How to prevent and combat employee burnout and create healthier workplaces during crises and beyond

How to prevent and combat employee burnout and create healthier workplaces during crises and beyond. Kelly P. Gabriel, Herman Aguinis. Business Horizons, February 4 2021. https://doi.org/10.1016/j.bushor.2021.02.037

Abstract: Burnout results from chronic work-related stress. People who are burned out are emotionally drained and feel negative and detached from work, which leads to decreased performance, inhibited creativity and innovation, workplace accidents, absenteeism, and physical and mental illnesses. Burnout is widespread, pernicious, and costly to human life, firm profits, and society—especially during a global crisis like the COVID-19 pandemic but also during a broader set of pan-global crises yet to come. Fostering healthier workplaces is a necessity at any time, but particularly during a crisis that has intensified job demands and drained job resources. Based on a review of the evidence, we provide five recommendations and implementation guidelines that can help organizations prevent and combat burnout: (1) provide stress management interventions, (2) allow employees to be active crafters of their work, (3) cultivate and encourage social support, (4) engage employees in decision-making, and (5) implement high-quality performance management. Overall, our evidence-based recommendations, together with the implementation guidelines we provide, will help business leaders promote and create sustainable wellness at work during crises and beyond.

Keywords: BurnoutEngagementJob demandsJob resourcesHuman resource management

3. Evidence-based recommendations to prevent and combat employee burnout

3.1. Provide stress management interventions

Because burnout results from chronic work-related stress, a seemingly obvious solution would be to implement some type of stress management intervention. Although developing distress tolerance skills can be helpful for all people, managers need to be intentional with the implementation of this recommendation because stress management interventions cannot necessarily change the primary cause of burnout (i.e., high job demands and low job resources). Employees cannot meditate away poor work conditions, precarious unemployment, and widespread global death like in the COVID-19 pandemic. Stress management interventions can cause negative unintended consequences when implemented alone because employees feel they are being blamed for organization-level causes of their burnout and are in an untrusting environment (LaMontagne et al., 2007). However, there is evidence that stress management interventions can help employees adapt to stressful situations, mitigate emotional exhaustion, and develop distress tolerance skills in their work and home lives (Tetrick & Winslow, 2015). We recommend two types of stress management interventions: cognitive-behavioral training and mindfulness meditation groups.

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In cognitive-behavioral training, employees learn how to change their thoughts and develop active coping skills. If large groups of employees lack important personal resources, organizations may decide to arrange this type of training. Cognitive-behavioral training is effective in improving employees’ perceived quality of work and reducing work complaints (Richardson & Rothstein, 2008). It can also help employees develop personal resources they can utilize in their daily work routines and acquire new competencies (Luthans et al., 2006). Through developing distress tolerance skills, employees can better handle job demands, and through cognitive-behavioral interventions, they can learn to reframe how they think about their work, job demands, and resources.

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Mindfulness meditation groups do not seek to change cognitions like cognitive-behavioral training, but mindfulness helps individuals adapt to stressful events and reduce tension (Tetrick & Winslow, 2015). This type of training can be especially useful in times of crisis as an on-the-spot intervention in workplace situations (Hafenbrack, 2017). Further, workplace-based mindfulness meditation programs improve physiological indicators of stress (Heckenberg et al., 2018) such as decreased cortisol. Overall, interventions targeted at changing one’s mental headspace can be beneficial for combating burnout and dealing with the consequences of stress.

3.2. Allow employees to be active crafters of their work

Employees often engage in job crafting—proactive behaviors to improve their job’s actual or perceived characteristics—to combat burnout (Bruning & Campion, 2019). Managers can encourage employees to alter tasks and interactions that might be particularly emotionally exhausting, implement new ways to do their work to increase self-efficacy, and exert agency over their jobs in other ways to decrease feelings of cynicism (Rudolph et al., 2017).

