Community Mental Health Journal

, Volume 49, Issue 4, pp 373–379 | Cite as

Transformational Leadership Moderates the Relationship Between Emotional Exhaustion and Turnover Intention Among Community Mental Health Providers

  • Amy E. Green
  • Elizabeth A. Miller
  • Gregory A. AaronsEmail author
Original Paper


Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively related to turnover intention, and transformational leadership was negatively related to both emotional exhaustion and turnover intention. Transformational leadership moderated the relationship between emotional exhaustion and turnover intention, indicating that having a transformational leader may buffer the effects of providers’ emotional exhaustion on turnover intention. Investing in transformational leadership development for supervisors could reduce emotional exhaustion and turnover among public sector mental health providers.


Emotional exhaustion Burnout Turnover Leadership Mental health services 



This research was supported by National Institute of Mental Health grants R01MH072961, R21MH082731, K01MH001695 (PI: Aarons) and P30MH074678 (PI: Landsverk). We thank the organizations, supervisors, and service providers that participated in the study and made this work possible.


  1. Aarons, G. A. (2006). Transformational and transactional leadership: Association with attitudes toward evidence-based practice. Psychiatric Services, 57, 1162–1169.PubMedCrossRefGoogle Scholar
  2. Aarons, G. A., Dlugosz, L. R., & Ehrhart, M. G. (2011). LEAP: Leadership and practice. Retrieved May 31, 2011, from Scholar
  3. Aarons, G. A., Fettes, D. L., Flores, L. E., & Sommerfeld, D. H. (2009a). Evidence-based practice implementation and staff emotional exhaustion in children’s services. Behaviour Research and Therapy, 47, 954–960.PubMedCrossRefGoogle Scholar
  4. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate mediates the effect of culture on work attitudes and turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33, 289–301.PubMedCrossRefGoogle Scholar
  5. Aarons, G. A., & Sommerfeld, D. H. (2011). The differential roles of transformational leadership and leader-member exchange in team climate for innovation and attitudes toward evidence-based practice during a randomized statewide implementation trial. (submitted).Google Scholar
  6. Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009b). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Journal of Consulting and Clinical Psychology, 77, 270–280.PubMedCrossRefGoogle Scholar
  7. Aarons, G. A., Sommerfeld, D. H., & Willging, C. (2011). The soft underbelly of system change: The role of leadership and organizational climate in turnover during statewide behavioral health reform. Psychological Services. Google Scholar
  8. Abbasi, S. M., & Hollman, K. W. (2000). Turnover: The real bottom line. Public Personnel Management, 29, 333–342.Google Scholar
  9. Albizu-García, C. E., Ríos, R., Juarbe, D., & Alegría, M. (2004). Provider turnover in public sector managed mental health care. Journal of Behavioral Health Services and Research, 31, 255–265.PubMedCrossRefGoogle Scholar
  10. Antonakis, J., Avolio, B. J., & Sivasubramaniam, N. (2003). Context and leadership: An examination of the nine-factor full-range leadership theory using the multifactor leadership questionnaire. Leadership Quarterly, 14, 261–295.CrossRefGoogle Scholar
  11. Argote, L., Insko, C. A., Yovetich, N., & Romero, A. A. (1995). Group learning curves: The effects of turnover and task complexity on group performance. Journal of Applied Social Psychology, 25, 512–529.CrossRefGoogle Scholar
  12. Avolio, B. J., & Bass, B. M. (1998). You can drag a horse to water, but you can’t make it drink except when it’s thirsty. Journal of Leadership Studies, 5, 1–17.CrossRefGoogle Scholar
  13. Bakker, A. B., Schaufeli, W. B., Sixma, H. J., & Bosveld, W. (2001). Burnout contagion among general practitioners. Journal of Social and Clinical Psychology, 20, 82–98.CrossRefGoogle Scholar
  14. Barling, J., Weber, T. J., & Kelloway, E. K. (1996). Effects of transformational leadership training on attitudinal and financial outcomes: A field experiment. Journal of Applied Psychology, 81, 827–832.CrossRefGoogle Scholar
