ABSTRACT
Horticultural activities in urban areas and suburbs describe economically viable ways of production (North and Patterson, 2018), and are a continuous growing segment of production in developing countries as well as in Romania countries and are expected to have positive impacts on nutrition quality first and implicit on people's health. This comes as a necessity as the population is continuously growing as the land has a limited use. In a wide sense, urban horticulture includes everything from small home and community gardens to city park management, rooftop greening, as well as complex vertical way of production. This sector assures increased availability of fresh products (vegetables and fruits) in big cities, healthier diets, improved food safety, low transportation costs, efficient resource use, and the mitigation of environmental impacts of horticultural production such as the emission of greenhouse gases.
ABSTRACT
Introduction: Literature, especially following the COVID-19 pandemic, has given considerable attention to burnout experienced by mental health professionals. Burnout is a multidimensional syndrome that has three indicators (1): emotional exhaustion (EE, fatigue that can be related to devoting excessive time and effort to a task that is not perceived to be beneficial), depersonalization (DP, distant or indifferent attitude towards work, and negative interactions with colleagues and patients), and reduced personal accomplishment (PA, negative evaluation of the worth of one's work and generalized poor professional self-esteem) for the worker. Burnout does not solely impact the wellbeing and quality of life of health professionals but also induces a decline in the quality of care provided to clients. Studies of mental health professionals have shown that this condition could be triggered by associated working stressors including overload, time pressure, understaffing, negative social climate in the workplace, conflicts with patients, job insecurity, and organizational changes. As burnout has important implications for the quality of care, it is essential that the factors which influence burnout and its implications are explored in different contexts, such as in the context of residential facilities (RFs). Workers in the field of mental health are more vulnerable to burnout, as compared with other health professionals (2) because of stigma of the profession, threats of violence from patients and patient suicide and highly demanding therapeutic relationships (3). In a systematic review and meta-analysis, O'Connor and colleagues (4) investigated the prevalence and determinants of burnout in mental health professionals highlighting that staff working in community mental health teams may be more vulnerable to burnout than those working in some other specialist community teams. The key issue that is often left out in literature is the measure of the quality of the health professionals' relationship with patients. Since both the health professional's burnout and the working alliance between them and patients are predictors of therapy outcomes, understanding how burnout affects health professionals' relationship with patients is crucial. Working Alliance (WA) is a well-established index of this relationship as it represents the degree to which a treatment dyad is engaged in collaborative work (5). This construct has an enormous literature in the field of psychotherapy, but it has not been studied in the common treatment of individuals diagnosed with severe mental illness in terms of its relationship with burnout. To our knowledge, this is the first study to investigate the link between burnout among health professionals working in psychiatric RF and WA between individuals with SSD and staff in RF. Method(s): This study is part of a large multicentric observational study conducted in Italy: the DiAPAson study. The final sample of this study includes 303 patients living in RFs (69.3% males;41.0+/-9.8 years) and 164 health workers (27.4% males;41.2+/-9.9 years) of the 99 participating RFs. After collecting sociodemographic data, standardized assessment tools including clinician-administered tools (e.g., psychiatric history, illness duration, lifetime hospitalization stay, total number of psychiatric hospitalizations in the last year, time in the RF, antipsychotic therapy, Brief Psychiatric Rating Scale - BPRS, and Specific Levels of Functioning Scale - SLOF) for patients and self-administered scales (the Italian version of the Working Alliance Inventory short form for Patients, WAI-P;the Italian version of the Working Alliance Inventory short form for Staff, WAI-S;and the Maslach Burnout Inventory, MBI for Staff) were collected. We investigated the relationship between sociodemographic and clinical variables, staff's burnout and working alliance. After rejecting the hypothesis of normality of the variables (by Kolmogorov Smirnov test), we computed correlation matrices calculating Spearman's correlation coefficients. We perfor ed all the analysis with SAS Studio, R and SPSS, considering a p<0.05 value as statistically significant. Result(s): The staff sample presented high mean DP (13.8+/-9.6) while no high mean EE (3+/-3.5) neither low mean PA (38.4+/-5.7) were found according to O'Connor and colleagues' indications (4). Data show significative correlations between: MBI EE and BPRS (beta=0.17;p=0.005), SLOF (beta=-0.12;p=0.048) and WAI-S (beta=-0.17;p=0.003);MBI DP and BPRS (beta=0.22;p<0.001), SLOF (beta=-0.18;p=0.003), WAI-S (beta=-0.19;p=0.001), and WAI-P (beta=-0.13;p=0.028);MBI PA and patients' education years (beta=-0.146;p=0.014) and WAI-S (beta=0.26;p<0.001). Conclusion(s): The result of our large multicentric observational study suggested that health professionals working with SSD patients reported high scores on MBI for the DP domain. This datum is particularly worrying considering the theoretical framework that in 1978 brought to the reform of the Italian Health System that abolished the Psychiatric Hospitals in favor of a community-based treatment approach where the RF where conceived as a temporal intensive approach for the treatment of the most severe conditions, specifically thought to avoid long term seclusion, institutionalization, and patients' depersonalization. In our sample the burnout, specifically higher EE and DP was associated with more severe symptomatology (as measure with BPRS) and poor socio-occupational functioning. These associations are consistent with previous reports. Lower sense of PA was instead reported in working with patients with higher education grade. This effect could be partially associated with the WA. In fact, our data reported greater sense of PA with higher scores of WA as perceived by the staff, again associated with working with patients with lower education grade. WA as perceived by the staff significantly associate with other burnout domains, being inversely correlated with EE and DP. On the other hand, WA rated by the patients was also inversely associated with DP burnout domain. Even though no causal relationship could be assumed from our data, the clear association between burnout and WA, specifically regarding the DP domain, strongly reinforce the need to further investigate the WA between health professionals and RF patients suffering from SSD. Intervention directed toward the improvement of WA could be a complementary way to improve the quality of care provided to severe SSD patients and a way to reduce burnout.