Employees can craft their jobs in a diversity of ways. For example, they can alter the number of tasks they have, the content of their tasks, or the frequency or intensity of contact with colleagues or customers (Tims et al., 2012). Employees engage in these behaviors to better align their jobs with their needs and abilities; when employees are allowed to engage in these behaviors, they are not only able to better complete their work, but they are also more motivated and engaged (Lu et al., 2014; Rudolph et al., 2017).

Although job crafting seems like the sole responsibility of the employee, managers should facilitate and encourage this behavior (Berg et al., 2010) by allowing employees autonomy and flexibility to negotiate job content. Job autonomy is an important resource that makes employees feel trusted, valuable, and in control (Demerouti et al., 2001). When employees feel responsible for their own work and its success or failure, they can better identify with their work rather than feel like they are a mere cog in the wheel. We recommend the following behaviors to promote job crafting:

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Managers should allow employees to choose tasks that play to their strengths but are also challenging when negotiating job content. According to goal-setting theory, the best goals are ones that are challenging but achievable (Locke & Latham, 2020). Giving employees more control and flexibility over tasks that are tailored to their individual strengths and stretch their capacity can increase motivation along with feelings of control (Hätinen et al., 2007).

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Managers can also encourage and provide skill and task variety to enhance employee motivation and self-efficacy (Oldham & Fried, 2016). According to job characteristics theory (Hackman & Oldham, 1976), a job has skill variety when it requires employees to develop and deploy a variety of skills, and it has task variety when employees need to engage in a variety of different tasks. When employees have skill and task variety, they feel more engaged and like they are using their abilities rather than feel like their work is monotonous and routine. Further, with more skills in their toolbox, employees can better respond to and manage work demands (Zaniboni et al., 2013).

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Finally, managers can provide development opportunities. When managers can expand or alter employees’ work in a way that does not add stress but instead provides opportunities to enhance skills and projects or tasks tailored to their professional development, employees can become more motivated, enthusiastic, and can find meaningfulness in their work (Harju et al., 2016). Through job crafting, employees are motivated to engage in professional development (Bruning & Campion, 2019), and managers can facilitate this by working with employees to find what developmental opportunities are conducive to achieving individual and organizational goals.

3.3. Cultivate and encourage social support

Social support is a powerful job resource that provides aid and comfort to others, typically to help them cope with physical, psychological, or social stressors. Social support can arise from many sources, such as family, friends, coworkers, and managers (Halbesleben, 2006), and it can take many forms, such as giving advice, listening, providing material assistance, or generally making a person feel valued and understood. As social creatures, employees always need social support. But in a crisis like the COVID-19 pandemic, where social distancing rendered people unable to spend time with loved ones to whom they might normally turn and where employees experienced strong emotions including fear, grief, isolation, and uncertainty, social support was even more critical. The following guidelines will help to cultivate and encourage social support in a workgroup:

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Managers should foster genuine and high-quality relationships with employees. In fostering these relationships, managers need to be empathetic, use perspective-taking to understand others’ points of view and create an environment of trust. Much research has shown that supervisor support is an important job resource (Schaufeli et al., 2009). Employees may receive supervisor support in the following ways: leaders may communicate the value of their employees, help employees develop new ways to achieve goals, and show concern for employee well-being (Pluut et al., 2018). Particularly in high-demand job conditions (e.g., emotionally draining work like that of a homeless shelter employee or emergency room worker), having a high-quality relationship with one’s supervisor can help to adjust an employee’s workload and provide job resources (Bakker et al., 2014).

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Managers should provide opportunities for coworkers to converse or reflect on their work. Individual burnout is related to team-level burnout (Bakker et al., 2006). If one employee is burned out, teammates are likely to be similarly burned out. At the same time, these employees are feeling isolated and likely not talking about their experiences due to their emotional exhaustion and the potential stigma. Workers in especially emotionally draining jobs such as crisis management or healthcare can benefit from venting about their upsetting or draining experiences, sharing ways they cope, and providing support.

