ArticleLiterature Review

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

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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.

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... Long-term exposure to stress can lead to a dysregulation in the allostatic system, "allostatic load", which constitutes the fundamental features in the development of chronic stress and stress-related disorders (Sterling & Eyer, 1988). Chronic stress has been associated with wellknown health implications, e.g., coronary artery disease, mortality, metabolic syndrome, cognitive impairments, lowered immune functioning, anxiety, depression and insomnia (Åkerstedt, 2006;Grossi et al., 2015;Kiecolt-Glaser et al., 2002;Kivimäki et al., 2006;Melchior et al., 2007). ...
... Contemporary research using modern brain imaging technology have found that chronic stress affects the volume in several cortical structures (Ansell et al., 2012;Arnsten, 2009Arnsten, , 2015Grossi et al., 2015;Lupien et al., 2007;McEwen & Morrison, 2013). For instance, in an fMRI study by Savic et al. (2017) of patients with chronic stress, reduced cortical volume in the prefrontal cortex, (e.g., attention, working memory, decision-making) and the hippocampus (e.g., memory formation, learning, and spatial cognition) were found. ...
... They also reported increased cortical volume in the amygdala, compared to healthy controls. Further, the size of changes in cortical volume correlated with selfestimates of perceived stress and burnout (Grossi et al., 2015;Savic et al., 2017). Repeated fMRI, after 1.5-2 years, showed remission of volume in the prefrontal cortex and partial remission in the amygdala. ...
... One of the most well-known constructs related to prolonged psychosocial stress exposure is burnout, commonly characterised across three dimensions: emotional exhaustion, cynicism and reduced personal accomplishment (Maslach et al., 2001). Burnout refers to an occupational phenomenon rather than a medical diagnosis; however, the growing problem with stress-related mental disorders has led researchers and clinicians alike to increasingly acknowledge the end stage of the burnout process, often referred to as clinical burnout (Grossi et al., 2015;Kleijweg et al., 2013;Schaufeli et al., 2001;van Dam, 2021). In this stage, burnout symptomology is severe enough to cause significant distress and impaired daily functioning and requires professional treatment (Grossi et al., 2015). ...
... Burnout refers to an occupational phenomenon rather than a medical diagnosis; however, the growing problem with stress-related mental disorders has led researchers and clinicians alike to increasingly acknowledge the end stage of the burnout process, often referred to as clinical burnout (Grossi et al., 2015;Kleijweg et al., 2013;Schaufeli et al., 2001;van Dam, 2021). In this stage, burnout symptomology is severe enough to cause significant distress and impaired daily functioning and requires professional treatment (Grossi et al., 2015). ...
... Despite the vast negative consequences of burnout, research and policy responses have been hampered by the large variability in how it is defined and assessed (Bayes et al., 2021;Eurofound, 2018) and caution has been raised that clinical burnout is poorly recognised and managed in health care practice (Kakiashvili et al., 2013). Consequently, attempts have been made to formalise diagnostic criteria in order to standardise diagnostic procedures and treatments, including the diagnosis exhaustion disorder, incorporated into the Swedish version of the International Classification of Diseases (ICD-10) (Grossi et al., 2015), as well as using the ICD-10 diagnosis of neurasthenia with the addition that symptoms are work-related (e.g. Roelofs et al., 2005;Schaufeli et al., 2001) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis for undifferentiated somatoform disorder with fatigue as the main complaint (e.g. ...
Article
Clinical burnout has been associated with impaired cognitive functioning; however, inconsistent findings have been reported regarding the pattern and magnitude of cognitive deficits. The aim of this systematic review and multivariate meta-analysis was to assess cognitive function in clinical burnout as compared to healthy controls and identify the pattern and severity of cognitive dysfunction across cognitive domains. We identified 17 studies encompassing 730 patients with clinical burnout and 649 healthy controls. Clinical burnout was associated with impaired performance in episodic memory (g = −0.36, 95% CI −0.57 to −0.15), short-term and working memory (g = −0.36, 95% CI −0.52 to −0.20), executive function (g = −0.39, 95% CI −0.55 to −0.23), attention and processing speed (g = −0.43, 95% CI −0.57 to −0.29) and fluency (g = −0.53, 95% CI −1.04 to −0.03). There were no differences between patients and controls in crystallized (k = 6 studies) and visuospatial abilities (k = 4). Our findings suggest that clinical burnout is associated with cognitive impairment across multiple cognitive domains. Cognitive dysfunction needs to be considered in the clinical and occupational health management of burnout to optimise rehabilitation and support return-to-work.
... The definition of clinical burnout is usually based on the criteria of work-related neuroasthenia in the International Classification of Diseases (ICD-10;World Health Organization, 2010), and comprises the following features (1) persistent and distressing complaints of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort; (2) at least four of the following additional symptoms -insomnia, cognitive deficits, pain, palpitations, gastroenteric problems, sound and light sensitivity. These complaints and symptoms (3) must be present nearly every day for at least two weeks; (4) are due to psychosocial stressors that have been present for at least six months before diagnosis; and (5) lead to clinically significant distress or impairment (Grossi et al., 2015;Persson Asplund, 2021;Schaufeli et al., 2001). ...
... Yet another reason to be specific about which definition of burnout is used is that there is discussion among clinicians and health insurance companies whether burnout is a mental disorder and qualifies for reimbursement (Grossi et al., 2015;Schaufeli, 2007;Van der Voort-van Beusekom et al., 2016;Van Dam et al., 2017). Clinical samples should therefore be homogeneous, consisting of persons with severe symptoms and fulfiling the work-related neuroasthenia criteria of the ICD-10 (Grossi et al., 2015;Persson Asplund, 2021;Schaufeli et al., 2001;World Health Organization, 2010). ...
... Yet another reason to be specific about which definition of burnout is used is that there is discussion among clinicians and health insurance companies whether burnout is a mental disorder and qualifies for reimbursement (Grossi et al., 2015;Schaufeli, 2007;Van der Voort-van Beusekom et al., 2016;Van Dam et al., 2017). Clinical samples should therefore be homogeneous, consisting of persons with severe symptoms and fulfiling the work-related neuroasthenia criteria of the ICD-10 (Grossi et al., 2015;Persson Asplund, 2021;Schaufeli et al., 2001;World Health Organization, 2010). Research shows that this is not always the case, which is problematic because it may fuel discussion about the legitimacy of the diagnosis of clinical burnout (Bianchi et al., 2015;Van Dam, 2016). ...
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In clinical psychology, burnout is regarded as a mental disorder assessed in patients who apply for psychological treatment and no longer work because of their symptoms or experience of serious problems in functioning at work. This definition of burnout is mostly referred to as ‘clinical burnout’. The purpose of this article is to provide insight into how clinicians in The Netherlands establish a diagnosis of clinical burnout and how they fit it in their classification systems. An outline is given on how psychological interventions for burnout are applied in therapies. The different phases in the treatment of clinical burnout – crisis, recovery, prevention, and post burnout growth, as well as their accompanying interventions are described. It may be relevant for work and organizational psychologists to realize that biological processes may play a role in the development of clinical burnout. For the physiology of stress, it does not matter whether the stress is work-related or the result of stress in private life or both. Central to understanding clinical burnout is the lack of recovery of the (physiological) stress system. It is also argued that the relevance of questionnaires, for detecting who is at serious health risk, is limited.
... Secondly, the timeframes of ED and fatigue as a PPS differ and might be a clinically important element when formulating the problem experienced by the patient and, hence, when providing treatment. Although ED has a long preface of stress, fatigue need only have been present for two weeks, and the onset is often sudden and intense [88]. On the other hand, fatigue as a PPS must be present for at least 6 months and is therefore long lasting, has a more chronic course and higher rates of reoccurrence [34]. ...
... On the other hand, fatigue as a PPS must be present for at least 6 months and is therefore long lasting, has a more chronic course and higher rates of reoccurrence [34]. Relatively little is known about the clinical course of ED [34,88], but studies suggest that symptom duration before intervention is highly important to recovery from ED [31] and fatigue in general [89]. ...
... ED and fatigue as a PPS both have fatigue as a central symptom, both are often accompanied by other physical symptoms and both influence disability and work absenteeism [24,55,61]. Yet, they have a differing clinical course, prognosis and treatment [34,88,90]. Our results suggest that among ED patients, there might be a group of patients experiencing a more complex problem of multiple PPSs that warrants a specialised approach to treatment. ...
