Table 1.

Study Authors; Design and Key Findings.

Authors, methods, sample	Country	Study Title	Summary of findings
Aitken and Schloss (1994); Quantitative, n = 150.	Australia	Occupational stress and burnout amongst staff working with people with an intellectual disability.	Burnout and stress found to be higher in institutional settings compared to community settings.
Alexander and Hegarty (2000); Quantitative, n = 13.	United Kingdom	Measuring staff burnout in a community home.	Both staff groups reported moderate stress/burnout; Senior staff higher in emotional exhaustion and depersonalization. Day care reported shortage of staff; medical problems (back pain); shift work; morale; working with others, and feeling ‘always on’. Senior staff reported demands; bad attitude; medical administration; staff issues; autonomy; and demands from others.
			Colleagues/supervision were main source of support.
Bailey et al. (2006); Quantitative, n = 27.	United Kingdom	The response to challenging behavior by care staff: emotional responses, attributions of cause, and observations of practice.	Care staff’s internal, stable and uncontrollable attribution of challenging behaviour (including self-injury) related to negative emotion responses.
			Did not support Weiner’s (1988) model of attribution.
			Clear relationships were not found between the care staff attributions, emotions, optimism, willingness to help, and observed helping behaviours.
Blumenthal et al. (1999); Quantitative, n = 106.	United Kingdom	Role clarity, perception of the organization and burnout amongst support workers in residential homes for people with intellectual disability: a comparison between a National Health Service trust and a charitable company.	Constructed a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). Most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff.
Bromley and Emerson (1995); Quantitative, n = 70.	United Kingdom	Beliefs and emotional reactions of care staff working with people with challenging behavior.	Significant proportion of colleagues reported to display emotional reactions such as sadness, despair, anger, annoyance, fear, and disgust to episodes of challenging behaviour
			The ‘daily grind’ of caring, difficulty in understanding the person's behaviour, the unpredictability of the behaviour, and the apparent absence of an effective way forward most stressful aspects.
			Causes of challenging behaviour attributed to internal psychological, broad environmental, and behavioural and medical factors.
Chung et al. (1996); Quantitative, n = 26.	United Kingdom	Relating staff burnout to clients with challenging behaviour in people with a learning difficulty: Pilot study 2.	Burnout among care workers more related to management issues at work rather than client issues.
Chung and Corbett (1998); Quantitative, n = 26	United Kingdom	The burnout of nursing staff working with challenging behaviour clients in hospital-based bungalows and a community unit.	Nurses in hospital-based units experienced more severe challenging behaviour, complained more, were less satisfied with pay, experienced less client contact, were more likely to feel their training was inadequate, and experienced more emotional exhaustion and depersonalisation than those based in community units.
Chung and Harding (2009); Quantitative, n = 103.	United Kingdom	Investigating burnout and psychological well‐being of staff working with people with intellectual disabilities and challenging behavior: the role of personality	Higher neuroticism predicted higher levels of emotional exhaustion and lower personal accomplishment. Converse found for extraversion. Higher conscientiousness predicted higher levels of depersonalization (moderated by agreeableness) while neuroticism and extraversion moderated the relationship between challenging behaviour and personal accomplishment.
Conradie et al. (2017); Quantitative, n = 89.	South Africa	A profile of perceived stress factors among nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex, South Africa.	The occupational stressors identified by this cohort were workload and long hours; lack of decision-making; underpayment; endangerment of physical health and safety issues; pressure; uncertainty of employment; responsibility; and perceiving that their skills/training not appreciated.
Corrigan (1993); Quantitative, n = 322.	United States	Staff stressors at a developmental center and state hospital.	Factor analysis of stress revealed lack of admin control and practice related stress. Opposition to behavior therapy predicted job stress Difference in stress by job category – higher in nurses, developmental specialists, and psychiatric technicians.
Dagnan et al. (1998); Quantitative, n = 40.	United Kingdom	Care staff responses to people with learning disabilities and challenging behavior: A cognitive—emotional analysis.	Those working with people with challenging behavior more likely to evaluate the person more positively and report they would be more likely to offer extra effort in helping. Helping behavior best predicted by optimism, which was best predicted by negative emotion which was best predicted by the attribution of controllability.