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However, managers should reduce stressful and unnecessary social interactions. Cultivating social support is that managers must understand that this is not the same as social interaction, which, even with the intention of being helpful, can ironically add more stress. Forcing employees to get together too often can add yet another job demand. Employees in the 21st-century workplace, full of endless meetings and expectations of 24/7 availability, are already overloaded with communication. In a crisis like COVID-19 in which almost all forms of communication and gathering must be virtual, employees already suffer from Zoom fatigue. Managers can establish norms to make clear that everyone’s time and energy are precious resources (Rogelberg et al., 2006). For example, they can treat meetings as only happening when completely necessary and avoid collaboration for collaboration’s sake. Overall, managers need to maximize social support while minimizing unnecessary stressful social interactions.

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Managers can combat burnout by recognizing the importance of the nonwork realm. They should encourage social support from nonwork family, friends, and community. In the nonwork realm, social support from family and friends can act as a resource to mitigate the emotional exhaustion aspects of burnout (Tetrick & Winslow, 2015). For example, managers can use nonmonetary rewards to facilitate nonwork-related social support. These nonmonetary rewards can be work/life rewards such as adjusted hours, a more flexible work schedule, more vacation time, or other goods or services that might satisfy an employee and their family’s needs. Crises often reveal the importance of close relationships, so managers should encourage and respect the importance of this type of social support especially in times of crisis.

3.4. Engage employees in decision-making

The fourth recommendation is to engage employees in decision-making, which can take many forms. When considering the types of decisions in which employees can participate, managers should consider where employees’ input will be most valuable—the input should be well-informed and should lead to effects employees can experience (Christina et al., 2017). Asking for employee input and advice and then not following through is worse—and especially for burnout—than never having asked for it in the first place. Further, involving employees in decisions that do not affect them or that they do not care about can create unnecessary meetings that can further burden employees, exacerbating burnout symptoms (Cross et al., 2018). These guidelines will help promote employee engagement in decision-making:

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Managers should learn what resources employees need to perform to the best of their abilities. If employees are overloaded with job demands and not provided the necessary resources, they will not only suffer decreased performance but will also become frustrated and disengaged (Demerouti et al., 2001). Reaching out to employees to learn this information is a win-win situation. When managers seek to understand what employees need, employees can provide crucial input as to what job demands are causing overwhelming strain and frustration or what job resources are lacking (Christina et al., 2017).

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Managers should communicate transparently how decisions are made. When employees are treated as valuable partners and understand how decisions such as workload distribution and pay are made, they feel increased commitment, feel the organization is more just and fair, and are ultimately less likely to burn out (Moliner et al., 2005). This recommendation is especially important in an evolving crisis. In the COVID-19 pandemic, information and news on the virus, lockdowns, and other stressful matters changed on an ongoing basis. As a result, employees experienced heightened uncertainty and fear about their health and livelihoods. Thus, it is important to keep channels of communication open about how the crisis affects the company, their work, and their employment.

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Managers should provide outlets for employee voice when decisions are made. In this dynamic, communication is a two-way street. There are many documented positive outcomes of employees expressing ideas, suggestions, concerns, and opinions about organizational decisions, such as organizational effectiveness and decision-quality improvement (Bashshur & Oc, 2015). However, employees often fear backlash for voicing their opinion and staying silent about these ideas, suggestions, concerns, or opinions has been associated with burnout (Sherf et al., 2021). Therefore, managers should encourage voice behavior and make employees feel comfortable doing so. Feeling that decisions are made behind closed doors and with no chance of change can increase feelings of cynicism and the belief that one cannot be effective at work. Although not every decision can be made as a group, employees should be given a voice, especially in designing and implementing systems that directly affect them. This is not only just and fair, but it also makes sense given the people doing the job have intimate knowledge about their work and how it should best be done and evaluated.