Article
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Fatigue is widespread in the population, particularly among working people. Exhaustion disorder (ED), a clinical manifestation of burnout, is common, but, after treatment, about one-third still experience fatigue and other physical symptoms. We propose that in some instances, fatigue as a persistent physical symptom (PPS) might be a more appropriate formulation of ED patients’ fatigue problems, and we suggest that ED patients who meet fatigue PPS criteria will differ from other ED patients in terms of psychological distress, non-fatigue PPSs and functional impairment. Questionnaires were sent to 10,956 members of a trade union of which 2479 (22.6%) responded. Of 1090 participants who met criteria for ED, 106 (9.7%) met criteria for fatigue as a PPS. Participants who met fatigue PPS criteria scored on average higher on measures of depression, anxiety and functional impairment and were more likely to have clinically significant scores. Moreover, they had 27 times higher odds of meeting other PPS subtypes and reported more non-fatigue PPS subtypes, suggesting a more complex health problem. Specific evidence-based interventions are available for both ED and PPSs, and therefore, it is crucial to accurately formulate the fatigue problem reported by patients to provide appropriate treatment.
... In international literature this condition is often referred to as Burnout or Clinical burnout. Burnout is a syndrome, but not a medical condition [9][10][11][12], which is characterized by fatigue, reduced professional efficacy and cynicism rather than the cognitive problems characteristic of SED. ...
... Cognitive symptoms are among the most prevalent and pervasive complaints in SED. Patients complain of concentration and memory lapses in everyday tasks, slowed thinking and reduced mental capacity for sustained effort or flexibility [10][11][12]. The approach to measure cognitive complaints is not standardized and varies between studies. ...
... There are apparent disparities in results between different studies, but the general overall picture of cognitive dysfunction in SED [11,12] points toward a cognitive dysfunction subserved by the frontal executive and attention systems. One of the possible reasons for differences in results in the literature is probably methodology i.e., differences in the selected clinical neuropsychological tests. ...
Article
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Background: The adverse health effects of stress induced exhaustion disorder (SED) cause increasing concern in Western societies. This disorder is characterized by severe fatigue, decreased tolerance to further stress, and attention and memory lapses. Despite subjective complaints, individual cognitive deficits are not always detected in a clinical setting, which calls for the validation of more sensitive instruments. Aim: The objective of this study was to investigate if a short, tablet-based serial naming task, MapCog Spectra (MCS) could be used as a marker for cognitive problems in SED. Participants: The study comprised of 39 subjects (35 females, four males) with SED. Their mean age was 46,8 years (SD 10.1; range 30-60 yrs.). All participants were healthcare professionals, with a college or university degree, doctors, registered nurses, and psychologists. Methods: The MCS was used to assess the number of aberrant pauses during serial naming of coloured geometrical shapes. The Coding, Matrix Reasoning, Digit Span, Symbol Search of the WAIS-IV, and RUFF 2&7 tests, were administered together with a short interview. Results: Mean values were within normal reference limits for all tests, except for the MCS, which showed a significantly higher number of aberrant pauses (p < 0,001) in the SED group, compared to normal reference values. Although subjects performed within normal limits on the RUFF 2&7, a significant difference between individuals was found in the performance strategy of the participants. Conclusion: Here we report that subjects with SED have performance deficits on the MCS, in terms of aberrant pause times, despite average performance on WAIS-IV tests measuring inductive reasoning, processing speed, working memory, and attention. We also demonstrate that subjects use different strategies to overcome their problems. These findings add to the growing evidence of cognitive deficits in SED and that the MCS might aid neuropsychologists in disentangling cognitive markers, important to substantiate the subjective complaints of affected individuals.
... Since burnout refers to an occupational phenomenon and not to a clinical condition [4], the Swedish version of the International Classification of Diseases (ICD-10-SE) has introduced exhaustion disorder (ED; code F43.8) as a clinical equivalent of the same stress reaction, while including also non-work stressors. Consequently, patients with ED score high levels of burnout [5]. ...
... The diagnostic criteria for ED include problems with memory or concentration and stress-related exhaustion has been associated with elevated levels of subjective cognitive complaints (SCCs) [6][7][8][9], as well as with suboptimal cognitive performance in executive functions, attention, working memory and processing speed [5,10]. Yet, the specific nature of the cognitive complaints reported by ED patients is unclear, as is the relationship between SCCs, cognitive performance and psychological distress. ...
... The PRMQ consists of 16 items describing everyday memory failures. Answers are given on a Likert scale ranging from never (1) to very often (5). The results were analysed as the total score, with a possible range between 16 and 80, expressing a general memory factor, as well as six subscales representing three contrasting pair of categories: prospective vs retrospective, short-term vs longterm and self-cued vs environmentally cued memory failures. ...
Article
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Background Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress. Methods We compared a group of patients with stress-related exhaustion disorder ( n = 103, female = 88) with matched healthy controls ( n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively. Results Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance. Conclusion Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation. Trial registration Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017
... One of the most well-known constructs related to prolonged psychosocial stress exposure is burnout, commonly characterized across three dimensions: emotional exhaustion, cynicism and reduced personal accomplishment (Maslach, Schaufeli, & Leiter, 2001). Burnout refers to an occupational phenomenon rather than a medical diagnosis; however, the growing problem with stressrelated mental disorders has led researchers and clinicians alike to increasingly acknowledge the end stage of the burnout process, often referred to as clinical burnout (Grossi, Perski, Osika, & Savic, 2015;Kleijweg, Verbraak, & Van Dijk, 2013;Schaufeli, Bakker, Hoogduin, Schaap, & Kladler, 2001). In this stage, burnout symptomology is severe enough to cause significant distress and impaired daily functioning and requires professional treatment (Grossi et al., 2015). ...
... Burnout refers to an occupational phenomenon rather than a medical diagnosis; however, the growing problem with stressrelated mental disorders has led researchers and clinicians alike to increasingly acknowledge the end stage of the burnout process, often referred to as clinical burnout (Grossi, Perski, Osika, & Savic, 2015;Kleijweg, Verbraak, & Van Dijk, 2013;Schaufeli, Bakker, Hoogduin, Schaap, & Kladler, 2001). In this stage, burnout symptomology is severe enough to cause significant distress and impaired daily functioning and requires professional treatment (Grossi et al., 2015). ...
... Consequently, attempts have been made to formalize diagnostic criteria in order to standardize diagnostic procedures and treatments, including the diagnosis exhaustion disorder, incorporated into the Swedish version of the International Classification of Diseases (ICD-10) (Grossi et al., 2015), as well as using the ICD-10 diagnosis of neurasthenia with the addition that symptoms are work-related (e.g., Roelofs, Verbraak, Keijsers, De Bruin, & Schmidt, 2005;Schaufeli et al., 2001) ...
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Clinical burnout has been associated with impaired cognitive functioning; however, previous findings have been heterogeneous and the specific domains that are affected and the magnitude of impairment is unclear. The aim of this systematic review and multivariate meta-analysis was to assess cognitive function in clinical burnout and identify the pattern and severity of cognitive dysfunction across cognitive domains. We identified 17 studies encompassing 730 patients with clinical burnout and 649 healthy controls. Clinical burnout was associated with small to moderate impairments in episodic memory (g = -0.36, 95 % CI -0.57 to -0.15), short-term and working memory (g = -0.36, 95 % CI -0.52 to -0.20), executive function (g = -0.39, 95 % CI -0.55 to -0.23), attention and processing speed (g = -0.43, 95 % CI -0.57 to -0.29) and fluency (g = -0.53, 95 % CI -1.04 to -0.03). There were no differences between patients and controls in crystallized (k = 6 studies) and visuospatial abilities (k = 4). Our findings suggest that clinical burnout is associated with cognitive impairment across multiple cognitive domains. Cognitive dysfunction needs to be considered in the clinical and occupational health management of burnout to optimize rehabilitation and prognosis.
... In Nordic countries and The Netherlands, occupational clinics manage work-related stress to promote recovery and labor market attachment. Many patients exposed to long-term stress report memory and concentration difficulties (ie, cognitive impairment) as a core feature in addition to symptoms of depression, anxiety, fatigue, sleep problems, and social withdrawal (2,3). As most modern jobs require complex cognitive skills, it is likely that consideration of cognitive impairment in clinical management of workrelated stress may improve occupational recovery, eg, when discussing strategies for cognitive remediation, adjustments of job tasks, and the optimal time for return to work (4)(5)(6)(7). ...
... However, the conservative SCIP-D total-score cut classified 28.6% of HC as cognitively impaired, while this number was 40.6% for the relaxed cut, suggesting an excess false-positive rate in the present HC sample. We identified about half of the patients with mild-to-moderate global objective impairment in line with previous findings among comparable (3,9) and psychiatric populations (18,19). Particularly, the present patients displayed lower performance on the subtests for processing speed (Cohen's d=0.61) and working memory (d=0.39) ...
