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Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout
Abstract
The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.
... Long-term stress-related disorders such as burnout or exhaustion are multifaceted phenomena that affect a person´s overall wellbeing and ability to function in life (Grossi et al., 2015). A majority of those suffering from stress-related disorders receive support and treatment at the primary healthcare level (Glise et al., 2014). ...
... It is a natural reaction that helps us to manage difficult situations, but stress can also be harmful and cause mental health problems (WHO, 2023a). A stressrelated disorder is a multifaceted condition that often includes exhaustion, fatigue, cognitive dysfunction, sleep disturbance, reduced tolerance to further stress, and somatic symptoms (Grossi et al., 2015). A common term, used globally, is the nondiagnostic, work-related term, burnout (Maslach & Leiter, 2008). ...
... A common term, used globally, is the nondiagnostic, work-related term, burnout (Maslach & Leiter, 2008). The diagnosis of exhaustion disorder has been used in Sweden since 2005 for long-term stress (Kalliomäki & Brodda Jansen, 2021) and appears to be the most valid clinical equivalent, overlapping with the term burnout, which is referred to as clinical burnout when the person is in need of care (Grossi et al., 2015). There is thus no international consensus on how to categorize stress-related disorders (Eurofound, 2018;Schaufeli, 2021). ...
Purpose
The aim of the study was to describe how the care relationship in primary healthcare has contributed to the recovery of persons with stress-related disorders.
Methods
This study was based on the phenomenological approach, Reflective Lifeworld Research (RLR). Fifteen persons who had recovered from stress-related disorders and who had experience of being cared for in primary healthcare were included. Lifeworld interviews were conducted, and the data were analysed according to the RLR principles of openness, flexibility and bridling.
Results
The participants experienced that the care relationship in primary healthcare contributed to their recovery from stress-related disorder by enabling them to land and be embraced in a safe relationship. This opened up a space for rest and growth that included time, being listened to and a permitting space for existential reflection based on one’s life story. The results also showed that a sense of disharmony in the care encounter constitutes a threat to recovery and reinforces vulnerability.
Conclusions
Sensing security and hope is a crucial element in the care relationship in primary healthcare when recovering from stress-related disorders. This includes the importance of being treated with respect, being given space to tell one’s story, being listened to and being supported in an existential reflection of one’s life situation.
... ED has been recognized in the Swedish edition of the International Statistical Classification of Diseases since 2005 (SE-ICD-10, code F43.8A.) [2]. The diagnosis is characterized by persistent mental and physical exhaustion and noticeably reduced energy, resulting from identifiable psychosocial stressors that have been present for at least six months without sufficient recovery [3]. Fatigue is a core clinical characteristic of ED, and it has recently been suggested that ED symptoms might be better understood as transdiagnostic symptoms of fatigue rather than a diagnosis-specific pathology [4]. ...
... ED shares several symptomatic features with burnout but differs by including preceding non-work-related stressors. Consequently, individuals with ED also score high on burnout [3]. Given that economic and societal costs associated with stress-related disorders, primarily from sick leave and productivity loss, have been estimated at approximately 187 billion USD in the Western World [6], it is imperative that research focuses on feasible and effective treatments [7]. ...
... Fatigue, being a central clinical characteristic of ED [3,4], can be defined as a "persistent sense of physical, emotional, and/or cognitive tiredness or exhaustion" [31] and implies a lack of ability to initialize and maintain mental and physical tasks that require effort and self-motivation. This has implications for the real-world transferability of the high compliance and low dropout rates in the exercise sessions, as participants had support in initiating the exercise, and researchers were present throughout the sessions. ...
Background
Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.
Aims
This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.
Methods
We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.
Results
ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.
Conclusions
A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.
Trial registration
The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022–04943-01.
... Empirical evidence for cognitive dysfunction and impairments related to burnout symptoms is based on both self-evaluations and objective tests of cognitive performance (Gavelin et al., 2021;Grossi et al., 2015). A literature review by Deligkaris et al. (2014) of 15 English-language articles published between 2005 and 2013 specifically addresses the connection between burnout and cognitive functioning through an objective assessment (i.e., by using psychometric tests rather than self-reported data). ...
... Yet, the review's authors criticise the scarcity and heterogeneity of available studies, the predominant cross-sectional designs, and the relatively small sample sizes used. Moreover, patients with comorbid mental disorders such as depression and anxiety were not excluded, and the studies did not consistently control for the effects of comorbidity (Grossi et al., 2015). Additionally, the majority of studies to date have either investigated patients who have a clinical diagnosis (Gavelin et al., 2021) or analysed exhaustion only as the core symptom of burnout syndrome in populationbased samples (e.g., Diestel et al., 2013;Feuerhahn et al., 2012). ...
... We conducted several tests for memory (short-term, long-term, and working memory) and executive functions (such as inhibition, updating, and shifting) that varied in cognitive load. In their reviews, Deligkaris et al. (2014), Gavelin et al. (2021), and Grossi et al. (2015) as well as several other researchers (e.g., Feuerhahn et al., 2012;Jonsdottir et al., 2013;May et al., 2015) have noted the need to control for co-morbidities, such as sleep problems and depression or anxiety symptoms, in designs that focus specifically on burnout. ...
Geriatric nurses are both ageing and at high risk for developing burnout symptoms. Burnout symptomatology relates to lower job performance and lower care quality. Developing impairments in cognitive functioning might explain such relationships. We examined prospective relationships of burnout symptoms and cognitive functioning (memory and executive functions objectively assessed). We included age as well as several control variables as predictors and searched for interaction effects to explain prior inconsistencies. German nurses (N = 191) from geriatric care filled out self-administered questionnaires at the workplace (t1) and performed a comprehensive cognitive test battery in the lab six months later at t2. Results showed expected age effects on executive functions but no relationships between burnout symptoms and cog-nitive functioning nor any interaction effects with age. Exhausted subjects had a slightly better performance in updating. The nearly robust null findings in this study indicate that the relationship of burnout symptoms and decreased cognitive functioning may be a predominantly clinical issue.
... stress-induced exhaustion disorder (SED), classified as an illness in the Swedish version of the ICD-10 (diagnostic code F43.8A). SED has been implemented in clinical practice and seems to be a valid clinical equivalent of burnout [3,4]. ...
... Persons with SED describe severe exhaustion, lack of endurance, and a prolonged recovery time after mental effort [3]. Core symptoms are sleep disturbances and cognitive impairments [4], and previous studies have shown that persons with clinical burnout perform worse than healthy controls in multiple cognitive areas [5]. A variety of psychiatric and somatic symptoms and decreased quality of life have also been presented [6]. ...
... However, factors that contribute to the development of SED may not be the same as those that contribute to maintenance of SED, where contextual factors and behaviour may play a role [26]. This point may be important, because despite a new workplace, and new or adapted work tasks, 31.5% of the participants in our study still self-reported SED and sleep disturbances, which likely contributes to a continued chronic lack of recovery [4]. The decreased energy and prolonged recovery time that characterises SED appears to persist, and to deal with this, some participants may have chosen to reduce their working hours. ...
Background
Stress-induced exhaustion disorder (SED) is the most common reason for long-term sick leave in Sweden and the recovery process may be long and troublesome. This study explores the symptoms of burnout, depression and anxiety among patients with SED 10 years after termination of a multimodal rehabilitation program. Another aim of the study was to investigate work situation, work functioning, and any remaining exhaustion and sleeping disorders among those who were gainfully employed at the 10-year follow-up.
Methods
This longitudinal study included 107 patients (91 women and 16 men), who had been diagnosed with SED 10 years prior to the study. After establishing the diagnosis they all underwent and completed an multimodal rehabilitation program. Data on symptoms of burnout, anxiety and depression were collected before and after the multimodal rehabilitation program, and at follow-ups after additional 1 year and an additional 10 years. At the 10-year follow-up, work situation, work functioning, and symptoms of exhaustion and sleep disorders were assessed in those who were gainfully employed (89 patients).
Results
Symptoms of burnout, anxiety, and depression remained stable from the 1- to the 10-year follow-up after completed rehabilitation. Among participants who were gainfully employed, 73% had changed workplaces, and 31.5% had reduced their working hours. Common reasons for these changes were lack of energy or because they had chosen to prioritise their lives differently. Work functioning was rated as moderate, one third self-reported SED to some extent, and one fifth reported moderate-to-severe insomnia.
Conclusion
A relatively large proportion of former patients with SED have residual health problems 10 years after rehabilitation and some have not been able to return to full-time work. Preventive and early rehabilitative interventions with adjustments and measures at the organisational level are probably needed to achieve a more sustainable working life.
... Since 2005, the diagnosis of ED (F48.3A) has been accepted into the Swedish ICD-10 and ICD-11 (Kalliomäki & Brodda Jansen, 2021). ED is defined as a reaction to a prolonged period of identifiable persistent stressors (at least six months, typically work-related) signified by substantial debilitating symptoms of exhaustion coupled with cognitive impairments, but not necessarily symptoms of depression (Grossi et al., 2015). These criteria (presented in Table 1) were developed by a task force of researchers and clinicians commissioned to investigate the underlying cause of an escalation of sick leave rates in the aftermath of the economic recession in the 1990s (Åsberg et al., 2003). ...
... The symptoms have developed in response to one or more identifiable stressors, which have been present for at least six months B. Markedly reduced mental energy, manifested by reduced initiative, lack of endurance, or increased time needed for recovery after mental efforts C. At least four of the following symptoms have been present most of the day, nearly every day, during the same 2-week period: Although related, ED is not to be equated with burnout. ED is regarded as the end stage of a severe burnout process that requires clinical attention, equitable to the concept of "clinical burnout" (Grossi et al., 2015). In this sense, everyone who reports burnout does not meet the requirements for ED, but everyone who meets the requirements for ED has probably, at a previous stage, reported high degrees of burnout. ...
... In psychiatric diagnostics, the diagnosis of ED is categorized within "reactions to severe stress and adjustment disorders" in the ICD (Grossi et al., 2015). ...
Long-term sick leave due to stress-related disorders has been steadily increasing in Western society. A portion of these sick leave rates is attributed to severe symptoms of exhaustion, assumed to be the result of persistent work stress. In Sweden, this symptomatology is currently classified using the diagnosis of stress-induced exhaustion disorder (ED). There are, however, no evidence-based treatments for ED, nor are there any established theoretical models to guide clinical interventions. Most current treatments revolve around promoting recovery behaviors, as ED is assumed to result from depleted psychophysiological resources. This thesis discusses the merits of this assumption and whether it is compatible with contemporary theories of stress and a contextual behavioral treatment approach. Additionally, a contextual behavioral model of ED is introduced with an accompanying biopsychosocial treatment, aiming to bridge the gap between theories of stress, basic learning principles, and clinically useful methods. The model suggests that ED can be conceptualized as a crisis of engagement rather than a result of depleted psychophysiological resources.
Complementing this theoretical work are empirical studies of different aspects of multimodal interventions (MMI) for ED with the overarching aim of fostering a more theoretically coherent ED treatment that can be made accessible to more patients. Study I was an open clinical trial tracking ED patients (N = 390) participating in a 24-week MMI based on cognitive behavior therapy (CBT). Study II explored sub-groups and predictors of improvements in a large cohort (N = 915) of ED patients participating in the same MMI as Study I. Study III explored mediators commonly suggested to be relevant within ED treatment in the same cohort as Study II: sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility. Study IV was an uncontrolled pilot trial (N = 26) of the biopsychosocial treatment for ED presented in this thesis, delivered within a 12-week online MMI.