Devereuxet al. (2009a) Quantitative; n = 96.	United Kingdom	Social support and coping as mediators or moderators of the impact of work stressors on burnout in intellectual disability support staff.	Social support at work moderated relationship between workplace demands and personal accomplishment. Higher demands related to greater emotional exhaustion (partially mediated by ‘wishful thinking’. Practical coping did not effect relationship but was predictive of personal accomplishment. Longitudinal analysis did not find that perceived work demands, wishful thinking, or practical coping predicted emotional exhaustion over time.
Dilworth et al. (2011); Quantitative, n = 43 care managers and n = 139 care staff.	United Kingdom	Factors relating to staff attributions of control over challenging behavior.	Challenging behavior attributed as being less under personal control if the organisation was of better quality. Attributions of control lower if staff displayed positive attitudes towards the client, the physical and social environment was appropriate and the overall approach to delivering care seemed well‐structured. No relationship between attributions of control and ability of the individual or the overall level of challenging behavior.
Dyer and Quine (1998); Quantitative, n = 80.	United Kingdom	Predictors of job satisfaction and burnout among the direct care staff of a community learning disability service.	Role conflict; role ambiguity; and role overload as prominent demands placed upon staff in an NHS learning disability service. Lack of participation in decision-making as a significant demand placed encountered by staff in a learning disability service.
Edwards and Miltenberger (1991); Quantitative, n = 125. Freeman (1994); Quantitative, n = 89 from Time 1–2; n = 71 from Time 2–3. Ford and Honnor (2000); Quantitative, n = 115.	United States United Kingdom Australia	Burnout among staff members at community residential facilities for persons with mental retardation. The differential impact on carers dealing with clients with challenging behaviours.  Job satisfaction of community residential staff serving individuals with severe intellectual disabilities.	Moderate degree of burnout reported by both direct care workers and supervisors. Supervisors reported higher burnout (greater emo exhaustion) and less personal accomplishment. Carers socialised in a traditional setting responded to challenging behaviours by becoming more negative in their attitudes towards clients. Strain related directly to challenging behaviours and unrelated to attitudes which remained positive. Staff held moderately favourable views toward their jobs, with work satisfaction reported in interactions with residents and families, the nature of the work itself, and supportive relationships with co-workers. Involvement in decision-making, opportunities for advancement, feelings of isolation, utilization of skills, and lack of feedback on performance were reported as challenges. Little relationship between demographics and job satisfaction.
Figueiredo-Ferraz et al. (2012); Quantitative, n = 422; Longitudinal with one year follow up (2015), n = 372	Spain	Influence of some psychosocial factors on mobbing and its consequences among employees working with people with intellectual disabilities.	Mobbing – interpersonal aggression and intention to harm between workers. Role clarity and social support at work can play a role in preventing mobbing, while role ambiguity can encourage it. Significant consequences for employee health (psychosomatic well-being and predicts absenteeism). Longitudinal study found that mobbing had a longer term impact on depressive symptoms – significantly higher depressive symptoms at Time 2 compared to those who did not experience at Time 1 or 2 or just a Time 2.
Gil-Monte (2012); Quantitative, n = 700.	Spain	The influence of guilt on the relationship between burnout and depression.	Guilt defined as unpleasant/remorseful feeling associated with violating a moral standard. Guilt found to moderate relationship between depersonalisation and depression, may have role in burnout process.
Gingi (2012); Quantitative, n = 127.	South Africa	Responses of nurses to violence from adults with ID in an in-patient psychiatric facility.	Inclusion criteria was involved or having witnesses violence directed at a nurse. Response distributed across avoidance, introversion, and hyperarousal, 82.75% of the nurses in this sample fitted the symptoms of Post Traumatic Stress Disorder. Over 80% scored moderately to very highly on scores of resilience.
Gray-Stanley and Muramatsu (2011); Quantitative, n = 323.	United States	Stress, burnout, and social and personal resources among direct care workers in community ID.	Work-overload, limited participation in decision making, and client disability care associated with increased burnout. Low social support related to increased burnout when workload was high. Internal control beliefs reduced feeling of burnout when participation in decision making was limited (reverse for external control beliefs).