Article
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Objective: Many patients with work-related stress display cognitive impairment that may hamper recovery. We examined objective and subjective tools for screening of cognitive impairment in this patient group. Methods: Patients were assessed with Danish versions of the objective Screen for Cognitive Impairment in Psychiatry (SCIP-D), standardized neuropsychological tests that tapped into the same cognitive domains, the self-assessed Cognitive Failure Questionnaire (CFQ), and several additional scales of symptom severity and psychosocial status. Concurrent validity of the SCIP-D and CFQ was assessed by calculation of Pearson's correlation coefficients between the objective and subjective tools and the scores on more conventional standardized neuropsychological tests. Decision validity was assessed with logistic receiver-operating-characteristic analyses using a cut-score approach to the objective and the subjective test results to predict impairment detected by the standardized tests. Cognitive norms were established through the data of 79 healthy controls. SCIP-D scores were compared between patients and healthy controls with independent t-tests. Results: We included 82 patients with work-related stress. The SCIP-D total scores were strongly associated with standardized neuropsychological tests (r=0.76, P<0.001). The self-assessed CFQ was not associated with either measure of objective cognitive functioning (r≤0.12, P≥0.30). The optimal SCIP-D total-score cut of ≤72 identified 43.2% of the patients with global objective cognitive impairment. The patients performed mildly-to.moderately lower than the healthy controls on the SCIP-D total score (Cohen's d=0.39) and the subtests for working memory (d=0.39) and processing speed (d=0.61). Conclusion: The SCIP-D is a valid screening tool sensitive to objective performance-based cognitive impairment among patients with work-related stress.
... Cognitive impairment is a key element in most mental disorders, including neurodegenerative disorders (Aarsland et al., 2017;Carter et al., 2012;Grzegorski & Losy, 2017), mood disorders (Grossi et al., 2015;Hammar & Årdal, 2009) and psychiatric disorders (Menkes et al., 2019;Yehuda et al., 2006). Comprehensive cognitive screenings are, however, uncommon with suspected mental disorders (Iracleous et al., 2010;Socialstyrelsen, 2017Socialstyrelsen, , 2018 even though they can lead to a multitude of benefits. ...
... The wide range of included tests covers the key domains attention and processing speed, memory, language, visuospatial functions and executive functions. Therefore, the screening battery is able to assess cognitive impairment associated with a multitude of mental disorders, including common disorders such as MCI and incipient dementia (Levey et al., 2006;Winblad et al., 2004), depression (Hammar & Årdal, 2009;Zaremba et al., 2019) and burnout (Ellbin et al., 2018;Grossi et al., 2015). Finally, the presented normative models may be of more general interest to clinical neuropsychologists as computerbased cognitive assessment gains ground in primary and specialist care (Miller & Barr, 2017;. ...
Article
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Objective Cognitive impairment is a key element in most mental disorders. Its objective assessment at initial patient contact in primary care can lead to better adjusted and timely care with personalised treatment and recovery. To enable this, we designed the Mindmore self-administrative cognitive screening battery. What is presented here is normative data for the Mindmore battery for the Swedish population. Method A total of 720 healthy adults (17 to 93 years) completed the Mindmore screening battery, which consists of 14 individual tests across five cognitive domains: attention and processing speed, memory, language, visuospatial functions and executive functions. Regression-based normative data were established for 42 test result measures, investigating linear, non-linear and interaction effects between age, education and sex. Results The test results were most affected by age and to a lesser extent by education and sex. All but one test displayed either linear or accelerated age-related decline, or a U-shaped association with age. All but two tests showed beneficial effects of education, either linear or subsiding after 12 years of educational attainment. Sex affected tests in the memory and executive domains. In three tests, an interaction between age and education revealed an increased benefit of education later in life. Conclusion This study provides normative models for 14 traditional cognitive tests adapted for self-administration through a digital platform. The models will enable more accurate interpretation of test results, hopefully leading to improved clinical decision making and better care for patients with cognitive impairment.
... burnout's core symptom). Lastly, more comprehensive burnout measures in the Belgian and Dutch populations indicate that 16.9% of the Belgian and 17.3% of the Dutch workers are either at a high risk of developing clinical burnout or currently experience one (Hooftman et al., 2019;Schaufeli, De Witte & Desart, 2019). 2 Following Grossi, Perski, Osika & Savic (2015), we define burnout patients as individuals suffering from 'clinically significant exhaustion and impaired performance, which motivates seeking professional help ' (p.626). for the applicant. ...
... Seven represented distinct productivity perceptions derived from prior research mentioned in section 1. More specifically, we asked whether the recruiters thought that applicants had sufficient (i) leadership abilities (Mendel et al., 2015), (ii) autonomy (Ozawa & Yaeda, 2007), (iii) ability to work under pressure (Mendel et al., 2015;Ozawa & Yaeda, 2007), were sufficiently (iv) manageable (Laberon, 2014;Stuart, 2006), had sufficient (v) learning abilities (Boštjančič & Koračin, 2014;Grossi et al., 2015;Öhman, Nordin, Bergdahl, Birgander & Neely, 2007) and were perceived as sufficiently healthy in terms of both (vi) current health and (vii) the likelihood of future sick leave (Laberon, 2014;Mendel et al., 2015) to perform well in the job. The remaining three statements related to statistical discrimination gauged for estimations on adaptational requirements in terms of work context, conditions and job content for the candidate to perform well in the job (Brohan et al., 2012;Laberon, 2014). ...
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Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such discrimination. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90% of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.
... A recent review of burnout in the workplace indicates that increased sick leave due to stress at work is a general trend seen across Europe [2]. Sick leave among patients seeking care for symptoms of exhaustion due to prolonged exposure to psychosocial and work-related stress has been shown to be long-lasting [1,[3][4][5]. Diagnostic criteria for ED, which can be considered a clinical form of burnout [4], have been established in Sweden ( Table 1). ...
... Sick leave among patients seeking care for symptoms of exhaustion due to prolonged exposure to psychosocial and work-related stress has been shown to be long-lasting [1,[3][4][5]. Diagnostic criteria for ED, which can be considered a clinical form of burnout [4], have been established in Sweden ( Table 1). ...
Article
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Background Exhaustion disorder (ED) is a common cause of sick leave in Sweden, and patients often have long-lasting symptoms and reduced work capacity. The aim of this study was to explore whether patients with ED had made any changes in their work situation from the period of treatment and up to 7 years later. Methods In this cross-sectional study, patients diagnosed with ED at a specialist outpatient clinic were followed up after 7 years (n = 217). They received questionnaires at baseline covering sex, age, marital status, level of education, and symptoms of burnout, depression, and anxiety measured with the Shirom-Melamed Burnout Questionnaire and the Hospital Anxiety and Depression Scale. After 7 years, they were sent a follow-up questionnaire asking about their work situation and work-related stressors both before they fell sick and at the 7-year follow-up. There were three questions on work situation (change of workplace, change of work tasks, and change of working hours), and 155 patients responded to all three. Results After 7 years, the majority of the patients (63%; n = 98/155) reported that they had made some kind of change at work. Women were more likely than men to report decreased working hours (p = 0.001), and work-related stressors such as conflicts at work, reorganization, deficient leadership, and general discontent with the work situation were significantly more common at baseline in the group who had made changes at work. Patients who made no changes at work experienced more work-related stress due to quantitative demands in the 7-year follow-up. Conclusion The majority of the patients with ED made some kind of change in their work situation, and gender differences were found for changes of work tasks and working hours. Work-related stressors might be decisive for making changes at work.
... 3 Following Grossi et al. (2015), we define burnout patients as individuals suffering from 'clinically significant exhaustion and impaired performance, which motivates seeking professional help' (p.626). 4 It should be noted that when a job candidate with a history of burnout is, indeed, less capable of performing in a job, we do not speak of discrimination (according to its strictest definition), but of 'a justified rejection in the selection procedure'. ...
... Seven represented distinct productivity perceptions derived from prior research. More specifically, we asked whether the recruiters thought that applicants had sufficient (i) leadership abilities (Mendel et al., 2015), (ii) autonomy (Ozawa and Yaeda, 2007), (iii) ability to work under pressure (Mendel et al., 2015;Ozawa and Yaeda, 2007), were sufficiently (iv) manageable (Laberon, 2014;Stuart, 2006), had sufficient (v) learning abilities (Boštjančič and Koračin, 2014;Grossi et al., 2015;Ö hman et al., 2007) and were perceived as sufficiently healthy in terms of both (vi) current health and (vii) the likelihood of future sick leave (Laberon, 2014;Mendel et al., 2015) to perform well in the job. The remaining three statements related to statistical discrimination gauged for estimations on adaptational requirements in terms of work context, conditions and job content for the candidate to perform well in the job (Brohan et al., 2012;Laberon, 2014). ...
Article
Full-text available
Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such unequal hiring opportunities. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90% of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.