In summary, the results of this thesis indicate that ED patients participating in CBT- based MMI benefit from treatment and report few adverse effects. Moreover, high degrees of perfectionism and high treatment credibility were identified as predictors of improvement, indicating the importance of addressing perfectionistic behaviors and treatment credibility in ED treatment. With positive results similar to those of Study I, Study IV provides preliminary support that ED can be treated more effectively with fewer clinical resources than more extensive MMIs when a more focused and theoretically stringent approach is utilized.
... Stress-related exhaustion is an increasing problem in many countries and is now one of the main causes of long-term sick leave in Sweden (Försäkringskassan The Swedish Social Insurance Agency, 2020;Grossi et al., 2015). However, different terms to describe the stress-related exhaustion are used in different countries. ...
... A commonly used term is burnout, defined by Maslach and co-workers as a psychological syndrome with exhaustion, cynicism, and inefficacy as the core dimensions (Maslach et al., 2001). As burnout is not a clinical diagnosis, the term clinical burnout has been proposed to describe clinically significant burnout (Grossi et al., 2015). In 2003, the term exhaustion disorder (ED) was introduced in Sweden. ...
... Previous research regarding biological mechanisms in ED and clinical burnout has mainly focused on dysregulation of the hypothalamuspituitary-adrenal (HPA) axis, and to a lesser extent on dysregulation of the autonomic nervous system, immune system, growth factors, and other hormones, but no conclusive biomarker has yet been found (Danhof-Pont et al., 2011;Grossi et al., 2015;Jonsdottir and Sjors Dahlman, 2019). However, several studies have raised the question if chronic stress may lead to cerebral changes or damage that could be long-lasting. ...
... It mainly refers to chronic stress in a work environment that is not well managed, but additional factors also have an impact. For example: family conflicts, serious illnesses, etc. (2)(3)(4). ...
... While burnout is often related to chronic workplace stress and results in emotional exhaustion, PTSD has deeper psychological and physiological impacts. Understanding these differences is essential for effective treatment and appropriate diagnosis (4,8). ...
INTRODUCTION: Professional burnout is an emotional and physical exhaustion closely related to stress that is not well managed. Initially considered to be specific to medical professionals, today burnout is spoken about in all spheres of social life. The development of the syndrome involves the physical condition, but outgrows or runs parallel to a dysfunctional change in the behavior of those affected.
... Furthermore, the regression analysis evidenced that burnout explained 7.6% of the variance in insomnia. The literature points to a bidirectional association between burnout and insomnia, suggesting that either might be a risk factor for the other [123,124]. Specifically, stress, burnout and insomnia are reciprocally related in a vicious cycle [124,125]. Dysregulation involving the sympathetic nervous system and/or the hypothalamic-pituitary-adrenal axis is observed in both burnout and insomnia [125]. ...
... The literature points to a bidirectional association between burnout and insomnia, suggesting that either might be a risk factor for the other [123,124]. Specifically, stress, burnout and insomnia are reciprocally related in a vicious cycle [124,125]. Dysregulation involving the sympathetic nervous system and/or the hypothalamic-pituitary-adrenal axis is observed in both burnout and insomnia [125]. ...
Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.
... In burnout individuals, the ability to downregulate negative emotions correlates with the weakening of functional connectivity between the amygdala and the anterior cingulate cortex, the dorsolateral prefrontal cortex, and the motor cortex (Golkar et al., 2014). Functional disintegration of the networks connecting the limbic system with the prefrontal cortex, as well as a decrease in the volume of the basal ganglia structures, has been revealed under clinical manifestations of exhaustion disorder (Grossi et al., 2015). According to Shang et al. (2022), burnout syndrome is associated with increased characteristic path length and decreased global efficiency, which suggests disrupted global Frontiers in Human Neuroscience 03 frontiersin.org ...
... These findings contribute to the growing body of knowledge on the neural correlates of burnout, fostering a deeper understanding of its underlying mechanisms. Results confirm previous neuroimaging studies that showed functional changes in frontal areas in burnout subjects (Abe et al., 2022;Blix et al., 2013;Golkar et al., 2014;Grossi et al., 2015;Savic et al., 2018;Sandström et al., 2011;Tei et al., 2014). Referring to previous EEG studies on burnout, the results confirm significant changes in alpha band (Luijtelaar et al., 2010;Golonka et al., 2019a;Harmatiuk et al., 2023;Tement et al., 2016). ...
Chronic occupational stress is associated with a pronounced decline in emotional and cognitive functioning. Studies on neural mechanisms indicate significant changes in brain activity and changed patterns of event-related potentials in burnout subjects. This study presents an analysis of brain functional connectivity in a resting state, thus providing a deeper understanding of the mechanisms accompanying burnout syndrome. The sample consists of 49 burnout employees and 49 controls, matched by age, gender and occupation (Mage = 36.15, SD = 8.10; 59 women, 39 men). Continuous dense-array EEG data were collected from a 256-channel EEG system. The difference in functional connectivity between burnout and control subjects was tested in the eyes-closed (EC) and eyes-open (EO) conditions using the resting-state paradigm. The results indicate significant differences in brain activity between the burnout and the control groups. The resting-state network of the burnout group is characterized by decreased functional connectivity in frontal and midline areas in the alpha3 sub-band (11–13 Hz) in an eyes-open condition. The most significant effect of decreased connectivity was observed in the right frontal brain area. For the first time, these analyses point to distinctive aspects of functional connectivity within the alpha3 sub-band in burnout syndrome. These findings provide insights into the neurobiological underpinnings of burnout syndrome and its associations with changed resting-state networks. The data on neural characteristics in burnout subjects may help to understand the mechanisms of decline in cognitive function and emotion regulation and to search for adequate methods of treatment.
... The description of exhaustion disorder includes physical and mental symptoms including markedly reduced energy manifesting as lack of initiative, lack of stamina, or increased need for recovery after completed assignments. In a review of burnout syndrome, Grossi et al. (2015) concluded that exhaustion is the most valid equivalent construct of burnout for clinical practice. Corroborating this suggestion, McCormack et al. (2018) reviewed the prevalence and causes of burnout among psychologists and found that exhaustion is the most pronounced dimension of burnout among psychologists. ...
... The present study has potential implications. Exhaustion is especially problematic among health care professionals such as clinical psychologists (e.g., McCormack et al., 2018;Rubert & Kent, 2007) and has negative effects for the affected individual as well as for patients/clients and organizations (e.g., Grossi et al., 2015;Jun et al., 2021). Although the relationship between emotional demands at work and exhaustion is well-established, emotional demands are difficult to reduce among clinical psychologists since it is so closely linked to the very core of the work. ...
The present study investigated the role of clinical supervision frequency for the workplace-related emotional demands on the exhaustion relationship among qualified clinical psychologists. Based on the self-reports of 789 clinical psychologists, the results showed a positive association between emotional demands at work and exhaustion and indicated that participating in clinical supervision at an average frequency (once a month) buffered (i.e. moderated) the emotional demands to exhaustion relationship, when compared to low frequency (every other month or less often). The empirical contributions and practical implications of the results are discussed.
... During the last decades, rapid advancements in society have transformed how we live, work, and interact, resulting in higher exposure to mental strain (Atroszko et al., 2020). Elevated stress over longer periods of time can have a negative impact on daily life and is associated with other physical and psychological problems such as anxiety, impaired sleep, depression, and exhaustion (Cohen et al., 2007;Grossi et al., 2015). Increased levels of stress are also associated with a negative impact on quality of life (Parsaei et al., 2020), a wider construct of self-perceived satisfaction with important life areas such as work, friendship, creativity, and leisure, that should be measured separately from other mental health symptoms (Lindner et al., 2016). ...
... Mental and physical effort in daily activities lead to long recovery periods and it is a common cause for workplace sick leave in Sweden . Prolonged exposure to stress has direct effects on people's well-being and leads to immense costs for society (Grossi et al., 2015;Hassard et al., 2018;Kivimäki & Steptoe, 2018;Melchior et al., 2007). Despite these well-known and detrimental consequences, a majority of all individuals suffering from stress and other mental health-related disorders, remain untreated . ...
Background
Internet-based Cognitive Behavior Therapy (ICBT) and mindfulness interventions are commonly used to treat elevated levels of stress. There are however few high-quality studies that examine ICBT with integrated mindfulness components for symptoms of stress and exhaustion, and the role of mindfulness exercises in digital treatment.
Method
The aim of the present study was to evaluate if a mindfulness-focused ICBT-program could reduce symptoms of stress and exhaustion, and increase quality of life, in a randomized controlled trial including 97 self-referred participants between 18 and 65 years who experienced elevated levels of stress.
Results
The intervention group had significantly reduced symptoms of stress and exhaustion, and increased quality of life, compared to the control group. Compared with the controls, participants in the intervention group showed a significant improvement with moderate to large effects on the primary outcome measure perceived stress ( d = 0.79), and the secondary outcomes, exhaustion ( d = 0.65), and quality of life ( d = 0.40). Participants in the ICBT group also increased their level of mindfulness ( d = 0.66) during the program. The amount of mindfulness training was significantly associated with an increased level of mindfulness, which in turn was significantly associated with reduced stress symptoms.
Conclusions
Mindfulness-focused ICBT can be an effective method to reduce stress-related mental health problems and the amount of mindfulness training seems to be of importance to increase the level of experienced mindfulness after treatment.
... Hence, burnout had been recognized as an "occupational phenomenon" resulting from chronic workplace stress that has not been managed [2]. Clinical burnout has been widely recognized by symptoms such as emotional exhaustion, physical fatigue, cognitive impairment, disturbed sleep, and functional impairment [3,4] and could lead to depression, or anxiety disorders [3]. Past studies suggested that overtime [5], shift work [6], lack of sleep [6], and chronic diseases [7] are the primary reasons for burnout. ...
... Hence, burnout had been recognized as an "occupational phenomenon" resulting from chronic workplace stress that has not been managed [2]. Clinical burnout has been widely recognized by symptoms such as emotional exhaustion, physical fatigue, cognitive impairment, disturbed sleep, and functional impairment [3,4] and could lead to depression, or anxiety disorders [3]. Past studies suggested that overtime [5], shift work [6], lack of sleep [6], and chronic diseases [7] are the primary reasons for burnout. ...
Background
During the COVID-19 pandemic, medical workers were concerned about the care of their children or family members and the impact of being separated from them. This increased stress could harm the relationship between nurses and patients. This study assessed how medical workers’ parental role may affect burnout during such a high-stress period.
Methods
This cross-sectional observational study was carried out in 2021 during the COVID-19 pandemic. The client burnout (CB) scale of the Copenhagen Burnout Inventory, the Nordic Musculoskeletal Questionnaire, and a demographic questionnaire were used. Statistical methods such as the t-test, one-way ANOVA, and univariable/multiple linear regression were applied.
Results
A total of 612 nurses were included in this study. The likely risk factors of CB were identified and the parenthood effect was found to be associated with reduced CB. The parental role and leisure activity with family and friends on CB were found to have an impact. Engaging in leisure activity with family and playing the role of a parent diligently will help relieve nurses’ burnout from frequent contact with patients and their families, thus lowering the risk of clinical burnout.
Conclusion
The parental role, family/friends relationships, and a complex work environment associated with nurses’ burnout during the COVID-19 pandemic. This finding allows us to re-examine the importance of family life and parent–child relationships in high-stress work environments.
... The diagnosis chronic stress-induced exhaustion disorder (SED) requires at least 6 months exposure to chronic intensive stress without recovery time, so this diagnosis could be used as a proxy for exposure to chronic stress (Grossi et al., 2015). In research, SED is also referred to as stress-related exhaustion but the direct translation of the Swedish diagnosis "utmattningssyndrom" accepted 2005 into the Swedish version of ICD-10, is exhaustion disorder. ...