Gray and Muramatsu (2013); Quantitative, n = 323 (follow-up)	United States	When the job has lost its appeal: intention to quit in direct care workers.	Increased social support associated with lower intention to quit. Relationship between control and intention to quit moderated by lack of participation in decision making.
Harries et al. (2015); Quantitative, n = 97	Australia	Evaluation of the Work Safety and Psychosocial Wellbeing of Disability Support Participants experienced significantly higher personal and work-related burnout but significantly lower client-related burnout compared to population norms.	The JDCS model components did not all predict any single wellbeing measure. However they each predicted individual aspects of burnout and job satisfaction. Well-being measures were associated with safety performance. The negative impact of Role Conflict were effectively moderated by support for personal and work-related burnout and job satisfaction.
Hatton and Emerson (1993); Quantitative, n = 64.	United Kingdom	Organizational predictors of perceived staff stress, satisfaction, and intended turnover in a service for people with multiple disabilities.	Support from other staff (mainly supervisory), job variety, perceived organization, democracy, goodness of fit b/n attitude and aims of staff and those of organization, staff development, and income.
Hatton et al. (1995); Quantitative, n = 68	United Kingdom	Stressors, coping strategies, and stress‐related outcomes among direct care staff in staffed houses for people with learning disabilities.	Work stress predicted by emotional impact of work, violent behavior, and wishful thinking. General distress related to conflict of work with personal/family life. Stress, uncertainty with tasks, and limited opportunity for advancement all had a high impact on work stress.
Hatton et al. (1999); Quantitative, n = 450.	United Kingdom	Factors associated with staff stress and work satisfaction in services for people with intellectual disability.	Wishful thinking; work-home conflict and role ambiguity predicted stress. Job strain related to wishful thinking, lack of support, alternative commitment, role ambiguity, low status of job, and longer hours. Satisfaction related to low status of work, support from colleagues and supervisors; alternative commitment; and older staff age.
Hatton et al. (2001); Quantitative, n = 450 (as previous).	United Kingdom	Factors associated with intended staff turnover and job search behavior in services for people with intellectual disability.	Work satisfaction, job strain, younger staff age and subjective labor conditions were directly associated with intended turnover. The same factors, with the exception of younger staff age, were also directly associated with job search behavior.
Hensel (2012, 2014); Quantitative, n = 926 and n = 42 matched pairs.	Canada	The mediating effect of severity of client aggression on burnout between hospital inpatient and community residential staff who support adults with intellectual disabilities.	2012 article found that nearly all reported exposure to aggression in previous six months. Aggression related to burnout (emotional exhaustion and depersonalization). 2014 study found hospital staff experienced more severe aggression and were more emotionally exhausted than community staff. Partially mediating effect of severity of aggression in hospital and community – more severe, more emotionally exhausted.
Hickey (2014); Quantitative, n = 1570.	Canada	Prosocial motivation, stress, and burnout among direct support workers.	Prosocial motivation may moderate or buffer against burnout among direct care workers. Depersonalization scores lower for staff with high motivation, this was especially pronounced in cases where staff had high emotional exhaustion. Depersonalization higher among staff with high role boundary stress in case of low motivation. Increased role ambiguity stress associated with lower personal accomplishment in case of lower motivation.
Howard and Hegarty (2003); Qualitative, n = 6	United Kingdom	Violent Incidents and Staff Stress Content analysis of semi-structured interviews identified seven key themes relating to The physical force of violence.	Staff reactions to violence; Acceptance of violence; The importance of support; Coping strategies used by staff; Effect of violence on the relationship between staff and students and Mediators of the staff reaction to violence.
Howard et al. (2009); Quantitative, n = 44 in medium security and n = 38 in community services.	United Kingdom	The psychological impact of violence on staff working with adults with intellectual disabilities.	Lower fear of violence and higher self-efficacy in medium secure staff. Burnout related to increased exposure to physical violence and reduced staff support. Higher threat of violence related to lower fear. Higher support related to lower emotional exhaustion; higher self-efficacy related to higher personal accomplishment. More physical/verbal aggression related to increased emotional exhaustion, verbal aggression also related to reduced personal accomplishment. Physical violence related to burnout but self-efficacy moderated relationship.
