Introduction: Burnout syndrome is widely studied in literature but there is still no questionnaire capable of combining the evaluation of both the risk of burnout and the associated suicidal risk. Materials and methods: The validation study was conducted by administering both BORI-1-v2 and BAT, to the selected population sample belonging to the Public Safety.
Results: In this study, a population of 167 individuals (150 m / 17 f), exercising military activities (aged 25-61 years; M: 44.5, SD: 7.6), were selected. KMO and EFA all show values above 0.500. Statistical comparison between BORI-1 and BAT showed good significance (p=0.021 and W=0.981), with a fair correlation matrix (r=0.842). 
Conclusions: BORI-1 is effective as an early screening tool for burnout with a particular sensitivity to suicide risk. In the future, this questionnaire will be used with larger population samples, and with extension to other occupational types, such as health care, transportation, and night workers.
Running head. Validation study of BORI-1-v2

Perrotta-Marciano Burnout Risk Interview 1 (BORI-1). Burnout Assessment Tool (BAT). Maslach Burnout Inventory (MBI). Griffiths' Work Organization Assessment Questionnaire (WOAQ). Shirom-Melamed-Burnout-Measurement (SMBM).

Key Points. 1. BORI-1 is a psychometric instrument that, for the first time, investigates both the clinical and socio-affective, cultural and family dimensions of the interviewee, emphasizing all individual life dimensions. 2. BORI-1 investigates the clinical dimension of the interviewee, emphasizing the symptomatologic rationale described through personality traits according to the PICI-3 model. 3. BORI-1 can identify the risk of burnout, including premature burnout, and suicide risk related to the stressful work condition.

The term "burnout" literally means "exhaustion", thus describing the lack of energy, fatigue and unproductivity at work that a person develops in the workplace. It has been considered a clinical syndrome since the studies of Herbert Freudenberger, who defined it as a condition of mental and physical exhaustion that wears a person down due to chronic exposure to interpersonal stresses in the workplace (Maslach, 1976). Beginning with his studies, Maslach and Cherniss focused their research, arriving at the packaging of a psychometric questionnaire dedicated first to social and health care workers, and then spread to other fields, such as the military (Rodrigues et al., 2018; Cherniss, 1986). In the ICD-11 (with code QD85), burnout is defined as "a state of vital exhaustion due to work-related stress", although in several clinical contexts this construct is challenged as being confounding with work-related stress, if not characterized by emotional exhaustion, depersonalization and cynicism, ineffectiveness, and unsatisfactory job accomplishment (WHO, 2019; Korczak et al., 2010; Borgogni & Consiglio, 2005), as indicated by Maslach himself (Golonka et al., 2019; Maslach & Leiter, 2016). The presence or absence of this syndrome, therefore, can only be verified through batteries of tests (Magnavita, 2018), in addition to the analysis of personal and work dynamics, in the clinical interview, such as excessive workload, reduced decision-making autonomy, diminished or absent rewards, poor sense of belonging, inequity, and lack or absence of values and ties to the organization and colleagues (Leiter et al., 2016; Maslach, 2012).  In particular, the most widely used psychometric tests include Burnout Assessment Tool (BAT), Maslach Burnout Inventory (MBI), Griffiths' Work Organization Assessment Questionnaire (WOAQ), and Shirom-Melamed-Burnout-Measurement (SMBM) (Borrelli et al., 2022; Michel et al., 2022; Schaufeli et al., 2020; Leiter et al., 2012; Maslach & Leiter, 2008; Griffiths et al., 2006; Cooper, 2002; Maslach et al., 1997; Rees & Cooper, 1994), partly because of the markedly increased suicide risk during a pandemic or the recent Covid-19 pandemic (Galanis et al., 2021; Avallone & Paplomatas; 2004). However, the testing landscape lacks a psychometric tool capable of identifying the risk of burnout (and quantifying it) in relation to the risk of suicide, as already well present in the literature (Perrotta et al., 2023a; Galanis et al., 2021; Rodrigues et al., 2018; Maslach & Leiter, 2016; Korczak et al., 2010); for this reason, BORI-1-v2 (Perrotta et al., 2023a) was designed to respond to this need and fill the literary and clinical-instrumental gap, in order to be able to offer not only the clinical picture but also the socio-affective, cultural and family one of the interviewee, structuring the clinical component according to a symptomatic logic described through personality traits. The objective of this study is to validate BORI-1-v2, using a representative population sample, related to the Public Safety and Defense sector (as data in this sector seem to be more swamped) (EI, 2015). The study aims to lay the groundwork for more in-depth and detailed research on a national scale, as well as including other professional categories, investigating the starting hypothesis whether it is possible to validate a psychometric tool capable of predicting burnout syndrome and the related suicidal risk from the symptoms described.