  15. Bass, B. M. (1990). From transactional to transformational leadership: Learning to share the vision. Organizational Dynamics, 18, 19–31.CrossRefGoogle Scholar
  16. Bass, B. M., & Avolio, B. J. (1995). MLQ: Multifactor leadership questionnaire (technical report). Binghamton University: Center for Leadership Studies.Google Scholar
  17. Blankertz, L. E., & Robinson, S. E. (1997). Turnover intention of community mental health workers in psychosocial rehabilitation services. Community Mental Health Journal, 33, 517–529.PubMedCrossRefGoogle Scholar
  18. Bono, J. E., & Judge, T. A. (2004). Personality and transformational and transactional leadership: A meta-analysis. Journal of Applied Psychology, 89(5), 901–910.PubMedCrossRefGoogle Scholar
  19. Bycio, P., Hackett, R. D., & Allen, J. S. (1995). Further assessments of Bass’s (1985) conceptualization of transactional and transformational leadership. Journal of Applied Psychology, 80, 468–478.CrossRefGoogle Scholar
  20. Cropanzano, R., Rupp, D. E., & Byrne, Z. S. (2003). The relationship of emotional exhaustion to work attitudes, job performance, and organizational citizenship behaviors. Journal of Applied Psychology, 88, 160–169.PubMedCrossRefGoogle Scholar
  21. Dvir, T., Eden, D., Avolio, B. J., & Shamir, B. (2002). Impact of transformational leadership on follower development and performance: A field experiment. Academy of Management Journal, 45, 735–744.CrossRefGoogle Scholar
  22. Glisson, C., Dukes, D., & Green, P. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children’s service systems. Child Abuse and Neglect, 30, 849–854.CrossRefGoogle Scholar
  23. Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23, 767–794.CrossRefGoogle Scholar
  24. Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., Mayberg, S., et al. (2008). Assessing the organizational and social context (OSC) of mental health services: Implications for research and practice. Administration and Policy In Mental Health, 35, 124–133.PubMedCrossRefGoogle Scholar
  25. Gray, A., Phillips, V. L., & Normand, C. (1996). The costs of turnover: Evidence from the British national health service. Health Policy, 38, 117–128.PubMedCrossRefGoogle Scholar
  26. Griffeth, R. W., Hom, P. W., & Gaertner, S. (2000). A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. Journal of Management, 26, 463–488.CrossRefGoogle Scholar
  27. Halfhill, T. R., Huff, J. W., Johnson, D. A., Ballentine, R. D., & Beyerlein, M. M. (2002). Interventions that work (and some that don’t): An executive summary of the organizational change literature. In R. L. Lowman (Ed.), The California school of organizational studies: Handbook of organizational consulting psychology: A comprehensive guide to theory, skills, and techniques (pp. 619–644). San Francisco: Jossey-Bass.Google Scholar
  28. Hedeker, D. R., Gibbons, R. D., & Davis, J. M. (1991). Random regression models for multicenter clinical trials data. Psychopharmacology Bulletin, 27, 73–77.PubMedGoogle Scholar
  29. Hughes, L. W., Avey, J. B., & Nixon, D. R. (2010). Relationships between leadership and followers’ quitting intentions and job search behaviors. Journal of Leadership and Organizational Studies, 17, 351–362.CrossRefGoogle Scholar
  30. Kelloway, K. E., Barling, J., & Helleur, J. (2000). Enhancing transformational leadership: the roles of training and feedback. Leadership & Organization Development Journal, 21, 145–149.CrossRefGoogle Scholar
  31. Kleinbaum, D. G., Kupper, L. L., Muller, K. E., & Nizam, A. (2008). Applied regression analysis and multivariable methods. London: Duxbury.Google Scholar
  32. Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2006). Counselor emotional exhaustion and turnover intention in therapeutic communities. Journal of Substance Abuse Treatment, 31, 173–180.PubMedCrossRefGoogle Scholar
  33. Knudsen, H. K., Johnson, J. A., & Roman, P. M. (2003). Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of Substance Abuse Treatment, 24, 129–135.PubMedCrossRefGoogle Scholar
  34. Lee, R. T., & Ashforth, B. E. (1996). A meta-analytic examination of the correlates of the three dimensions of job burnout. Journal of Applied Psychology, 81, 123–133.PubMedCrossRefGoogle Scholar