Hussein (2017); n = 196 who provided both qualitative and quantitative responses.	Australia	Perspective of support challenges in rural versus urban workers for adults with ID (medical, health, and support workers).	Only 23.7% felt they had adequate training. Lack of services and poor carer health were triggers for institutionalization.
Ineland et al. (2018) Quantitative, n = 333.	Sweden	Sources of job satisfaction in intellectual disability services: a comparative analysis of experiences among human service professionals in schools, social services, and public health care in Sweden.	Majority experienced heavy workload and psychological strain, though majority also experience high job satisfaction (plurality). Sources of stress were target group; social environment, social relations, professional core mission; and results/outcomes. Content analysis revealed that sources of job satisfaction irrespective of organization, is categorized in five different core categories; target group, social rewards, social relations, professional core mission, and results/outcomes.
Ito et al. (1999); Quantitative, n = 3774	Japan	Burnout among direct-care staff members of facilities for persons with mental retardation in Japan.	Burnout higher among direct care staff compared to facility director or middle managers. Burnout was lower among staff who felt that they could consult supervisors about work or personal problems compared to those who felt they could not.
Jenkins et al. (1997); Quantitative, n = 78.	United Kingdom	Psychological correlates of well-being in direct care staff in services for children with intellectual disabilities and challenging behaviour.	Higher anxiety among staff working in houses where clients had challenging behaviors – also felt less supported, less clear about identifying risky situations and lower job satisfaction. No difference in demand or depression. Challenging Behavior emerged as the best predictor of anxiety, with job demands second best predictor. Together, these accounted for 21% of the variance. Depression was the best predictor of staff support.
Judd et al. (2017); Qualitative, n = 12.	Australia	Workplace stress, burnout, and coping: a qualitative study of the experiences of Australian disability support workers.	Theme of balance identified, relation to positive, and negative experiences of work, managing periods of imbalance and strategies to reclaim balance. Rewards included seeing client develop new skills and express appreciation for work. Challenges were challenging behavior, low income, and limited decision making power. Sought support and developed own strategies to manage.
Jenkins et al. (1997) Quantitative, n = 78	United Kingdom	Psychological well-being of staff working with people who have challenging behaviour Higher anxiety among staff working in houses where clients had challenging behaviours – also felt less supported, less clear about identifying risky situations and lower job satisfaction.	No difference in demand or depression. Challenging Behaviour emerged as the best predictor of anxiety, with Job Demands second best predictor. Together, these accounted for 21% of the variance. Depression was the best predictor of Staff Support.
Kile (2014); Quantitative, n = 222.	United States	Relationship among relational coping and reciprocity in direct care staffing services for adults with developmental disabilities and challenging behavior.	Low to moderate levels of burnout found. Challenging behaviour related to higher emotional exhaustion and depersonalisation. Emotion-focused coping was related to emotional exhaustion and depersonalisation. Problem focused coping related to increased personal accomplishment. Relationship-focused most effective; related to higher personal accomplishment. Emotional exhaustion related to lack of reciprocity (across clients, colleagues, and organization). Inequity within the org related to all three burnout measures. Relationship between challenging behavior and burnout weaker when staff felt they had invested more in clients and organization than the reverse.
Ko et al. (2012); Quantitative, n = 169.	Canada	Burnout in summer camp workers for ID	Frequent exposure to severe aggression was related to higher levels of emotional exhaustion and lower personal accomplishment.
