence will cause physical damage to the disease. This fear is always with them and thinking about the lives and health of people is a major concern for them. This thinking and fear cause a lot of pressure on them and they cannot show a decent job at all times. This will exacerbate dissatisfaction in them and provide the basis for job burnout in them.

As shown in Tables 4-6, there was a significant positive correlation between personality type A and job burnout. The prediction of job burnout based on personality type A is similar to the results of other researches [16, 17]. Persons with behavioral type A seem to be vulnerable to stress, especially occupational stress, due to features such as high energy, competition, ambition, and militancy. These people determine their high standards for their better performance, they work hard and are less satisfied with their working conditions, and consequently, are more vulnerable to job burnout. Medical staff at work is severely under pressure because of frequent observation of patients and various illnesses. They are faced with a large number of clients every day and have to deal with a large number of patients who have been referred to them for various reasons, including complaints, medical treatment, and so on. Seeing the disorderly state of patients causes their discomfort and disorientation, which gradually causes job dissatisfaction and a lack of hope in them, and ultimately, creates job burnout.

There is no relationship between metacognition and job burnout. This result is consistent with the results of the research of Sabzepari [12]. There is a negative relationship between metacognition in the component of positive beliefs and job burnout. People working at the University of Medical Science are always concerned about the lives of society’s people, and they regard the health of people as the main concern of their lives. This concern makes them do their utmost to maintain their health and solve the problems of people, including the clients. This thinking is always with them and they prefer people's problems to their work problems, and as a result, they always seek the best response to the client, which leads to satisfaction of the client on the one hand and improving the accountability of the organization, on the other hand. In fact, the belief of positive concern is like the motive that drives them and acts as a positive progressing stimulus. They also cause a person to feel liable to suffer in life, especially in the work environment, and this will cause more time to cope with burnout [28].

There is a significant negative relationship between metacognition in the component of the need for control of thoughts and job burnout. There are many topics in controlling thoughts and the need for controlling thoughts, and whatever the control of thoughts in a person is felt more, the person is more capable of responding to the environment and the work efficiency of the individual goes up. This increases the skill in the person and the person is resistant to burnout in his work, and the fields of job promotion are found in the person.

There is a significant positive correlation between metacognition in the component of uncontrollability and the risk of thoughts and burnout. In explaining this hypothesis, it can be said that when negative thoughts are brought to the minds of staff, stress is created. Disturbing thoughts persist regardless of the type of effort that the individual is taking to stop them. But an individual's inability to control them makes him or her tired and produces poor performance in the workplace, which gradually causes job burnout and gradually leads to loss of efficiency and individual returns. This leads to the organization’s and the client’s criticisms of the individual.

There is a significant positive relationship between metacognition in the component of cognitive self-consciousness and burnout. Cognitive self-consciousness helps the individual to understand the cognitive processes of himself or herself and how best to use them to achieve his or her goals. This makes it possible for a person to recognize his talents and use them in the best possible time, and the individual's inner satisfaction of himself or herself and his or her work, as a result of the burnout situation among these people is very low and unthinkable.

There is a significant positive relationship between metacognition in the component of cognitive conflict and job burnout. In explaining this hypothesis, it can be said that the minds of these people are continuously involved in the health of the people. They want to help the health of society’s people. But in reality, due to organizational constraints, existing laws, and many uncontrollable cases, there is no possibility of full cooperation with the client. Laws and regulations have many limitations in the free exercise of people. In this case, the individual has its own aspirations and intentions in his mind, he or she cannot implement them in the best possible way in practice. Consequently, there is a conflict between cognition and action. This conflict between thought and action causes impairment in performance and lower efficacy in a person, causing incapability of the person against burnout.

The prediction regression of employees’ burnout was not significant due to variables such as perfectionism, character type A, and metacognition. The results of the regression analysis showed that only variable A personality type predicted employee burnout. Therefore, in order to reduce job burnout and prevention in this regard, considering the occupational status of individuals in the medical sciences university, it is possible to teach methods for coping with burnout, especially for persons with personality A type, so that their efficiency can be increased, in addition to preventing burnout.

ACKNOWLEDGMENTS

We thank the Vice-Chancellor for Research and Technology of Ahvaz Jundishapur University of Medical Sciences and the Student Research Committee, as well as the staff of the hospitals that helped us with this research.

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