... Therefore, the CESQT questionnaire does not replace the measurement of physiological stress. This result is in accordance with other studies [36] that concluded that although there is a growing body of literature on the physiological correlates of clinical burnout, there are no biomarkers to date for the measurement of this condition. Consequently, it is recommended that both tools, the CESTQ questionnaire and HRV measurements, be integrated to detect stress levels. ...
... The salary was also studied, and the results suggest that higher remuneration satisfaction has a positive influence on RMMSD. Based on these findings, it can be concluded that improving workplace conditions might have a positive effect on workers' levels of health, happiness, subjective wellbeing and self-esteem [36]. ...
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Background: This study aimed (1) to analyse the effect of non-occupational physical activity (NOPA) on the stress levels of fitness professionals, and (2) to apply a questionnaire to workers measuring burnout syndrome, working conditions and job satisfaction, and to compare the results with physiological stress and recovery measured objectively through heart rate variability (HRV). Methods: The HRV of 26 fitness instructors was recorded during 2-5 workdays using Firstbeat Bodyguard 2. Participants also completed a questionnaire (CESQT) measuring working conditions and job satisfaction variables and occupational burnout syndrome. Results: NOPA showed a negative association with both the percentage of stress (p < 0.05) and stress-recovery ratio (p < 0.01), and a positive association with the percentage of recovery (p < 0.05). Better work conditions (working hours, salary satisfaction and length of service) were associated with lower stress in fitness professionals. Conclusion: NOPA appears to improve the stress levels of fitness instructors in this study cohort. Self-reported burnout levels measured through the CESQT questionnaire do not coincide with the physiological stress responses measured through HRV. Better working conditions appear to reduce the stress response in fitness professionals.
... Although they were not extreme in their exhaustion, it is puzzling that coaches who worked fewer hours had higher levels of exhaustion. One possible explanation is that certain individuals in this group worked less because they felt exhausted or worked less because they were recovering from higher levels of burnout (Grossi et al., 2015). This issue is indicative of a kind of "healthy worker effect" where coaches who were suffering from the highest levels of exhaustion did not complete the survey because they were absent due to their exhaustion-related sick leave (Li & Sung 1999;Schaufeli & Enzmann, 1998). ...
Article
The present study examined levels of emotional exhaustion, a key symptom of burnout, in Swedish professional and semiprofessional sport coaches in comparison to the normative values specified in the Maslach Burnout Inventory manual, and to the clinical cutoffs developed by Kleijweg, Verbraak, and Van Dijk. The sample contained 318 Swedish coaches ( M age = 42.7 years, 12% female) working at least 50% full time away from both team (60%) and individual (40%) sports. Our study shows that, in general, coaches in this sample experience lower average levels of exhaustion than normative samples both regarding the Maslach Burnout Inventory and clinical cutoffs. Two groups of coaches did, however, stand out. Coaches living in single households as well as coaches working part time had higher risk of severe levels of emotional exhaustion. These results place coach exhaustion levels in relation to other occupations and highlight that in this sample, the coaching profession does not stand out as more emotionally exhausting than other occupations.
... In Sweden, the clinical diagnosis Exhaustion Disorder (ED) is used for more severe stress-related illness, internationally referred to as clinical burnout (Grossi et al., 2015). The diagnose was in 2005 incorporated in the Swedish version of the ICD-10 with the diagnostic code Other reactions to severe stress (F43.8) ...
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Objective Recovery from stress‐related diagnoses can, in some cases, be long‐lasting, and several different factors could be related to such a lengthy recovery. One plausible aspect is obsessive–compulsive personality disorder (OCPD), which has previously been seen to be related to stress‐related mental health. Thus, the aim of this study was to investigate whether recovery from exhaustion disorder (ED) is associated with OCPD. Methods This study includes data from 147 patients (78% women, mean age 52.4 ± 9.8 years) who have been treated for ED. Clinical assessment was performed 7–10 years after first seeking care identifying patients with residual exhaustion. Symptoms of OCPD were concomitantly measured and several aspects of work‐ and private‐related stress exposure. Results The main result of this study is that patients with residual clinical ED report OCPD to a greater extent, compared with patients who no longer fulfill the clinical criteria for ED, 7–10 years after seeking care. Patients with OCPD that have not recovered report “excessive devotion to work” to a higher degree than patients with OCPD that have recovered. Conclusion The results indicate that factors related to OCPD may be of clinical importance for the patient's recovery from ED. However, prospective studies should be conducted and studies elucidating whether symptoms of exhaustion among patients with OCPD can be affected by therapeutic interventions.
... Hallsten et al. (2005) also connects the same aspect of a performance-based selfesteem relationship to emotional exhaustion. Even if acute stress has been described to trigger pro-social behavior (Raposa et al., 2016) chronic stress on the other hand have been shown in several studies to increase the risk for both mental (Grossi et al., 2015) and e.g., cardiovascular diseases (Steptoe and Kivimäki, 2012). ...
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Objective Benevolence is an emerging concept in motivation theory and research as well as in on pro-social behavior, which has stimulated increasing interest in studying factors that impair or facilitate benevolence and effects thereof. This exploratory study examines the associations between benevolence, stress, mental health, self-compassion, and satisfaction with life in two workplace samples. Methods In the first study n = 522 (38% = female, median age = 42) participants answered questionnaires regarding self-reported stress symptoms (i.e., emotional exhaustion), depressive symptoms and benevolence. In the second study n = 49 (female = 96%) participants answered questionnaires regarding perceived stress, self-compassion, anxiety, depression symptoms, and benevolence. Results In study 1, measures of emotional exhaustion ( r = −0.295) and depression ( r = −0.190) were significantly negatively correlated with benevolence. In study 2, benevolence was significantly negatively correlated with stress ( r = −0.392) and depression ( r = −0.310), whereas self-compassion (0.401) was significantly positively correlated with benevolence. While correlations were in expected directions, benevolence was not significantly associated with Satisfaction with Life ( r = 0.148) or anxiety ( r = −0.199) in study 2. Conclusion Self-assessed benevolence is associated with levels of perceived stress, exhaustion, depression, and self-compassion. Future studies are warranted on how benevolence is related to stress and mental ill health such as depression and anxiety, and if benevolence can be trained in order to decrease stress and mental ill health such as depression and anxiety in workplace settings.
... Complicating this area further, the Swedish version of the ICD-10 incorporates "exhaustion disorder", attempting to facilitate 3 diagnosis of more significant burnout, attributed to work or personal life (Adamsson & Bernhardsson, 2018), with criteria covering exhaustion, reduced mental energy, concentration problems, reduced functional capacity, emotional instability, sleep problems and physical symptoms including increased sensitivity to sound. Others have also argued for burnout not limited to occupational stress (Grossi et al., 2015). There are significant overlaps with conditions such as "chronic fatigue syndrome" which appears in both the international versions of ICD-10 and 11, with elements of exhaustion and concentration problems common across these diagnoses, though no firmly established biomarkers, and diagnosis by exclusion. ...
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Lay abstract: Autistic burnout has been commonly described in social media by autistic people. There is little mention of autistic burnout in the academic literature. Only one recent study has used interviews and reviews of social media descriptions to try to understand autistic burnout. Anecdotally, autistic burnout is a very debilitating condition that reduced people's daily living skills and can lead to suicide attempts. It is suggested that autistic burnout is caused by the stress of masking and living in an unaccommodating neurotypical world. We wanted to create a definition of autistic burnout that could be used by clinicians and the autism community. We used the Grounded Delphi method, which allowed autistic voice to lead the study. Autistic adults who had experienced autistic burnout were considered as experts on the topic, in the co-production of this definition. The definition describes autistic burnout as a condition involving exhaustion, withdrawal, problems with thinking, reduced daily living skills and increases in the manifestation of autistic traits. It is important for future research that there is a specific description of the condition. In practice, it is important for clinicians to be aware that autistic burnout is different from depression. Psychological treatments for depression potentially could make autistic burnout worse. Further awareness of autistic burnout is needed, as well as further research to prove this condition is separate from depression, chronic fatigue and non-autistic burnout.
... Based on a comprehensive study of the literature, which included a first validated burnout stigma scale (May 2020), we bundled eight productivity perceptions with relevance to former burnout patients. More specifically, we asked participants whether they thought candidates had sufficient (1) leadership capacities (Mendel et al., 2015), could take on an (2) exemplary role for others (Pichler & Holmes; Boštjančič & Koračin, 2014), were sufficiently (3) motivated (May, 2020), (4) autonomous (Sterkens et al., 2020), (5) stress tolerant (Mendel et al., 2015;Ozawa & Yaeda, 2007), possessed sufficient (6) learning capacities (Boštjančič & Koračin, 2014;Grossi et al., 2015;Öhman, Nordin, Bergdahl, Birgander & Neely, 2007), were (7) currently sufficiently healthy and whether they would often (8) take sick leave in the future (Laberon, 2014;Mendel et al., 2015). In line with the invisibility hypothesis (Cassidy et al., 2016;Milgrom & Oster, 1987), the last statement gauged perceived candidate 'visibility', that is, whether the manager believed the candidate could easily find a similar job in another organisation if denied the promotion. ...
