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Occupational burnout

March 03, 2023

"Burn out" and "Burn Out" redirect here. For other uses, see Burnout (disambiguation).
Not to be confused with Occupational burning.

According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy".[4] While burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition or mental disorder.[4] WHO additionally states that "Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."[4]

Occupational burn-out
Other namesBurn-out, exhaustion disorder, neurasthenia
A person who is experiencing psychological stress
SpecialtyPsychology 
SymptomsEmotional exhaustion, depersonalization, reduced personal accomplishment,[1][2] fatigue[3]
Differential diagnosisMajor depressive disorder

History

According to Wolfgang Kaskcha, "Burnout as a phenomenon has probably existed at all times and in all cultures."[5] He notes that the condition is described in the Book of Exodus (18:17–18).[5]

Gordon Parker believes the ancient European concept of acedia refers to burnout, and not depression as many others believe.[6][7]

It has been suggested that the first printed use of the term "burnout" in English was in one of Shakespeare's sonnets in 1599,[8] referring to a woman's love burning out. The sonnet in question is one of Shakespeare's most famous.

In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which was thought to be particularly found in "civilized, intellectual communities."[9] The concept soon became popular, and many in the United States believed themselves to have it. Some came to call it "Americanitis".[10] The rest cure was a commonly prescribed treatment (though there were many others). Beard yet further broadened the potential symptoms of neurasthenia over time, so that almost any symptom or behaviour could be deemed to be caused by it.[11] Don R Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful.[12]

In 1961, Graham Greene published the novel A Burnt-Out Case, the story of an architect who became greatly fatigued by his work, and who took much time to recover.[13]

In 1969, HB Bradley used the term "burnout" in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders.[14] This has been cited as the first known academic work to use the term for this concept.[8]

In 1974, Herbert Freudenberger, an American psychologist, used the term in his academic paper "Staff Burn-Out."[15] The paper was based on his qualitative observations of the volunteer staff (including himself) at a free clinic for drug addicts.[16] He characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands as well as physical symptoms such as headaches and sleeplessness, "quickness to anger", and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed." After the publication of Freudenberger's paper, interest in the concept grew.

In 1976, Christina Maslach noted the term being used by California lawyers working with the poor, and began to study the concept.[8]

In 1981, Maslach and Susan E. Jackson published an instrument for assessing burnout, the Maslach Burnout Inventory (MBI).[2] It was the first such instrument of its kind and the most widely used burnout instrument.[17] The two researchers described burnout in terms of emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment.[1][18]

In 2010, the Swedish Board of Health and Welfare adopted a refined conceptualisation of severe burnout it described as "exhaustion disorder."[19]

In 2015, The World Health Organization adopted a conceptualisation of burnout[20] that is consistent with Maslach's. It adopted a modified version of this in 2022. However, "is not itself classified by the WHO as a medical condition or mental disorder."[4]

Also in 2015, Bianchi and colleagues brought to bear evidence that the construct of burnout substantially overlaps with depression.[21]

As of 2017, nine European countries considered burnout as being a recognised medical disorder.[22]

Diagnosis

Classification

The two main classification systems of psychological disorders are the Diagnostic and Statistical Manual of Mental Disorders (DSM, used in North America and elsewhere) from the American Psychiatric Association (APA), and the International Classification of Diseases (ICD, used in Europe and elsewhere) from the World Health Organisation (WHO).

Burnout is not recognized as a distinct mental disorder in the DSM-5 (published in 2013).[23] Its definitions for Adjustment Disorders,[24][25][26] and Unspecified Trauma- and Stressor-Related Disorder[citation needed] in some cases reflect the condition. 2022's update, the DSM-5-TR, did not add a definition of burnout.[27]

As of 2017, nine European countries considered burnout as being a recognised medical disorder.[22] These countries classify it under one or more codes of the ICD.

The ICD-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code Z73.0.[28] It was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding".[29] It was also considered one of the "problems related to life-management difficulty".[30] The condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia.[31]

The ICD-10 also contained a medical condition category of "F43.8 Other reactions to severe stress."[32]

In 2010 the Swedish Board of Health and Welfare added “exhaustion disorder” (ED; F43.8A) to the Swedish version of the ICD-10, the ICD-10-SE, representing what is typically called "burnout" in English.[33][34] (See also sv:Utmattningssyndrom). Swedish sufferers of severe burnout had earlier been treated as having neurasthenia.[35]

The ICD-10-SE defined exhaustion disorder as consisting of:

A. Physical and mental symptoms of exhaustion during at least two weeks. The symptoms have developed in response to one or more identifiable stressors present for at least six months.

B. The clinical picture is dominated by markedly reduced mental energy, as manifested by reduced initiative, lack of endurance, or increased time needed for recovery after mental effort.

C. At least four of the following symptoms have been present, nearly every day, during the same 2-week period:

  1. Concentration difficulties or impaired memory
  2. Markedly reduced capacity to tolerate demands or to work under time pressure
  3. Emotional instability or irritability
  4. Sleep disturbance
  5. Marked fatigability or physical weakness
  6. Physical symptoms such as aches and pains, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sound

D. The symptoms cause clinically significant distress or impairment in occupational, social or other important respects.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a physical illness/injury (e.g., hypothyroidism, diabetes, infectious disease).[19]

According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country."[36]

The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder[37] as part of the ICD-10 system. In the Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment.[35] A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practiconers were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.[38]

A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022.[39] The new version has an entry coded and titled "QD85 Burn-out". The ICD-11 describes the condition this way:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.[40]

This condition is classified under "Problems associated with employment or unemployment" in the section on "Factors influencing health status or contact with health services." The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services.[4][41] In a statement made in May 2019, the WHO said "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition."[42]

The ICD's browser and coding tool both attach the term "caregiver burnout" to category "QF27 Difficulty or need for assistance at home and no other household member able to render care."[43][44] QF27 thus acknowledges that burnout can occur outside the work context.

The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress",[45] which is the equivalent of the ICD-10's F43.8.

If, after treatment, a person with burnout continues to have persistent physical symptoms triggered by the condition, in Iceland they may be considered to have "somatic symptom disorder" (DSM-5) and "bodily distress disorder" (ICD-11).[46]

Further detail about the varied ways clinicians and others use ICD and DSM classification with burnout was published by Arno Van Dam in 2021.[47]

The US government's National Institutes of Health includes the condition as "psychological burnout" in its index of the National Library of Medicine,[48] and provides a number of synonyms. It defines the condition as "An excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure."[48]

SNOMED CT includes the term "burnout" as a synonym for its defined condition of "Physical AND emotional exhaustion state," which is a subtype of anxiety disorder.[49] The Diseases Database defines the condition as "professional burnout."[50]

Instruments

In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory (MBI).[2] It remains by far the most commonly used instrument to assess the condition. Consistent with Maslach's conceptualization, the MBI operationalizes burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization (an unfeeling and impersonal response toward recipients of one's service, care, treatment, or instruction),[a] and reduced personal accomplishment.[1][2]

The MBI originally focused on human service professionals (e.g., teachers, social workers).[2] Since that time, the MBI has been used for a wider variety of workers (e.g., healthcare workers). The instrument or its variants are now employed with job incumbents working in many other occupations.[1]

There are other conceptualizations of burnout that differ from that suggested by Maslach and adopted by the WHO.

In 1999, Demerouti and Bakker, with their Oldenburg Burnout Inventory (OLBI), conceptualized burnout in terms of exhaustion and disengagement,[51] linking it to the job demands-resources model. This instrument is used mainly in the United States.

Also that year, Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale (UWES). It uses a similar conceptualisation to the MBI. However the UWES measures vigour, dedication and absorption; positive counterparts to the values measured by the MBI.[52] It is used mainly in Germany.

In 2005, TS Kristensen et al. released the public domain Copenhagen Burnout Inventory (CBI).[3] They argued that the definition of burnout should be limited to fatigue and exhaustion.[3] The CBI has had some use in Germany.