... In research, SED is also referred to as stress-related exhaustion but the direct translation of the Swedish diagnosis "utmattningssyndrom" accepted 2005 into the Swedish version of ICD-10, is exhaustion disorder. The diagnoses adjustment disorder and post-traumatic stress disorder (PTSD) also require stress exposure, however, they do not necessarily reflect exposure to chronic stress without recovery time, which has been suggested to be particularly detrimetal for health and function (Grossi et al., 2015). The other diagnostic criteria of SED are fatigue, cognitive symptoms, sleep disturbances, emotional lability or irritability, reduced ability to handle demands or perform tasks under time pressure, and physical symptoms, as well as that no other somatic or psychiatric diagnosis can better explain the symptoms (Socialstyrelsen). ...
The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ. The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012-2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014-2022. Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for the depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5). The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.
... Frailty was measured using a slight modification of the criteria of the frailty phenotype developed by Fried et al. [2] in the Cardiovascular Health Survey. The criteria consist of the following 5 components: 1) unintentional weight loss (self-reported unintentional weight loss in the last 1 year of > 3 kg) [25]; 2) exhaustion (self-perception of stress is extremely high, they are classified as exhaustion) [26]; 3) weakness (handgrip strength < 26 kg based on the Asian working group criteria for sarcopenia) [27]; 4) walking difficulties (if the subjects responded to the mobility question of EQ-5D that there was a difficulty in walking, it was classified as walking difficulties) [28]; 5) low physical activity (physical activity was measured using the Global Physical Activity questionnaire and was classified as low physical activity when recreational activity was < 2 hour per week) [29]. Participants were classified as robust if they fulfilled none of the criteria, pre-frail if they fulfilled 1 or 2 criteria, and frail if they fulfilled 3 or more criteria [2]. ...
... These disruptions can cause a person to feel irritated, sleepless, helpless, dissatisfied, depressed, anxious, and have confidence issues (Bianchi, Schonfeld, & Laurent, 2017). Burnout hinders focus, memory, and awareness, which prompts cognitive ability complications (Grossi et al., 2015). This causes a person to lack the mental energy and comprehension to complete the necessary tasks. ...
Burnout poses a hindrance to the health, productivity, and motivation of workers across various fields. Specifically, burnout has been linked to the education profession due to its high emotional, physical, and intellectual demands. Educators experience burnout after continuously working to accomplish tasks and requirements while under extreme pressure for extended periods. The purpose of this study was to utilize the Maslach Burnout Inventory to observe the prevalence and burnout levels in university teachers. For this study, the quantitative method was applied, and lecturers from universities within the Kurdistan Region of Iraq completed the questionnaire. There were 107 participants, mostly from the private sector, consisting of 54% males and 46% females. SPSS was used to show the statistical differences in burnout regarding aspects of experience, sector, position, age, university, and gender. The results displayed moderate levels of occupational exhaustion (mean score = 20.37) and depersonalization (mean score = 9.92). The evaluation presented that decreased levels of personal accomplishment were found in lecturers with a mean of 30.70. Acknowledging and managing burnout instigators is necessary for preserving the well-being of educators and educational quality. Thus, institutions applying specific approaches or providing services can ensure that burnout is prevented or contained.
... The most widely recognized and used scale is the Maslach Burnout Inventory (MBI). Other commonly used scales include the Burnout Measure (BM), the Copenhagen Burnout Inventory (CBI), the Oldenburg Burnout Inventory (OLBI), the Shirom-Melamed Burnout Questionnaire (SMBQ), and its later version, the Shirom-Melamed Burnout Measure (SMBM) [8]. Clinicians often associate burnout syndrome with severe stress, adjustment disorder, undifferentiated somatoform disorder, or major depression; however, it appears that "work-related neurasthenia" most closely aligns with the clinical manifestations of burnout [6]. ...
Background/Objectives: Burnout is a critical concern among healthcare professionals, particularly during crises such as the COVID-19 pandemic. This study investigated burnout levels among forensic medicine and pathology personnel at three distinct phases: the early pandemic period (Phase 1—September 2020), the peak of the pandemic (Phase 2—October 2021), and the post-pandemic period (Phase 3—October 2024). Methods: A total of 37 participants employed in forensic medicine and pathology departments completed the Maslach Burnout Inventory (MBI). A one-way repeated measures ANOVA was conducted to assess within-subject differences over time. Normality and sphericity were tested using the Shapiro–Wilk test and Mauchly’s test, with the Greenhouse-Geisser correction. Post hoc Bonferroni-adjusted comparisons identified significant differences, and partial eta squared (η²) was reported for effect sizes. Results: Results showed significant fluctuations in burnout levels across the three phases. Emotional exhaustion and low personal accomplishment peaked during Phase 2, with slight reductions observed in Phase 3. Gender differences were evident, with females reporting higher EE levels and males exhibiting higher depersonalization across all phases. Marital and parental status also influenced burnout levels, with unmarried individuals and those without children showing higher burnout scores. Medical doctors experienced the highest burnout levels among professional roles, while auxiliary staff showed significant challenges in the PA subscale. Conclusions: The COVID-19 pandemic was pivotal in exacerbating burnout levels due to increased workload, crisis decision-making, and emotional toll. Although the sample size is limited, these findings underscore the importance of implementing targeted interventions to mitigate burnout among forensic and pathology personnel, especially during healthcare emergencies. Gender-based differences in burnout suggest the necessity of specific workplace well-being strategies, while the protective role of family status demonstrates the importance of work-life balance policies. The persistence of psychological distress after a medical crisis calls for long-term monitoring and support programs. There is a need for improved workload distribution, peer support networks, and mental health training to build resilience among forensic and pathology personnel.
... Other scales include the Burnout Measure (BM), Copenhagen Burnout Inventory (CBI), Oldenburg Burnout Inventory (OLBI), Shirom-Melamed Burnout Questionnaire (SMBQ), and its later version, the Shirom-Melamed Burnout Measure (SMBM). Sweden has introduced a disorder called "exhaustion disorder" in their version of the ICD-10 to facilitate a more accurate and rapid diagnosis of burnout [34]. Studies have identified psychophysiological symptoms characteristic of burnout syndrome compared to other psychiatric disorders such as major depressive disorder, anxiety disorder, or posttraumatic stress disorder (PTSD). ...
The burnout phenomenon is a subject of considerable interest due to its impact on both employee well-being and scientific inquiry. Workplace factors, both intrinsic and extrinsic, play a pivotal role in its development, often leading to job dissatisfaction and heightened burnout risk. Chronic stress and burnout induce significant dysregulation in the autonomic nervous system and hormonal pathways, alongside structural brain changes. This paper presents a preliminary review of the literature on burnout syndrome among forensic science workers, focusing on the prevalence of this phenomenon and its triggers. This review aims to consolidate existing research on burnout among forensic medicine workers, highlight significant findings, and encourage further studies. Symptoms range from demoralization to somatic complaints. The Maslach Burnout Inventory (MBI) was the main tool in assessing burnout levels alongside measures of occupational stress, vicarious trauma and posttraumatic stress syndrome. Forensic medicine workers face unique stressors, with notable impacts on burnout levels. These workers experience challenges such as workplace conflicts and exposure to traumatic cases, leading to moderate or high burnout levels, particularly, emotional exhaustion, depersonalization or low personal accomplishment. Despite the prevalence of burnout, many forensic medicine workers lack access to support networks and perceive a disregard for their well-being from supervisors. There is a pressing need for further research to understand the biological mechanisms, susceptibility factors, and discover diagnostic markers of burnout syndrome, with the goal of its recognition as a psychiatric disorder in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders.
... Although there seems to be an international consensus that long-term exposure to external threats and challenges can have detrimental health consequences (e.g., mental and physical fatigue/exhaustion, cognitive deficits, and impaired sleep), the specific nomenclature for medical conditions related to prolonged exposure to stressors is less agreed upon. Terms such as burnout, adjustment disorder, work-related stress, stressrelated mental disorders, and allostatic overload are used interchangeably in the literature (Arends et al. 2012;Fava, Cosci, and Sonino 2017;Grossi et al. 2015) and are often debated. The burnout construct, for example, has been subject to international debate for decades pertaining to definition, discriminant validity, and whether the condition merits a place in established diagnostic manuals (Bianchi et al. 2021;Nadon, De Beer, and Morin 2022). ...
Exhaustion disorder (ED) was introduced to the Swedish version of the International Classification of Diseases, 10th edition (ICD‐10) 2005. Primarily characterized by general fatigue and cognitive deficits, ED has become one of the most common mental health diagnoses in Sweden. Little is still known regarding the discriminative validity of the ED diagnosis and how it relates to other diagnostic constructs. The study aimed to investigate the discriminative validity of ED compared with two similar diagnoses, major depressive disorder (MDD) and adjustment disorder (AD). Using data from a sample of patients with a principal diagnosis of either ED ( n = 352), MDD ( n = 99), or AD ( n = 302), we compared demographic and clinical variables and scores on self‐report symptom scales. Results showed that ED patients were of a higher age and had a higher frequency of sickness absence than MDD and AD patients. There was a substantial overlap of symptoms between ED and MDD, only differing on two of nine self‐report symptom scales, with ED patients rating lower work ability d = −0.37 and alcohol consumption d = −0.57. Compared with AD patients, ED patients reported more severe symptoms in every symptom domain. Given the prevalent use of ED diagnosis, its diagnostic validity and clinical usefulness merit further attention.
... In an international context the core symptoms of ED share many similarities with the frequently used concept of clinical burnout, in the literature described as a syndrome resulting from chronic workplace stress that has not been successfully managed. However, clinical burnout is not a medical diagnosis, while the Swedish diagnosis ED, is classified as a medical condition caused by stress factors both in the workplace and home life (Grossi et al., 2015). Earlier studies focusing on course of symptoms, biological processes and sick leave pattern of individuals diagnosed with ED have shown that sick leave leave longer than 6 months is common in this patient group (Glise et al., 2012(Glise et al., , 2014(Glise et al., , 2020Hansson et al., 2022). ...
Patients diagnosed with stress induced exhaustion disorder (ED) often require long sick leave before returning to work. The aim of this study was to describe the experiences of physiotherapists and occupational therapists with respect to interprofessional collaboration and treatment strategies for patients diagnosed with ED. This study has an explorative qualitative design and was conducted as an interview study using a semi-structured question guide. All interviews were tape-recorded and transcribed verbatim. The interviews were conducted at 14 different rehabilitation centres with 12 physiotherapists and 3 occupational therapists. Six of these centres were run within the public sector and 9 were run by private suppliers. The informants had an average of 17 years of experience in their profession, with a range of 4–49 years. The interviews were analysed by means of qualitative inductive content analysis, where the manifest as well as the latent content became visual. The analysis resulted in an overall theme: Equitable care—a strategy on feet of clay, supported by three main categories (a) rehabilitation centres- an isolated island, (b) evidence-based treatments- under the radar (c) patient participation-a double-edged sword. The current organizational structure of rehabilitation centers within Swedish primary health care falls short in meeting the integrated and collaborative care requirements for patients with stress-related exhaustion disorder (ED). Furthermore, the absence of evidence-based treatments poses a challenge in devising personalized and appropriately timed treatment strategies.