2.1. Methods

The methods used for this study, limited to the selected population sample, consist of the administration via Google Forms of the BORI-1-v2 and the Burnout Assessment Tool (BAT), Italian version, a psychometric tool with ideal characteristics for comparison with the first questionnaire, and therefore functional to proceed with data analysis for validation purposes.  The following statistical analyses were performed: descriptive profile, comparison of means, KMO (measure of sampling adequacy - MSA), χ² (Barlett's test of sphericity), EFA (exploratory factor analysis, using the "maximum likelihood" extraction method in combination with a "promax" rotation), Pearson's r (BORI-BAT correlation matrix), W (Shapiro-Wilk normality test), paired T-test (with 95% confidence interval) and multivariate regression model. IBM SPSS software (28th edition) was used. P<0>

2.2. Materials

Two questionnaires were used for this research: the BORI-1-v2, for validation purposes, and the BAT (Italian version), for comparison with the first questionnaire.  BORI-1 (Perrotta et al., 2023a) is structured into 6 sections, with a total of 50 items, usable for a population aged 18 to 75 years old. Section A consists of 15 items and is devoted to biographical information. Section B consists of 7 items and is devoted to personal information regarding neurotic symptoms suffered, in terms of anxiety, somatization, obsessions and behavioral addictions. Section C consists of 7 items and is devoted to personal information related to the dramatic symptoms suffered, in terms of depression, maniacally, theatricality, instability and attachment. Section D consists of 7 items and is devoted to personal information related to psychotic symptoms, in terms of delirium, paranoia, dissociation and hallucinations. Sections B, C and D are in line with Perrotta Integrative Clinical Interviews - 3 (PICI-3) (Perrotta, 2024ab; Perrotta, 2023b; Perrotta, 2023) and Perrotta Human Emotions Model - 2v2 (PHEM-2v2) (Perrotta et al., 2023cd), in that the BORI model argues that burnout syndrome is characterized by symptoms that by their nature are nurtured by the structure and personality function of the subject. These last two models refer to the investigation of the functional and dysfunctional personality profile, in a clinical key (PICI-3) and in an emotional key (PHEM-2v2) according to the studies of Giulio Perrotta (Perrotta et al., 2024ab, 2023abcd, 2022). Therefore, despite the presence of specific symptoms, each syndrome differs in its subjective manifestation and the impact of symptoms on quality of life (for example, a subject with a psychotic tendency will manifest more psychotic burnout symptoms, such as dissociation and paranoia). Section E consists of 11 items and is devoted to occupational information about one's own or others' behavior in the specific workplace, with indications of different daily dynamics. Finally, section F consists of 3 items and is devoted to personal information related to one's experiences with suicidal tendencies. Scoring involves a partial calculation of individual sections and an overall calculation, to detect burnout risk (and related suicidal risk) (Perrotta, 2020), with a minimum-maximum score of 0-240 points. The questionnaire can be viewed as an attachment to the publication by Perrotta, Marciano & Fabiano (2023a). BAT (Borrelli et al., 2022) is structured into 33 items (Italian version), divided into primary symptoms (exhaustion, mental distance, loss of cognitive control, and loss of emotional control) and secondary symptoms (psychological disorders and psychosomatic disorders), both on a scale of 5 possible different choices (never, rarely, sometimes, often, and always).The BAT was chosen to compare the data from BORI-1-v2, and perform the validation analyses, because it is a self-report questionnaire developed using a combination of a deductive (theoretical) method and an inductive (empirical) approach. Burnout is understood as a mental state of exhaustion that manifests itself both as an inability to perform one's job properly due to chronic fatigue ("I can't do my job anymore"), and as an unwillingness to apply oneself due to mental distance to one's job ("I don't want to do my job anymore"). Two other aspects related to Burnout are emotional and cognitive impairment, which can manifest, for example, in sudden bursts of anger and with poor concentration. Thus, the scales investigated by the BAT are exhaustion, mental distance, emotional impairment and cognitive impairment, but it also investigates secondary symptoms of a psychological nature.  BORI-1 uses the same methodological combination, but delves into the suffered symptomatology according to a multidisciplinary logic, which first investigates the identity, socio-affective and socio-familial component (age, gender, sexual orientation, personal and family status, people with disabilities and children in family status) and the subjective characteristics related to the employment status (years of service, living quarters, geographic distances, types of service, missions and travel). Subsequent sections examine the symptom structure of burnout modeled on the trait theory of Perrotta Integrative Clinical Interviews 3 (PICI-3), with a section devoted entirely to suicide risk-related burnout. 