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Finally, managers should involve employees in strategic decision-making. Strategy is usually created solely by top managers, but it is employees who carry out the strategy in their everyday work. This recommendation is particularly useful for crises because organizations face ongoing challenges, and employees are often an untapped source of knowledge for strategic decision-making. For example, many companies responded to the COVID-19 pandemic with corporate social responsibility initiatives but have not engaged employees in creating these strategies. This has not only created unnecessary stress and frustration for employees already at a high risk of burnout, but it also has led to unsuccessful initiatives (Aguinis et al., 2020). Involving employees in the decision-making process not only empowers employees to contribute to the success of the organization and feel meaning in their work but also saves the company time and money in increased productivity, reduced outsourcing, and, ultimately, better strategic decisions.

3.5. Implement high-quality performance management

Many managers and employees perceive performance appraisals (i.e., reviewing employee strengths and weaknesses usually once per year) as not only a bureaucratic waste of resources and time but also as awkward and stressful encounters that add little value (Aguinis & Burgi-Tian, 2021). In contrast to performance appraisals, performance management is “a continuous process of identifying, measuring, and developing the performance of individuals and teams and aligning performance with the strategic goals of the organization” (Aguinis, 2019, p. 8). Unlike a performance appraisal, implementing high-quality performance management can be effective in preventing and combating burnout, and the following guidelines can help:

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Managers should provide strengths-based feedback that is timely, frequent, specific, verifiable, consistent, and consequential. Unlike the weakness-focused approach of a typical performance appraisal, managers that deliver strengths-based feedback highlight employees’ strengths in job performance, knowledge, skills, and talents. Managers should provide positive feedback on behaviors that reflect employees’ strengths that they can extend to other contexts and situations (Aguinis, 2019). Good quality feedback is considered a job resource: When employees receive clear, actionable information about their work performance, they have better knowledge of the grander effect of their activities, have a better idea of what they need to do to improve their productivity, and feel motivated to further leverage their strengths. This job resource is even more valuable in a crisis because employees feel forgotten and uncertain about their current and future place in the organization.

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Managers should set developmental objectives and involve employees in the goal-setting process. When employees have a developmental plan, they feel more committed to their goals (Locke & Latham, 2020). Also, when both managers and employees are held accountable for seeing through these plans, employees feel supported socially and tangibly and are ultimately less likely to burn out. Involving employees in the goal-setting process benefits both the employee and the organization. The employee feels they can tangibly impact the type of work they do, choose the type of career they want for themselves, and remove obstacles to their most effective performance. The organization benefits because it cultivates a long-term, high-performing, and happy employee who will be motivated and proactive about goal attainment.

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Managers can connect performance management to financial and nonfinancial rewards as a way to target burnout. Performance management encourages timely rewards through ongoing and regular evaluations, feedback, and developmental opportunities (Aguinis et al., 2013). Through the use of rewards, employees feel engaged and motivated and also that they are being treated justly and fairly. Nonmonetary rewards can be especially important for dealing with burnout because monetary rewards alone cannot decrease the stressful characteristics of one’s job. For example, employees could be rewarded with developmental training. A more flexible work schedule could be an extremely valuable nonmonetary reward in a crisis like the COVID-19 pandemic where employees were forced to work while also caring for or even teaching their school-aged children at home. Managers and employees can also negotiate idiosyncratic deals – customized work arrangements. Distinct from job crafting, as described earlier, these formal negotiations can provide valuable career opportunities and additional work-life benefits (Liao et al., 2016).

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Finally, managers should implement fair and equitable performance management. Although managers should strive for fairness because it is the right thing to do, they should also do it for the pragmatic reason that unfairness perceptions are tied to burnout (Moliner et al., 2005). Performance management systems should entail two-way communication, not a top-down, supervisor-employee relationship with no employee input. Finally, to increase fairness and justice, performance management systems should be correctable. If employees feel they have no recourse if a mistake or an unjust decision is made, they will be more likely to disengage from work and burn out (Aguinis, 2019).