... A study suggested that long-term exposure to aircraft noise leads to hypothalamic-pituitaryadrenal (HPA) axis dysregulation and a flattened cortisol rhythm characterized by a small morning-evening difference 41,42 . Flattened diurnal cortisol profiles have been reported to be associated with fatigue, burnout, and vital exhaustion [43][44][45] . However, large-scale prospective investigations are required to evaluate the role of HPA axis dysregulation in the association between environmental noise exposure and burnout. ...
Few studies have explored the association between residential noise exposure and burnout. In this study, we investigated the association between residential noise exposure and burnout prevalence among 5416 health-care workers in Taiwan from 2012 to 2017. Burnout was evaluated using the Mandarin version of the Copenhagen Burnout Inventory by considering both continuous and binary measures. We applied ordinary Kriging models to calculate the annual average residential noise exposure at an individual level. Multivariable linear regression models and logistic regression models were employed. Restricted cubic splines were used to explore dose–response relationships. The median age of the health-care workers was 31.5 years. In the multivariable linear regression models, exposure to residential noise (per 1 dBA) was associated with increases in personal burnout and work-related burnout scores by 1.59 ± 0.25 and 1.38 ± 0.20, respectively. In the multivariable logistic regression models, the adjusted odds ratios were 1.24 (95% confidence interval [CI]: 1.16, 1.32) for personal burnout and 1.19 (95% CI: 1.13, 1.26) for work-related burnout per 1-dBA increase in residential noise exposure. Linear dose–response associations of burnout with residential noise level were detected. Our findings suggest that exposure to residential noise may increase the risk of burnout among health-care workers.
... The second majority of research respondents responses is feel exhausted. The exhaustion of available cognitive resources, appeared in terms of decreased speed as well as in terms of subjective feelings, mainly fatigue and sleepiness, (Gilsoul et al., 2020;Grossi et al., 2015;Ketvel et al., 2023). Also, burnout (Cuadrado et al., 2022;Libano et al 2021) and social media fatigue, (Nurhamidin & Huwae, 2024), which later result in elevated anxiety and depression, (Dhir et al., 2018). ...
Depression, like other psychological disorders, is dynamic. To achieve complete level of healing is a challenge in itself for survivors. Guilty feeling, emotional exhaustion, unfinished conflict or problems with other people, and or even stressful events, can turn into depression. The aim of this research is to examine the role of hardiness as a mediator in the relationship between revenge motivation of forgiveness and depression in depth, in order to be able to overcome the problems that arise when an event threatens to occur. The participants in this research were 140 college students from campus X, the majority of whom were female. The sampling technique in this research uses incidental sampling. Hardiness and Forgiveness are variables that contribute to a person's level of depression. In this study, depression is the dependent variable, forgiveness is independent variable, and hardiness is intervening variable. The research measuring tools in this study used the Beck Depression Inventory test, the Resilience scale, and the Transgression-Related Interpersonal Motivations Inventory (TRIM R) scale. The data analysis techniques used in this research are Multiple Linear Regression and Path Analysis techniques. Based on the analysis data, hardiness plays a role in helping revenge motivation of forgiveness reduce depression, where the direct and indirect effect are significant. Amounting to 37.9 % contribution of the mediation model in this study to depression.
... To date, there is no consensus on how to diagnose clinical burnout and related fatigue-dominated disorders and different overlapping definitions have been used in the literature, including chronic burnout, stressrelated exhaustion, job stress-related depression and work-related neurasthenia [9]. In Sweden, exhaustion disorder (ED) has been introduced as a clinical diagnosis equivalent to clinical burnout, characterized by physical and psychological exhaustion and symptoms such as disturbed sleep, cognitive impairment, emotional lability, and somatic symptoms [10], with fatigue being a core symptom reported by patients [11,12]. ...
Background
Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process.
Method
Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6–10 years after undergoing treatment. The interviews were analyzed with thematic analysis.
Results
Three themes resulted from the analysis. The first theme, “A long and rocky road”, summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants’ own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme “Recovery activities are needed every step of the way” describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, “Reorienting to a new place”, captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning.
Conclusions
Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process.
Trial registration
ClinicalTrials.gov: NCT0073772. Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).
... *Significant at 10%; **significant at 5%; ***significant at 1%. and behavioural change [39]. In burnout research, symptoms can be signals of a "sick system" and dysfunctional coping strategies, and the need for other, more benefitting structures [40]. Similarly, negative responses to the ongoing destruction of nature and mass suffering of animals could indicate lower cognitive dissonance (value-action gap) and a higher connection to the surrounding world, serving as mental manifestations of the human-animal-environmental bond and desire for structural changes. ...
This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.
... WM operates by directing attentional resources to relevant information [12] but has a limited capacity [13]. The workload and exhaustion experienced in clinical settings have a profound neurobiological impact on several cognitive functions, including WM [14]. cognitive load, defined as 'the amount of information a person holds and processes within working memory' [15], can be negatively impacted by physicians being overloaded or burned out by clinical duties. ...
Background:
Optimal cognitive functions, including working memory (WM), are crucial to enable trainee physicians to perform and excel in their clinical practice. Several risk factors, including on-call shifts, poor mental health, burnout, and sleep problems, can impair clinical practice in trainee physicians, potentially through cognitive impairment; however, these associations have not been fully explored.
Objective:
This study investigated the effect of on-call shifts on WM among trainee physicians and its association with burnout, depression, anxiety, affect, and sleep.
Materials and methods:
This cross-sectional study involved 83 trainee physicians (45% male). We measured demographic and training-related factors including on-call shifts and working hours. We also assessed depressive symptoms (PHQ-9), both state and trait anxiety (STAI total score), burnout (OLBI total score), positive and negative affect scores (PANAS), and sleep disturbances (PSQI total score). WM was evaluated using spatial working memory (SWM) strategy scores that reflected performance and total error counts.
Results:
Trainee physicians with more on-calls per month had significantly worse depressive symptoms, burnout scores, and sleep, as well as more negative affect. While controlling for covariates, being on-call more times per month was significantly associated with worse WM. Worse depressive symptoms and burnout scores were also significantly associated with impaired WM.
Conclusion:
Working more on-call shifts is associated with compromised WM. Trainee physicians who experienced more depressive symptoms and burnout had worse WM.
... Da das Kardinalsymptom des Burnout-Syndroms die Erschöpfung darstellt [12,20], überschneidet sich Burnout symptomatisch mit der Neurasthenie (ICD-10-Code: F48.0) und dem chronischen Fatique-Syndrom (CFS; ICD-10-Code: G93.3; [7,21]). Die klinische Validität der Neurasthenie ist insgesamt fraglich [22]. ...
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
... Finally, individuals need to seek help and intervention due to poor physical and emotional problems. Symptoms of clinical burnout include emotional exhaustion, physical fatigue, cognitive impairment, disturbed sleep, and functional impairment [3,4]. As for the factors that impact burnout, previous studies have determined that overtime [5], rotating shift work [6], lack of sleep [6,7], and chronic diseases [8] are associated with an increased risk of burnout. ...
Objectives
This study explores the relationship among commuting, musculoskeletal (MS) pain, and burnout.
Methods
An observational and cross-sectional study was conducted at a medical university-affiliated hospital in Taichung, Taiwan in 2021. The two questionnaire was used and they included the Copenhagen Burnout Inventory (CBI) and the Nordic Musculoskeletal Questionnaire (NMQ). All participants were invited to complete the cross-sectional survey. A multiple linear regression was assessed correlations between commuting, MS pain, and burnout.
Results
After excluding those with missing data, 1,615 healthcare workers were deemed valid as research participants. In multiple linear regression, commuting time longer than 50 min was associated with personal burnout (PB) in the presence of adjusted confounders; however, long commuting time was not associated with work-related burnout (WB). Furthermore, the choice of commuting method did not affect PB or WB. Notably, both neck and shoulder pain (NBSP) and ankle pain (BAP) increase the risk of PB and WB. The mediation analysis demonstrated that NBSP is a mediating factor, increasing the level of PB and WB for commuting times longer than 50 min.
Conclusions
Healthcare workers who commute for more than 50 min should be considered part of a high-risk group for burnout and musculoskeletal pain. They should also be provided with resources and programs focused on burnout prevention and MS pain relief.
... In total 36 of the 220 PHCCs in Region Västra Götaland were approached to inquire whether professionals working with patients seeking care for stress-related exhaustion, preferably those fulfilling the criteria for ED could participate in an interview study. The ED diagnosis is recommended to be used in Sweden for this patient group [22]. These patients can also be classified to have clinical burnout, which is used in many countries, but burnout as a psychological concept has not been proven well suited to be used in clinical practice [4]. ...
Background
Primary health care is the setting for most patients with stress-related mental health problems. Good care processes are important for patients with stress-related mental health problems and the complex needs of these patients has become a challenge for primary care settings which is traditionally designed to manage acute episodes of one illness. The care process of these patients is thus interesting to investigate. The aim of this study was to explore psychologists´ involvement and experiences regarding the organisation of the care process and treatment of patients seeking care for stress-related exhaustion.
Method
Fifteen psychologists (14 women and 1 man, age range 27–72 years)c from fifteen different primary health care centres in the western part of Sweden, located in both rural and urban areas were included. Qualitative content analysis of individual semi-structured interviews was conducted.
Results
The analysis resulted in eight subcategories within the two main categories studied illuminating psychologists’ involvement and experiences regarding the organisation of the care process and challenges regarding treatment of patients seeking care for stress-related exhaustion.
Conclusion
The care process of patients with stress-related exhaustion is perceived to be ineffective and not congruent with the needs of the patients. A lack of holistic overview of the care process, a lack of collaboration and poor utilization of the health care professionals’ competence leads to an unstructured process forcing the patients to be the carriers and coordinators of their own care.
... (2). Although unique as a medical diagnosis with formalized diagnostic criteria, ED is conceptually similar to other widely recognized stress-related constructs, such as burnout, fatigue, and chronic occupational stress (3,4). Such stress-related mental illness is a large and rapidly growing problem in industrialized societies at large, often leading to long-term sick leave (5) and residual symptoms for several years following the acute phase (6). ...
Introduction
Impaired executive functioning, including cognitive fatigue, is a core feature of the long-term stress-related condition exhaustion disorder (ED). Recent research suggests that a key area for executive control, the lateral prefrontal cortex (LPFC), may be mechanistically linked to cognitive fatigue due to stress. Here, we therefore asked if and how stress, the LPFC and cognitive fatigue may be related in ED.
Methods
We used a multimodal cross-sectional study design with high-resolution structural magnetic resonance imaging (MRI), self-reported measures, and path analysis modeling in 300 participants with ED.
Results
We found positive associations between stress and cognitive fatigue, and stress and LPFC thickness,but no association between LPFC thickness and cognitive fatigue. Furthermore, LPFC thickness did not mediate or moderate the association between stress and cognitive fatigue.
Discussion
These findings suggest that LPFC brain morphology is related to perceived stress levels but not cognitive fatigue, expanding previous research on the role of the LPFC in executive functioning. Moreover, the results support the notion that the LPFC may be mechanistically involved in stress-related executive function impairment but prompt further research into if and how this may be related to cognitive symptoms in ED.