Koritsas et al. (2010); Qualitative, n = 11; Quantitative, n = 191. Kowalski et al. (2010); Quantitative, n = 175.	Australia Germany	Exposure to challenging behavior and support worker/house supervisor well-being.  Associations between emotional exhaustion, social capital, workload, and latitude in decision-making among professionals working with people with disabilities.	Qualitative research found awareness of triggers for challenging and that staff implemented strategies to manage (mostly reactive). Most were exposed to CB (almost half had experienced injury; over half had seen injury in others). Depression related to reduced decision latitude, lower education, and exposure to challenging behaviour. Stress was predicted by exposure to challenging behaviour, lower education, and decision latitude. Emotional exhaustion associated with higher psychological job demands and more exposure to challenging behaviour. Personal accomplishment increased as decision latitude increased Workload, latitude in decision-making and being of a male gender were all significant predictors of emotional exhaustion in this study. The strongest inter-correlations between professional experience, age, and job tenure. Social capital was inversely correlated with emotional exhaustion; the lower the social capital in the organization perceived by an employee, the higher the emotional exhaustion.
Kozak et al. (2013); Quantitative, n = 409.	Germany	Psychosocial work-related predictors and consequences of personal burnout among staff working with people with intellectual disabilities.	Personal burnout related to work-privacy conflict, emotional demands, role conflict, job insecurity, and feedback (49%). Higher burnout related to higher intention to leave and stress symptoms. Lower burnout related to job satisfaction, good health, and higher life satisfaction.
Kurz et al. (2014); Quantitative, n = 128	United States	Mediating the relation between workplace stressors and distress in ID support staff: Comparison between the roles of psychological inflexibility and coping styles.	Psychological flexibility (defined as ‘Willingness to experience difficult thoughts and emotions, and to relinquish one's efforts to control the same’ mediated the impact of workplace demands on psychological distress.
Lahana et al. (2017); Quantitative, n = 180. Langdon et al. (2007); Quantitative, n = 27.	Greece United Kingdom	Burnout among nurses working in social welfare centres for the disabled. Staff working with people who have intellectual disabilities within secure hospitals: expressed emotion and its relationship to burnout, stress and coping.	Burnout levels were found to be high. Marital status, routine, and supervisor relationship and professional experienced related to emotional exhaustion and depersonalization. Relationship with colleagues was associated with all three dimensions of burnout syndrome. Quality of relations with supervisors affected both Emotional Exhaustion and Personal Achievement. Sixty three percent coded as having high expressed emotion. These participants reported significantly higher levels of depersonalization and lower levels of personal accomplishment.
Lee et al. (2009); Quantitative, n = 1243.	Taiwan	Extrinsic high-effort and low-reward conditions at work among institutional staff caring for people with intellectual disabilities in Taiwan.	15% - low effort/low reward; 35.9% - low effort/high reward;17.9% - high effort/high reward; 31.1% - high effort/low reward. Perceived job support, control, demands, and stress related to high effort/low reward at work.
Lernihan and Sweeney (2010); Quantitative, n = 69	Ireland	Measuring levels of burnout among care workers.	Thirty percent reported moderate to high emotional exhaustion, most did not report high depersonalization. Two-thirds higher in personal accomplishment. Emotional exhaustion significantly higher in residential compared to day care staff.
Leyin and Wakerly (2007)	United Kingdom	Staff support, staff stress and job satisfaction in working with people with learning disabilities and challenging behaviors.	Overall support was relatively high for both formal and informal supports, only the informal supports from colleagues were negatively correlated with ratings of work‐related stress. Levels of stress could not be inferred from overall ratings of job satisfaction or vice versa. Identified a potentially vulnerable group of staff who reported relatively high job satisfaction but also some degree of stress.
Lin et al. (2009); Quantitative, n = 46 (23 native and 23 non-native)	Taiwan	Job strain and determinants in staff working in institutions for people with intellectual disabilities in Taiwan: a test of the job demand-control-support model.	Native workers had higher burnout (personal and work-related). Job satisfaction slightly higher among foreign compared to native workers (non-significant).
Lundström et al. (2007); Quantitative, n = 112.	Sweden	Personality impact on experiences of strain among staff exposed to violence in care of people with intellectual disabilities.	No evidence of direct influence of personality variables on exposure to violence. Personality dimensions of harm avoidance and self‐directedness were related to increased burnout, tedium, emotional exhaustion, and depersonalization.
