Burnout: An Analysis Describing Advances on the Study of the Area in Brazil

This paper employs the bibliographic inquiry of publications about Burnout in Brazil inthe period of 2012 through July 2015. For this, researches were made using the SCIELO databasewhere 67 papers were cataloged, describing applied researches in various professional categories,mainly analyzing the incidence of Burnout in professionals of the Health and Education segments.The results of this research confirm the inquiry made by FREIRE et al (2012), in which the resultsare close to the ones shown here, the difference being the broadening to studies of professionalsof other segments, also pointing out the need for better understanding of the syndrome in aninterdisciplinary, critic and systemic view.


INTRODUCTION
defined burnoutas a psychological syndrome of emotional exhaustion, depersonalization and reduction of personal realization that is inflicted upon people that work with other people's capacity. The concept was initially developed by Freudenberger in the 70s, however there is a need to improve and update the concept and ways of measurement of this syndrome along the time, due to changes on lifestyle and working conditions. Main symptoms are: emotional exhaustion, depersonalization and reduced professional achievement; fatigue; pain ; immunodeficiency; sexual dysfunction, distrust, irritability, loss of initiative, tendency to isolation.
Previous studies about burnout that try to identify and also understand how subjects react to their jobs in relation to lack of satisfaction about the activities, low organizational engagement, absenteeism, intention of quitting their jobs, turnover and performance at work. (MASLACH, LEITER and JACKSON, 2012).
The main objective of this paper is to analyze the current scientific production about this subject being developed in Brazil, with focus in the work environment, and ascertain which are the instruments used to measure this syndrome.

METHODOLOGY
The method used as basis for this study was the bibliographic exploratory research (MICHEL, 2009), through the inquiry of published Works in Brazil from 2012 until July 2015. The SCIELOScientific Electronic Library Online database was used with the following keywords: burnout no Brazil, syndrome de burnout. There was scrutiny in choosing only papers that studied Burnout inside Brazil. 67 papers were cataloged analyzing the Burnout syndrome in workers of different segments and activities, with focus on the ones from the Educational and Health segments. However, there is a notable broadening of studies researching other professional categories as shown in the results.

Concept of burnout
Shaufeli; Leiter and Maslach (2009) wrote a valuable paper for the knowledge of Burnout, as 35 years of research and experiments about this syndrome was investigated and thoroughly described.
The concept of Burnout appeared in the USA in the 70's, and afflicted particularly professionals of Health such as medics, nurses and psychologists as well as lawyers and police officers, which complained about the lack of energy or the extraction of such during their work and losing the value and sense of their jobs. A metaphor known and used by Freudenberg (1974) to express this experience is of a lit candle, which demonstrates the exhaustion of energy to maintain itself lit. The syndrome contains three basic elements: exhaustion, isolation and delusion; and seems to be consequence of chronic stress related to work.
The authors of this study observed that the origin of this concept is rooted to a more openly social, economic and cultural development context and it appears with the fast and deep changes of the transition between the industrial society to a service economy. This process is happening since the last quarter of century XX until today, and it seems present in the work life around the world. There have been thousands of publications about the subject and is estimated that more than 6000 works that exists, as researchers and alumni try to understand it and how to prevent it.
In some countries such as Sweden and Netherlands the Burnout is found in manuals as a defined medical diagnosis, and these countries have the trained professionals to evaluate and treat these cases. However, the majority of the nations don't have these resources and don't understand the syndrome as a clear and defined health issue. The study demonstrates that at times, when this illness was detected there was influence of social values defended by the government. This led young idealist professionals to be deluded with the development of the more humanist careers and ended up in frustration, as the solution of the social issues lived in that context could not be reached by their individual effort but by systemic components of various factors. Shaufeli, Leiter and Maslach (2009, p.207) indicates, "The experience of burnout does not refer as an inconvenience or occupational risk, but as a devastating attack at the professional identity".
The same work points out that in the 21st century there is two distinct contributions in the life of a worker that influence the appearance of the syndrome: 1) The lack of balance between demand of services, which is always rising and the lack of resources needed for this work, such as personnel, equipment, supplies or even time and space.
2) The reasons for the dissatisfaction or frustration: Current employees are critic and demanding and realize that, for example, there is a lack of coherence between the organizational speech and what it does in reality. Sometimes there are conflicts between corporate values and individual values of the employee.
Despite those facts, there is the observation of the emergence of Burnout in countries everywhere; and this seems to show that there are relations between the emergence of the syndrome and the economic development of countries. For example as China and India are progressing economically, there is focus and more studies on the subject. There is a hypothesis that the globalization, privatization and new workers' demands, such as, development of new skills, new types of work, pressure for productivity and quality and accelerated pace in all work processes, are the cause for the emergence of Burnout.
However, Schaufeli, Leiter e Maslach (2009) points out that the fact of Burnout being globalized does not mean that its understanding and treatment has to be equal everywhere. For some, the syndrome is so intensive that is believed that there is may lead to the psychological death of the subject. For others, the development process of the syndrome includes the exhaustion in its most light form and the neutralization of the subject happens only at its final stage. The right to claim benefits and financial compensation depends on the understanding of Burnout in determined context, as its imperative to obtain the formal diagnosis and the acknowledgement of the authorities. Moreover using the scientific research it may be possible to develop specific instruments to detect and evaluate subjects afflicted by Burnout.