In 2006, Shirom and Melamed with their Shirom-Melamed Burnout Measure (SMBM) conceptualized burnout in terms of physical exhaustion, cognitive weariness, and emotional exhaustion.[53][54] An examination of the SMBM's emotional exhaustion subscale, however, indicates that the subscale more clearly embodies Maslach's[55] concept of depersonalization than her concept of emotional exhaustion.[17] This measure has seen little use.

In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index, a nine-item self-assessment tool designed to measure burnout and other dimensions of distress in healthcare workers specifically.[56] It has been mainly used in the United States.

In 2014, Aniella Besèr et al. developed the Karolinska Exhaustion Disorder Scale (KEDS),[19][57] which is used mainly in Sweden. It was designed to measure the symptoms defined by the ICD-10-SE's category for exhaustion disorder. The authors believed that those with the disorder were often initially depressed, but that this soon passed. The core symptoms of the disorder were deemed to be "exhaustion, cognitive problems, sleep disturbance". The authors also believed that the condition was clearly differentiated from both depression and anxiety.

In 2020, the Occupational Depression Inventory (ODI),[58] was developed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression.[59][60] The ODI covers nine symptoms, including exhaustion (burnout’s putative core). The instrument exhibits robust psychometric properties. The ODI is the only instrument that assesses work-related suicidal thoughts, a particularly important symptom calling for immediate attention. Available evidence indicates that burnout scales have very high correlations with the ODI, correlations that cannot be explained by item overlap,[59] suggesting that the ODI is a suitable replacement for burnout scales like the MBI.[61]

In 2021, the Sydney Burnout Measure (SBM) was released by Gordon Parker et al., which "captures domains of exhaustion, cognitive impairment, loss of empathy, withdrawal and insularity, and impaired work performance, as well as several anxiety, depression and irritability symptoms."[62]

There are still other conceptualizations as well that are embodied in other instruments, including the Hamburg Burnout Inventory,[63] and Malach-Pines's Burnout Measure.[64]

Kristensen et al.[3] and Malach-Pines (who also published as Pines)[65] advanced the view that burnout can also occur in connection to life outside of work. For example, Malach-Pines developed a burnout measure keyed the role of spouse.[66][67]

The core of all of these conceptualizations, including that of Freudenberger, is exhaustion.[55][68]

Maslach[55] advanced the idea that burnout should not be viewed as a depressive condition. Recent evidence, based on factor-analytic and meta-analytic findings, calls into question this supposition.[69][70][17] Burnout is also now often seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance).[71][72]

Marked differences among researchers' conceptualizations of what constitutes burnout have underlined the need for a consensus definition.[73][74]

Subtypes

In 1991, Barry A. Farber in his research on teachers proposed that there are three types of burnout:

  • "wearout" and "brown-out," where someone gives up having had too much stress and/or too little reward
  • "classic/frenetic burnout," where someone works harder and harder, trying to resolve the stressful situation and/or seek suitable reward for their work
  • "underchallenged burnout," where someone has low stress, but the work is unrewarding.

Farber found evidence that the most idealistic teachers who enter the profession are the most likely to suffer burnout.[75]

Caregiver burnout

Main article: Caregiver stress

Burnout affects caregivers.

Relationship with other conditions

A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression.[76][77][78][79][80][81][82][73] In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients.[83] Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with very high scores on the MBI meet diagnostic criteria for depression.[79] The view that burnout is a form of depression has found support in several recent studies.[68][77][78][80][81][82][63] Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on burnout's diagnostic criteria.[73][84] A newer generation of studies indicates that burnout, particularly its exhaustion dimension, problematically overlaps with depression; these studies have relied on more sophisticated statistical techniques, for example, exploratory structural equation modeling (ESEM) bifactor analysis, than earlier studies of the topic.[85][68] The advantage of ESEM bifactor analysis, which combines the best features of exploratory and confirmatory factor analysis, is that it provides a granular look at item-construct relationships, without falling into traps earlier burnout researchers fell into.[86]

Liu and van Liew[26] wrote that "the term burnout is used so frequently that it has lost much of its original meaning. As originally used, burnout meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p. 434). The authors equate burnout with adjustment disorder with depressed mood.

Kakiashvili et al.,[87] however, argued that although burnout and depression have overlapping symptoms, endocrine evidence suggests that the disorders' biological bases are different. They argued that antidepressants should not be used by people with burnout because the medications can make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse.

Test Major depressive disorder (typically melancholic depression) Atypical depression PTSD Chronic Fatigue Syndrome Burnout
Cortisol awakening response ↑[87] ↓[88] ↓[87] ↓ [89][90] ↓[87][91]
Adrenocorticotropic hormone (ACTH) ↑[87] -[92] or ↓[91] - or ↓[87] - [93] - or ↓[87] or ↑[91]
Dehydroepiandrosterone sulphate (DHEA-S) ↓[87] ↑ or ↓[87] ↓[94] ↑[87]
Low dose dexamethasone suppression test effect on cortisol no suppression[87] hypersuppression[87] hypersuppression[87]

[87][95][96][97][98][99][100][101][102][103]

Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression.[104] The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in burnout.[79] Commentators advanced the view that burnout differs from depression because the cortisol profile of burnout differs from that of melancholic depression; however, as the above table indicates, burnout's cortisol profile is similar to that of atypical depression.[79]

It has previously been hypothesised that Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is caused by burnout.[105] It is suggested that the "burning out" of the body's stress symptom (by any of a wide range of causes) can lead to chronic fatigue. However, the very nomenclature of "Chronic Fatigue Syndrome" is viewed as problematic by both patients and healthcare professionals specialising in the condition, as it fails to encompass the wide range of non-fatigue related symptoms present in ME/CFS, or to differentiate between the so-named condition and the symptom of chronic fatigue which is present in many unrelated conditions or diseases. Furthermore, more up-to-date research has shown that ME/CFS is a multi-systemic condition that is not psychological in etiology and so comparison to occupational burnout is now less prudent.[106]

Overtraining syndrome is also known as "chronic fatigue," "burnout" and "overstress" in athletes.[107][108] It has been conceptualised as adjustment disorder, a common diagnosis for those burnt out.[109]

Recovering alcoholics often have a blunted cortisol response to stress,[110] as do some cancer patients and survivors.[111] This symptom is a particular feature of people suffering burnout. Altered cortisol response is experienced by up to 80% of people with depression.[112]

Risk factors

Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role.[113][114] Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout.[115] One cause of burnout includes stressors that a person is unable to cope with fully.[116]

Burnout is thought to occur when a mismatch is present between the nature of the job and the job the person is actually doing. A common indication of this mismatch is work overload, which sometimes involves a worker who survives a round of layoffs, but after the layoffs the worker finds that he or she is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organization's goals, but requires fewer employees to meet those goals.[117] The research on downsizing, however, indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than mere burnout; these health effects include increased levels of sickness and greater risk of mortality.[118]

The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI.[119] Lack of job resources was associated with the disengagement component of the OLBI.

Maslach, Schaufeli and Leiter identified six risk factors for burnout in 2001: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.[55]

Although job stress has long been viewed as the main determinant of burnout, recent meta-analytic findings indicate that job stress is a weak predictor of burnout.[120] These findings question one of the most central assumptions of burnout research.

In a systematic literature review in 2014, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) found that a number of work environment factors could affect the risk of developing exhaustion disorder or depressive symptoms:

  • People who experience a work situation with little opportunity to influence, in combination with too high demands, develop more depressive symptoms.
  • People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others. Those who experience bullying or conflict in their work develop more depressive symptoms than others, but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder.
  • People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others. This also applies to those who experience insecurity in the employment, for example concerns that the workplace will be closed down.
  • In some work environments, people have less trouble. People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others.
  • Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder.[121]

Negative consequences of burnout on both the employee and the organization call for preventive measures in order to reduce the impact of the risk factors. Burnout prevention strategies, either addressing to the general working population (primary prevention) or the occupational groups which are more vulnerable (secondary prevention), are focused on reducing the impact of risk factors. Reviews of healthcare professionals‟ burnout focusing on identifying risk factors have been conducted previously.[122]

Effects

Some research indicates that burnout is associated with reduced job performance,[citation needed] coronary heart disease,[54] and mental health problems.[citation needed] Examples of emotional symptoms of occupational burnout include a lack of interest in the work being done, a decrease in work performance levels, feelings of helplessness, and trouble sleeping.[123] With regard to mental health problems, research on dentists[77] and physicians[63] suggests that what is meant by burnout is a depressive syndrome. Thus reduced job performance and cardiovascular risk could be related to burnout because of burnout's tie to depression. Behavioral signs of occupational burnout are demonstrated through cynicism within workplace relationships with coworkers, clients, and the organization itself.