Earlier research finds social comparison and envy to be common on social media and linked to lower well-being; newer studies contradict this conclusion, finding positive links to well-being as well as heterogeneous, person-specific, effects

Meier, Adrian, and Benjamin K. Johnson. 2021. “Social Comparison and Envy on Social Media: A Critical Review.” PsyArXiv. November 15. doi:10.31234/osf.io/93ftm

Abstract: Popular concern and much research assumes that (passive) social media use decreases well-being by providing a fertile ground for harmful (upward) social comparison and envy. The present review critically summarizes empirical evidence on this assumption. We first comprehensively synthesize existing studies, with a focus on the most recent publications (2019 to 2021). Results show that earlier research finds social comparison and envy to be common on social media and linked to lower well-being. Yet, increasingly, newer studies contradict this conclusion, finding positive links to well-being as well as heterogeneous, person-specific, conditional, and reverse or reciprocal effects. The review further identifies four critical conceptual and methodological limitations of existing studies, which offer new impulses for future research.

Older adults in four European countries: Associated factors and prevalence of masturbation

Prevalence of Masturbation and Associated Factors Among Older Adults in Four European Countries. Nantje Fischer, Cynthia A. Graham, Bente Træen & Gert Martin Hald. Archives of Sexual Behavior, Nov 9 2021. https://link.springer.com/article/10.1007%2Fs10508-021-02071-z

Abstract: Solitary sexual activity is a free, safe, and accessible way to experience sexual pleasure. Despite these advantages, research on masturbation in later life is highly understudied. Using data from a cross-sectional probability-based survey of 3816 European adults (mean age 67 years; range 60–75 years), we explored several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency. Across all countries, between 41% and 65% of men and 27% and 40% of women reported any masturbation in the preceding month. Satisfaction with sexual activity and attitudes related to disapproval of sex without love were significant predictors of reported masturbation in almost all countries and in both genders. Age, education, self-perceived health, and depression were for the most part predictive of men’s reported masturbation, but not women’s. Generally, those believing sex is beneficial to older people were more likely to masturbate, while less permissive attitudes decreased the likelihood of reporting masturbation. To improve healthy sexual aging, misinformation about masturbation and sexual attitudes in older people need to be addressed.

Discussion

In this European four-country study, we assessed several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency among men and women aged 60–75 years. Despite marked cross-cultural and gender differences in masturbation frequency, predictors of masturbation were in most instances more similar than different across the four countries. Satisfaction with the level of sexual activity was a significant negative predictor of masturbation in Norwegian, Danish, and Belgian men and women, and Portuguese men. Another important predictor of frequent masturbation was sexual attitudes. Specifically, attitudes reflecting the idea that sex is legitimized by love were associated with masturbation in Norwegian, Danish, and Belgian men, and Norwegian and Portuguese women. While age, education, self-perceived health, and depression were significantly related to men’s reported masturbation, few sociodemographic and health factors were associated with masturbation activity among women.

Satisfaction with sexual activity was significantly related to masturbation in almost all countries. Men and women in Norway, Denmark, and Belgium, and men in Portugal were less likely to report frequent masturbation if they were satisfied with their level of sexual activity. The central role of sexual contentment in predicting solitary sexual activity may reflect older adults’ tendency to view masturbation as a second-best alternative that is only needed if one desires more sex or partnered sex is not satisfying. Although this finding supports the idea that masturbation functions as a substitute among contemporary older populations, it is possible that this will not be the case for the coming generations. Findings from Finland and Germany indicate cultural changes in the meaning of masturbation, with younger generations increasingly considering it as an independent source of experiencing sexual pleasure (Dekker & Schmidt, 2003; Kontula & Haavio-Mannila, 2003).