Burnout syndrome, which significantly impacts both individual and societal quality of life, is primarily characterized by three key criteria: depersonalization, emotional exhaustion, and low personal accomplishment, all linked to work-related stress. Purpose: Comparative evaluation of urine metabolite patterns that may discriminate the burnout levels and the effects of night shifts on healthcare professionals. The Maslach Burnout Inventory survey was administered to 64 physicians and nurses working day and night shifts, with scores for each criterion recorded. Methods: Urine samples were collected, and metabolomic patterns were analyzed using UHPLC-QTOF-ESI+-MS technology. This analysis employed both untargeted and semi-targeted metabolomics, coupled with multivariate and ANOVA statistics, utilizing the online Metaboanalyst 6.0 platform. Partial Least Squares Discriminant Analysis (PLSDA) was performed, along with VIP values, Random Forest graphs, and heatmaps based on 79 identified metabolites. These were further complemented by biomarker analysis (AUC ranking) and pathway analysis of metabolic networks. Results: The findings highlighted the biochemical effects of night shifts and their correlation with burnout scores from each dimension. Conclusions: This study demonstrated the involvement of three major metabolic pathways in diagnosing burnout: lipid metabolism, particularly related to steroid hormones (cortisol, cortisone, and androsterone metabolites); energetic metabolism, involving long-chain acylated carnitines as transporters of free fatty acids, which play a role in burnout control; and a third pathway affecting catecholamine metabolism (neurotransmitters derived from tyrosine, such as dopamine, adrenaline, and noradrenaline), as well as tryptophan metabolism (serotonin and melatonin metabolites) and amino acid metabolism (including aspartate, arginine, and valine).
Introduction. The prospect of increasing annually makes burnout a global phenomenon, one of the most common stress-related and mental disorders. Emotional burnout leads to serious destructive consequences for society, organizations, and interpersonal relationships due to mental and behavioural changes. Burnout develops gradually and often goes unnoticed, with symptoms that may take years to manifest and lead to significant mental and behavioral changes. Despite its impact, the processes underlying burnout remain largely unknown due to a lack of specialized studies identifying specific biomarkers. Early detection of burnout, particularly at the critical onset of symptoms, is essential. Aim. This study aimed to examine EEG frequency changes associated with the severity of the Anxiety-Tension stage of Emotional Burnout. Materials and methods. A total of 752 participants, including students and staff from Taras Shevchenko National University of Kyiv (209 males, mean age=19.2; 543 females, mean age=18.28), were assessed using the 84-item Boyko's Syndrome of Emotional Burnout Inventory. EEG data were recorded during a 3-minute resting state with eyes closed, and artifact-free segments from all frequency bands (0.2-45 Hz) were analyzed. Normalized power spectral densities (PSD) were calculated, focusing on the 61-70 second segment of the recordings. Results. The results revealed burnout-related changes in spectral characteristics associated with the Anxiety-Tension stage, with significant alterations observed in the theta 2 band (frontal and left temporal-parietal cortex), alpha 2 band (right parietotemporal cortex), and beta 1 band (left frontal-central-right parietal axis). Conclusions. These findings suggest that the Anxiety-Tension stage primarily impacts processes related to short-term memory and focused attention, providing a potential framework for the early identification of burnout through neurophysiological markers.
The article highlights the problem of the formation and development of the syndrome of professional burnout and evaluates its impact on the functioning of the physiological systems of the human body. The analysis of scientific literature is also presented regarding the definition of specific markers of burnout syndrome, which are formed as a result of the influence of its components on the functioning of the individual, the analysis of neuropsychophysiological changes. In burnout syndrome, morphofunctional changes are observed in the form of a decrease in dendritic arborization in such structures of the CNS as: prefrontal and anterior cingulate cortex, caudate nucleus, insula, hippocampus, and pons. Increases in dendritic arborization and spine density in the amygdala lead to impaired attention, reduced working memory, emotional exhaustion, irritability, anxiety, and physical fatigue. Hyperstimulation of the hypothalamic-pituitary-adrenal axis leads to an increase in the secretion of cortisol and catecholamines, which, in combination with the inhibition of nitric oxide production, contributes to the risk of cardiovascular diseases, such as arteriosclerosis, hypertension, and other metabolic disorders. There are changes in the respiratory system, including bronchial hypersensitivity, asthma, increased respiratory symptoms and the risk of developing inflammatory processes. Exhaustion syndrome is accompanied by a malfunction of the organs of the gastrointestinal tract, and narrowing of blood vessels in them, which can be the cause of gastric and duodenal ulcers, irritable bowel syndrome, portal hypertension, and liver necrosis. Along with this, there is a decrease in the bodys resistance to infectious diseases, which manifests in a violation of the ability of the immune system to suppress latent viruses and inflammatory processes. Long-term exposure to stressors leads to a decrease in libido, erectile dysfunction and deterioration of sperm quality in men, as well as menstrual cycle disorders, anovulation and infertility in women. Energy metabolism in the body during burnout syndrome is inhibited, and the ATP levels and mitochondrial respiration decrease. Prospects for further development include additional diagnostics of the above markers, including the determination of the concentration of components of the adenyl system in saliva, which will allow a more objective determination of the presence or absence of this syndrome, and the development of a correctional program aimed at restoring mental health.
The Shirom‐Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) is a self‐report instrument frequently used for assessing degree of burnout and screening for stress‐related exhaustion disorder. The aim of the present study was three‐fold. First, to examine reliability and construct validity of different versions of SMBM with 6–22 items in a clinical context. Second, to examine the criterion validity by assessing sensitivity and specificity and determining clinical cut‐offs for these versions of the SMBM, and third to examine the prevalence of burnout in a general population and primary care sample using the proposed cut‐offs. Two Swedish samples were used for the first two purposes: a clinical sample of patients diagnosed with exhaustion disorder ( n = 149), and a matched sample of healthy controls ( n = 60). For the third purpose a sample from the general population ( n = 3406), and a primary care clinical sample ( n = 326) was used. The modified versions of the SMBM showed good internal consistency, construct validity, dimensionality and model fit on the clinical exhaustion disorder sample, as well as configural measurement invariance across clinical and non‐clinical samples. The sensitivity (94.6%–95.3%) and specificity (93.3%–95.0%) in identifying cases with exhaustion disorder based on the cut‐off of 4.0 for the 19‐, 16‐ and 11‐items versions, and on the cut‐off of 3.75 for the 6‐item version was high. The prevalence of burnout was 81.2% in the primary care sample and 16.6% in the general population sample. The findings indicate that the SMBM is a useful instrument for screening for exhaustion disorder and burnout.
Background Understanding acute psychological responses to physical exercise is important since they likely influence the initiation and maintenance of this behavior. Given its effectiveness in reducing symptoms in various psychological disorders, physical exercise should be further explored in Exhaustion Disorder (ED; ICD-10-SE: F43.8A), a condition characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies are available on the psychological effects of acute exercise in ED patients. Aims This study aims to (1) investigate the psychological responses to acute exercise in ED patients compared to healthy controls and (2) determine if these responses differ between low and moderate exercise intensities. Methods We conducted a two-armed cross-over trial in two groups: ED patients (n = 30) and healthy controls (n = 30). On two separate occasions, participants completed a 22-minute exercise at low or moderate intensity on a cycle ergometer, in randomized order. The main outcome was perceived fatigue, and secondary outcomes were feelings of energy, anxiety, stress, perceived exertion, and perceived psychological discomfort, all measured before, during, and up to 24 hours after exercise. Effects of the exercise conditions were assessed with repeated measures analysis of variance. Results ED patients reported higher exertion and psychological discomfort before and during exercise, higher fatigue, anxiety, and stress but lower energy throughout the trial compared to the controls. ED patients experienced more reduced fatigue and stress after both intensities (p < 0.05), and a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). No interactions between groups were found for anxiety over time. No differences were observed between pre-exercise and 6 hours or 24 hours post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 minutes after moderate-intensity exercise. Conclusions A 22-minute exercise was perceived as more strenuous by patients with exhaustion disorder and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals, without delayed negative changes. These findings can inform intervention design and guide clinical practice. Trial registration The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022-04943-01.
Erlendar rannsóknir sýna að háskólakennarar upplifa mikið álag í starfi og að tíðni kulnunareinkenna meðal þeirra er há, ekki síður en hjá kennurum annarra skólastiga. Hér á landi hafa kulnunareinkenni meðal háskólakennara ekki verið rannsökuð áður, en í starfsumhverfiskönnun Háskóla Íslands segjast 80% akademískra starfsmanna upplifa mikið vinnuálag. Kulnunareinkenni, svo sem örmögnun, hugræn og tilfinningaleg skerðing, og skyn-, hjartsláttar-, og meltingartruflanir, eru afleiðing langvarandi vinnuálags og ofvirkni streitukerfa líkamans. Séu kulnunareinkenni mikil og langvinn skapast hætta á kulnunarröskun sem er alvarleg og kostnaðarsöm fyrir einstaklinga og samfélag. Í þessari rannsókn var tíðni kulnunareinkenna metin með netkönnun meðal félagsfólks í Félagi háskólakennara og Félagi prófessora við ríkisháskóla, N = 624. Tíðni kulnunareinkenna og líkur á kulnunarröskun voru metin með íslenskri útgáfu skimunarlistans Burnout Assessment Tool. Þá svöruðu þátttakendur spurningum um vinnuálag og félagslegan stuðning á vinnustað. Niðurstöður sýna að 36% svarenda eru í mikilli eða mjög mikilli hættu á kulnunarröskun, en að tíðni og alvarleiki einkenna fari eftir stöðu innan háskólanna. Doktorsnemar eru í sérlega mikilli hættu á kulnunarröskun, en starfsfólk sem ekki sinnir kennslu er í minni hættu. Konur og yngri svarendur mælast með tíðari einkenni en karlar og eldri svarendur. Vinnuálag mælist mjög mikið hjá akademísku starfsfólki og álag hefur sterk tengsl við tíðni kulnunareinkenna. Félagslegur stuðningur á vinnustað er mestur hjá stjórnsýslustarfsfólki og hefur neikvæð tengsl við tíðni einkenna. Það er mat höfunda að háskólayfirvöldum beri að taka þessar niðurstöður alvarlega og koma á forvörnum með því markmiði að minnka vinnuálag á akademískt starfsfólk háskóla og draga þar með úr líkum á kulnun.
A report on burnout-related practices in 10 different countries, commissioned by the Finnish Government's analysis, assessment and research services and conducted as a consortium between the Finnish Institute of Occupational Health and Tampere University.
Amaç: Ülkemizde asistan hekimlerin, uzmanlık eğitimi sürecinde ağır iş yükü ve önemli zorluklarla karşı karşıya kaldığı bilinmektedir. Bu durumun asistan hekimlerde stres ve mesleki doyum düzeylerini etkileyebileceği, ruhsal ve bedensel yakınmalara sebep olabileceği düşünülmektedir. Bu çalışmanın amacı, asistan hekimlerde stresle başa çıkma tarzları ve mesleki doyum düzeylerini değerlendirmenin yanısıra asistan hekimlerin mevcut ruhsal belirtilerini araştırmaktır. Yöntemler: Araştırmaya dahil edilme kriterlerini karşılayan toplam 174 asistan hekim katıldı. Katılımcılara Sosyodemografik Veri Formu, Stresle Başa Çıkma Tarzları Ölçeği, Mesleki Doyum Ölçeği, Eysenck Kişilik Anketi ve Belirti Tarama Ölçeği (SCL-90-R)uygulandı. Bulgular: Çalışmamızda asistan hekimlerde stresle başa çıkma tarzları arasında en sık kullanılan yöntemin kendine güvenli yaklaşım olduğu bulunmuştur. İyimser yaklaşım tarzı ve mesleki doyum düzeyleri; erkek, 30 ve üzeri yaştaki hekimlerde, kıdemli asistan hekimlerde anlamlı derecede yüksek çıkmıştır. Çaresiz yaklaşım tarzı, asistanlık süresi 18 ay ve altı olan asistan hekimlerde daha fazla tespit edilmiştir. Stresle başa çıkma tarzları ve mesleki doyum düzeyleri arasında anlamlı ilişki bulunamamıştır. Ruhsal belirti dağılımına bakıldığında en yüksek puanların sırasıyla obsesif kompulsif belirti, kişilerarası duyarlılık ve depresyon alt kategorilerine ait olduğu, kadın hekimlerde depresyonun, erkek hekimlerde kişilerarası duyarlılığın en sık görülen ruhsal belirti olduğu saptanmıştır. Tüm ruhsal belirtiler, kendine güvenli yaklaşım ve iyimser yaklaşım ile negatif yönlü, çaresiz yaklaşım ile pozitif yönlü anlamlı bir ilişki göstermiştir. Branşlar arasında stresle başa çıkma tarzları, mesleki doyum düzeyleri ve ruhsal belirti dağılımı açısından anlamlı farklılık olmadığı saptanmıştır. Sonuç: Asistan hekimlerde stres düzeylerini azaltacak ve mesleki doyum düzeylerini artıracak müdahaleler (daha iyi çalışma koşulları oluşturulması, yoğun iş yükünün azaltılması, bilgi ve tecrübeyi arttıracak çalışma motivasyonunu yükseltecek imkanlar sunulması vb.) hekimlerin ruhsal bedensel iyilik hali ve topluma daha nitelikli hizmet sunmaları açısından önemlidir.