Other effects of burnout can manifest as lower energy and productivity levels, with workers observed to be consistently late for work and feeling a sense of dread upon arriving. They can suffer concentration problems, forgetfulness, increased frustration, and/or feelings of being overwhelmed. They may complain and feel negative, or feel apathetic and believe they have little impact on their coworkers and environment.[123] Occupational burnout is also associated with absenteeism, other time missed from work, and thoughts of quitting.[124]

Chronic burnout is also associated with cognitive impairments in memory and attention.[125] (See also Effects of stress on memory.)

Research suggests that burnout can manifest differently between genders, with higher levels of depersonalisation among men and increased emotional exhaustion among women.[126][127] Other research suggests that people revealing a history of occupational burnout face future hiring discrimination.[128]

When it happens in the context of volunteering, burnout can often lead to volunteers significantly reducing their activities or stopping volunteering altogether.[129] Likewise, academic stress, as it has been called, or academic burnout is a process originated from the inciting element, which implies the subjection to events that from the student's perspective can be considered as stressors.[130]

Burnout might result in learned helplessness.[47]

Burnout has been found to be associated with spiritual health.[131]

Stages

Drozdstoj Stoyanov et al. believe burnout has three stages:

  1. Flame out - trying to deal with excessive stress, causing depression and anxiety.
  2. Genuine burn out - a process of increasing emotional exhaustion.
  3. Rust out - being completely alienated from other people, cynical and ineffective.[132]

Treatment and prevention

Health condition treatment and prevention methods are often classified as "primary prevention" (stopping the condition occurring), "secondary prevention" (removing the condition that has occurred) and "tertiary prevention" (helping people live with the condition).[133] In addition to interventions that can address and improve conditions on the work side of work-life balance, the ways in which people spend their non-work time can help to prevent burnout and improve health and well-being.[134]

Primary prevention

See also: Occupational stress, Caregiver stress, and Stress management

Maslach believes that the only way to truly prevent burnout is through a combination of organizational change and education for the individual.[117]

Maslach and Leiter postulated that burnout occurs when there is a disconnection between the organization and the individual with regard to what they called the six areas of worklife: workload, control, reward, community, fairness, and values.[55] Resolving these discrepancies requires integrated action on the part of both the individual and the organization.[55] With regard to workload, assuring that a worker has adequate resources to meet demands as well as ensuring a satisfactory work–life balance could help revitalize employees' energy.[55] With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment.[55] Supportive leadership and relationships with colleagues are also helpful.[55]

One approach for addressing these discrepancies focuses specifically on the fairness area. In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job.[135] The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.[55]

Hätinen et al. suggest "improving job-person fit by focusing attention on the relationship between the person and the job situation, rather than either of these in isolation, seems to be the most promising way of dealing with burnout."[136] They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."

Burnout prevention programs have traditionally focused on cognitive-behavioral therapy (CBT),[137][138] cognitive restructuring, didactic stress management, and relaxation. CBT, relaxation techniques (including physical techniques and mental techniques), and schedule changes are the best-supported techniques for reducing or preventing burnout in a health-care setting. Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners.[139] Combining both organizational and individual-level activities may be the most beneficial approach to reducing symptoms. A Cochrane review, however, reported that evidence for the efficacy of CBT in healthcare workers is of low quality, indicating that it is no better than alternative interventions.[18]

For the purpose of preventing occupational burnout, various stress management interventions have been shown to help improve employee health and well-being in the workplace and lower stress levels. Training employees in ways to manage stress in the workplace have also been shown to be effective in preventing burnout.[140] One study suggests that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness, and hope may insulate individuals from experiencing occupational burnout.[124] Increasing a worker's control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace.[136]

Additional prevention methods include: starting the day with a relaxing ritual; yoga; adopting healthy eating, exercising, and sleeping habits; setting boundaries; taking breaks from technology; nourishing one's creative side, and learning how to manage stress.[141][142][143]

Barry A. Farber suggests strategies like setting more achievable goals, focusing on the value of the work, and finding better ways of doing the job, can all be helpful ways of helping the stressed. People who don't mind the stress but want more reward can benefit from reassessing their work–life balance and implementing stress reduction techniques like meditation and exercise. Others with low stress, but are underwhelmed and bored with work, can benefit from seeking greater challenge.[144]

In one trial, workers taking a high-dose Vitamin B complex "reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood after 12 weeks."[145]

In another trial, doctors undertaking a program involving "mindfulness, reflection, shared experience, and small-group learning" for 9 months had a much lessened propensity to burn out.[146] Another trial with medical interns found a ten-week mindfulness program reduced the incidence of burnout.[147]

Secondary and tertiary prevention (aka treatment and management)

See also: Management of depression, Treatments for PTSD, and Anxiety Disorder § Treatment

Hätinen et al. list a number of common treatments, including treatment of any outstanding medical conditions, stress management, time management, depression treatment, psychotherapies, ergonomic improvement and other physiological and occupational therapy, physical exercise and relaxation. They have found that is more effective to have a greater focus on "group discussions on work related issues", and discussion about "work and private life interface" and other personal needs with psychologists and workplace representatives.[136]

Jac JL van der Klink and Frank JH van Dijk suggest stress inoculation training, cognitive restructuring, graded activity and "time contingency" (progressing based on a timeline rather than patient's comfort) are effective methods of treatment.[37]

Kakiashvili et al. said that "medical treatment of burnout is mostly symptomatic: it involves measures to prevent and treat the symptoms." They say the use of anxiolytics and sedatives to treat burnout related stress is effective, but does nothing to change the sources of stress. They say the poor sleep often caused by burnout (and the subsequent fatigue) is best treated with hypnotics and CBT (within which they include "sleep hygiene, education, relaxation training, stimulus control, and cognitive therapy"). They advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis dysfunction at the core of burnout. They also believe "vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction," noting the importance of specific nutrients. Omega-3 fatty acids may be helpful. DHA supplementation may also be useful for moderating norepinephrine. 11 beta-hydroxysteroid dehydrogenase (and potentially other metabolites of liquorice root extract) may help with lowered cortisol response.[87]

Salomonsson et al. found that for workers with exhaustion disorder, CBT was better than a Return to Work Intervention (RTW-I) for reducing stress; and that people whose symptoms were primarily depression, anxiety or insomnia had reduced total time away from work after a RTW-I than for CBT.[148]

Ybe Meesters found that light therapy (similar to that used for Seasonal Affective Disorder) may be effective.[149]

Gordon Parker et al. found that the most useful treatment strategies appear to be talking to someone and seeking support, walking or other exercise, mindfulness and meditation, improving sleep, and leaving work completely or taking time off work.[6][7]

Korczac et al. in a 2012 literature review found that "only for cognitive behavioural therapy (CBT) exists an adequate number of studies which prove its efficacy."[150]

Ahola et al. in a 2014 literature review found that less than 1% of 4430 papers reviewed contained scientifically rigorous data, and that the 14 well-designed studies collectively "showed that such [randomised control trial] interventions did not succeed in alleviating burnout symptoms."[151]

Lindsäter et al. in a 2022 literature review note the reported success of CBT, acceptance and commitment therapy (ACT), a multimodal rehabilitation program (MMR) program (involving group CBT, applied relaxation in a group, individual psychotherapy, physiotherapy, lectures, and medical treatment), physical exercise, cognitive training, consuming rhodiola rosea extract, and participating in an African dance program. However, overall they noted that "a multitude of interventions have been investigated for exhaustion disorder, but the evidence for any one type of intervention is limited."[36]

Burnout also often causes a decline in the ability to update information in working memory. This is not easily treated with CBT.[152]

One reason it is difficult to treat the three standard symptoms of burnout (exhaustion, cynicism, and inefficacy), is because they respond to the same preventive or treatment activities in different ways.[136]

Exhaustion is more easily treated than cynicism and professional inefficacy, which tend to be more resistant to treatment. Research suggests that intervention actually may worsen the professional efficacy of a person who originally exhibited low professional efficacy.[135]

Employee rehabilitation is a tertiary preventive intervention which means the strategies used in rehabilitation are meant to alleviate burnout symptoms in individuals who are already affected without curing them.[136] Such rehabilitation of the working population includes multidisciplinary activities with the intent of maintaining and improving employees' working ability and ensuring a supply of skilled and capable labour in society.