Lundström et al. (2007); Quantitative, n = 120.	Sweden	Prevalence of violence and its relation to caregivers’ demographics and emotional reactions – an explorative study of caregivers working in group homes for persons with learning disabilities.	Thirty one percent exposed to violence during the preceding year with physical violence most common. Daytime work was the only independent factor in a regression model predicting violence towards the caregivers. Of those exposed to violence; violent incidents occurred several times a week (41%) while 24% (7.5% of all caregivers) reported daily exposure to violence. Seventy three percent of caregivers reported that the violent incidents were only managed by internal discussions with colleagues. Only two (5.4%) of the exposed caregivers reported personal support from the manager. The most frequently reported types of emotional reactions to violence were feelings of powerlessness, insufficiency, and anger.
Lunsky et al. (2014); Quantitative, n = 926.	Canada	Perceptions of positive contributions and burnout in community developmental disability workers.	Factor analysis identified two factors: General positive contributions and positive work motivation. Positive work motivation associated with higher levels of personal accomplishment. Lend support to the idea of need to consider both positive and negative aspects of work life.
Mascha (2007); Quantitative, n = 36	United Kingdom	Staff morale in day care centres for adults with intellectual disabilities.	High levels of job satisfaction, moderate levels of emotional exhaustion, and personal accomplishment. Wishful thinking related to lower levels of role clarity and more emotional exhaustion, as well as lower levels of lack of personal accomplishment. Staff who were satisfied with supervision reported higher role clarity and job satisfaction and lower levels of intended turnover and emotional exhaustion. Emotional exhaustion also highly associated with lower levels of satisfaction with support, role clarity, and overall job satisfaction. Role clarity and job satisfaction related to satisfaction with support and negatively related to intended turnover.
Mitchell and Hastings (2001); Quantitative, n = 83.	United States	Coping, burnout, and emotion in staff working in community services for people with challenging behaviors.	Adaptive coping more frequent than maladaptive coping when faced with challenging behavior. Disengagement, adaptive coping and emotional reaction to aggressive behaviour predicted burnout. Negative emotional reaction to aggressive behaviour predicted emotional exhaustion and depersonalization.
Mills and Rose (2011); Quantitative, n = 78.	United Kingdom	The relationship between challenging behavior, burnout, and cognitive variables in staff working with people who have intellectual disabilities.	Relationship between challenging behavior and burnout mediated by ‘fear of potential assault’. Higher challenging behaviour related to greater fear of assault. Greater fear of assault and challenging behavior related to increased burnout (on all measures). Cognitive variables of consequence carer/control carer/emotional representation related to burnout. ‘Fear of assault’ mediated the relationship between aggressive behavior and emotional exhaustion and depersonalization. ‘Emotional representation’ mediated relationship between CB and depersonalization.
Mutkins et al. (2011); Quantitative, n = 80.	Australia	Stress, depression, workplace, and social supports and burnout in intellectual disability support staff.	Depression and lower perceived organisational support related to higher worse emotional exhaustion and depersonalization. Less social support related to lower personal accomplishment. Satisfaction with social support moderated between psychological stress and burnout.
Outar and Rose (2017); Quantitative, n = 70.	United Kingdom	Is there a relationship between role identity, work demands, and burnout in direct care staff working with individuals with intellectual disability.	Demands related to emotional exhaustion and depersonalization; role identity related to personal accomplishment and self-determination.
Robertson et al. (2005); Quantitative, n = 157.	United Kingdom	Staff stress and morale in community‐based settings for people with intellectual disabilities and challenging behavior: a brief report.	Congregate settings not associated with higher levels of stress. Overall, over a quarter of staff reached criterion on the General Health Questionnaire‐12 for experiencing emotional distress and over a third were likely to actively seek new employment in the next year. The greatest perceived sources of stress were lack of resources and lack of staff support. The lowest level of satisfaction was with the rate of pay. Those in non‐congregate settings reported greater perceived stress due to lack of procedures to deal with challenging behaviour.
Rose (1993); Quantitative, n = 112.	United Kingdom	Stress and staff in residential settings: the move from hospital to the community.	Hospital and group home staff reported similar, relatively high levels of strain. Community unit group reported significantly lower levels of strain.
