The vulnerability to burn out in healthcare personnel according to the Stoyanov-Cloninger model: evidence from a pilot study


  • Ralitsa D. Raycheva Assistant Professor, Department of Social Medicine and Public Health, Faculty of Public Health, Medical University Plovdiv (MUP), Bulgaria
  • Radost S. Asenova Senior Assistant Professor, Department of Health Management, Health Economics and Primary Care, Faculty of Public Health, Medical University Plovdiv (MUP), Bulgaria
  • Dimitar N. Kazakov Graduate student in the Faculty of Medicine, Medical University Plovdiv (MUP), Bulgaria
  • Simeon Y. Yordanov Graduate student in the Faculty of Medicine, Medical University Plovdiv (MUP), Bulgaria
  • Tanya Tarnovska Associate Professor, Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University Plovdiv (MUP), Bulgaria
  • Drozdstoy Stoyanov Stoyanov



Burn out, personality, psychological climate, resilience, vulnerability


Background: The vulnerability to burn out is determined by the specific interaction of the two domains – personality disposition and complementary anomalies in the psychological climate of the work place. Our basic hypotheses include inferences in 3 different, but strongly associated dimensions: specific personality traits as measured by the Temperament and Character Inventory (TCI-R) will reveal profiles of vulnerability vs. resilience to burn out; dimensions of the psychological climate will elicit the relevant precipitating factors determining burn out and dimensions where significant relations between personality structure, psychological climate and burn out are anticipated.Aim: To design a complex person-centered model (battery of assessment tools) for early detection of burn out in populations of healthcare employees at risk and to determine the profile of the individual vulnerability to burn out both in terms of personality and psychological climate.Methods: Based on a literature research, 5 healthcare personnel risk groups were identified as being highly affected by burn out syndrome: (i) general practitioners; (ii) palliative care physicians and nurses; (iii) psychiatrists; (iv) oncologists & (v) emergency and intensive care personnel. The battery was tested on 73 randomly selected healthcare professionals from the above-mentioned groups.The following methods were employed in our cross-sectional study in order to construct the assessment battery: Personality Profile Inventory: TCI-R – 240 items; Inductive Measurement of Psychological Climate - 40 items Psychological Climate Inventory (courtesy of Koys and DeCotiis); Measurements of burn out as control condition – 22 items Maslach Burn Out Inventory.Results: Temperamental traits (harm avoidance and persistence) and Character dimensions (self-directedness and cooperativeness) have been largely correlated with burn out performance, mostly represented by emotional exhaustion, de-personalization and reduced personal accomplishment and result from psychological climate impact, mediated by 8 basic criteria: independence, unity, confidence, pressure, support, recognition, honesty and innovation.Conclusion: We have identified so far two groups of vulnerability (proneness) and protective (resilience) factors in relevance with the emergence of burn out syndrome in healthcare personnel. The vulnerability is defined with the following constellations: (i) high levels of harm avoidance in combination with pressure leads to high emotional exhaustion; (ii) high persistence in combination with low autonomy leads to low personal accomplishment and high emotional exhaustion. The resilience is outlined with the following constellations: (i) high persistence with high autonomy determines high personal accomplishment and low emotional exhaustion; (ii) self-directedness is an independent indicator of resilience: (iii) high personal accomplishment and low emotional exhaustion (i.e. protects from burn out regardless of the psychological climate at workplace) & (iv) cooperativeness in combination with high cohesion determines a low level of de-personalization. Also, cohesion and fairness from the Psychological Climate Inventory define resilience to burn out as independent indicators.