Similar to previous findings, the association between intercourse and masturbation frequency was not unequivocal (Regnerus et al., 2017; Rowland et al., 2020). As with Gerressu et al. (2008), we found a gender-specific pattern where, among Norwegian and Belgian women, more frequent intercourse increased the likelihood of frequent masturbation (reflecting the complementary model), while the opposite relationship was found among Danish men (in line with the compensatory model). In contrast to this pattern was the finding in Portuguese men, where more intercourse activity was related to higher levels of masturbation. Although this finding may represent a difference in sexual culture in southern Europe, it is more likely that it reflects a sample selection bias, given a less reliable sampling method, a high refusal rate, and a much lower response rate for the Portuguese sample than for the samples in Norway, Denmark, and Belgium.

Another key finding points to the important role of sexual attitudes in predicting sexual behavior in aging men and women. Sexual attitudes mirror prevailing sociocultural norms and the attached meaning of sexual behavior within a cultural context (Masters et al., 2013). We investigated several sexual attitudes as possible predictors of masturbation and found that attitudes reflecting the idea that sex is legitimized by love were negatively associated with masturbation in Norwegian, Danish, and Belgian men, and in Norwegian and Portuguese women. This finding may reflect the prevailing heterosexual sexual script, where sexual behavior is legitimized by romantic love (also termed the “love ideology”) (Francoeur & Noonan, 2004; Gagnon & Simon, 2005; Træen & Lewin, 2008). According to this script, “good” sexuality is contextualized within intimate relationships, where partnered sex symbolizes mutual love and commitment (Fileborn et al., 2017; Gagnon & Simon, 2005; Hinchliff & Gott, 2004; Træen & Lewin, 2008). Within this love script, there exists little space for sexual self-pleasuring (Hogarth & Ingham, 2009). Disapproval of sex without love among older adults seems to reflect this traditional script and the idea that partnered sex is superior to masturbation. Hence, masturbation signifies something suboptimal and unnecessary, especially if one has access to the “real deal” (Træen et al., 2019). Moreover, practicing sexual self-pleasuring in a relationship might be associated with the fear that the partner may misconstrue the behavior as a sign of personal undesirability and sexual incompetence (Onar et al., 2020). Attitudes reflecting the notion that sexuality decreases with older age and that society has become too sexualized were also negatively related to masturbation frequency, but only in men from Norway and Denmark. In contrast to these less permissive attitudes, Danish and Belgian men and women who believed that sexual activity is beneficial for older people were more likely to report frequent masturbation than those who did not endorse these attitudes. This finding is consistent with previous research showing a positive link between more liberal attitudes/values and reported masturbation (Das et al., 2009; Gerressu et al., 2008).

Overall, more sociodemographic factors were predictive of men’s masturbation than women’s. As found by others (Corona et al., 2010; Lee et al., 2016; Lindau et al., 2007; Mercer et al., 2013; Palacios-Ceña et al., 2012; Richters et al., 2014; Schick et al., 2010), older age was negatively associated with masturbation in Norwegian, Danish, and Belgian men, and Danish women. However, as with previous cross-sectional data, it was not possible to assess whether this reflected an age or cohort effect. Regarding the level of education, we found some cultural-specific patterns. While higher levels of education increased the likelihood of masturbation frequency in northern European men (Norway and Denmark), southern European men (Portugal) with higher levels of education were less likely to report frequent masturbation. Being socialized in an environment influenced by traditional and religious structures repressing sex education (Francoeur & Noona, 2004), older educated Portuguese men may have internalized more normative constraints inhibiting sexual self-pleasure. In contrast, among Norwegian and Danish men who were socialized in the sex-liberal Nordic countries, with open discourses on sexual issues and broad dissemination of sex education, pornography, and sex literature (Francoeur & Noona, 2004), higher education may have shaped masturbation habits by diminishing health-related fears and guilt about masturbation (Kontula & Haavio-Mannila, 2003).