See also

 
Scholia has a topic profile for Occupational burnout.

Stress and the workplace

Medical

Notes

  1. ^ The term "depersonalization" as used by Maslach and Jackson should not be confused with the same term used in psychiatry and clinical psychology as a hallmark of dissociative disorder.

References

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Further reading

  • Ahola K (2007-12-08). Occupational burnout and health (Report). University of Helsinki.
  • Caputo JS (1991). Stress and Burnout in Library Service. Phoenix, AZ: Oryx Press.
  • Cordes C, Dougherty T (1996). "A review and integration of research on job burnout". Academy of Management Review. 18 (4): 621–656. doi:10.5465/AMR.1993.9402210153.
  • Freudenberger HJ F (1974). "Staff burnout". Journal of Social Issues. 30: 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
  • Freudenberger HJ (1980). Burn-Out: The High Cost of High Achievement. Anchor Press.
  • Freudenberger HJ, North G (1985). Women's Burnout: How to Spot It, How to Reverse It, and How to Prevent It. Doubleday.
  • Maslach C, Leiter MP (May 2008). "Early predictors of job burnout and engagement". The Journal of Applied Psychology. 93 (3): 498–512. CiteSeerX 10.1.1.607.4751. doi:10.1037/0021-9010.93.3.498. PMID 18457483.
  • Ray B (2002). An assessment of burnout in academic librarians in America using the Maslach Burnout Inventory. New Brunswick, NJ: Rutgers University Press.
  • Shaw CS (1992). "A Scientific Solution To Librarian Burnout". New Library World. 93 (5). doi:10.1108/eum0000000002428.
  • Shirom A, Melamed S (2005). "Chapter 39: Does burnout affect physical health? A review of the evidence.". In Antoniou AS, Cooper CL (eds.). Research companion to organizational health psychology. Cheltenham, UK: Edward Elgar. pp. 599–622.
  • Wang Y, Ramos A, Wu H, Liu L, Yang X, Wang J, Wang L (July 2015). "Relationship between occupational stress and burnout among Chinese teachers: a cross-sectional survey in Liaoning, China". International Archives of Occupational and Environmental Health. 88 (5): 589–597. doi:10.1007/s00420-014-0987-9. PMID 25256806. S2CID 29960829.
  • Warr P (1999). Psychology at Work (4th ed.). London: Penguin.