Rose (1999); Quantitative, n = 216.	United Kingdom	Stress and residential staff who work with people who have an intellectual disability: a factor analytic study.	Development of a questionnaire and collection of data.
Rose and Schelewa-Davies (1997); Quantitative, n = 29.	United Kingdom	The relationship between staff stress and team climate in residential services.	Team climate, namely greater support for innovation, and task orientation (commitment to high performance) associated with reduced staff stress.
Rose et al. (2003); Quantitative, n = 131.	United Kingdom	Staff who work with people who have intellectual disabilities: the importance of personality.	Higher demands and lower support linked to poorer psychological well-being. Higher neuroticism and lower extraversion related to higher stress. Practical coping not related to work strain, though wishful thinking related to higher stress. Neuroticism and wishful thinking moderated relationship between demands and higher stress.
Rose et al. (2004); Two quantitative studies, n = 101 and 99, respectively.	United Kingdom	Negative emotional reactions to challenging behaviour and staff burnout (replication studies of a previous study by Mitchell and Hastings,2001).	Supported the previous study though no causal links identified. Both studies found relationship between negation emotional reaction to challenging behaviour and emotional exhaustion and depersonalization (not personal accomplishment).
Rose and Rose (2005); Quantitative, n = 107.	United Kingdom	Staff in services for people with intellectual disabilities: the impact of stress on attributions of challenging behavior.	Although staff reported high stress levels and moderate burnout, this did not appear to have any relationship to their reporting of thoughts and feelings, and propensity to help regarding challenging behavior in study vignettes.
Rose et al. (2006); Quantitative, n = 72.	United Kingdom	Attitudes of direct care staff towards external professionals, team climate, and psychological wellbeing: a pilot study.	Care staff attitudes towards professionals and levels of team climate related to psychological well-being.
Rose and Cleary (2007); Quantitative, n = 87.	United Kingdom	Care staff perceptions of challenging behavior and fear of assault.	Investigated fear of assault in relation to exposure to challenging behavior. The extent to which a social psychological model of fear of assault could be generalised to care staff was tested. Staff exposed to more challenging behavior had high a fear of assault.
Rose et al. (2010); Quantitative, n = 242.	United Kingdom	Reciprocity and burnout in direct care staff.	‘Under benefit’ in relationships with service users, colleagues, and the organisation related to emotional exhaustion. ‘Under benefit’ in organisational and staff relationships related to increased depersonalization.
Rose et al. (2013); Quantitative, n = 78.	United Kingdom	Client characteristics, organizational variables, and burnout in care staff: The mediating role of fear of assault.	Relationship between challenging behavior and emotional exhaustion fully mediated by fear of assault. Relationship between emotional exhaustion and experienced safety also fully mediated by fear of assault.
Rose et al. (1998) Quantitative, n = 33	United Kingdom	Investigating the relationship between stress and worker behaviour. Residential group homes were classified as `low stress' and four as ‘high stress’. Staff in the high stress homes reported greater demands and less support than those in the low stress homes.	Higher levels of interaction were found between staff and residents in low stress houses, whereas activities in higher-stress group homes appeared to be more community oriented.
Shaddock et al. (1998); Quantitative, n = 173.	Australia	Factors associated with burnout in workers in residential facilities for people with an intellectual disability.	Association between the burnout and variables such as religious affiliation, personal relationships, perceived skill levels, job satisfaction, case-loads, decision-making, and social support. Significant associations were found between burnout scores and some demographic variables. Low burnout scores were associated with some features of the work situation.
Shead et al. (2016); Quantitative, n = 86. Smithson-Sims (1996); Quantitative, n = 105.	United Kingdom United Kingdom	Investigating predictors and moderators of burnout in staff working in services for people with intellectual disabilities: the role of emotional intelligence, exposure to violence, and self-efficacy. Coping and stress: unqualified direct-care staff working with challenging behaviour clients in learning disability residential settings.	Exposure to violence and low self-efficacy predicted emotional exhaustion and depersonalization. Self-efficacy moderated the relationship between exposure to violence, emotional exhaustion, and depersonalization. Both emotion- and problem-focused coping strategies used when dealing with the demands of the workplace. Significant association between use of problem-focused coping strategies and lower levels of stress and incidence of stress caseness. Also significant association between use of predominantly emotion-focused coping strategies and higher levels of stress and incidence of stress caseness.