International research has documented that prosecutors and lawyers are at increased risk of reporting symptoms of internalizing mental health disorders. Much existing research is based on small convenience samples and no studies have hitherto been conducted among Danish prosecutors. EU estimates indicate that Denmark reports among the highest number of legal cases while simultaneously figuring among the countries with the lowest governmental expenditures on courts of law. The aim of this study was to estimate the occurrence of burnout, secondary traumatization, and posttraumatic stress disorder among Danish prosecutors. Additionally, we aimed to study the relationship between these outcomes perceived work-environment and stressors at work, as well as different coping strategies in handing emotionally demanding cases at work. A nation-wide online survey was distributed to all attorneys in Denmark. A total on N = 233 participated, corresponding to a participation rate of 39%. Findings indicated that burnout was the most important concern among Danish prosecutors compared to rates of secondary traumatization and PTSD that were generally low. Quantitative demands, abusive behavior from professional counterparts and emotional impact from cases were the main correlates of burnout symptoms.
Burnout is an increasing public health problem. Although research indicate that cognitive and affective factors are related to burnout, there is a lack of knowledge about the extent to which specific cognitive and affective symptoms are related to burnout, and whether there are sex-related differences. An aim of this study was to identify specific self-reported cognitive and affective symptoms that are particularly associated with burnout, both in the population in general and in men and women separately. Another aim was to examine the risk of burnout for specific symptoms and total number of symptoms in the general population and in men and women separately. Cross-sectional data were used from a large population-based questionnaire study consisting of 3406 participants (18–79 years) randomly selected from a general population in northern Sweden. Eleven cognitive and affective symptoms were assessed with a subsection of the Environmental Hypersensitivity Symptom Inventory, and the 22-item Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. The findings suggest that burnout is associated with a rather large number of cognitive and affective symptoms, in particular feeling tired/lethargic, having concentration difficulties, sleep disturbance, feeling depressed and being absent minded. Women with burnout (SMBQ score ≥ 4) reported higher prevalence of feeling tired/lethargic and sleep disturbance. The results add to the understanding of affective and cognitive symptomatology in burnout, which might have implications for early identification and prevention of burnout and exhaustion disorder.
This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5–10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation’s outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel’s mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status.
Despite the extensive knowledge about the effects of chronic stress on cognition, the underlying mechanisms remain unclear. We conducted a cross-sectional moderation analysis on a population-based sample of 596 adults to examine the age- and sex-specific role of emotion regulation (ER) in the relationship between chronic stress and cognitive performance using validated self-report questionnaires. While women showed no direct or moderated relationship between stress and cognition, men displayed a distinct age-related pattern where stress was negatively associated with poorer cognitive performance at older ages, and the onset of this relationship was detected earlier in men with ER problems. These results showed that suppression of emotions and lack of executive control of ER amplify the negative consequences of chronic stress and suggest that there are sex-specific differences in the decline of ability to cope with long-term exposure to stressors.
The burnout literature has focused on the determinants of burnout, whereas its careers consequences remain understudied. Therefore, we investigate whether recently burned-out individuals differ in job preferences from non-burned-out workers. We link these differences in preferences with (1) perceptions of job demands and resources, as well as (2) the weighting of such perceptions. To this end, a sample of 582 employees varying in their history of burnout judged job offers with manipulated characteristics in terms of their willingness to apply as well as perceived job demands and resources. We find that recently burned-out employees appreciate possibilities to telework and fixed feedback relatively more, while being relatively less attracted to learning opportunities. These findings can be partially explained by differences in the jobs’ perceived resources.
Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
Задача обзора зарубежных публикаций заключается в анализе психопатологических проявлений выгорания и его клинического варианта (истощения). Исследования указывают на наличие тесной взаимосвязи выгорания и депрессивных расстройств, провоцированных хроническими профессиональными стрессовыми факторами. Приводятся критерии клинического варианта выгорания (истощения), включающие все признаки астенического синдрома. Рассматриваются особенности психофармакотерапии депрессий с сопутствующим истощением с акцентом на препаратах с дофаминергическими свойствами.
This review focuses on human psychoneuroimmunology studies published in the past decade. Issues discussed include the routes through which psychological factors influence immune function, how a stressor's duration may influence the changes observed, individual difference variables, the ability of interventions to modulate immune function, and the health consequences of psychosocially mediated immune dysregulation. The importance of negative affect and supportive personal relationships are highlighted. Recent data suggest that immune dysregulation may be one core mechanism for a spectrum of conditions associated with aging, including cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes, certain cancers, and frailty and functional decline; production of proinflammatory cytokines that influence these and other conditions can be stimulated directly by negative emotions and indirectly by prolonged infection.
Background:
Insomnia-type sleep disturbances are frequent among patients suffering from stress-related exhaustion disorder. However, clinical observations indicate that a subgroup suffer from sleep lengths frequently exceeding 9 hours, coupled with great daytime sleepiness.
Aims:
The aim of the present study was to investigate differences in socio-demographic variables, use of medications, sleep parameters, anxiety, depression and fatigue, between individuals with varying sleep lengths, in a sample of 420 Swedish patients (mean age 42 ± 9 years; 77% women) referred to treatment for exhaustion disorder. Patients were allocated to the groups: "never/seldom ≥ 9 hours" (n = 248), "sometimes ≥ 9 hours" (n = 115) and "mostly/always ≥ 9 hours" (n = 57), based on their self-rated frequency of sleep lengths ≥ 9 hours.
Methods:
The design was cross-sectional and data was collected by means of questionnaires at pre-treatment.
Results:
Univariate analyses showed that patients in the "mostly/always ≥ 9 hours" group were more often on sick leave, and reported more depression and fatigue, better sleep quality and more daytime sleepiness, than patients in the other groups. Multivariate analyses showed that these patients scored higher on measures of fatigue than the rest of the sample independently of gender, use of antidepressants, sick leave, depression and quality of sleep.
Conclusions:
Patients suffering from exhaustion disorder and reporting excessive sleep seem to have a generally poorer clinical picture but better quality of sleep than their counterparts with shorter sleep lengths. The mechanisms underlying these differences, together with their prognostic value and implications for treatment remain to be elucidated in future studies.
Despite mounting reports about the negative effects of chronic occupational stress on cognitive and emotional functions, the underlying mechanisms are unknown. Recent findings from structural MRI raise the question whether this condition could be associated with a functional uncoupling of the limbic networks and an impaired modulation of emotional stress. To address this, 40 subjects suffering from burnout symptoms attributed to chronic occupational stress and 70 controls were investigated using resting state functional MRI. The participants' ability to up- regulate, down-regulate, and maintain emotion was evaluated by recording their acoustic startle response while viewing neutral and negatively loaded images. Functional connectivity was calculated from amygdala seed regions, using explorative linear correlation analysis. Stressed subjects were less capable of down-regulating negative emotion, but had normal acoustic startle responses when asked to up-regulate or maintain emotion and when no regulation was required. The functional connectivity between the amygdala and the anterior cingulate cortex correlated with the ability to down-regulate negative emotion. This connectivity was significantly weaker in the burnout group, as was the amygdala connectivity with the dorsolateral prefrontal cortex and the motor cortex, whereas connectivity from the amygdala to the cerebellum and the insular cortex were stronger. In subjects suffering from chronic occupational stress, the functional couplings within the emotion- and stress-processing limbic networks seem to be altered, and associated with a reduced ability to down-regulate the response to emotional stress, providing a biological substrate for a further facilitation of the stress condition.
Relatively little is known about cognitive performance in burnout. The aim of the present study was to further our knowledge on this topic by examining, in one study, cognitive performance in both clinical and non-clinical burnout while focusing on three interrelated aspects of cognitive performance, namely, self-reported cognitive problems, cognitive test performance, and subjective costs associated with cognitive test performance. To this aim, a clinical burnout patient group (n = 33), a non-clinical burnout group (n = 29), and a healthy control group (n = 30) were compared on self-reported cognitive problems, assessed by a questionnaire, as well as on cognitive test performance, assessed with a cognitive test battery measuring both executive functioning and more general cognitive processing. Self-reported fatigue, motivation, effort and demands were assessed to compare the different groups on subjective costs associated with cognitive test performance. The results indicated that the clinical burnout patients reported more cognitive problems than the individuals with non-clinical burnout, who in turn reported more cognitive problems relative to the healthy controls. Evidence for impaired cognitive test performance was only found in the clinical burnout patients. Relative to the healthy controls, these patients displayed some evidence of impaired general cognitive processing, reflected in slower reaction times, but no impaired executive functioning. However, cognitive test performance of the clinical burnout patients was related to larger reported subjective costs. In conclusion, although both the clinical and the non-clinical burnout group reported cognitive problems, evidence for a relatively mild impaired cognitive test performance and larger reported subjective cost associated with cognitive test performance was only found for the clinical burnout group.
This third version of the MBI was developed across several occupations and countries, in order to assess burnout in all occupations. It was originally published in 1996 by CPP, but is now published and distributed online by Mind Garden (www.mindgarden.com/products/mbi.htm)
This research examines the construct validity of Schaufeli, Leiter, Maslach, and Jackson's (1996) general burnout measure, the Maslach Burnout Inventory-General Survey (MBI-GS). Whereas burnout is traditionally defined and measured in terms of a phenomenon occurring among workers who work with people, the MBI-GS is intended for use outside the human services. The authors first address the internal validity of the MBI-GS using data from two Dutch samples (179 software engineers and 284 university staff members). Confirmatory factor analysis revealed that the distinction among the three subscales of the MBI-GS was retained. To examine external validity, these subscales were then related to selected work characteristics. Based on conservation of resources theory, differential patterns of effects were predicted among the correlates and the three burnout subscales. Expectations were largely supported, suggesting that the meaning of the three subscales is quite different. These results largely replicate findings obtained in similar studies on the validity of the contactual version of the MBI.
Although it is generally accepted that burnout has an effect on cognitive functioning, very few
studies have so far examined the link between cognitive functioning and job burnout. The purpose
of this systematic review was to explore the reported association between burnout and cognitive
functioning, as assessed objectively (that is, using psychometric tests rather than self-reports). The
review identified 15 English-language articles published between 2005 and 2013. The results
suggest that burnout is connected to specific cognitive deficits. In particular, burnout has been found
to be associated with a decline in three main cognitive functions: executive functions, attention and
memory. These results have clear implications, in particular for professions that are characterized by
high levels of both work pressure and cognitive demands. Due to the scarcity and heterogeneity of
available articles, future longitudinal prospective studies are needed, in order to determine the
cognitive functions predominantly impaired as a result of burnout, and to establish causal
relationships.