External links

March 03, 2023
occupational, burnout, burn, burn, redirect, here, other, uses, burnout, disambiguation, confused, with, occupational, burning, according, world, health, organization, occupational, burnout, syndrome, resulting, from, chronic, work, related, stress, with, symp. Burn out and Burn Out redirect here For other uses see Burnout disambiguation Not to be confused with Occupational burning According to the World Health Organization WHO occupational burnout is a syndrome resulting from chronic work related stress with symptoms characterized by feelings of energy depletion or exhaustion increased mental distance from one s job or feelings of negativism or cynicism related to one s job and reduced professional efficacy 4 While burnout may influence health and can be a reason for people contacting health services it is not itself classified by the WHO as a medical condition or mental disorder 4 WHO additionally states that Burn out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life 4 Occupational burn outOther namesBurn out exhaustion disorder neurastheniaA person who is experiencing psychological stressSpecialtyPsychology SymptomsEmotional exhaustion depersonalization reduced personal accomplishment 1 2 fatigue 3 Differential diagnosisMajor depressive disorder Contents 1 History 2 Diagnosis 2 1 Classification 2 2 Instruments 2 3 Subtypes 2 3 1 Caregiver burnout 2 4 Relationship with other conditions 3 Risk factors 4 Effects 4 1 Stages 5 Treatment and prevention 5 1 Primary prevention 5 2 Secondary and tertiary prevention aka treatment and management 6 See also 7 Notes 8 References 9 Further reading 10 External linksHistory EditAccording to Wolfgang Kaskcha Burnout as a phenomenon has probably existed at all times and in all cultures 5 He notes that the condition is described in the Book of Exodus 18 17 18 5 Gordon Parker believes the ancient European concept of acedia refers to burnout and not depression as many others believe 6 7 It has been suggested that the first printed use of the term burnout in English was in one of Shakespeare s sonnets in 1599 8 referring to a woman s love burning out The sonnet in question is one of Shakespeare s most famous In 1869 New York neurologist George Beard used the term neurasthenia to describe a very broad condition caused by the exhaustion of the nervous system which was thought to be particularly found in civilized intellectual communities 9 The concept soon became popular and many in the United States believed themselves to have it Some came to call it Americanitis 10 The rest cure was a commonly prescribed treatment though there were many others Beard yet further broadened the potential symptoms of neurasthenia over time so that almost any symptom or behaviour could be deemed to be caused by it 11 Don R Lipsitt would later wonder if the term burnout was similarly too broadly defined to be useful 12 In 1961 Graham Greene published the novel A Burnt Out Case the story of an architect who became greatly fatigued by his work and who took much time to recover 13 In 1969 HB Bradley used the term burnout in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders 14 This has been cited as the first known academic work to use the term for this concept 8 In 1974 Herbert Freudenberger an American psychologist used the term in his academic paper Staff Burn Out 15 The paper was based on his qualitative observations of the volunteer staff including himself at a free clinic for drug addicts 16 He characterized burnout by a set of symptoms that includes exhaustion resulting from work s excessive demands as well as physical symptoms such as headaches and sleeplessness quickness to anger and closed thinking He observed that the burned out worker looks acts and seems depressed After the publication of Freudenberger s paper interest in the concept grew In 1976 Christina Maslach noted the term being used by California lawyers working with the poor and began to study the concept 8 In 1981 Maslach and Susan E Jackson published an instrument for assessing burnout the Maslach Burnout Inventory MBI 2 It was the first such instrument of its kind and the most widely used burnout instrument 17 The two researchers described burnout in terms of emotional exhaustion depersonalization feeling low empathy towards other people in an occupational setting and reduced feelings of work related personal accomplishment 1 18 In 2010 the Swedish Board of Health and Welfare adopted a refined conceptualisation of severe burnout it described as exhaustion disorder 19 In 2015 The World Health Organization adopted a conceptualisation of burnout 20 that is consistent with Maslach s It adopted a modified version of this in 2022 However is not itself classified by the WHO as a medical condition or mental disorder 4 Also in 2015 Bianchi and colleagues brought to bear evidence that the construct of burnout substantially overlaps with depression 21 As of 2017 nine European countries considered burnout as being a recognised medical disorder 22 Diagnosis EditClassification Edit The two main classification systems of psychological disorders are the Diagnostic and Statistical Manual of Mental Disorders DSM used in North America and elsewhere from the American Psychiatric Association APA and the International Classification of Diseases ICD used in Europe and elsewhere from the World Health Organisation WHO Burnout is not recognized as a distinct mental disorder in the DSM 5 published in 2013 23 Its definitions for Adjustment Disorders 24 25 26 and Unspecified Trauma and Stressor Related Disorder citation needed in some cases reflect the condition 2022 s update the DSM 5 TR did not add a definition of burnout 27 As of 2017 nine European countries considered burnout as being a recognised medical disorder 22 These countries classify it under one or more codes of the ICD The ICD 10 current 1994 2021 classified burn out as a type of non medical life management difficulty under code Z73 0 28 It was considered to be one of the factors influencing health status and contact with health services and should not be used for primary mortality coding 29 It was also considered one of the problems related to life management difficulty 30 The condition is further defined as being a state of vital exhaustion which historically had been called neurasthenia 31 The ICD 10 also contained a medical condition category of F43 8 Other reactions to severe stress 32 In 2010 the Swedish Board of Health and Welfare added exhaustion disorder ED F43 8A to the Swedish version of the ICD 10 the ICD 10 SE representing what is typically called burnout in English 33 34 See also sv Utmattningssyndrom Swedish sufferers of severe burnout had earlier been treated as having neurasthenia 35 The ICD 10 SE defined exhaustion disorder as consisting of A Physical and mental symptoms of exhaustion during at least two weeks The symptoms have developed in response to one or more identifiable stressors present for at least six months B The clinical picture is dominated by markedly reduced mental energy as manifested by reduced initiative lack of endurance or increased time needed for recovery after mental effort C At least four of the following symptoms have been present nearly every day during the same 2 week period Concentration difficulties or impaired memory Markedly reduced capacity to tolerate demands or to work under time pressure Emotional instability or irritability Sleep disturbance Marked fatigability or physical weakness Physical symptoms such as aches and pains palpitations gastrointestinal problems vertigo or increased sensitivity to soundD The symptoms cause clinically significant distress or impairment in occupational social or other important respects E The symptoms are not due to the direct physiological effects of a substance e g a drug of abuse a medication or a physical illness injury e g hypothyroidism diabetes infectious disease 19 According to Lindsater et al The diagnosis has become almost as prevalent as major depression in Swedish health care settings and currently accounts for more instances of long term sick leave reimbursement than any other single diagnosis in the country 36 The Royal Dutch Medical Association defined burnout as a subtype of adjustment disorder 37 as part of the ICD 10 system In the Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment 35 A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012 Practiconers were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder 38 A new version of the ICD ICD 11 was released in June 2018 for first use in January 2022 39 The new version has an entry coded and titled QD85 Burn out The ICD 11 describes the condition this way Burn out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed It is characterized by three dimensions 1 feelings of energy depletion or exhaustion 2 increased mental distance from one s job or feelings of negativism or cynicism related to one s job and 3 reduced professional efficacy Burn out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life 40 This condition is classified under Problems associated with employment or unemployment in the section on Factors influencing health status or contact with health services The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services 4 41 In a statement made in May 2019 the WHO said Burn out is included in the 11th Revision of the International Classification of Diseases ICD 11 as an occupational phenomenon It is not classified as a medical condition 42 The ICD s browser and coding tool both attach the term caregiver burnout to category QF27 Difficulty or need for assistance at home and no other household member able to render care 43 44 QF27 thus acknowledges that burnout can occur outside the work context The ICD 11 also has the medical condition 6B4Y Other specified disorders specifically associated with stress 45 which is the equivalent of the ICD 10 s F43 8 If after treatment a person with burnout continues to have persistent physical symptoms triggered by the condition in Iceland they may be considered to have somatic symptom disorder DSM 5 and bodily distress disorder ICD 11 46 Further detail about the varied ways clinicians and others use ICD and DSM classification with burnout was published by Arno Van Dam in 2021 47 The US government s National Institutes of Health includes the condition as psychological burnout in its index of the National Library of Medicine 48 and provides a number of synonyms It defines the condition as An excessive reaction to stress caused by one s environment that may be characterized by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure 48 SNOMED CT includes the term burnout as a synonym for its defined condition of Physical AND emotional exhaustion state which is a subtype of anxiety disorder 49 The Diseases Database defines the condition as professional burnout 50 Instruments Edit In 1981 Maslach and Jackson developed the first widely used instrument for assessing burnout the Maslach Burnout Inventory MBI 2 It remains by far the most commonly used instrument to assess the condition Consistent with Maslach s conceptualization the