Table 1 shows the structural and functional clinical differences between BORI-1 and BAT.

Variable: N_items indicates the number of questions; type_items indicates the type of questions; type_answer indicates the type of answers; neurotic symptoms represent the group of questions with neurotic features (anxious, phobic, obsessive, somatic); dramatic symptoms represent the group of questions with dramatic features (depressive, bipolar, theatrical, borderline, narcissistic, antisocial); psychotic symptoms represent the group of questions with psychotic features (delirium, paranoia, dissociation); primary symptoms represent the group of questions related to the main symptoms of burnout (exhaustion, mental distance, loss of cognitive control and loss of emotional control); secondary symptoms represent the group of questions related to the psychological symptoms of burnout; negative consequences in the work environment represent the group of questions related to the specific negative consequences related to one's work activity; suicidal tendency indicates the group of questions about this specific risk; risk of burnout indicates the overall risk detected by the questionnaire score.

Table 1: Structural and functional differences between BORI-1-v2 and BAT.

(Source: Authors)

2.3. Setting and participants

The inclusion criteria are: 1) age between 25 and 61; 2) binary gender (male/female); 3) exclusively Italian citizenship; 4) professional membership in the Public Security and/or Military Forces. Exclusion criteria are: 1) age under 25 and over 61; 2) non-binary gender; 3) non-Italian citizenship; 4) professional activity not in the employ of the Public Security Forces and/or Military; 5) absence, withdrawal or incorrect signing of data processing and informed consent.  The population sample was selected from a group of volunteers registered online (“Diritto Militare Scafetta”: https://www.facebook.com/share/g/183uLsZBqr), through Facebook (managed by Antonio Marciano), who were part of the Public Security Forces and military, with questionnaires being administered by special online link creation through Google Forms (as the participants came from all over Italian territory), managed exclusively by Antonio Marciano. Identity and professional affiliation have been verified by Antonio Marciano; for this reason, the data were not collected anonymously but Antonio Marciano did not personally know any of the participants and the data was passed to Giulio Perrotta, who carried out the statistical analyses, anonymously, first individually and then aggregated. A control group was not selected since the BORI-1 is not administered to a clinical group but to a population to predict the risk of burnout and related suicidal risk.

The present research work was conducted from July 2025 to November 2025, while data analysis was carried out in the last quarter of the same year. The selected population sample, which met the above requirements, initially consisted of 173 participants. However, only 167 were included in the final sample (males: 150; females: 17) [Table 2], as some participants (drop-out: 4%) refused to sign the informed consent and privacy data processing agreement. The participants' ages ranged from 25 to 61 years (M = 44.5; SD = 7.6). The informed consent and data processing agreement were signed before the questionnaires were administered.