  35. Lowe, K. B., Kroeck, K. G., & Sivasubramaniam, N. (1996). Effectiveness correlates of transformational and transactional leadership: A meta-analytic review of the MLQ literature. Leadership Quarterly, 7, 385–425.CrossRefGoogle Scholar
  36. MacKenzie, S. B., Podsakoff, P. M., & Rich, G. A. (2001). Transformational and transactional leadership and salesperson performance. Journal of the Academy of Marketing Science, 29, 115–134.CrossRefGoogle Scholar
  37. Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99–113.CrossRefGoogle Scholar
  38. Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual. Palo Alto: Consulting Psychologists Press.Google Scholar
  39. Mor Barak, M. E., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and turnover among child welfare, social work, and other human service employees: What can we learn from past research? A review and metanalysis. Social Service Review, 75, 625–661.CrossRefGoogle Scholar
  40. Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2011). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-011-0352-1.
  41. Paris, M., & Hoge, M. A. (2010). Burnout in the mental health workforce: A review. Journal of Behavioral Health Services and Research, 37, 519–528.PubMedCrossRefGoogle Scholar
  42. Parry, K. W., & Sinha, P. N. (2005). Researching the trainability of transformational organisational leadership. Human Resource Development International, 8, 165–183.CrossRefGoogle Scholar
  43. Rafferty, A. E., & Griffin, M. A. (2004). Dimensions of transformational leadership: Conceptual and empirical extensions. The Leadership Quarterly, 15, 329–354.CrossRefGoogle Scholar
  44. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks: Sage Publications.Google Scholar
  45. Salyers, M. P., Hudson, C., Morse, G., Rollins, A. L., Monroe-DeVita, M., Wilson, C., et al. (2011). BREATHE: A pilot study of a one-day retreat to reduce burnout among mental health professionals. Psychiatric Services, 62, 214–217.PubMedCrossRefGoogle Scholar
  46. Schneider, B., Ehrhart, M. G., Mayer, D. M., Saltz, J. L., & Niles-Jolly, K. (2005). Understanding organization-customer links in service settings. Academy of Management Journal, 48, 1017–1032.CrossRefGoogle Scholar
  47. Shirom, A. (1989). Burnout in work organizations. In C. L. Cooper (Ed.), International review of industrial and organizational psychology (pp. 25–48). Oxford: Wiley.Google Scholar
  48. Stordeur, S., D’Hoore, W., & Vandenberghe, C. (2001). Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing, 35, 533–542.PubMedCrossRefGoogle Scholar
  49. van Daalen, G., Willemsen, T. M., Sanders, K., & van Veldhoven, M. J. (2009). Emotional exhaustion and mental health problems among employees doing “people work”: The impact of job demands, job resources and family-to-work conflict. International Archives of Occupational and Environmental Health, 82, 291–303.PubMedCrossRefGoogle Scholar
  50. Vandenberg, R. J., & Nelson, J. -B. (1999). Disaggregating the motives underlying turnover intentions: When do intentions predict turnover behavior? Human Relations, 52, 1313–1336.Google Scholar
  51. Walsh, J. P., Ashford, S. J., & Hill, T. E. (1985). Feedback obstruction: The influence of the information environment on employee turnover intentions. Human Relations, 38, 23–46.CrossRefGoogle Scholar
  52. Walumbwa, F. O., Orwa, B., Wang, P., & Lawler, J. J. (2005). Transformational leadership, organizational commitment and job satisfaction: A comparative study of Kenyan and US financial firms. Human Resource Development Quarterly, 16, 235–256.CrossRefGoogle Scholar
  53. Wright, T. A., & Cropanzano, R. (1998). Emotional exhaustion as a predictor of job performance and voluntary turnover. Journal of Applied Psychology, 83, 486–493.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Amy E. Green
    • 1
    • 2
  • Elizabeth A. Miller
    • 1
    • 2
  • Gregory A. Aarons
    • 1
    • 2
    Email author
  1. 1.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  2. 2.Child and Adolescent Services Research Center at Rady Children’s HospitalSan DiegoUSA

Personalised recommendations