MBI operationalizes burnout as a three dimensional syndrome consisting of emotional exhaustion depersonalization an unfeeling and impersonal response toward recipients of one s service care treatment or instruction a and reduced personal accomplishment 1 2 The MBI originally focused on human service professionals e g teachers social workers 2 Since that time the MBI has been used for a wider variety of workers e g healthcare workers The instrument or its variants are now employed with job incumbents working in many other occupations 1 There are other conceptualizations of burnout that differ from that suggested by Maslach and adopted by the WHO In 1999 Demerouti and Bakker with their Oldenburg Burnout Inventory OLBI conceptualized burnout in terms of exhaustion and disengagement 51 linking it to the job demands resources model This instrument is used mainly in the United States Also that year Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale UWES It uses a similar conceptualisation to the MBI However the UWES measures vigour dedication and absorption positive counterparts to the values measured by the MBI 52 It is used mainly in Germany In 2005 TS Kristensen et al released the public domain Copenhagen Burnout Inventory CBI 3 They argued that the definition of burnout should be limited to fatigue and exhaustion 3 The CBI has had some use in Germany In 2006 Shirom and Melamed with their Shirom Melamed Burnout Measure SMBM conceptualized burnout in terms of physical exhaustion cognitive weariness and emotional exhaustion 53 54 An examination of the SMBM s emotional exhaustion subscale however indicates that the subscale more clearly embodies Maslach s 55 concept of depersonalization than her concept of emotional exhaustion 17 This measure has seen little use In 2010 researchers from Mayo Clinic used portions of the MBI along with other comprehensive assessments to develop the Well Being Index a nine item self assessment tool designed to measure burnout and other dimensions of distress in healthcare workers specifically 56 It has been mainly used in the United States In 2014 Aniella Beser et al developed the Karolinska Exhaustion Disorder Scale KEDS 19 57 which is used mainly in Sweden It was designed to measure the symptoms defined by the ICD 10 SE s category for exhaustion disorder The authors believed that those with the disorder were often initially depressed but that this soon passed The core symptoms of the disorder were deemed to be exhaustion cognitive problems sleep disturbance The authors also believed that the condition was clearly differentiated from both depression and anxiety In 2020 the Occupational Depression Inventory ODI 58 was developed to quantify the severity of work attributed depressive symptoms and establish provisional diagnoses of job ascribed depression 59 60 The ODI covers nine symptoms including exhaustion burnout s putative core The instrument exhibits robust psychometric properties The ODI is the only instrument that assesses work related suicidal thoughts a particularly important symptom calling for immediate attention Available evidence indicates that burnout scales have very high correlations with the ODI correlations that cannot be explained by item overlap 59 suggesting that the ODI is a suitable replacement for burnout scales like the MBI 61 In 2021 the Sydney Burnout Measure SBM was released by Gordon Parker et al which captures domains of exhaustion cognitive impairment loss of empathy withdrawal and insularity and impaired work performance as well as several anxiety depression and irritability symptoms 62 There are still other conceptualizations as well that are embodied in other instruments including the Hamburg Burnout Inventory 63 and Malach Pines s Burnout Measure 64 Kristensen et al 3 and Malach Pines who also published as Pines 65 advanced the view that burnout can also occur in connection to life outside of work For example Malach Pines developed a burnout measure keyed the role of spouse 66 67 The core of all of these conceptualizations including that of Freudenberger is exhaustion 55 68 Maslach 55 advanced the idea that burnout should not be viewed as a depressive condition Recent evidence based on factor analytic and meta analytic findings calls into question this supposition 69 70 17 Burnout is also now often seen as involving the full array of depressive symptoms e g low mood cognitive alterations sleep disturbance 71 72 Marked differences among researchers conceptualizations of what constitutes burnout have underlined the need for a consensus definition 73 74 Subtypes Edit In 1991 Barry A Farber in his research on teachers proposed that there are three types of burnout wearout and brown out where someone gives up having had too much stress and or too little reward classic frenetic burnout where someone works harder and harder trying to resolve the stressful situation and or seek suitable reward for their work underchallenged burnout where someone has low stress but the work is unrewarding Farber found evidence that the most idealistic teachers who enter the profession are the most likely to suffer burnout 75 Caregiver burnout Edit Main article Caregiver stressBurnout affects caregivers Relationship with other conditions Edit A growing body of evidence suggests that burnout is etiologically clinically and nosologically similar to depression 76 77 78 79 80 81 82 73 In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients no diagnostically significant differences were found between the two groups burned out workers reported as many depressive symptoms as clinically depressed patients 83 Moreover a study by Bianchi Schonfeld and Laurent 2014 showed that about 90 of workers with very high scores on the MBI meet diagnostic criteria for depression 79 The view that burnout is a form of depression has found support in several recent studies 68 77 78 80 81 82 63 Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on burnout s diagnostic criteria 73 84 A newer generation of studies indicates that burnout particularly its exhaustion dimension problematically overlaps with depression these studies have relied on more sophisticated statistical techniques for example exploratory structural equation modeling ESEM bifactor analysis than earlier studies of the topic 85 68 The advantage of ESEM bifactor analysis which combines the best features of exploratory and confirmatory factor analysis is that it provides a granular look at item construct relationships without falling into traps earlier burnout researchers fell into 86 Liu and van Liew 26 wrote that the term burnout is used so frequently that it has lost much of its original meaning As originally used burnout meant a mild degree of stress induced unhappiness The solutions ranged from a vacation to a sabbatical Ultimately it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression but with a less serious significance p 434 The authors equate burnout with adjustment disorder with depressed mood Kakiashvili et al 87 however argued that although burnout and depression have overlapping symptoms endocrine evidence suggests that the disorders biological bases are different They argued that antidepressants should not be used by people with burnout because the medications can make the underlying hypothalamic pituitary adrenal axis dysfunction worse Test Major depressive disorder typically melancholic depression Atypical depression PTSD Chronic Fatigue Syndrome BurnoutCortisol awakening response 87 88 87 89 90 87 91 Adrenocorticotropic hormone ACTH 87 92 or 91 or 87 93 or 87 or 91 Dehydroepiandrosterone sulphate DHEA S 87 or 87 94 87 Low dose dexamethasone suppression test effect on cortisol no suppression 87 hypersuppression 87 hypersuppression 87 87 95 96 97 98 99 100 101 102 103 Despite its name depression with atypical features which is seen in the above table is not a rare form of depression 104 The cortisol profile in atypical depression in contrast to that of melancholic depression is similar to the cortisol profile found in burnout 79 Commentators advanced the view that burnout differs from depression because the cortisol profile of burnout differs from that of melancholic depression however as the above table indicates burnout s cortisol profile is similar to that of atypical depression 79 It has previously been hypothesised that Chronic Fatigue Syndrome CFS also known as Myalgic Encephalomyelitis ME is caused by burnout 105 It is suggested that the burning out of the body s stress symptom by any of a wide range of causes can lead to chronic fatigue However the very nomenclature of Chronic Fatigue Syndrome is viewed as problematic by both patients and healthcare professionals specialising in the condition as it fails to encompass the wide range of non fatigue related symptoms present in ME CFS or to differentiate between the so named condition and the symptom of chronic fatigue which is present in many unrelated conditions or diseases Furthermore more up to date research has shown that ME CFS is a multi systemic condition that is not psychological in etiology and so comparison to occupational burnout is now less prudent 106 Overtraining syndrome is also known as chronic fatigue burnout and overstress in athletes 107 108 It has been conceptualised as adjustment disorder a common diagnosis for those burnt out 109 Recovering alcoholics often have a blunted cortisol response to stress 110 as do some cancer patients and survivors 111 This symptom is a particular feature of people suffering burnout Altered cortisol response is experienced by up to 80 of people with depression 112 Risk factors EditEvidence suggests that the etiology of burnout is multifactorial with personality factors playing an important long overlooked role 113 114 Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout 115 One cause of burnout includes stressors that a person is unable to cope with fully 116 Burnout is thought to occur when a mismatch is present between the nature of the job and the job the person is actually doing A common indication of this mismatch is work overload which sometimes involves a worker who survives a round of layoffs but after the layoffs the worker finds that he or she is doing too much with too few resources Overload may occur in the context of downsizing which often does not narrow an organization s goals but requires fewer employees to meet those goals 117 The research on downsizing however indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than mere burnout these health effects include increased levels of sickness and greater risk of mortality 118 The job demands resources model has implications for burnout as measured by the Oldenburg Burnout Inventory OLBI Physical and psychological job demands were concurrently associated with the exhaustion as measured by the OLBI 119 Lack of job resources was associated with the disengagement component of the OLBI Maslach Schaufeli and Leiter identified six risk factors for burnout in 2001 mismatch in workload mismatch in control lack of appropriate awards loss of a sense of positive connection with others in the workplace perceived lack of fairness