The aim of this study is to investigate differences in thyroid-stimulating hormone (TSH) level in patients with acute schizophrenia, unipolar depression, bipolar depression and bipolar mania. Serum level of TSH was measured in 1,685 Caucasian patients (1,064 women, 63.1 %; mean age 46.4). Mean serum TSH concentration was: schizophrenia (n = 769) 1.71 μIU/mL, unipolar depression (n = 651) 1.63 μIU/mL, bipolar disorder (n = 264) 1.86 μIU/mL, bipolar depression (n = 203) 2.00 μIU/mL, bipolar mania (n = 61) 1.38 μIU/mL (H = 11.58, p = 0.009). Depending on the normal range used, the overall rate of being above or below the normal range was 7.9-22.3 % for schizophrenia, 13.9-26.0 % for unipolar depression, 10.8-27.6 % for bipolar disorder, 12.2-28.5 % for bipolar depression, and 11.4-24.5 % for bipolar mania. We have also found differences in TSH levels between the age groups (≤20, >20 years and ≤40, >40 years and ≤60 years and >60 years). TSH level was negatively correlated with age (r = - 0.23, p < 0.001). Weak correlations with age have been found in the schizophrenia (r = - 0.21, p < 0.001), unipolar depression (r = - 0.23, p < 0.001), bipolar depression (r = - 0.25, p = 0.002) and bipolar disorder (r = - 0.21, p = 0.005) groups. Our results confirm that there may be a higher prevalence of thyroid dysfunctions in patients with mood disorders (both unipolar and bipolar) and that these two diagnostic groups differ in terms of direction and frequency of thyroid dysfunctions.
The aim of this study is to assess the mutual relationships between burnout and sleep disorders in students in the preclinical phase of medical school.
This study collected data on 127 medical students who filled in the Maslach Burnout Inventory-Student Survey, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Hierarchical logistic regressions tested the reciprocal influence between sleep disorders and burnout, controlling for depression and anxiety.
Regular occurrence of emotional exhaustion, poor sleep quality, and excessive daytime sleepiness affected 60, 65, and 63 % of medical students, respectively. Emotional exhaustion and daytime sleepiness influenced each other. Daytime sleep dysfunctions affected unidirectionally the occurrence of cynicism and academic efficacy. The odds of emotional exhaustion (odds ratio (OR) = 1.21, 95 % confidence interval (CI) = 1.08 to 1.35) and cynicism (OR = 2.47, 95 % CI = 1.25 to 4.90) increased when daytime sleepiness increased. Reciprocally, the odds of excessive daytime sleepiness (OR = 2.13, 95 % CI = 1.22 to 3.73) increased when emotional exhaustion worsened. Finally, the odds of academic efficacy decreased (OR = 0.86, 95 % CI = 0.75 to 0.98) when daytime sleepiness increased.
Burnout and sleep disorders have relevant bidirectional effects in medical students in the early phase of medical school. Emotional exhaustion and daytime sleepiness showed an important mutual influence. Daytime sleepiness linked unidirectionally with cynicism and academic efficacy.
Prolonged stress (≥ six months) may cause a condition which has been named exhaustion disorder (ED) with ICD-10 code F43.8. ED is characterised by exhaustion, cognitive problems, poor sleep and reduced tolerance to further stress. ED can cause long term disability and depressive symptoms may develop. The aim was to construct and evaluate a self-rating scale, the Karolinska Exhaustion Disorder Scale (KEDS), for the assessment of ED symptoms. A second aim was to examine the relationship between self-rated symptoms of ED, depression, and anxiety using KEDS and the Hospital Anxiety and Depression Scale (HAD). Items were selected based on their correspondence to criteria for ED as formulated by the Swedish National Board of Health and Welfare (NBHW), with seven response alternatives in a Likert-format. Self-ratings performed by 317 clinically assessed participants were used to analyse the scale's psychometric properties. KEDS consists of nine items with a scale range of 0-54. Receiver operating characteristics analysis demonstrated that a cut-off score of 19 was accompanied by high sensitivity and specificity (each above 95%) in the discrimination between healthy subjects and patients with ED. Reliability was satisfactory and confirmatory factor analysis revealed that ED, depression and anxiety are best regarded as different phenomena. KEDS may be a useful tool in the assessment of symptoms of Exhaustion Disorder in clinical as well as research settings. There is evidence that the symptom clusters of ED, anxiety and depression, respectively, reflect three different underlying dimensions.
Burnout is a common metaphor for a state of extreme psychophysical exhaustion, usually work-related. This book provides an overview of the burnout syndrome from its earliest recorded occurrences to current empirical studies. It reviews perceptions that burnout is particularly prevalent among certain professional groups - police officers, social workers, teachers, financial traders - and introduces individual inter- personal, workload, occupational, organizational, social and cultural factors. Burnout deals with occurrence, measurement, assessment as well as intervention and treatment programmes.; This textbook should prove useful to occupational and organizational health and safety researchers and practitioners around the world. It should also be a valuable resource for human resources professional and related management professionals.
The dimensionality and validity of the BM (Burnout Measure) is investigated in Dutch samples of human services professionals and white-collar workers (total N = 2190). Results show that, in contrast to the presumed dimensions 'physical exhaustion', 'emotional exhaustion' and 'mental exhaustion', the factors of the BM are 'demoralization', 'exhaustion', and 'loss of motive'. The factorial structure is not affected by using different time frames although an unrestricted time frame results in significantly higher mean scores. A BM version with a seven-point Likert scale results in more reliable subscales than a five-point scale. The factor 'loss of motive' is substantially affected by inconsistent answering patterns of the respondents. The three-factor model of the BM fits equally well in samples of professionals with and without patient contact. The BM subscales correlate highly with fatigue and with the dimension 'emotional exhaustion' of the. Maslach-Burnout-Inventory (MBI) but cannot be distinguished from psychological strain and psychosomatic complaints. Problems in the conceptualization of burnout and its operationalization are discussed. It is concluded that the BM captures only a particular aspect of burnout and is rather a measure of general well-being. Recommendations for further use of a modified BM are given.
Purpose/Objectives: To test the feasibility of a cognitive-behavioral therapy for an insomnia (CBT-I) intervention in chronically bereaved hospice nurses.
Design: Five-week descriptive correlational.
Setting: Nonprofit hospice in central Texas.
Sample: 9 agency nurses providing direct patient and family care.
Methods: Direct care nurses were invited to participate. Two intervention group sessions occurred at the hospice agency and included identification of dysfunctional thoughts and beliefs about sleep, stimulus control, sleep hygiene, and relaxation techniques to promote sleep. Measurements were taken at baseline and three and five weeks postintervention.
Main Research Variables: Sleep quality, depressive symptoms, and narrative reflections on the impact of sleep quality on self-care.
Findings: Participants reported moderate-to-severe sleep disturbances and moderate depressive symptoms. The CBT-I intervention was well accepted by the participants, and on-site delivery increased participation.
Conclusions: Additional longitudinal study is needed to investigate the effectiveness of CBT-I interventions to improve self-care among hospice nurses who are at high risk for compassion fatigue and, subsequently, leaving hospice care.
Implications for Nursing: Hospice nurses are exposed to chronic bereavement that can result in sleep disturbances, which can negatively affect every aspect of hospice nurses' lives. Cognitive-behavioral sleep interventions show promise in teaching hospice nurses how to care for themselves by getting quality sleep.
Knowledge Translation: Identifying the risks for sleep disturbances and depressive symptoms in hospice nurses will allow for effective, individualized interventions to help promote health and well-being. If hospice nurses achieve quality sleep, they may remain in the profession without suffering from chronic bereavement, which can result in compassion fatigue. A CBT-I intervention delivered at the agency and in a group format was feasible and acceptable by study participants.
So far, the large majority of studies on burnout in the international literature have employed the Maslach Burnout Inventory (MBI). In this paper we criticize the MBI on a number of points and present a new tool for the measurement of burnout: the Copenhagen Burnout Inventory (CBI). The CBI consists of three scales measuring personal burnout, work-related burnout, and client-related burnout, for use in different domains. On the basis of an ongoing prospective study of burnout in employees in the human service sector, the PUMA study (Project on Burnout, Motivation and Job Satisfaction; N=1914 at baseline), we analysed the validity and reliability of the CBI. All three scales were found to have very high internal reliability, and non-response rates were small. The scales differentiated well between occupational groups in the human service sector, and the expected pattern with regard to correlations with other measures of fatigue and psychological well-being was found. Furthermore, the three scales predicted future sickness absence, sleep problems, use of pain-killers, and intention to quit. Analyses of changes over time showed that substantial proportions of the employees changed with regard to burnout levels. It is concluded that the analyses indicate very satisfactory reliability and validity for the CBI instrument. The CBI is being used in a number of countries and translations into eight languages are available.
There are increasing reports of cognitive and psychological declines related to occupational stress in subjects without psychiatric premorbidity or major life trauma. The underlying neurobiology is unknown, and many question the notion that the described disabilities represent a medical condition. Using PET we recently found that persons suffering from chronic occupational stress had limbic reductions in the 5-HT1A receptor binding potential. Here we examine whether chronic work-related stress is also associated with changes in brain structure. We performed MRI-based voxel-based morphometry and structural volumetry in stressed subjects and unstressed controls focusing on gray (GM) and white matter (WM) volumes, and the volumes of hippocampus, caudate, and putamen - structures known to be susceptible to neurotoxic changes. Stressed subjects exhibited significant reductions in the GM volumes of the anterior cingulate cortex and the dorsolateral prefrontal cortex. Furthermore, their caudate and putamen volumes were reduced, and the volumes correlated inversely to the degree of perceived stress. Our results add to previous data on chronic psychosocial stress, and indicate a morphological involvement of the frontostriatal circuits. The present findings of morphological changes in these regions confirm our previous conclusion that symptoms from occupational stress merit careful investigations and targeted treatment.
Relatively little is known about the course of symptoms in patients suffering from burnout and
even less about the status of their cognitive functioning. We followed 40 burnout patients and
40 healthy controls who had participated in a previous study on the effect of motivational
interventions on cognitive performance in an experimental task and repeated these
measurements two years later (T2). The burnout patients, who had received psychological
treatment, showed substantial improvement regarding burnout symptoms and cognitive
performance at T2. The pre-post-effect size for symptom reduction was large. Importantly,
cognitive performance and responsiveness to motivational interventions improved to normal
levels. The patients no longer fulfilled the criteria for burnout or any other psychiatric
disorder. Despite these improvements, burnout patients still experienced more exhaustion,
general fatigue, depressive symptoms and general distress in comparison to healthy controls
and compared to normed groups. The same pattern was observed with regard to cognitive
performance: performance improved but remained below normal levels. Perceived job
competence, involvement in work and responsiveness to rewards had returned to normal
levels. The results indicate that although recovery from burnout is possible, symptoms may
persist over the long term (here, two years). This should be taken into consideration by
employers.