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Recent studies have explored hiring discrimination as an obstacle to former burnout patients. Many workers, however, return to the same employer, where they face an even more severe aftermath of burnout syndrome: promotion discrimination. To our knowledge, we are the first to directly address this issue in research. More specifically, we conducted a vignette experiment with 406 genuine managers, testing the potential of the main burnout stigma theoretically described in the literature as potential mediators of promotion discrimination. Estimates reveal that compared to employees without an employment interruption, former burnout patients have no less than a 34.4% lower probability of receiving a promotion. Moreover, these employees are perceived as having low (1) leadership, (2) learning capacity, (3) motivation, (4) autonomy and (5) stress tolerance, as well as being (6) less capable of taking on an exemplary role, (7) having worse current and (8) future health, (9) collaborating with them is regarded more negatively, and (10) managers perceive them as having fewer options to leave the organisation if denied a promotion. Four of these perceptions, namely lower leadership capacities, stress tolerance, abilities to take on an exemplary role and chances of finding another job explain almost half the burnout effect on promotion probabilities.
... Third, both overwork and wearing tight protective clothing can lead to chronic fatigue and exhaustion, which are reported to be related to sleep disturbance [24]. Gao et al. [25] employed VR to investigate physiological responses, psychological responses, and individual preferences for different urban environments. ...
... The core signs of stress-related illness are tiredness and decreased energy levels. Physical symptoms such as gastrointestinal problems, headache, dizziness, chest pain and other bodily pain are also common [16], as well as sleep disturbances and cognitive difficulties such as impaired memory, concentration and executive function [17]. People with stress-related illness can manage to perform despite cognitive difficulties but with a great effort, resulting in increased mental tiredness [18]. ...
Article
Background: Stress-related illness is increasing and is a common cause of sick leave. Spending time in nature have a positive effect on health and well-being for instance by reducing stress. Specific programmes with nature-based interventions (NBI) with the intention to involve people in activities in a supportive natural environment have been developed for people with stress-related illness. Aim: To identify and summarise scientific studies of NBIs to promote health for people with stress-related illness. Method: The design used in this study is integrative literature review. Scientific studies focusing on any type of NBI for people with stress-related illness were sought in Cinahl, PubMed, PsycInfo, AMED and Scopus. In total, 25 studies using both qualitative and quantitative designs were included in the review. Result: The reviewed studies focused on garden or forest interventions. In the majority of the studies, NBIs were performed in groups, including individual activities, and the length of programmes varied. Interventions in natural environments have unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. NBIs offer restoration that reduces stress, improves health and well-being and strengthen self-efficacy and work ability. Connectedness with nature support existential reflections and people with stress-related illness can achieve balance in everyday life. Conclusion: In conclusion, NBIs may have advantages to promote health for people with stress-related illness and should therefore be considered as an alternative to those affected. Further research from different perspectives, including nursing, is needed to understand the possibilities of NBIs and how they can be integrated into practice.
... Burnout scores range from 14-98-rescaled to 1-7 by dividing by total number of items for ease of comparison with sub-domains. Scores of �2.0 are considered no burnout, 2-3.74 moderate burnout, and �3.75 as high burnout [44]. We used the same cutoffs for burnout domains. ...
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Introduction The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and identified potential mediating factors among healthcare workers in Ghana. Methods Healthcare workers in Ghana completed a cross-sectional self-administered online survey from April to May 2020; 414 and 409 completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial scales. We assessed associations using linear regressions with robust standard errors. Results The average score for preparedness was 24 (SD = 8.8), 16.3 (SD = 5.9) for stress, and 37.4 (SD = 15.5) for burnout. In multivariate analysis, healthcare workers who felt somewhat prepared and prepared had lower stress (β = -1.89, 95% CI: -3.49 to -0.30 and β = -2.66, 95% CI: -4.48 to -0.84) and burnout (β = -7.74, 95% CI: -11.8 to -3.64 and β = -9.25, 95% CI: -14.1 to –4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to 17% of the effect. Conclusions Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions, incentives, and health systemic changes to increase healthcare workers’ morale and capacity to respond to the pandemic are needed.
... In normal individuals, somatic symptoms and sleep disorders are two common conditions that are often connected to acute stress exposure, often in demanding workrelated contexts [1]. If persistent, both symptoms can impact quality of life and may require the use of individual counseling and/or organizational supportive systems dedicated to stress prevention and relief [2,3]. ...
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This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957-2020. Search terms included "somatic symptoms disorder", "sleep disorders", "insomnia", "somatoform", "somatization", "therapeutic", "psychotherapy", and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4%-48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
... It has been suggested that the chronicity of clinical burnout syndrome may possibly be explained by chronic changes in biological functions including brain functions [19]. However, there are no biomarkers for clinical burnout [26], and thus no evidence for such an explanation or for clinical burnout lasting for many years, despite the absence of current significant stressors and stress behaviors. Accordingly, I hypothesize that clinical burnout is in many cases partially or fully maintained by current contextual and behavioral factors. ...
Article
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Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stress-ors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individ-ual's clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.
... Based on literature review about clinically signifi cant burnout, Grossi et al. (2015) say that studies on relevant 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. As music Neuroplasticity and hippocampal neurogenesis play an important role in stress and burnout conditions; impacts of auditory stimuli on these mechanisms are considered crucial factors of music in stress-management and burnout therapy Cortical functions (attention, hermeneutic and aesthetic processes) ...
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Therapeutic experiences in stress-related disorders and burnout espouse the integration of music-based interventions. As there is no direct proof of central cerebral mechanisms that underlie the efficacy of music in the therapy of stress-related disorders and burnout, a meta-synthesis gives rise to a theoretical framework on the connection between music processing and the control of psycho-physiological stress-responses. The consequently coined term 'music-stress-interface' refers to a multimodal spectrum involving the impact of music on neuroplasticity and neurogenesis as well as stress-modulating functional units in the limbic system such as the amygdala and the cingulate gyrus. Music is described as a means to trigger the hippocampal regulation of the HPA-axis and the enhancement of neuroplasticity. Music-based modes of emotional regulation and the modifi ca-tion of stress-maintaining cognitive patterns are discussed. This leads to the cultural-anthropo-logical issue of aesthetic experience as an operative factor in the psychosomatic equilibrium. The hypothetical model of the music-stress-interface shall elucidate underlying mechanisms of music in the therapy of stress-related disorders and burnout and help to design comprehensive therapeutic plans. The subsequent theoretical and clinical discussion leads to the proposition to include music in the spectrum of standards in stress therapy and stress care.
... Frailty was measured using a slight modification of the five criteria for the frailty phenotype developed by Fried et al. [17]: (1) unintentional weight loss (self-reported unintentional weight loss in the last year of >3 kg) [18], (2) exhaustion (if self-perception of stress is extremely high, it is considered to be emotional/physical exhaustion) [19], (3) weakness (handgrip strength <26 kg for men and <18 kg for women based on the Asian Working Group criteria for sarcopenia) [20], (4) walking difficulties (if the subjects responded to the mobility question of the European Quality of Life 5-Dimensions (EuroQoL-5D) questionnaire that walking was difficult, it was classified as walking difficulties) [21], and (5) low physical activity (physical activity was measured using the Global Physical Activity Questionnaire (GPAQ) developed by the World Health Organization (WHO) and was classified as low physical activity when recreational activity was <2 h per week) [22]. Participants were classified as robust if they fulfilled none of the criteria, pre-frail if they fulfilled one or two criteria, and frail if they fulfilled three or more criteria. ...
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Proper nutrition is a modifiable factor in preventing frailty. This study was conducted to identify the association between dietary patterns and frailty in the older adult population. The cross-sectional analysis was performed on 4632 subjects aged ≥65 years enrolled in the Korea National Health and Nutrition Examination Survey from 2014–2018. Food variety score (FVS) was defined as the number of foods items consumed over a day. Three dietary patterns were identified using factor analysis: “white rice and salted vegetables,” “vegetables, oils, and fish,” and “noodles and meat.” The higher “white rice and salted vegetables” pattern score was related to significantly lower FVS, whereas higher “vegetables, oils, and fish” and “noodles and meat” pattern scores were associated with a higher FVS. Participants with higher FVS showed a low risk of frailty (odds ratio (OR) (95% confidence interval, CI) = 0.44 (0.31–0.61), p-trend = 0.0001) than those with lower FVS. Moreover, the “vegetables, oils, and fish” pattern score was significantly associated with a low risk of frailty (OR (95% CI) = 0.55 (0.40–0.75), p-trend = 0.0002). These results suggested that consuming a dietary pattern based on vegetables, oils, and fish with high FVS might ameliorate frailty in older adults.