The table is divided into 3 sub-tables, based on the number of possible responses per single variable (2, 3 or 4 response hypotheses). In the first sub-table, there are 4 response hypotheses, and they are divided into variables that by their nature can be grouped into 4 different percentile groups (0-25%, 26-50%, 51-75%, and 76-100%, with adjustments to have full figures). In this first sub-table, the variables involved are: age, in relation to birth age; work_years, in relation to years of professional service; gender_male_150, in relation to the subgroup of the male gender of the population (150 subjects); gender_female_17, in relation to the subgroup of the female gender of the population (17 subjects); transfers_mission_total_how_much_time, in relation to how long he/she has been performing missions or transfers compared to the total amount of time since he/she has been in public safety or military service.In the second sub-table, there are 3 response hypotheses, and they are divided by three different response hypotheses. In this second sub-table, the variables involved are: residence/domicile, in relation to the geo-location of the private place of residence; geo_distance_work-residence, in relation to the distance in km between the home address and the place of work; performance_work_type, in relation to the type of work he/she permanently performs ("simple" to indicate easy manual technical work, "office" for administrative work, and "operational" for hazardous or complex work); personal_status, in relation to personal-family status. In the third sub-table, there are 2 response hypotheses, and they are divided by positive (yes) or negative (no) responses. In this third sub-table, the variables involved are: optimal_services_near_res_dom, in relation to the presence or absence of utilities, such as supermarkets, pharmacies, and home utilities calculated by distance from the place of living; fam_disabled, in relation to the presence or absence of a disabled family member in one's family status and present in the place of living; children_status, in relation to the presence or absence of a child under the age of 18 or of age 18 who is economically dependent in one's family status and present in the place of living; suicide risk, in relation to the suicide risk revealed by the BORI-1, structured in the intermediate and high risk score. 

Table 2. Descriptive population datawith variables.

Using IBS's software application for statistical analysis (Statistical Package for Social Science, SPSS, version 28.0) the descriptive, frequency and mean comparison analyses (T-Test for paired data) were performed. T-tests were then conducted for paired data and correlation matrix relative for data on the 2 questionnaires administered. Statistical analysis is significant for values of p<0>

Table 3 shows the descriptive data of the selected population sample, denoted by n/tot (%), in relation to the mean high values of the two questionnaires used and divided according to the variables listed in Table 1.

BORI-1: Perrotta-Marciano Burnout Risk Interview 1 (normal: 0-60; intermediate: 61-104; critic: 105-213). BAT: Burnout Assessment Tool (normal: 33-85; intermediate: 86-105; critic: 106-65). Variables: age, in relation to age of birth, subdivided into 4 subgroups (23-33y, 34-42y, 43-51y, 52-61y); work_years, in relation to years spent working in public safety and military, subdivided into 4 subgroups (5-10y, 11-20y, 21-30y, 31-38y); gender group, in relation to sexual gender, subdivided into male and female; mission_time_total, in relation to the total time spent on missions and travel during the entire professional career, divided into 4 subgroups (less than 1 year, between 1 and 5 years, between 6 and 10 years, and more than 10 years); residence/domicile, with reference to the Italian geographic area of residence, divided into North, Center and South;geo_distance_work-res, referring to the geographical distance between the place of work and the home address, measured in km, and divided into 3 subgroups (less than 5 km, between 5 and 20 km, between 20 and 50 km); work_type, referring to the type of stable job performance, divided into 3 subgroups (simple, office and operational); personal_ status, referring to affective personal status, divided into 3 subgroups (single, partner and married); optimal_ services_near_res_dom_yes, referring to the presence of public services, hospitals, pharmacies, and supermarkets within 1 km of one's place of residence;fam_disabled_yes, referring to the presence of a disabled person in one's family status; children_status_yes, referring to the presence of at least one minor child or adult who is not economically independent, in one's family status.

Table 3: Descriptive population data in relation to the values of the two questionnaires used, divided into 3 severity bands inherent in burnout risk (normal, intermediate and critical, based on the scoring rules of each questionnaire).