This replication study examines the use of the Maslach Burnout Inventory (MBI-GS), a self-report questionnaire on burnout, as a clinical diagnostic instrument for measuring clinical burnout. The MBI and Mini International Neuropsychiatric Interview (MINI), a semistructured interview based on classifications in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), were administered to 419 outpatients at a Dutch multicenter institution specializing in the treatment of work-related psychological problems. MBI scores indicative of the presence of burnout were compared to the primary DSM-IV diagnosis as established by the MINI. The DSM-IV diagnosis "undifferentiated somatoform disorder" was used as a proxy measure for clinical burnout. The results showed that the psychometric properties of the MBI were good. The factorial validity of the MBI could be confirmed. Several decision rules or cutoff points were assessed to determine the discriminant validity of the MBI. None of these cutoff points proved to be sufficiently discriminable, however. Receiver operating characteristic analyses revealed that the MBI showed the highest sum of sensitivity (78%) and specificity (48%) with a cutoff point of 3.50 on the Exhaustion subscale, with a kappa agreement of .25 with the structured diagnostic interview. The practical implication is that the MBI should not be used by itself as a diagnostic tool in a patient population, because of a resultant high probability of overdiagnosing burnout. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
It has been suggested that the motivation to spend effort is decreased in burnout patients, resulting in reduced cognitive performance. A question that remains is whether this decreased motivation can be reversed by motivational interventions. We investigated this by examining the effect of a motivational intervention on cognitive performance. We presented 40 burnout patients in The Netherlands and 40 matched healthy controls with a complex attention task. As expected, in a first block of trials the performance of the burnout patients was poorer than that of healthy controls. Subsequently, we provided the participants with fake positive feedback about their performance and announced that we would financially reward those who performed best in a subsequent block of trials. Contrary to the healthy controls, the burnout patients did not improve their performance and experienced more aversion to spend effort. The study demonstrated that impaired cognitive performance in burnout patients could not be reversed by motivational interventions, which is in line with contemporary theories on burnout that state that physiological changes in burnout may underlie a relatively long-term decrease in motivation. The implication of these results is that in practice employers and therapists might need to accept that there could be a reduction in cognitive performance in employees with burnout.
Despite mounting reports about the negative effects of chronic occupational stress on cognitive functions, it is still uncertain whether and how this type of stress is associated with cerebral changes. This issue was addressed in the present MRI study, in which cortical thickness (Cth) and subcortical volumes were compared between 40 subjects reporting symptoms of chronic occupational stress (38 ± 6 years) and 40 matched controls (36 ± 6 years). The degree of perceived stress was measured with Maslach Burnout Inventory. In stressed subjects, there was a significant thinning of the mesial frontal cortex. When investigating the correlation between age and Cth, the thinning effect of age was more pronounced in the stressed group in the frontal cortex. Furthermore, their amygdala volumes were bilaterally increased (P = 0.020 and P = 0.003), whereas their caudate volumes were reduced (P = 0.040), and accompanied by impaired fine motor function. The perceived stress correlated positively with the amygdala volumes (r = 0.44, P = 0.04; r = 0.43, P = 04). Occupational stress was found to be associated with cortical thinning as well as with selective changes of subcortical volumes, with behavioral correlates. The findings support the hypothesis that stress-related excitotoxicity might be an underlying mechanism, and that the described condition is a stress related illness.
This study provides a summary of 45 exploratory and confirmatory factor-analytic studies that examined the internal structure of scores obtained from the Maslach Burnout Inventory (MBI). It highlights characteristics of the studies that account for differences in reporting of the MBI factor structure. This approach includes an examination of the various sample characteristics, forms of the instrument, factor-analytic methods, and the reported factor structure across studies that have attempted to examine the dimensionality of the MBI. This study also investigates the dimensionality of MBI scale scores using meta-analysis. Both descriptive and empirical analysis supported a three-factor model. The pattern of reported dimensions across validation studies should enhance understanding of the structural dimensions that the MBI measures as well as provide a more meaningful interpretation of its test scores.
In an attempt to understand the effects of the Palestinian uprising on Israelis' burnout, five groups were interviewed: 32 left wingers, 35 right wingers, 32 Orthodox Jews, 30 high-ranking officers, and 30 Arabs. Significant differences were found among the five groups in levels of burnout, with the groups in the following rank order: Left, Arabs, Right, Officers, and Orthodox Jews. The differences in burnout are explained by the difference in existential significance the intifada holds for the five groups. This interpretation is supported by interviews and a burnout workshop conducted with representatives of 14 peace organizations in Israel.
The term “burnout” refers to a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur in human service professionals. There are now over 2,000 publications on the topic. This paper reviews a subset of the literature concerned with burnout, depressive symptomatology, and perceptions of job control. It appears that the first two constructs share appreciable variance but are not isomorphic. Research also indicates that the development of burnout has a modest association with perceptions of job uncontrollability (i.e., perceived lack of autonomy and little decisional latitude). A conceptual model proposing that perceived uncontrollability induces depression indirectly. by operating through differences in the magnitude of burnout received only equivocal support in longitudinal studies. Prospective designs were proposed as a high priority for future burnout research. Other recommendations for future research included rests of a model that hypothesizes frustrated achievement striving as a key etiological factor in the development of burnout and depressive affect.
The study investigated the associations between burnout—conceptualized as a syndrome of emotional exhaustion/physical fatigue and cognitive weariness—and pain parameters (overall pain, pain sites, intensity and frequency, and perceived disability) among 2,300 women living in Stockholm County. The study was a longitudinal panel survey with two assessments by means of questionnaires, 1 year apart. After adjustment for socio-demographic and work characteristics, smoking, psychological distress, physical health and basal pain parameters, T1 levels of burnout and/or their change scores were the most important predictors of overall pain, neck/shoulder pain, back pain and disability. Pain frequency was related to increases in tension and listlessness. The results indicated that burnout contributes to the onset and maintenance of pain and to the functional impairment that it causes. Further studies are needed to evaluate the extent to which pain and burnout, may be mutually reinforcing. Copyright © 2009 John Wiley & Sons, Ltd.
Discusses 3 current approaches to marital therapy, including the psychoanalytic, the behavioral, and the systems approach. The 3 traditional approaches represent clinical psychology in terms of theory and treatment. Burnout, on the other hand, is a social psychological approach defined as a state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding. Those emotionally demanding situations are characterized by a combination of unrealistic expectations and the vicissitudes of life with another person. Implications of the difference between these approaches for working with couple's problems are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Addresses the chronic occupational health problem of burnout, beginning with an examination of the Maslach Burnout Inventory, the Pines' Burnout Measure, and the Shirom-Melamed Burnout Measure. The author conducts a critical review of the various approaches to burnout. The central part of the chapter is a review of the research literature, with an emphasis placed on longitudinal studies as well as the antecedents, symptoms, and consequences of burnout. In addition, the chapter addresses personality traits associated with burnout, burnout and job performance, burnout and health, burnout at the organizational level of analysis, and approaches to reduce burnout in work organizations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
discusses the conceptual meaning of burnout, in an attempt to identify its unique content and theoretical underpinnings / definitional approaches
construct validity of burnout / concurrent and discriminant validity / convergent validity
consider a few epidemiological aspects of burnout
burnout among teachers is taken as a case in point, offering tentative generalizations which may apply to other people occupations
covers the issues of the causes and consequences of burnout
outline the major findings of the few longitudinal studies which have been undertaken in this field of study
details recommended directions for future research, to enhance our understanding of burnout (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Our work had a dual focus: research on the causes and consequences of burnout, and application of our findings to the real-life problems of people. This book combines both features—insight and action. In it we tried to convey both the feel and the psychological dynamics underlying the experience of burnout. The first part of the book provides a description of the experience and the process of burnout. . . . The second part of the book addresses its second purpose—to describe common causes of burnout in business, in social service work, in bureaucratic organizations, and in women. The third part is devoted to "what to do with it," because we strongly believe that it is not enough to be aware of a problem and its causes. The crucial step is to find and apply solutions. Some of the solutions we offer are for individuals, some are for support groups at work places, and some are for the organization. All three perspectives are combined in the description of our burnout workshops. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background:
The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings.
Aim:
The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity.
Methods:
Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee.
Results:
The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale.
Conclusion:
The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.
Post-traumatic stress disorder (PTSD) is the only major mental disorder for which a cause is considered to be known: that is, an event that involves threat to the physical integrity of oneself or others and induces a response of intense fear, helplessness or horror. Although PTSD is still largely regarded as a psychological phenomenon, over the past three decades the growth of the biological PTSD literature has been explosive, and thousands of references now exist. Ultimately, the impact of an environmental event, such as a psychological trauma, must be understood at organic, cellular and molecular levels. This Review attempts to present the current state of this understanding on the basis of psychophysiological, structural and functional neuroimaging, and endocrinological, genetic and molecular biological studies in humans and in animal models.
Purpose of review: Cardiovascular disease remains the leading cause of mortality in the western world. The absence of smoking, hypertension, hyperlipidaemia, diabetes and a sedentary lifestyle in over 50% of patients with atherosclerosis indicates that additional risk factors remain to be identified. One putative risk factor is vital exhaustion, a state characterized by fatigue, irritability, and general malaise that precedes the onset of coronary artery disease in more than half of all cases. Although epidemiological studies have shown that vital exhaustion predicts cardiovascular disease in both healthy and cardiac populations, the origin of these symptoms is poorly understood.
Recent findings: Stress-related changes in haemostasis and infections/inflammation may constitute important pathways that link vital exhaustion with cardiovascular disease. In line with these findings, the hypothesis is put forward that the exhaustion before a cardiac event in fact reflects an adaptive response of the host that is triggered by pro-inflammatory cytokines during an infectious period.
Summary: A better understanding of stress-related immune dysregulation not only enhances the knowledge of specific psychobiological mechanisms in cardiovascular disease, but also gives insight into the origins of the mental state of coronary patients.
Psychometric properties of the Dutch version of the Maslach Burnout Inventory General Survey, the MBI-DV, were examined in individuals with and without clinical burnout. The factor structure, the utility of the MBI-DV as a screening instrument in addition to a clinical interview for diagnosing clinical burnout, as well as construct validity and reliability (internal consistency) were investigated. Individuals underwent a clinical interview and completed the MBI-DV as well as the Symptom Checklist (SCL-90). Confirmatory factor analysis, correlational analyses, and Cronbach alphas were computed and used to examine the objectives of the present study. A three-factor model of the MBI-DV best fitted the data in both individuals with and without clinical burnout. The Emotional Exhaustion subscale was highly associated with clinical diagnosis of burnout even when controlling for depression and general psychopathology. Construct validity of the MBI-DV was supported by modest correlations with the SCL-90 and subscales of the MBI-DV showed good internal consistency in individuals with and without clinical burnout. The MBI-DV is a valid and reliable multidimensional construct of which the Emotional Exhaustion subscale may be particularly useful as a screening tool in addition to a clinical interview for determining the presence of clinical burnout. Copyright © 2004 John Wiley & Sons, Ltd.
Abstract Current knowledge about burnout suffers from a healthy worker bias since only working - and thus relatively healthy - employees have been investigated. The main objective of this study is to examine - for the first time among employees who sought psychological treatment - the validity of the two most widely used burnout instruments; the Maslach Burnout Inventory (MBI) and the Burnout Measure (BM). Two groups were distinguished: a "burned out" group (n = 71) that suffers from work-related neurasthenia (according to ICD-10 criteria), and a "non-burned out" group (n = 68). Results show that: (1) the validity of the three-factor structure of the MBI and the BM is confirmed; (2) burnout can partly be differentiated from other mental syndromes (e.g., anxiety and depression); and (3) two MBI-scales (Emotional Exhaustion and Depersonalization) and one BM-scale (Exhaustion) are able to discriminate between burned out and non-burned out employees. The practical implications of these results are discussed.