In terms of health, we observed a negative association between self-estimated health and reported masturbation among older men in Denmark, Belgium, and Portugal. Previous evidence on the relationship between general health and masturbation has been mixed (Das, 2007; Lee et al., 2016; Lindau et al., 2007; Schick et al., 2010). One possibility for the inconsistency is that the association might be confounded by older men’s sexual difficulties and sexual desire. While for some men poor health may negatively affect their overall sexual functioning and sexual interest, hence influencing both partnered and solo sex, others with reduced sexual function but high desire may replace partnered sex by increased autoerotic behavior. Future research is needed to address this moderation hypothesis.

In addition to self-rated general health, we assessed the relationship between negative mood and solitary sexual activity. Interestingly, our findings demonstrated a significant association between depression and masturbation among Norwegian and Belgian men; the higher the level of depression, the more likely the reported masturbation. Although this finding seems counterintuitive, it is consistent with previous research (Cyranowski et al., 2004; Frohlich & Meston, 2002; Rowland et al., 2020). One assumption has been that when feeling depressed increased masturbation might reflect a self-soothing strategy, where solo sex functions as a reliable way to make oneself feel better (Frohlich & Meston, 2002). Although self-stimulation when feeling depressed may be self-soothing in the short term, it does not necessarily enhance mood as masturbation also seems to reinforce feelings of loneliness and isolation (Bancroft et al., 2003).

Finally, regarding relationship status, we found that women in Norway and Portugal were less likely to report frequent masturbation if they were in a current relationship. This finding seems to corroborate results from previous studies among varied age groups (DeLamater & Moorman, 2007; Regnerus et al., 2017; Rowland et al., 2020; Schick et al., 2010). It seems probable that since partnered adults may anticipate the opportunity of having sex with their committed partner, they wish to channel their sexual desire into their sexual relationship and/or do not feel the need for masturbation (Regnerus et al., 2017).

Strengths and Limitations

Our survey had several strengths, including the large probability-based samples and the use of similar sampling methods, identical measures, and age cohorts across four European countries. Several limitations, however, should also be acknowledged. The sample size in Portugal, as well as the response rate, was much lower than in the other countries. Due to a less reliable sampling method, an overrepresentation of urban individuals, and a high refusal rate, the selection bias was possibly most substantial among Portuguese participants (Boughner, 2010). Overall, this gives rise to questions relating to the Portuguese samples’ representativeness and its comparability with the samples from Norway, Denmark, and Belgium, which should be taken into consideration when evaluating the study findings. A second limitation pertains to the item formation. In this study, a preexisting one-item indicator was used to measure reported masturbation frequency (ELSA; Lee et al., 2016). Because the question did not specifically refer to solo masturbation, we cannot be sure about the extent to which the results reflected only solo masturbation or both partnered and solo masturbation. However, both the wording of the item (“How often did you masturbate in the past month”) and the context (following a question asking about sexual intercourse frequency) provide some reassurance that the participants interpreted it as a question about solo sexual activity. Further, satisfaction with sexual activity was measured by the question: “How satisfied are you with the current level of sexual activity in your life, in a general way?” Considering the lack of defining sexual activity when asking about participants’ levels of sexual satisfaction, it is likely that participants used divergent definitions when they evaluated their levels of sexual satisfaction (Regnerus et al., 2017). Some might limit sexual activity to solely partnered sex, while others might incorporate solo sexual activities. Yet, a study that investigated the concept of sexual satisfaction among German women found that most of the variance in satisfaction with sex life in general was explained by sexual satisfaction through intercourse and intercourse frequency (Philippsohn & Hartmann, 2009). Another important limitation was that the survey did not assess the role of pornography use. Although our samples might have been biased toward individuals with more liberal and open views about sexuality (Boughner, 2010; Dunne et al., 1997; Strassberg & Lowe, 1995), as sexual self-stimulation is a stigmatized and sensitive topic that might be embarrassing to older individuals, the prevalence of masturbation may still have been underestimated due to social desirability. How possible volunteer bias and social desirability influenced the associations is uncertain, but it may restrict the generalizability of our findings (Boughner, 2010). Finally, due to the cross-sectional design, conclusions about possible causal relationships are not warranted.