and conflict between values 55 Although job stress has long been viewed as the main determinant of burnout recent meta analytic findings indicate that job stress is a weak predictor of burnout 120 These findings question one of the most central assumptions of burnout research In a systematic literature review in 2014 the Swedish Agency for Health Technology Assessment and Assessment of Social Services SBU found that a number of work environment factors could affect the risk of developing exhaustion disorder or depressive symptoms People who experience a work situation with little opportunity to influence in combination with too high demands develop more depressive symptoms People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others Those who experience bullying or conflict in their work develop more depressive symptoms than others but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others This also applies to those who experience insecurity in the employment for example concerns that the workplace will be closed down In some work environments people have less trouble People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder 121 Negative consequences of burnout on both the employee and the organization call for preventive measures in order to reduce the impact of the risk factors Burnout prevention strategies either addressing to the general working population primary prevention or the occupational groups which are more vulnerable secondary prevention are focused on reducing the impact of risk factors Reviews of healthcare professionals burnout focusing on identifying risk factors have been conducted previously 122 Effects EditSome research indicates that burnout is associated with reduced job performance citation needed coronary heart disease 54 and mental health problems citation needed Examples of emotional symptoms of occupational burnout include a lack of interest in the work being done a decrease in work performance levels feelings of helplessness and trouble sleeping 123 With regard to mental health problems research on dentists 77 and physicians 63 suggests that what is meant by burnout is a depressive syndrome Thus reduced job performance and cardiovascular risk could be related to burnout because of burnout s tie to depression Behavioral signs of occupational burnout are demonstrated through cynicism within workplace relationships with coworkers clients and the organization itself Other effects of burnout can manifest as lower energy and productivity levels with workers observed to be consistently late for work and feeling a sense of dread upon arriving They can suffer concentration problems forgetfulness increased frustration and or feelings of being overwhelmed They may complain and feel negative or feel apathetic and believe they have little impact on their coworkers and environment 123 Occupational burnout is also associated with absenteeism other time missed from work and thoughts of quitting 124 Chronic burnout is also associated with cognitive impairments in memory and attention 125 See also Effects of stress on memory Research suggests that burnout can manifest differently between genders with higher levels of depersonalisation among men and increased emotional exhaustion among women 126 127 Other research suggests that people revealing a history of occupational burnout face future hiring discrimination 128 When it happens in the context of volunteering burnout can often lead to volunteers significantly reducing their activities or stopping volunteering altogether 129 Likewise academic stress as it has been called or academic burnout is a process originated from the inciting element which implies the subjection to events that from the student s perspective can be considered as stressors 130 Burnout might result in learned helplessness 47 Burnout has been found to be associated with spiritual health 131 Stages Edit Drozdstoj Stoyanov et al believe burnout has three stages Flame out trying to deal with excessive stress causing depression and anxiety Genuine burn out a process of increasing emotional exhaustion Rust out being completely alienated from other people cynical and ineffective 132 Treatment and prevention EditHealth condition treatment and prevention methods are often classified as primary prevention stopping the condition occurring secondary prevention removing the condition that has occurred and tertiary prevention helping people live with the condition 133 In addition to interventions that can address and improve conditions on the work side of work life balance the ways in which people spend their non work time can help to prevent burnout and improve health and well being 134 Primary prevention Edit See also Occupational stress Caregiver stress and Stress management Maslach believes that the only way to truly prevent burnout is through a combination of organizational change and education for the individual 117 Maslach and Leiter postulated that burnout occurs when there is a disconnection between the organization and the individual with regard to what they called the six areas of worklife workload control reward community fairness and values 55 Resolving these discrepancies requires integrated action on the part of both the individual and the organization 55 With regard to workload assuring that a worker has adequate resources to meet demands as well as ensuring a satisfactory work life balance could help revitalize employees energy 55 With regard to values clearly stated ethical organizational values are important for ensuring employee commitment 55 Supportive leadership and relationships with colleagues are also helpful 55 One approach for addressing these discrepancies focuses specifically on the fairness area In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job 135 The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy suggesting that a broader approach is required 55 Hatinen et al suggest improving job person fit by focusing attention on the relationship between the person and the job situation rather than either of these in isolation seems to be the most promising way of dealing with burnout 136 They also note that at the individual level cognitive behavioural strategies have the best potential for success Burnout prevention programs have traditionally focused on cognitive behavioral therapy CBT 137 138 cognitive restructuring didactic stress management and relaxation CBT relaxation techniques including physical techniques and mental techniques and schedule changes are the best supported techniques for reducing or preventing burnout in a health care setting Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners 139 Combining both organizational and individual level activities may be the most beneficial approach to reducing symptoms A Cochrane review however reported that evidence for the efficacy of CBT in healthcare workers is of low quality indicating that it is no better than alternative interventions 18 For the purpose of preventing occupational burnout various stress management interventions have been shown to help improve employee health and well being in the workplace and lower stress levels Training employees in ways to manage stress in the workplace have also been shown to be effective in preventing burnout 140 One study suggests that social cognitive processes such as commitment to work self efficacy learned resourcefulness and hope may insulate individuals from experiencing occupational burnout 124 Increasing a worker s control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace 136 Additional prevention methods include starting the day with a relaxing ritual yoga adopting healthy eating exercising and sleeping habits setting boundaries taking breaks from technology nourishing one s creative side and learning how to manage stress 141 142 143 Barry A Farber suggests strategies like setting more achievable goals focusing on the value of the work and finding better ways of doing the job can all be helpful ways of helping the stressed People who don t mind the stress but want more reward can benefit from reassessing their work life balance and implementing stress reduction techniques like meditation and exercise Others with low stress but are underwhelmed and bored with work can benefit from seeking greater challenge 144 In one trial workers taking a high dose Vitamin B complex reported significantly lower personal strain and a reduction in confusion and depressed dejected mood after 12 weeks 145 In another trial doctors undertaking a program involving mindfulness reflection shared experience and small group learning for 9 months had a much lessened propensity to burn out 146 Another trial with medical interns found a ten week mindfulness program reduced the incidence of burnout 147 Secondary and tertiary prevention aka treatment and management Edit See also Management of depression Treatments for PTSD and Anxiety Disorder Treatment Hatinen et al list a number of common treatments including treatment of any outstanding medical conditions stress management time management depression treatment psychotherapies ergonomic improvement and other physiological and occupational therapy physical exercise and relaxation They have found that is more effective to have a greater focus on group discussions on work related issues and discussion about work and private life interface and other personal needs with psychologists and workplace representatives 136 Jac JL van der Klink and Frank JH van Dijk suggest stress inoculation training cognitive restructuring graded activity and time contingency progressing based on a timeline rather than patient s comfort are effective methods of treatment 37 Kakiashvili et al said that medical treatment of burnout is mostly symptomatic it involves measures to prevent and treat the symptoms They say the use of anxiolytics and sedatives to treat burnout related stress is effective but does nothing to change the sources of stress They say the poor sleep often caused by burnout and the subsequent fatigue is best treated with hypnotics and CBT within which they include sleep hygiene education relaxation training stimulus control and cognitive therapy They advise against the use of antidepressants as they worsen the hypothalamic pituitary adrenal axis dysfunction at the core of burnout They also believe vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction noting the importance of specific nutrients Omega 3 fatty acids may be helpful DHA supplementation may also be useful for moderating norepinephrine 11 beta hydroxysteroid dehydrogenase and potentially other metabolites of liquorice root extract may help with lowered cortisol response 87 Salomonsson et al found that for workers with exhaustion disorder CBT was better than a Return to Work Intervention RTW I for reducing stress and that people whose symptoms were primarily depression anxiety or insomnia had reduced total time away from work after a RTW I than for CBT 148 Ybe Meesters found that light therapy similar to that used for Seasonal Affective Disorder may be effective 149 Gordon Parker et al found that the most useful treatment strategies