... One common assumption is that clinical burnout symptoms "by nature" require long recovery time, perhaps several years [34]. The chronicity of clinical burnout syndrome may be explained by chronic changes in biological functions, including brain functions [28,35]. In contrast, I hypothesize that clinical burnout is in many cases partially or fully maintained by current contextual and behavioral factors. ...
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Full-text available
Burnout is common in many countries and is associated with several other problems, such as depression, anxiety, insomnia and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature despite full time sick-leave and absence of work stress. Literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles and stress theory this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene clinical burnout.
... The summative burnout scores range from 14-98-rescaled to 1-7 by dividing by the total number of items for ease of comparison with sub-domains. Scores of �2.0 were considered no burnout, 2-3.74 moderate burnout, and �3.75 as high burnout [51]. ...
Article
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The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcare workers (N = 1012). The two phased data collection included: (1) survey data collected in Ghana from April 17 to May 31, 2020, and (2) survey data collected in Ghana and Kenya from November 9, 2020, to March 8, 2021. We utilized a quantitative measure of job satisfaction, as well as validated psychosocial measures of perceived preparedness, stress, and burnout; and conducted descriptive, bivariable, and multivariable analysis using ordered logistic regression. We found high levels of job dissatisfaction (38.1%), low perceived preparedness (62.2%), stress (70.5%), and burnout (69.4%) among providers. High perceived preparedness was positively associated with higher job satisfaction (adjusted proportional odds ratio (APOR) = 2.83, CI [1.66,4.84]); while high stress and burnout were associated with lower job satisfaction (APOR = 0.18, CI [0.09,0.37] and APOR = 0.38, CI [0.252,0.583] for high stress and burnout respectively). Other factors positively associated with job satisfaction included prior job satisfaction, perceived appreciation from management, and perceived communication from management. Fear of infection was negatively associated with job satisfaction. The COVID-19 pandemic has negatively impacted job satisfaction among healthcare workers. Inadequate preparedness, stress, and burnout are significant contributing factors. Given the already strained healthcare system and low morale among healthcare workers in SSA, efforts are needed to increase preparedness, better manage stress and burnout, and improve job satisfaction, especially during the pandemic.
... When caregiving continues over a long period, caregivers could experience distress and burnout, which results in psychological morbidity, depression, and increased frequency of illnesses [8,9]. Exhaustion disorder is considered as the most valid clinical equivalent of burnout [10]. High reported levels of emotional exhaustion and reduced personal accomplishment established the relevance of the burnout construct for informal caregivers [11]. ...
... Previous findings illustrate there are many serious psychological implications as a result of burn-out (Carod-Artal & Vázquez-Cabrera, 2013; Kakiashvili et al., 2013). There is evidence to suggest an association between burn-out and reductions in executive functioning, memory and attention, and general cognitive performance, which can have serious implications for those in cognitively demanding professions (Deligkaris et al., 2014;Grossi et al., 2015). ...
Article
Mental health problems have been established as one of the leading causes of the global burden of disease. Approximately a quarter of all people worldwide will experience a mental disorder during their lifetime. With depression and anxiety becoming the leading causes of mental ill health globally, the numbers of people reporting mental health complaints are set to grow. The dramatic increase in reporting and diagnosis of mental health disorders has been in parallel to a decline in the ability to cope with mental health symptoms and a rise in the incidence of self‐harm and suicidal ideation. While mental health assessment and diagnoses are usually the responsibility of general practitioners (family doctors) or psychiatrists, the frontline provision of mental health care is often delegated to counsellors and psychotherapists. Publicly funded counselling and psychotherapy services vary across the globe, but are commonly under‐resourced and lacking in adequate funding. This may lead to insufficient clinical supervision and compressed time to complete continuing professional development, which are both vital for new counsellors and psychotherapists to feel confident in providing care, and to learn new skills. Newly qualified counsellors and psychotherapists may also experience emotional, physical, and mental exhaustion or ‘burn‐out’. This position paper aims to critically appraise available cross‐cultural literature on the experiences of ‘burn‐out’ by newly qualified counsellors and psychotherapists, globally. Finally, we make recommendations for how best to support the mental health and psychological well‐being of newly qualified practitioners.
... Due to diurnal and ultradian variation, there are complexities in measuring cortisol, with various approaches including examining the cortisol awakening response (CAR), undertaking serial measures across the day and probing HPA function through challenge tests. Cortisol has most frequently been measured in saliva (see Grossi et al. 2015), with a minority of studies involving blood or urine samples. ...
Article
Objectives Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focusing on mechanisms and physical consequences. Methods We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. ‘clinical’ burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach. Results Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout. Conclusions Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.
... This criteria-based diagnosis is applicable in clinical practice to describe patients seeking care for symptoms of exhaustion due to identifiable stress exposure lasting for at least 6 months. ED overlaps with the concept of clinical burnout (Grossi, Perski, Osika & Savic, 2015) and has substantial comorbidity with depression and anxiety (Glise, Ahlborg & Jonsdottir, 2012). ...
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The overall aim of this study was to investigate self‐reported cognitive difficulties, daily life activities, and health/sleep factors in former patients with exhaustion disorder (ED) who still fulfill the clinical criteria for exhaustion 7–12 years after seeking care. The Sahlgrenska Self‐reported Cognitive Impairment Questionnaire (SASCI‐Q) was used to measure cognitive difficulties, daily life activities, and health/sleep factors. Three groups were compared: previous patients still judged to be clinically exhausted seven years or more after seeking care (n = 51); previous patients considered clinically recovered (n = 98); and healthy controls (n = 50). Patients who still fulfilled the diagnostic criteria for ED reported widespread problems related to cognition, fatigue, and daily life functioning compared to the clinically recovered group. Furthermore, despite no longer fulfilling the clinical criteria, the recovered patients still reported more problems related to cognitive functioning and fatigue compared to healthy controls. Thus, this group appeared intermediary between the non‐recovered group and healthy controls regarding self‐reported cognitive functioning. To conclude, ED may have considerable negative long‐term effects, and it is possible that some of these residual symptoms, particularly the cognitive problems and persistent fatigue, are permanent in some patients. Preventive measures should be the primary focus for all stakeholders, since the consequences of stress‐related mental health problems seem to be extensive and long‐lasting.
... Further research from Brosschot et al. (2018) argues that our mind is always searching for cues of safety, and that a default stress response occurs when an individual perceives their environment as unsafe. Both acute and chronic stress trigger and increase mental ill-health (Grossi et al., 2015) as well as somatic ill-health (Brotman et al., 2007). Both types of stress lead to subsequent reduced working capacity and life satisfaction, respectively (Zuzanek, 1998). ...
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Stress and mental ill-health carry considerable costs for both individuals and organizations. Although interventions targeting compassion and self-compassion have been shown to reduce stress and benefit mental health, related research in organizational settings is limited. We investigated the effects of a 6-week psychological intervention utilizing compassion training on stress, mental health, and self-compassion. Forty-nine employees of two organizations were randomly assigned to either the intervention (n = 25) or a physical exercise control condition (n = 24). Multilevel growth models showed that stress (p = .04) and mental ill-health (p = .02) decreased over three months in both groups (pre-intervention to follow-up: Cohen’s d = –0.46 and d = 0.33, respectively), while self-compassion only increased in the intervention group (p = .03, between group d = .53). There were no significant effects on life satisfaction in any of the groups (p > .53). The findings show promising results regarding the ability of compassion training within organizations to decrease stress and mental ill-health and increase self-compassion.
... This is consistent with previous findings that sleep impairments have been found to be causal and maintaining factors behind exhaustion disorders (e.g. Grossi et al., 2015). Such association is particularly problematic, as maternal sleep problems have previously been found to have negative effects on the family environment (Gregory et al., 2012) and are associated with higher levels of stress and dysfunctional parenting (McQuillan et al., 2019). ...
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Increased and long-term parental stress related to one's parental role can lead to parental burnout. In the early phase of the COVID-19 pandemic, families experienced intensified pressure due to the government-initiated contact restrictions applied to prevent the spread of the virus in the population. This study investigates the risk factors and predictors of parental burnout in a large sample of parents (N = 1488) during the COVID-19 pandemic in Norway. Demographic and psychosocial factors were assessed at two timepoints: at the beginning of the pandemic outbreak in March 2020 (T1) and at 3 months follow-up (T2). A hierarchical regression analysis was applied to identify the factors that contribute to parental burnout at T2. Parental burnout was additionally explored across subgroups. Findings revealed that younger age was associated with more parental burnout. Concurrent (T2) use of unhelpful coping strategies, insomnia symptoms, parental stress, and less parental satisfaction was significantly associated with the presence of greater parental burnout (T2). Additionally, parental stress and satisfaction measured in the earliest phase of the pandemic (T1) were associated with parental burnout 3 months later (T2) over and above concurrent parental stress/satisfaction. Unemployed parents and individuals with a mental health condition were identified as subgroups with substantially heightened levels of parental burnout.