Smyth et al. (2015); Quantitative, n = 138.	United Kingdom	An analysis of stress, burnout, and work commitment among disability support staff in the UK.	Exposure to challenging behavior was associated with perceived stress and emotional exhaustion. Perceived stress and burnout were associated with work commitment. Frequency and severity of aggressive/destructive behavior predicted depersonalization. Greater perceived stress was a predictor of depersonalization and emotional exhaustion.
Stube (2016); Quantitative, n = 201.	United States	The prediction of staff burnout indicators in IDD community services by staff depression, work functioning, and working alliance.	Depressions, working alliance, and work functioning all related to difference aspect of burnout (no interaction effect for working alliance) Depression predicted all burnout measures (emotional exhaustion strongest). Work functioning predicted emo exhaustion and depersonalization (depersonalization strongest). Working alliance predicted depersonalization (best predictor of personal accomplishment).
Tartakovsky et al. (2013); Quantitative, n = 222.	Israel	Staff members of community services for people with intellectual disability and severe mental illness: values, attitudes, and burnout.	Higher preference for self-transcendence values and a lower preference for the self-enhancement values associated with a lower level of depersonalization and a higher sense of professional accomplishment. A more positive attitude toward empowerment, a higher sense of similarity, and a more negative attitude toward exclusion associated with lower burnout.
Thomas and Rose (2010); Quantitative, n = 102.	United Kingdom	The relationship between reciprocity and the emotional and behavioral responses of staff.	A lack of reciprocity in care staff relationships related to burnout. Emotional exhaustion and depersonalization were also found to be related to negative affect, positive emotion, optimism, and helping behaviors; while personal accomplishment was related to negative mood, positive emotion, optimism, and helping behaviour.
Van Dierendonck et al. (1996); Quantitative, n = 301 (n = 189 in care of mentally disabled)	Netherlands	Inequity Among Human Service Professionals: Measurement and Relation to Burnout Majority of professionals felt under-benefited in relation with recipients as well as in relation with their organization.	Inequity was curvilinearly related to burnout. Staff who felt over-benefited experienced more burnout than colleagues who felt under-benefited.
Van Dierendonck et al. (2001); Quantitative, n = 245 (n = 125 in care of mentally disabled)	Netherlands	Burnout and inequity among human service professionals; A longitudinal study. Inequity affected the central component of burnout (emotional exhaustion).	This relationship was curvilinear. Feeling more deprived and feeling more advantaged resulted in higher future emotional exhaustion levels. No longitudinal relation between inequity and depersonalization.
Vassos and Nankervis (2012); Quantitative, n = 108.	Australian	Investigating the importance of various individual, interpersonal, organisational, and demographic variables when predicting job burnout in disability support workers.	Challenging behavior (interpersonal), workload (individual), supervisor support (individual), work-home conflict (individual), job feedback (individual), role ambiguity (organisational), low job status (organisational), role conflict (organisational), gender (demographic), and work hours (demographic) all predicted one or more of the facets of burnout.
Vassos (2013); Quantitative, n = 258.	Australia	Engagement and burnout is disability support staff as predicted by JDR model.	Role ambiguity related to all three measures of engagement and burnout. Accounted for most unique variance in three scores of engagement and PA. Resources (job feedback) related to engagement and all burnout measures. First to explore engagement at work.
Vassos et al. (2017); Quantitative, n = 325.	Australia	Can the JDR-S model predict stress in disability workers?	High workload, low control, and low colleague support related to higher burnout and lower engagement. High support and increased control reduced the impact of workload on these variables.
Wanless and Jahoda (2002); Quantitative, n = 38.	United Kingdom	Responses of staff towards people with mild to moderate intellectual disability who behave aggressively: a cognitive emotional analysis.	More negative emotions to real aggression versus hypothetical vignettes. Failed to support Weiner’s model of aggression.