Table 4 shows the data for the statistical analyses carried out about KMO (Measure of Sampling Adequacy - MSA), χ² (Barlett's Test of Sphericity), EFA (Exploratory Factor Analysis), as indicated in the Methods section, for the BORI-1 items and for the totals of its individual sections (Figure 1). BORI-BAT correlation matrix shows the r=0.842 (Figure 2), with df=165 and p=<0 W=0.981 p=0.021; p=0.769 d=0.023>Figure 3). The multivariate regression model showed interesting correlations with registry age (the older the age, the higher the risk of burnout, p=0.004), type of service (operators are at higher risk of burnout, p=0.001), and geographic distance between home and operating location (the greater the distance, the higher the risk of burnout, p=0.002), with discrepancies between the final outcomes of the two questionnaires to the extent of 41/167 (25%) (Figure 4), of which 26/41 (63%) show a worse score on the BORI-1 than on the BAT, while 15/41 (37%) show worse scores on the BAT. An interview which followed the administration of the questionnaire has examined these latter subjects and it showed that all 41 subjects agreed more with the result of the BORI-1 than the BAT, and that in the opinion of the respondents the latter did not meet their interpretive expectations, while the subjects who scored higher on the BAT stated that they had completed the questionnaire administration in conjunction with an acute stressful event (personal or family related to the professional sphere) that influenced the outcome of the administration. In second administration, to verify the accuracy of the statements during the interview, the discordant outcome fell in all 15 cases. 

Item: the column corresponds to the number of items in BORI-1, showing both the individual items and the total of the 5 individual sections. KMO_MSA: the column corresponds to the value of the sample adequacy measure. χ²: the column corresponds to the value of Barlett's test of sphericity. p(χ²): the column corresponds to the p-value related to Barlett's test. EFA: the column corresponds to the exploratory factor analysis.

Table 4: Results of statistical analysis carried out on the administration of the BORI-1 and the BAT.

Figure 1: Graphical representation of EFA data relating to BORI-1.

Figure 2: BORI-BAT correlation matrix (r=0.842).

Figure 3: Effect size (Cohen's), in relation to the difference in means.

Figure 4: Scoring outcomes between BORI-1 and BAT.

According to the original proposal [21], the total scoring of all 35 items ranged from a minimum of 0 points to a maximum of 240 points, as section F, regarding suicide risk, had a different scoring precisely to emphasize the importance of the issue. During this study, we realized that the proposed scoring rules were not adequate and balanced, and based on the results, a new decalogue for interpreting the scores of sections B-C-D-E-F and BORI-total was drawn up, as shown in Table 5.

Table 5. Readjustment of scoring rules proposed in Perrotta-Marciano-Fabiano (2023a). Title_ Section: Neurotic symptoms represent the column of section B of BORI-1-v2. Dramatic symptoms represent the column of section C of BORI-1-v2. Psychotic symptoms represent the column of section D of the BORI-1-v2. Negative consequences in the work environment represent the column of section E of the BORI-1-v2. Suicidal tendency represents the column of section F of the BORI-1-v2. BORI-total represents the total score column of the questionnaire.

The modest selected but still representative population, based on the KMO (Kaiser-Meyer-Olkin is a statistical measure used in psychometrics to assess the adequacy of a data sample for factor analysis or principal components analysis) always exceeding 0.500 which proves its sample adequacy, was studied by administering the BORI-1-v2 and BAT, to validate the first questionnaire, to the Italian population working in the public security sectors and military forces. BORI-1-v2, unlike the BAT, uses a structure more centered on the personality trait model of the PICI-3, and thus the sections that are affected by the partial and total scoring of the questionnaire are subsections B-C-D-E-F, specifically devoted to neurotic symptoms (B), dramatic symptoms (C), psychotic symptoms (D), negative consequences in the work environment (E) and suicidal tendency (F), as well as an overall calculation that measures burnout risk in current time and space, while the responses to section A are instrumental in framing the respondent's personal context and therefore do not have a score to assign. The 12 variables selected and then investigated with BORI-1-v2 show a disturbing descriptive picture in the selected population sample, with intermediate and severe values on burnout risk for 76/167 (46%), of which 36/76 (47%) are at high risk. Suicide tendency is also dramatic and represented by intermediate risk for 32/167 (19%) and high risk for 16/167 (10%), for a total of 48/167 (29%), of which 6/167 (4%) show suicide tendency not directly related to burnout or otherwise burnout syndrome is not the primary cause, while 15/28 (54%) show high scores on suicide risk directly related to burnout risk (p=<0>0.500, for all individual items and sections, except for item F3, which shows a value of 0.398, which is interpreted as reduced appropriateness, but still above 0.300 (excessively poor index). Again, the multivariate regression model showed interesting correlations with registry age (the higher the age, the higher the risk of burnout, p=0.004), type of service (operators are at higher risk of burnout, p=0.001), and geographic distance between home and operating location (the greater the distance, the higher the risk of burnout, p=0.002), showing that the burnout condition is fueled or otherwise exacerbated by perceived unfair or otherwise stressful living and working conditions compared to the job performance itself.  Finally, the outcomes of the correlation matrix (r=0.842, p=<0 W=0.981, p=0.021) d=0.023, p=0.769)>