... Employees with mental health issue could suffer exhaustion which is the core component of job burnout. Grossi, Perski, Osika and Savic (2015) describe exhaustion as poor social interactions, physical exhaustion, having difficulties to complete/cope with everyday commands, weak memory, inability to concentrate, sleeping problems and unstable emotions. Negative impacts of exhaustion are employees' turnover, higher absenteeism, lower job productivity, performance and satisfaction (Nordhall et al., 2018). ...
Article
Mental health includes emotional, psychological, and social wellbeing of a person. A good mental health also helps individual handles stress, relate to others and make choices while, occupational mental health is one of the work-related stresses that detract employees from optimal job performance and damages organizational effectiveness. Most of the employer do not aware and care about the mental health of their employees. Besides that, it also affects the way of thinking, feeling and acting. Therefore, this cross-sectional study highlighted the main objective as to investigate the relationship between job demand and interpersonal conflict on occupational mental health among employees in private college in northern region of peninsular Malaysia. This quantitative study employed questionnaire as a research instrument and being distributed to the 171 employees via Google form link. A total of 102 completed questionnaires have been received and keyed into SPSS version 26.0 and regression analysis was conducted. The results revealed job demand and interpersonal conflict have a significant relationship with occupational mental health. This study recommends the employer to make adjustment in their current employment practices, justify clearly their employees’ job descriptions and prevent workload or overlapping task to their employees. Employer or organization also need be to more openness toward cultural, style and opinions differences among employees.
... Burnout remains uncharacterized and unrecognized as a disorder or medical condition by the ICD-11 and DSM-5 [2,19,55]. The impossibility of diagnosing burnout obstructs case identification, prevalence estimation, and treatment planning, and has implications for matters of public health policymaking and industrial relations [9,10]. ...
Article
Objective: There is mounting evidence that burnout problematically overlaps with depression. However, the generalizability of this finding remains debated. This study examined the burnout-depression distinction based on a recently developed measure of work-attributed depressive symptoms-the Occupational Depression Inventory (ODI). Methods: We relied on a sample of 891 Australian teachers. The ODI was employed to assess work-attributed depressive symptoms. The Shirom-Melamed Burnout Measure (SMBM) and the Oldenburg Burnout Inventory (OLBI) were employed to assess burnout symptoms. The SMBM assesses burnout as a syndrome combining physical fatigue, cognitive weariness, and emotional exhaustion. The OLBI assesses burnout as a syndrome of exhaustion and disengagement. Results: Confirmatory factor analysis indicated that the factors underlying burnout's components correlated more highly with the Occupational Depression factor than with each other, calling into question the syndromal unity of burnout. Moreover, the factors underlying burnout's components and the Occupational Depression factor were reflective of a common higher-order factor. Conclusions: Our findings are consistent with the view that burnout symptoms are part of a depressive syndrome and do not reflect a unique or distinct entity. Conducted in the Australian context, this study strengthens the generalizability of the finding that burnout problematically overlaps with depression. Given the profound problems affecting the burnout construct, we recommend a paradigm shift from burnout to occupational depression. Such a shift raises the prospects of more reliably and validly assessing severity and prevalence of job-related distress and, consequently, of reaching more psychologically meaningful and productive conclusions regarding treatment, prevention, and public health decision-making.
... 10,11,22 Therefore, it is essential to rule out certain medical conditions including clinical depression, primary anxiety, mental maladjustment or work-related disorders before committing to a diagnosis of occupational burnout. [23][24][25] As there are no universally agreed or binding diagnostic criteria for burnout, interested researchers and healthcare professionals use disparate ways of defining, measuring and evaluating the phenomenon, and as these diagnostic criteria are often vague and clinically problematic, it is difficult with any accuracy or consistency to determine the true epidemiological features of burnout. 20,[26][27][28] Nevertheless, it is evident that anyone with a personal trait of neuroticism, with type A personality behaviour, or those who are over-concerned with time management and control of situations and relationships, are at risk of burnout. ...
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Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.
... In normal individuals, somatic symptoms and sleep disorders are two common conditions that are often connected to acute stress exposure, often in demanding workrelated contexts [1]. If persistent, both symptoms can impact quality of life and may require the use of individual counseling and/or organizational supportive systems dedicated to stress prevention and relief [2,3]. ...
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This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4%–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
Article
Purpose The purpose of this study was to examine the possibility that culture influences burnout. Characterized by emotional, cognitive and physical exhaustion, burnout stems from chronic, unresolvable stress experienced when resources to meet demands are insufficient or inaccessible. This study investigated whether people in the US experience burnout differently than people in Sweden. Design/methodology/approach The relationship between demands and burnout was hypothesized to be mediated by perceived stress, role conflict and role ambiguity. Country was hypothesized to moderate these relationships. Data collected through surveys from Swedish and American participants were analyzed using a process macro model. Findings The results showed demands as positively related to burnout. This relationship was mediated by perceived stress and the mediation was moderated by country with a stronger effect for Swedes. The relationship between demands and role conflict was significant and moderated by country; however, role conflict did not predict burnout. Role ambiguity was not a significant predictor or mediator. After accounting for covariates and predictors, demands generated unique variance in burnout and country played a moderating role in this direct relationship, which was stronger for Americans than Swedes. Originality/value The results suggest that culture may play a role in the burnout process. Although a global issue, between-country differences and cultural influences on burnout have received little attention, even though shared culture governs perceptions, identities, roles, norms and practices associated with known predictors of burnout. By examining burnout cross-culturally, this study adds to the limited literature on burnout processes across different professional contexts.
Article
Objectives To investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick leave certificates, diagnoses made in structured interviews and symptom severity. Design Observational study consisting of a secondary analysis of data from a randomised controlled trial and an observational study. Setting The regions of Stockholm and Västra Götaland, Sweden. Participants 480 people on sick leave for common mental disorders. Interventions Participants were examined with structured psychiatric interviews and self-rated symptom severity scales. Outcome measures (1) Sick leave certificate diagnoses, (2) diagnoses from the Mini International Neuropsychiatric Interview and the Self-rated Stress-Induced Exhaustion Disorder (SED) Instrument (s-ED), (3) symptom severity (Montgomery-Asberg Depression Rating Scale-self-rating version and the Karolinska Exhaustion Disorder Scale) and (4) number of sick leave days. Results There was little correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Many participants on sick leave for SED, anxiety disorder or depression fulfilled criteria for other mental disorders. Most on sick leave for SED (76%) and anxiety disorder (67%) had depression (p=0.041). Length of sick leave did not differ by certificate diagnoses. Participants with SED (s-ED) had longer sick leave than participants without SED (144 vs 84 days; 1.72 (1.37–2.16); p<0.001). More severe symptoms were associated with longer sick leave. Conclusion Diagnoses on sick leave certificates did not reflect the complex and overlapping nature of the diagnoses found in the structured psychiatric interviews. This finding is relevant to the interpretation of information from health data registers, including studies and guidelines based on these data. A result of clinical interest was that more severe symptoms predicted long-term sick leave better than actual diagnoses.
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Background: Burnout has negative psychological and physical consequences for physicians in training. Mindfulness-based stress reduction (MBSR) has a promising track record for improving well-being. This study aims to demonstrate biophysical and psychological benefit from the incorporation of MBSR into the curriculum of an urban anesthesiology residency program. Methods: This prospective cohort study compared the effect of a voluntary 18-month (January 2018 – June 2019) biweekly MBSR course to an active control (availability of virtual cognitive behavioral therapy (CBT) curriculum and app-based mindfulness tools). Biometric data (e.g., sleep quantity and quality, physical activity and heart rate variability) from wearable devices; hair cortisol levels, and Maslach Burnout Inventory scores were compared between and within cohorts. Results: Data collection was discontinued at the end of the first year of the study due to poor utilization of the in person MBSR and virtual/ app-based trainings. Of 76 eligible anesthesiology trainees, 38 participated (50% of total eligible). Depersonalization scores were significantly lower in the MSBR group. Emotional exhaustion and depersonalization scores were significantly higher for clinical anesthesia (CA) CA-2 (post-graduate year (PGY)-3) than CA-1 (PGY-2) residents. There were no significant differences between cohorts for biophysical outcomes. Conclusions: The implementation of an in-person MBSR curriculum for anesthesiology residents in an urban setting suffered from low utilization. Depersonalization scores were significantly lower in the MBSR compared to the active control group. Perioperative training programs may find more utility in wellness initiatives that are not reliant on inflexibly scheduled courses that require additional time commitment on the part of trainees.