Author Biography

Drozdstoy Stoyanov Stoyanov

Drozdstoj (Drossi) Stoyanov was born on July, 20th 1980 in Sofia, Bulgaria in the family of outstanding psychiatrists. He graduated from the high school at the age of 15 (1996), and received his MD from the Medical University of Sofia at the age of 21 (2002). Prof. Stoyanov developed and defended a PhD thesis in the field of neurology and psychiatry in 2005, certified in December 2007 by the Government Specialty Board with the rank of Psychiatrist and was elected associate professor of medical psychology in 2008. He is co-founder of the Balkan Association of History and Philosophy of Medicine (2005) as well as the Balkan Academy for Philosophy, Psychiatry and Psychology (2007) and designed the peer-reviewed project for the establishment of the first University Centre in Philosophy and Mental Health (UCPMH) in South-Eastern and Central Europe. The Centre organized two consequent international symposia in the field in 2008 and 2009. Prof. Stoyanov was invited at the discretion of the Chair into the Philosophy Special Interest Group of the Royal College of Psychiatrists in 2007 and was awarded Postgraduate Certificate in Philosophy of Mental Health from the University of Central Lancashire, United Kingdom in October 2010. In 2009 the Center for Philosophy of Science, University of Pittsburgh, USA elected Prof. Stoyanov for Visiting Fellow.Prof. Stoyanov hold the position of Vice Dean for International Affairs of the Faculty of Public Health, University of Medicine, Plovdiv from 2009 to 2011. Since 2011 he has been appointed assoc. professor in the Faculty of Medicine, Department of Psychiatry and Medical Psychology and Special Advisor Strategic Parnerships to the Vice Rector. Besides he still acts as Deputy Director and Scientific Secretary of the Expert Board of UCPMH and  works as practicing psychiatrist in the ‘St. Ivan Rilski’ State Psychiatric Hospital.He published and/or edited about 110 papers, three monographs and a textbook of psychology and received a number of awards for his research such as Hippocratic Medal from the International Hippocratic Foundation for his contributions in philosophy of medicine. Drossi’s latest publications are on the convergent trans-disciplinary validity of the methods and categories in psychology and psychiatry.Since 2007 Prof. Stoyanov acts as a member of the Editorial board, secretary coordinator (2009) and most recently as Deputy Editor-in-chief (2010) of the International Annual for History and Philosophy of Medicine. Besides he has been Chair of Conceptual group in the Global Network for Diagnosis and Classification launched by the World Psychiatric Association (2008) as well as member of the teaching committee of the European Association for Communication in Healthcare (2010).  Selected publications list:Stoyanov,D. (1999) About Schweitzer, In: Young medics about Albert Schweitzer, Albert Schweitzer World Academy of Medicine, Ed. K. Imjelinsky, WarsawStoyanov, D. S. et Al (2006), Comorbidity Monograph 4, Perspectives across Europe, European Collaborating Centers for Addiction Studies, Eds A.Baldacchino, J.Corkery, LondonStojanov, D.S.(2007), Validation theory - from basic neuroscience to pharmaco-psychology, SA Journal of Psychiatry, Vol.13, 3, 2007:116Stoyanov, D. St (2009)., Review - Psychiatry as Cognitive Neuroscience: Philosophical Perspectives, Metapsychology, Volume 13, Issue 47Stoyanov, D.St.(2009),The Cross-Validation in the Dialogue of Mental and Neuroscience, Dial Phil. Ment. Neuro. Sci,  2(1): 24-28Stoyanov, DS, PK Machamer and KF Schaffner (2010), In quest for scientific status of psychiatry: towards bridging the explanatory gap, In: Traditions and Innovations in Psychiatry, World Psychiatric Association, St. Petersburg: 44-45Stoyanov, D and KWM Fulford (2010), Values based medical practice: challenges before the system of education and healthcare in Bulgaria, In: Public Health and Health Care in Greece and Bulgaria: the challenge of cross-border collaboration, Papazissis Publishers, Athens: 327-334Stoyanov D (2010), Why a logical-pragmatic perspective on validity in mental health is not sufficient: introduction of the principle of convergent trans-disciplinary cross-validity, Dial Phil. Ment. Neuro. Sci, 3(1): 25-26


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