Measuring the murnout: maslach burnout inventory x copenhagen burnout inventory
Christina Maslach and her fellow researchers developed the MBI (standing for Maslach Burnout Inventory). The MBI is a quiz containing twenty-two questions addressing three central issues: emotional exhaustion, depersonalization and personal realization. (CARLOTTO and CÂMARA, 2007).
Despite the broad use of this instrument in empirical studies about Burnout around the world, we have considered important to bring another instrument to polarize against the MBI. It is the Copenhagen Burnout Inventory (CBI). This instrument consists of three scales that measures the personal Burnout, Burnout related to work and the Burnout related to customer services (KRISTENSEN, BORRITZ, VILLADEN and CHRISTENSEN, 2005).
The basis for the critique issued by these authors about the MBI are as follows: • Burnout is a broad term, and the MBI deals with it in specific terms; • There is no clear relationship between the MBI and the concept of Burnout; • What the MBI measures is not clear; • The MBI is not a public instrument, but is one distributed by a commercial company.
It is important to emphasize that they elaborated a pilot study named PUMA (in Danish stands for: Burnout, Motivation and Satisfaction at work Project), and the most natural thing to do would be to translate the questionnaire to Danish, but as the studies about the subject deepened they have considered that would be better to develop a tool to close the eventual gaps of the MBI; and this lead to the CBI.
Our suggestion is that the measurement of the Burnout should be done by both instruments as to identify eventual differences and similarities, being applied in the same group of people.
Describing the summary of the main elements known and discussed about Burnout today, we have surveyed studies in Brazil and developed a general analysis about it the country.

Bibliographical review about studies of burnout in brazil
In Brazil, studies about Burnout are lacking and specified in determined segments of profession, as pointed out by Trigo (2010). The author made a bibliographical review, using BVS, index Psi and Pepsic databases, meeting 27 papers about the subject in Brazil. These studies were made in the Health segment with professionals such as nurses and medics. As a matter of the World Health Organization has being working dor some time with a quality of life assessment called WHOQOL, and moreover a Brazilian version of the World Health Organization's Quality of Life Instrument--Short Version (WHOQOL BREF) was tested already a decade or so ago by Berlim et al (2005) with patients 98 patients with major depression.
Still in 2008, Carlotto and Câmara (2008) made studies of bibliographic reviews about the subject in Brazil. The authors identified that the first studies about Burnout in the country emerged in the 90's, through the publication of the first group of thesis and papers about it. In the same period, the first groups of research in universities and institutes were created, being intensified after 2001. To the authors, the interest for Burnout was risen due to three key factors: The first of them were the modifications introduced in the concept of health and better quality of life of the WHO -World Health Organization. The second was the rise of demands of the population in relation to social, educational and health services. At last, the awareness of public organizations, researchers and clinical services relating to the syndrome, understanding, the need to deepen its studies and the importance of prevention, as it was more complex and noxious compared to initial projections. There were 25 papers found, 60% of these approach professionals of the Health segment, 20% teachers, 4% police officers, 4% psychiatric clinic patients and 12% other categories. The central focus was to analyze the prevalence of the Burnout syndrome. (FREIRE et al, 2012, page 66) In 2015, in bibliographic review done by the authors of this paper, using Burnout no Brazil keywords, cataloged in the Scielo database the existence of 67 papers about the subject between the years of 2012 and 2015. Those papers were distributed as follows: • 30 papers focused in health professionals such as nurses, psychologists, health agents, etc.
• 16 papers focused on the effects of Burnout in students and professionals of the education segment.
• 07 papers analyzed the methodological procedures of the factorial scale of the Maslach Burnout inventory-Human Services Survey (MBI-HSS).
• 3 papers analyzed the syndrome in civil servants. • 2 papers analyzed the incidence in firefighters.
• 2 papers analyzed the issue with focus on employees of funerary services. • 2 papers researched the syndrome on professionals in the dance segment.
• 2 papers had emphasis on swimmers.
• 1 paper investigated the syndrome in athletes in general.
• 1 paper analyzed the syndrome on soccer players and • 1 paper analyzed the Burnout on tennists. Clearly Health and Education are the areas most affected, but it's also perceived a broadening of segments in which its professionals receives the attention of researchers, which could mean a relevant advance in the field of study of the syndrome, its recognition by authorities and mainly, in detailed investigation processes, according to the specific demands of each segment of work. However, the process of questioning and investigating has to advance as the current society in which we live require every time more of its workers, intensifying hence the incidence of Burnout.

CONCLUDING REMARKS
The different arguments held in the whole world indicates that the Burnout syndrome doesn't yet have a complete definition and its researches show different points of view in the matter.
The bibliographic review developed points to a broadening of professionals afflicted by the syndrome and a rising in the research numbers. This indicates the need and interest of a more meaningful and effective action in organizations that must concern themselves about people affected by the syndrome, as it causes ailments to workers and society.
However, we can observe that the economic and social contexts in Brazil accord with what previous studies pointed out: Development in search for a better and stable economy, but with a long way to go. This fact hits all population in its cultural and social way of life, which permits a distant view about better life quality to workers and, as indicated by Schaufeli, Leiter e Maslach (2009) studies, what could be considered as a positive pole of a continuum in which the negative pole would be the Burnout.
Furthermore, if we consider the current crisis going on in Brazil, which in itself led to an impasse in the rights of the worker, bringing a scenario of intensification of outsourcing and inflexibility in the workers' rights. We could foresee a scenario of losing quality of life and intensification of bad developments to the health of the worker, which could rise the Burnout cases in different segments of Brazilian workers. Hence studies about the Burnout Syndrome are urgent as well as improving life styles.