Chapter
Burnout constitutes a serious health concern in the modern working environment. It is a stress-related condition that has developed as a result of a prolonged psychosocial stress exposure causing a persistent mismatch between demands and resources. The main symptom is emotional exhaustion, but physical fatigue, diminished professional efficacy, cynicism, and cognitive impairments are also associated with this condition. Burnout has been used both as a psychologic term in occupational settings and as a clinical diagnosis in patient populations, and there is currently no universally accepted definition and diagnostic criteria of burnout. It has been hypothesized that the two main stress response systems, the autonomic nervous system (ANS) and the hypothalamus–pituitary–adrenal axis (HPA axis), are involved in the pathogenesis of burnout. A common hypothesis is that in the early stages of chronic stress, the HPA axis and sympathetic ANS activity tend to be higher, while it will decrease with a longer duration of chronic stress to ultimately reach a state of hypoactivity in clinical burnout. The current research in this field shows many contradictory results. Thus there is no compelling evidence of either ANS or HPA dysfunction in burnout. However, there is partial support for the hypothesis of HPA and sympathetic hyperactivity in early stages, and HPA hyporeactivity and low vagal activity in more severe burnout cases, but high-quality studies investigating the causal links are still lacking.
Article
Academic burnout and engagement are critical factors in student success, school attendance and dropout. It is important to determine the variables associated with burnout and engagement to develop university students and their competencies. Therefore, the current study aims to elucidate the association of morningness-eveningness preferences, average sleep length (ASL) and social jetlag (SJL) with burnout and engagement in university students. The sample was composed of 270 university students. The composite scale of morningness (CSM), the Maslach burnout inventory-student scale, student engagement scale and a questionnaire were utilized. CSM total score was found to correlate with both burnout and engagement sub-domains significantly. In addition, CSM total score was a significant predictor in all burnout and engagement models. ASL was a significant predictor of exhaustion and cynicism while SJL was significant predictor of efficacy. Both ASL and SJL were significant predictors of silent in-class behaviours sub-domain of engagement. In sum, CSM total score was found to be the most significant predictor of both burnout and engagement compared to other study variables. Considering the relationships of CSM total score with burnout and engagement sub-dimensions, eveningness can be treated as an important risk factor for burnout and engagement in the context of university students.
Article
To investigate the association between chronic stress and executive functioning (EF), we assessed 514 young to middle-aged adults in three EF tasks (i.e., Number-Letter, 2-Back, Go/Nogo) that assessed shifting, updating, and inhibition. Chronic stress was assessed by various self-report measures and hair cortisol concentrations as indicators of subjective and objective chronic stress, respectively. In order to test the association between chronic stress and EF, we fit a structural equation model with a latent common EF factor predicted by subjective and objective chronic stress on Kaplan-Meier estimates of response times. Controlling for participants' sex, age household income and the delay between cognitive testing and hair sample collection, neither subjective nor objective chronic stress showed a meaningful association with common EF. Exploratory analyses suggested a moderation effect of income on the association between subjective chronic stress and common EF, with a smaller association or high-income participants. Additionally, we conducted a specification curve analysis on the association between chronic stress and EF to assess the influence of different analysis choices on results in our dataset. This analysis confirmed the absence of a coherent association between chronic stress and EF by showing that the majority of analytical choices produced null effects and only a small number of analytical choices produced meaningful associations (negative or positive). Taken together, our findings suggest that common EF likely remains preserved under the influence of chronic stress. Our specification-curve analysis, however, also shows that chronic stress may also have either a positive or a negative effect on EF depending on the choice of covariates and measures of chronic stress and EF. More research on the role of these factors for the association between chronic stress and EF is needed to avoid the interpretation of non-replicable stress-EF associations caused by analytical choices or selection bias.
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Background: Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, Exhaustion Disorder (ED), was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. Aim: Create the first comprehensive synthesis of research on ED to report on the current state of knowledge. Method: A PRISMA-guided scoping review of all empirical studies of ED was conducted. Searches were run in the Medline, PsycINFO, and Web of Science databases. Data were systematically charted and thematically categorized based on primary area of investigation.Results: Eighty-eight included studies were sorted into six themes relating to lived experience of ED (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 3), and treatment (n = 29). Although several studies indicated that individuals with ED experience a range of psychiatric and somatic symptoms beyond fatigue, robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings, and methodological limitations (e.g., small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. Conclusions: More research is needed to build a solid knowledge base for ED. International collaboration regarding the conceptualization of chronic stress and fatigue is warranted to accelerate the growth of evidence.
Article
Background Empathy refers to an individual's ability to experience the emotional and cognitive processes of another person during social interactions. Although many studies have examined the effects of genetic variation on emotional empathy, little is currently known about whether genetic factors may influence cognitive empathy. This study investigated the relationship between BDNF rs11030101 genotype, job stress, and empathy, especially cognitive empathy, in a Chinese Han population. Methods A cross-sectional design was used and 340 participants were recruited from a university in Beijing. Interpersonal Reactivity Index (IRI) was used to measure empathy. Job stress was measured using House and Rizzo's Job Stress Scale. The BDNF rs11030101 was genotyped in all participants. Results Gender and age were associated with various IRI subscales (p < 0.001). After controlling for gender, age and education level, BDNF rs11030101 genotype had no main effect on all empathy subscales (p > 0.05). Job stress was negatively associated with Perspective Taking (p = 0.006) and positively associated with Personal Distress (p < 0.001). In addition, the BDNF rs11030101 genotype modulated the relationship between job stress and Fantasy (p = 0.013), indicating that T allele carriers had higher Fantasy scores at higher job stress and lower Fantasy scores at lower job stress than AA homozygotes. This interaction was only present in women. Limitations The sample size and single-nucleotide polymorphism are limited, and the cross-sectional design should be improved. Conclusions Female university faculty with the BDNF rs11030101 T allele may utilize higher emotional job demands, thereby fostering their cognitive empathy.
Article
Addressing burnout through well-being initiatives in anesthesiology residency training has been well described. Our intervention of in-person mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) as a means of addressing burnout among anesthesiology trainees proved unfeasible given attitudinal and logistic variables. We subsequently found success with a "confessions session" model structured as a modification of the Delphi method; this led to organizational changes associated with reduced resident burnout and well-being measured through internal (GME) and external (the Accreditation Council for Graduate Medical Education (ACGME)) annual anonymous surveys.
Article
This research analyzes the impact of fear of Covid-19 on perceived stress and its effect on emotional exhaustion, cynicism and self-efficacy of Mexican university students. The research design was non-probabilistic, cross-sectional, quantitative and explanatory in a sample of 478 university students. Structural equation modeling based on partial least squares was used as an analysis technique. The results indicate that the fear of contracting Covid-19 triggers stress, which causes emotional exhaustion and cynicism and decreases the self-efficacy of students.
Article
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Vascular endothelial growth factor (VEGF) has been implicated in the pathophysiology of stress-related mental disorders. However, VEGF levels have seldom been compared across mental disorders and never by isoforms. Pathophysiological processes involving leakage of astrocyte-derived extracellular vesicles (EVs) across the blood–brain barrier could be associated with VEGF levels in patients with stress-related mental disorders. This cross-sectional study compared plasma levels of VEGF 121 , VEGF 165 , and VEGF 121 + VEGF 165 (VEGF total ) in patients with stress-induced exhaustion disorder (SED) (n = 31), patients with major depressive disorder (MDD) (n = 31), and healthy controls (n = 61). It also analyzed the correlation between VEGF and astrocyte-derived EVs in plasma. An enzyme-linked immunosorbent assay (ELISA) was used to measure VEGF 121 and VEGF 165 in citrate plasma, and flow cytometry was used to measure astrocyte-derived EVs in plasma. The mean concentration of soluble VEGF 121 (sVEGF 121 ) was significantly higher in patients with SED than healthy controls ( P = 0.043). Mean sVEGF 165 was significantly lower in patients with MDD than patients with SED ( P = 0.004) or healthy controls ( P = 0.037). Mean sVEGF total was significantly higher in patients with SED than in patients with MDD ( P = 0.021) and also higher in patients with SED than healthy controls ( P = 0.040). Levels of sVEGF 121 were positively correlated with levels of astrocyte-derived EVs only in patients with SED ( P = 0.0128). The same was true of levels of sVEGF total and astrocyte-derived EVs ( P = 0.0046). Differing levels of VEGF isoforms may reflect different pathophysiological mechanisms in SED and MDD. Further research is needed to better understand the potential roles of VEGF isoforms and astrocyte-derived EVs in mental disorders.
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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.
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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.
Article
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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.
Technical Report
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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)
Article
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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.
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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.
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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.
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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.
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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.
Book
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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.
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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.
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