The present study has structural and functional limitations that, in the authors' opinion, do not affect the quality of the results obtained but should be taken into consideration for future research to avoid analytical bias. Structurally, the choice of the population sample suffers from selection biases related to numerosity (which is why the study is classified as "modest" although the sample is representative, based on the statistical data obtained), gender of professional activity (thus grouped by gender but not by type: state police, military police, border police, financial police, army, navy, air force, coast guard, intelligence services), and history of burnout symptoms, determined on the basis of a history prior to the administration of the questionnaire. In addition, the absence of a follow-up assessment of the management of medium to severe symptoms is another limit to be evaluated in future studies. Selection bias related to geographic location could not be avoided, as the population sample did not offer more opportunities and thus selection was strongly influenced by a massive presence of subjects with Southern Italian backgrounds; finally, the low representation of the female population severely limits the scope of the results. Future studies will analyze the phenomenon starting from the assumption of a selection of both the clinical and control groups. Functionally, the results can be considered functional and applicable to the general reference population, but new studies with larger population samples are underway.

BORI-1-v2, considering the limitations of the study, showed good efficiency and effectiveness, to detect burnout risk early or identify the syndrome already in progress, with special attention to the associated suicidal risk. The sectional structure, devoted to clinical symptoms, also offers more insights because of the clinical evaluation in case of positivity in the questionnaire. The validity of the questionnaire is confirmed by statistical analysis, thus offering the therapist a new psychometric tool, not currently present in the literature, capable of investigating the clinical symptoms of burnout syndrome and the related suicide risk. The research stands out for its intent to overcome the limits of the tools used so far, proposing a model that, in addition to identifying the symptoms of burnout, explores the personal and relational dimensions of the individual. BORI-1-v2 is thus proposed not only as an indicator of discomfort, but also as a guide for the interpretation of risk in a predictive and multifactorial way.           

In the future, this questionnaire will be used with larger population samples, including both the clinical group and the control group, and with extension to other occupational types, such as health care, transportation, and night workers.

Funding: None.

Ethics profile: Approval by the Ethics Committee (IRB) of the Istituto per lo Studio delle Psicoterapie (ISP), Rome (Italy), dated July 28, 2025, no. ISP-IRB-2025-10.

Informed Consent Statement: Subjects were recruited who gave regular informed consent and treatment of sensitive data; moreover, via Google forms prepared and maintained exclusively by Antonio Marciano.

Data Availability Statement: The data are stored and managed by Antonio Marciano, while Giulio Perrotta processed them exclusively in aggregate and anonymous form.

Authors' contribution: Giulio Perrotta is the creator and sole owner of the questionnaire, and he alone holds the rights of use and exploitation, including economic exploitation, of the invention. He also drafted the manuscript, assuming the role of corresponding during revision, application and publication. Antonio Marciano freely revised, in support of Giulio Perrotta, some items of the questionnaire, prior to administration. He provided data collection, administration of the questionnaires for the present research and statistical analysis of the data. He also contributed to the editing of the "results" section. Stefano Eleuteri contributed to the revision and first publication phase of the final manuscript.

The authors declare no conflicts of interest.