appear to be talking to someone and seeking support walking or other exercise mindfulness and meditation improving sleep and leaving work completely or taking time off work 6 7 Korczac et al in a 2012 literature review found that only for cognitive behavioural therapy CBT exists an adequate number of studies which prove its efficacy 150 Ahola et al in a 2014 literature review found that less than 1 of 4430 papers reviewed contained scientifically rigorous data and that the 14 well designed studies collectively showed that such randomised control trial interventions did not succeed in alleviating burnout symptoms 151 Lindsater et al in a 2022 literature review note the reported success of CBT acceptance and commitment therapy ACT a multimodal rehabilitation program MMR program involving group CBT applied relaxation in a group individual psychotherapy physiotherapy lectures and medical treatment physical exercise cognitive training consuming rhodiola rosea extract and participating in an African dance program However overall they noted that a multitude of interventions have been investigated for exhaustion disorder but the evidence for any one type of intervention is limited 36 Burnout also often causes a decline in the ability to update information in working memory This is not easily treated with CBT 152 One reason it is difficult to treat the three standard symptoms of burnout exhaustion cynicism and inefficacy is because they respond to the same preventive or treatment activities in different ways 136 Exhaustion is more easily treated than cynicism and professional inefficacy which tend to be more resistant to treatment Research suggests that intervention actually may worsen the professional efficacy of a person who originally exhibited low professional efficacy 135 Employee rehabilitation is a tertiary preventive intervention which means the strategies used in rehabilitation are meant to alleviate burnout symptoms in individuals who are already affected without curing them 136 Such rehabilitation of the working population includes multidisciplinary activities with the intent of maintaining and improving employees working ability and ensuring a supply of skilled and capable labour in society See also EditThis see also section may contain an excessive number of suggestions Please ensure that only the most relevant links are given that they are not red links and that any links are not already in this article September 2022 Learn how and when to remove this template message Scholia has a topic profile for Occupational burnout Psychology portalMotivational crowding Compassion fatigue Counterproductive work behavior Emotional exhaustion Employee engagement Meditation Spoon theory Writer s block Workaholism KaroshiStress and the workplace Caregiver stress Industrial and organizational psychology Occupational health psychology Occupational Health Science Perceived organizational support Perceived psychological contract violation Workplace stress Teacher burnoutMedical Acute stress disorder Adjustment disorder Chronic fatigue syndrome Depression Hypothalamic pituitary adrenal axis Mental disorder Pathological demand avoidance Posttraumatic stress disorder StressNotes Edit The term depersonalization as used by Maslach and Jackson should not be confused with the same term used in psychiatry and clinical psychology as a hallmark of dissociative disorder References Edit a b c d Maslach C Jackson SE Leiter MP 1996 MBI The Maslach Burnout Inventory Manual Palo Alto Consulting Psychologists Press a b c d e Maslach C Jackson SE 1981 The measurement of experienced burnout Journal of Occupational Behavior 2 2 99 113 doi 10 1002 job 4030020205 S2CID 53003646 a b c d Kristensen TS Borritz M Villadsen E Christensen KB 2005 The Copenhagen Burnout Inventory A new tool for the assessment of burnout Work amp Stress 19 3 192 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Step Back Where Are the Elixirs of Yesteryear When We Hurt The New York Times Retrieved 2008 09 11 Beard George Miller 1881 American Nervousness Its Causes and Consequences A Supplement to Nervous Exhaustion neurasthenia Putnam Lipsitt Don R September 2019 Is Today s 21st Century Burnout 19th Century s Neurasthenia The Journal of Nervous and Mental Disease 207 9 773 777 doi 10 1097 NMD 0000000000001014 ISSN 0022 3018 PMID 31464987 S2CID 201667337 Greene G 1961 A Burnt Out Case William Heinemann Ltd pp cover title ISBN 978 0140185393 Bradley HB July 1969 Community based treatment for young adult offenders Crime amp Delinquency 15 3 359 370 doi 10 1177 001112876901500307 S2CID 144032733 Freudenberger HJ January 1974 Staff Burn Out Journal of Social Issues 30 1 159 165 doi 10 1111 J 1540 4560 1974 TB00706 X Freudenberger HJ 1974 Staff burnout Journal of Social Issues 30 159 165 doi 10 1111 j 1540 4560 1974 tb00706 x a b c Schonfeld IS Verkuilen J Bianchi R December 2019 Inquiry into the correlation between burnout and depression Journal of Occupational Health Psychology 24 6 603 616 doi 10 1037 ocp0000151 PMID 30945922 S2CID 92997542 a b Ruotsalainen JH Verbeek JH Marine A Serra C April 2015 Preventing occupational stress in healthcare workers The Cochrane Database of Systematic Reviews 2015 4 CD002892 doi 10 1002 14651858 CD002892 pub5 PMC 6718215 PMID 25847433 a b c Beser Aniella Sorjonen Kimmo Wahlberg Kristina Peterson Ulla Nygren Ake Asberg Marie February 2014 Construction and evaluation of a self rating scale for stress induced exhaustion disorder the Karolinska Exhaustion Disorder Scale Scandinavian Journal of Psychology 55 1 72 82 doi 10 1111 sjop 12088 ISSN 1467 9450 PMC 4235404 PMID 24236500 2022 ICD 10 CM Diagnosis Code Z73 0 Burn out www icd10data com Retrieved 2022 07 15 Bianchi R Schonfeld I S amp Laurent E 2015 Burnout depression overlap A review Clinical Psychology Review 36 28 41 doi 10 1016 j cpr 2015 01 004 a b Lastovkova A Carder M Rasmussen HM Sjoberg L Groene GJ Sauni R et al April 2018 Burnout syndrome as an occupational disease in the European Union an exploratory study Industrial Health 56 2 160 165 doi 10 2486 indhealth 2017 0132 PMC 5889935 PMID 29109358 Vahia VN July 2013 Diagnostic and statistical manual of mental disorders 5 A quick glance Indian Journal of Psychiatry 55 3 220 223 doi 10 4103 0019 5545 117131 PMC 3777342 PMID 24082241 Boudoukha AH Hautekeete M Abdellaoui S Abdelaoui S Groux W Garay D September 2011 Burnout and victimisation impact of inmates aggression towards prison guards L Encephale 37 4 284 292 doi 10 1016 j encep 2010 08 006 PMID 21981889 Burnout doesn t appear per se in any international classification of mental disorders clinicians often use the diagnosis of adjustment disorder Hoschl C January 2013 2394 Burnout is a myth European Psychiatry 28 Supplement 1 1 doi 10 1016 S0924 9338 13 77215 8 S2CID 144410795 a b Liu PM Van Liew DA 2003 Depression and burnout In Kahn JP Langlieb AM eds Mental 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external cause classifiable elsewhere are recorded as diagnoses or problems This can arise When some circumstance or problem is present which influences the person s health status but is not in itself a current illness or injury Such circumstance or problem may be elicited during population surveys when the person may or may not be currently sick or be recorded as additional information to be borne in mind when the person is receiving care for some illness or injury Burn out an occupational phenomenon International Classification of Diseases WHO Need for assistance at home and no other household member able to render care Archived from the original on 2014 08 08 Retrieved 2020 03 06 ICD 11 Coding Tool Mortality and Morbidity Statistics MMS icd who int ICD 11 Mortality and Morbidity Statistics Broddadottir Elin Flovenz Sigrun olafsdottir Gylfason Haukur Freyr THormar THorey Einarsson Hjalti Salkovskis Paul Sigurdsson Jon Fridrik 2021 08 16 I m So Tired Fatigue as a Persistent Physical 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S2CID 34659420 Salomonsson Sigrid Santoft Fredrik Lindsater Elin Ejeby Kersti Ingvar Martin Ljotsson Brjann Ost Lars Goran Lekander Mats Hedman Lagerlof Erik April 2020 Effects of cognitive behavioural therapy and return to work intervention for patients on sick leave due to stress related disorders Results from a randomized trial Scandinavian Journal of Psychology 61 2 281 289 doi 10 1111 sjop 12590 ISSN 0036 5564 PMID 31691305 S2CID 207893892 Meesters Y February 2010 Burnout and light treatment Stress amp Health 26 1 13 20 doi 10 1002 smi 1250 Korczak Dieter Wastian Monika Schneider Michael 2012 Therapy of the burnout syndrome GMS Health Technology Assessment 8 Doc05 doi 10 3205 hta000103 PMC 3434360 PMID 22984372 Ahola Kirsi Toppinen Tanner Salla Seppanen Johanna 2017 03 01 Interventions to alleviate burnout symptoms and to support return to work among employees with burnout Systematic review and meta analysis Burnout Research 4 1 11 doi 10 1016 j burn 2017 02 001 ISSN 2213 0586 Oosterholt BG Van der Linden D Maes JH Verbraak MJ Kompier MA July 2012 Burned out cognition cognitive functioning of burnout patients before and after a period with psychological treatment Scandinavian Journal of Work Environment amp Health 38 4 358 369 doi 10 5271 sjweh 3256 JSTOR 41508903 PMID 22025205 Further reading EditAhola K 2007 12 08 Occupational burnout and health Report University of Helsinki Caputo JS 1991 Stress and Burnout in Library Service Phoenix AZ Oryx Press Cordes C Dougherty T 1996 A review and integration of research on job burnout Academy of Management Review 18 4 621 656 doi 10 5465 AMR 1993 9402210153 Freudenberger HJ F 1974 Staff burnout Journal of Social Issues 30 159 165 doi 10 1111 j 1540 4560 1974 tb00706 x Freudenberger HJ 1980 Burn Out The High Cost of High Achievement Anchor Press Freudenberger HJ North G 1985 Women s Burnout How to Spot It How to Reverse It and How to Prevent It Doubleday Maslach C Leiter MP May 2008 Early predictors of job burnout and engagement The Journal of Applied Psychology 93 3 498 512 CiteSeerX 10 1 1 607 4751 doi 10 1037 0021 9010 93 3 498 PMID 18457483 Ray B 2002 An assessment of burnout in academic librarians in America using the Maslach Burnout Inventory New Brunswick NJ Rutgers University Press Shaw CS 1992 A Scientific Solution To Librarian Burnout New Library World 93 5 doi 10 1108 eum0000000002428 Shirom A Melamed S 2005 Chapter 39 Does burnout affect physical health A review of the evidence In Antoniou AS Cooper CL eds Research companion to organizational health psychology Cheltenham UK Edward Elgar pp 599 622 Wang Y Ramos A Wu H Liu L Yang X Wang J Wang L July 2015 Relationship between occupational stress and burnout among Chinese teachers a cross sectional survey in Liaoning China International Archives of Occupational and Environmental Health 88 5 589 597 doi 10 1007 s00420 014 0987 9 PMID 25256806 S2CID 29960829 Warr P 1999 Psychology at Work 4th ed London Penguin External links Edit Retrieved from https en wikipedia org w index php title Occupational burnout amp oldid 1140714998, wikipedia, wiki, book, books, library,

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